Reimbursement medical insurance (general medical insurance) means that the patient is reimbursed by the insurance company for the medical expenses incurred in the hospital. It is generally divided into outpatient medical insurance and inpatient medical insurance.
Compensatory medical insurance (special medical insurance) means that the patient is clearly diagnosed by the hospital as suffering from a disease specified in the contract, and the insurance company pays the patient for treatment and care according to the amount agreed in the contract. It is generally divided into single disease insurance (e.g., cancer insurance) and major disease insurance (10, 20, and 30 types of major diseases, etc.).
The above two types of medical insurance have similarities but also differences. The similarity is that you can only get insurance benefits if you are sick, and the differences are mainly: general medical insurance is of the all-encompassing type, i.e., all types of illnesses can be covered by the insurance. Specialized medical insurance is a special category, i.e., only a certain disease or surgery specified in the insurance contract can be paid for.
Medical insurance policies offered by insurance companies are often a combination of some of these two categories.
[edit]Benefit-paying medical insurance
In short, benefit-paying medical insurance is medical insurance in which the insurance company pays benefits to the insured person on a per-occurrence, per-day, or per-item basis in accordance with the subsidy rate stipulated in the contract. Claims are independent of actual medical expenses incurred, and no invoices are required.
Regardless of what disease one has and how much one spends on treatment, the standard of payment remains the same. If you are insured with more than one company, you can get claims from more than one company, and payment is made regardless of the number of copies insured. This portion of the benefit compensates for losses other than medical expenses incurred as a result of hospitalization, such as loss of income due to sick leave, transportation expenses, etc.
The "icing on the cake" of benefit-paying health insurance Generally speaking, if you are already covered by social health insurance, it is more suitable for you to choose critical illness insurance and benefit-paying health insurance. Benefit-based health insurance is not directly linked to social security, and the insurance company must pay for any hospitalization or surgery.
Expense-based medical insurance
Expense-based medical insurance, on the other hand, is based on the actual medical expenses incurred by the customer and pays the insurance amount agreed in the policy. The purpose is to compensate for the medical expenses of the customer, and the claim requires the customer to produce outpatient or hospitalization invoices, and the scope of the claim is basically the same as the "social security".
How to buy without medical insurance: first of all, the cost of medical insurance because according to the current level of medical care, the general hospitalization of diseases for about 10 days can be insured, the cost of products, reasonable hospitalization medical expenses, if 80% of the proportion of the reimbursement, can be reimbursed for most of the medical costs. If you take out an allowance-type medical insurance product, you can usually only get a claim on the 4th day. If the number of days of hospitalization is 10 days, you can get a claim of 1,500 RMB according to the daily allowance of 250 RMB, which is a relatively small amount of claim, and the expenses of the insured person in the hospitalization of 10 days should be far greater than this figure, so it is recommended to take out an expense-type policy first, and then consider to buy an allowance-type policy after that.
How to buy with health insurance: allowance-based health insurance and expense-based health insurance complement China's current social health insurance policy is divided into two parts, one is the cost of outpatient and emergency care, and the other is the cost of hospitalization. Generally speaking, about 80% of outpatient and emergency costs are borne by yourself. A hospitalization cost of about 10,000 yuan is usually about 30% covered by oneself, while a hospitalization cost of about 100,000 yuan for a serious illness is 20% covered by oneself.
In addition, social health insurance has strict limits. New, imported and expensive drugs are not covered by social health insurance. For medical expenses caused by traffic accidents, social health insurance is not reimbursed. In addition to this, expenses that often occur during illness, such as nutritional costs, nursing costs, lost wages and so on, are even more excluded from reimbursement.
So, those who have medical insurance to take out hospitalization medical insurance can consider buying expense-based and allowance-based to complement each other. Choosing expense-based hospitalization medical insurance is also a useful supplement.
[edit]Social medical insurance
China's publicly-funded medical care and labor insurance medical care established in the early 1950s are collectively known as employee social medical insurance. It is an important part of the national social security system and one of the important programs of social insurance.
Medical insurance has the basic characteristics of social insurance, such as compulsory, mutual aid and social. Therefore, the medical insurance system is usually legislated by the state, mandatory implementation, the establishment of a fund system, the cost of which is paid by the employer and the individual *** together, and the medical insurance premiums are paid by the medical insurance organization, in order to solve the medical risks brought about by the workers due to illnesses or injuries.
Medical insurance is a kind of material help given by the state or society when people are sick or injured, that is, a social security system that provides medical services or financial compensation.
China's medical insurance has been implemented for more than 40 years and has played a positive role in protecting the health of workers and maintaining social stability. However, with the establishment of the socialist market economy and the deepening of the reform of state-owned enterprises, it has become difficult for this system to solve the problem of basic medical protection for employees in a market economy.
The State Council issued the Decision of the State Council on the Establishment of a Basic Medical Insurance System for Urban Workers (Guo Fa [1998] No. 44) in December 1998, deploying a nationwide effort to comprehensively push forward the reform of the workers' medical insurance system, and calling for the basic establishment of a basic medical insurance system for workers nationwide within 1999.
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