Enterprise supplementary medical insurance is a form of supplementary medical insurance organized or participated in by enterprises on their own initiative, on the basis of the enterprises' participation in the urban basic medical insurance, and with policy encouragement from the State. The enterprise factors affecting the payment of commercial supplementary medical insurance mainly include: the content of the enterprise's work, health and welfare status, the level of past medical expenses, and the age structure of the insured enterprise. First, the enterprise supplemental medical insurance provisions of the supplemental medical insurance fund for enterprises to participate in the local basic medical insurance in accordance with the provisions of the basic medical insurance for urban workers, the treatment of urban workers other than the basic medical insurance system to pay for the treatment, by the staff of the individual burden of medical expenses appropriate subsidies, to reduce the burden of medical expenses of the insured workers. The portion of the enterprise's supplementary medical insurance premiums within 4% of the total wage bill may be directly charged to the cost of the enterprise, and will no longer be subject to the approval of the finance department at the same level. Enterprises and institutions with basic medical insurance may establish supplementary medical insurance. The enterprise supplementary medical insurance scheme shall be connected with the local basic medical insurance system. The funds for enterprise supplementary medical insurance shall be centrally used and managed by the enterprise or industry, with separate accounts and separate management, and shall be used to subsidize the medical fees of the employees and retirees of the enterprise who have a heavier personal burden, and shall not be transferred to the individual accounts of the basic medical insurance, nor shall they be used to set up separate individual accounts or be used for the employees' other expenditures in a disguised manner. The finance department and the labor security department shall strengthen the supervision and financial regulation of the management of enterprise supplementary medical insurance funds to prevent misappropriation of funds and other irregularities. Second, the purchase of commercial insurance principles 1, the first insurance adults, after the insurance children most parents will have a child, will consider the child to develop a comprehensive protection program, at the same time, parents often ignore to buy insurance for themselves. In fact, for children, the biggest protection is from the parents, once the child relies on the parents have an accident, especially without any financial ability of the child is really losing the most basic protection. Therefore, to buy insurance to follow a basic principle: the first insurance parents, especially the highest contribution to family finances. 2, first to meet the protection needs, and then consider the investment needs to buy insurance should be to meet the needs of their own needs under the premise of protection, and then consider the need for investment. Even the basic protection is not, once the policyholder appears, it is even more impossible to talk about other investments. Therefore, it is necessary to first consider to meet the basic protection, and then consider other. 3, first meet the needs of the amount of coverage, and then consider the premium expenditure in the purchase, should first meet the needs of the amount of coverage, and then consider the premium expenditure. This is mainly because the amount of coverage is more important than the premium, the amount of coverage as a necessary amount of protection, the purchase of too little will have no meaning, too much is no longer their own affordable range, so, should choose the appropriate range is appropriate. In addition, the premiums need to be adjusted according to the actual situation of the policyholder, different personal stage, different financial situation, different occupational categories, there can be different options to arrange your premium expenses, consumers can be a reasonable combination of ways to achieve the amount of coverage they need. 4, meet the first life insurance, after considering property insurance most people believe that they should consider the purchase of property insurance, but often neglect to insure their own life insurance. Most people think that they should consider purchasing property insurance first, but often neglect to insure their own life insurance; there are also many business owners who will insure property insurance for their business, but not insure their own life insurance. This is actually the problem of putting the cart before the horse. 5, first meet the insurance planning, and then consider insurance products In general, the purchase of commercial insurance first meet the insurance planning, and then consider insurance products, which is more conducive to the policyholder's protection more comprehensive, maximize the benefits. Commercial insurance types 1, according to the number of policyholders classification, can be divided into individual health insurance and group health insurance. 2, according to the length of the insured time, can be divided into short-term health insurance and long-term health insurance. The length of the insurance period is also combined with the number of policyholders to form group short-term insurance and group long-term insurance, and also combined with individuals to form individual short-term insurance and individual long-term insurance, etc. 3, according to the classification of insurance responsibility (1) Sickness insurance Sickness insurance refers to the insurance that pays benefits for diseases, i.e., as long as the insured person suffers from a certain disease listed in the terms of the insurance, regardless of whether or not medical expenses or how much expenses occur, the insurance can receive a fixed amount of compensation. The insured person is entitled to a fixed amount of compensation. (2) Medical Insurance Medical insurance, also known as medical expense insurance, refers to insurance that compensates the insured for expenses incurred while receiving medical services. (3) Incapacity insurance Incapacity insurance, also known as loss of income insurance and income protection insurance, refers to a kind of insurance that compensates the insured for the loss of income and property due to the insured's incapacity.4. Classification according to the type of loss According to the classification of the type of loss, it can be classified into medical expense insurance, loss of income insurance for incapacity, and longterm care insurance.5. Classification according to the different ways of payment (1) Expense-type insurance. The insurer compensates all or part of the insured's medical expenses based on the reasonable medical expenses incurred in the course of medical consultation and treatment in accordance with the agreement of the insurance contract. (2) Allowance-type insurance (fixed-payment insurance). Allowance-type insurance refers to insurance that pays benefits at the rate agreed upon in the insurance contract without regard to the actual expenses incurred by the insured. (3) Provision of service-type products. In the provision of this type of product, the insurer is directly involved in the management of the medical service system. The insurer selects medical service providers (hospitals, clinics, doctors) based on certain criteria and organizes the selected medical service providers to provide medical services to the insured. There are strict formal operating rules to ensure the quality of services, the use of medical services is frequently reviewed, and the insured can enjoy financial benefits when seeking treatment from the designated medical service providers in accordance with the prescribed procedures. In summary, commercial supplementary medical insurance is characterized by: settlement by service item; settlement by service unit; the ability to make a reasonable choice of insured enterprises or participants; the ability to design additional provisions for specific situations; and the possibility of close integration with medical insurance, *** with the control of moral hazard.
