Medical insurance refers to the insurance that pays the insurance premium on the condition that the medical behavior agreed in the insurance contract occurs, and provides protection for the medical expenses of the insured during the medical treatment. Medical insurance, like other types of insurance, collects medical insurance premiums from people threatened by diseases in advance in the form of contracts and establishes medical insurance funds; When the insured goes to a medical institution for medical treatment, the medical insurance institution will give him some economic compensation.
Therefore, medical insurance also has two functions of insurance: risk transfer and compensation transfer. That is, the economic losses caused by individual disease risks are distributed to all members threatened by the same risks, and the economic losses caused by diseases are compensated by centralized medical insurance funds.
The scope of medical insurance is very wide. Generally, medical expenses are distinguished according to the characteristics of medical services, including doctor's outpatient expenses, medicine expenses, hospitalization expenses, nursing expenses, hospitalization miscellaneous expenses, operation expenses, and various inspection expenses.
Medical expenses are all kinds of expenses incurred by patients to treat diseases, including not only doctors' medical expenses and operation expenses, but also hospitalization expenses, nursing expenses and hospital equipment expenses.
Now I have a general understanding of the free content of medical insurance. Although medical insurance has its content of non-payment, a medical insurance is still worth all of us to insure.
Medical insurance is divided into three grades, the first grade is the best and the third grade is the worst.
The specific differences are as follows:
The personal account of the first insured person is used to pay the medical expenses within the scope of the general outpatient medical insurance catalogue of the insured person. Community health center basic medical expenses personal account to pay 70%, the overall fund to pay 30% in accordance with the provisions.
Second-class insured; Three types of insured persons, belonging to Class A drugs and Class B drugs, are paid by the community outpatient co-ordination fund according to the proportion of 80% and 60% respectively; 90% of the single diagnosis and treatment or medical materials belonging to the medical insurance catalogue shall be paid by the community outpatient co-ordination fund, but the maximum payment amount shall not exceed 120 yuan; The total outpatient medical expenses paid by the community outpatient co-ordination fund to each second-grade and third-grade insured within a medical insurance year shall not exceed 1000 yuan.
legal ground
People's Republic of China (PRC) social insurance law
Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.