Legal Objective:The Interim Measures on Supplementary Medical Insurance for Enterprises in Beijing Municipality specifies that enterprises participating in Beijing Municipality's basic medical insurance can set up supplementary medical insurance for their own employees and retirees (limited to Chinese employees in the case of foreign-invested enterprises), and at the same time makes specific provisions for the withdrawal and payment of supplementary medical insurance premiums and other related issues, which are aimed at implementing the provisions of Beijing Municipality's basic medical insurance and ensuring that the insurance policy is implemented in accordance with the provisions of Beijing Municipality's basic medical insurance. Beijing Municipal Basic Medical Insurance Regulations" to ensure a smooth transition of the medical insurance system. The measures are as follows: Article 1 In order to improve the level of medical insurance for employees and retirees, these measures are formulated in accordance with the Provisions of Beijing Municipality on Basic Medical Insurance (Decree No. 68 of the Beijing Municipal People's Government of Feb. 20, 2001), and Article 2 Supplementary Medical Insurance is a part of the basic medical insurance. Article 2 Supplementary medical insurance is a supplementary form of basic medical insurance. Enterprises that have participated in Beijing's basic medical insurance can establish supplementary medical insurance for their own employees and retirees (foreign-invested enterprises are limited to Chinese employees). The supplemental medical insurance of the enterprise is mainly used to solve the medical expenses borne by the retirees individually and the medical expenses that need to be paid by the employees out of their own pockets when they are hospitalized. Article supplemental medical insurance premiums withdrawn in the enterprise within 4% of the total wages of employees in the previous year, part of the cost from the expense. Article 4 supplementary medical insurance premiums pay for the following expenses incurred by employees and retirees in designated medical institutions and designated retail pharmacies: (a) medical expenses when the individual account is insufficient to pay; (b) medical expenses that should be paid by individuals in addition to those paid by the basic medical insurance co-ordination fund; (c) medical expenses that should be paid by individuals in addition to those paid by the mutual aid fund for large medical expenses. Article 5: The scope of payment of enterprise supplementary medical insurance can be determined in accordance with the provisions of the Beijing Municipal Basic Medical Insurance Designated Medical Care Management Regulations, as well as the basic medical insurance drug directory, diagnosis and treatment item directory, the scope of services and facilities, and the payment standard. The specific payment ratio shall be determined by the enterprise. Article 6 The balance of the supplemental medical insurance premiums of the enterprise in the current year shall be carried forward for use in the next year. Article 7 supplementary medical insurance is managed by the enterprise. Enterprises shall formulate specific management methods in accordance with these Measures. The specific management methods of the supplemental medical insurance and the annual budget plan shall be considered by the general meeting of employees (representatives), and the shareholders' meeting and the board of directors of the joint-stock enterprises shall also be considered by the general meeting of shareholders and the board of directors. The implementation of the enterprise supplementary medical insurance shall be subject to review by the employees' (representative) general meeting and announced to all employees. Article 8 Other employers who are not entitled to medical subsidies for state civil servants may establish supplementary medical insurance with reference to these Measures. Article 9 the establishment of supplementary medical insurance employer before January 30 each year in the participating districts, counties, medical insurance affairs agencies to register, and report the previous year's expenditure of funds. Article 10 of these measures by the Municipal Bureau of Labor and Social Security is responsible for the interpretation. Article XI of these measures since April 1, 2001 shall come into force. The issuance of the measures require full understanding of the importance of the establishment of enterprise supplemental medical insurance, and requires that enterprises with conditions to establish enterprise supplemental medical insurance, while highlighting the key issues to be resolved.