Design of Commercial Operation Plan for Supplementary Medical Insurance in Beijing [Date: 2005-10-12] Source: Beijing Social Science Planning Office Author: Wang Guojun of Renmin University of China [Font: Large, Medium, Small] According to "Beijing Basics" According to the "Medical Insurance Regulations", the mutual aid system for large medical expenses (supplementary medical insurance) shall be borne by the labor department. When the mutual aid funds for large medical expenses are insufficient to pay, appropriate subsidies will be provided by the finance department. The specific measures shall be determined by the municipal labor and social security administrative department in conjunction with the municipal finance department. formulated. There are no clear regulations on other types of supplementary medical insurance. It is only stated in Article 41 that enterprises and institutions participating in basic medical insurance can establish supplementary medical insurance. The part of the enterprise's supplementary medical insurance premiums that is within 3 (4 according to the State Council's documents) of the total wages of the employees of the enterprise shall be paid out of employee welfare fees. The supplementary medical insurance measures shall be formulated by the municipal labor and social security administrative department in conjunction with the municipal financial department. It is not difficult to see from this that Beijing’s specific plan for supplementary medical insurance still has considerable room for maneuver and a lot of space. If this space can be filled in the most effective way, whether it is for the entire social medical insurance system Construction, medical security for residents, and economic development in Beijing will all play a huge role in promoting it. We are trying to optimize the connection between basic medical insurance and commercial medical insurance without violating the "Beijing Basic Medical Insurance Regulations", choose an effective supplementary medical insurance operation model, and improve the overall efficiency of Beijing's social medical insurance. , to achieve the ideal state where citizens, labor and social security administrative departments, medical departments, financial departments and commercial insurance companies all benefit from supplementary medical insurance. To this end, the following "Commercial Reform of the Mutual Assistance System for Large Medical Expenses" plan is proposed for Beijing's existing mutual aid system for large medical expenses, and on this basis, a complete tax-preferential supplementary medical insurance will be gradually established. Generally speaking, the commercial operation of the social security system has two meanings: First, the operation of the social security system follows the principle of commercialization, and the government reduces financial subsidies or does not provide subsidies, but provides legal protection and tax benefits. The second is to hand over part or all of the business to non-governmental departments for operation and operation. This refers to the latter meaning, that is, drawing on the "Xiamen Model", the basic medical insurance management agency transfers the large-amount medical expense mutual assistance system to commercial insurance companies. The basic medical insurance management agency and commercial insurance companies will discuss relevant medical insurance matters. Sign a contract with rights and obligations such as terms, rates, claims, etc. Basic medical insurance management agencies can act as agents of commercial insurance companies and charge a certain commission to cover the costs incurred in the process of cooperation with commercial insurance companies. With the development of the insurance business, commercial insurance companies can expand insurance responsibilities and improve the level of insurance protection based on the voluntariness and requirements of insured units. The following options are proposed for the selection of commercial insurance companies in the early stage:
Option 1. Social bidding
That is, the basic medical insurance agency will use social bidding to start from the current business of medical insurance. Choose an insurance company with low rates, high-quality services, and strong strength among the life insurance companies as the underwriting company for large medical expense insurance. Social bidding can be divided into overall bidding and split bidding. The former refers to the unified bidding of all businesses under the mutual aid system for large medical expenses in Beijing to commercial insurance companies, emphasizing the integrity of the business. The latter means that according to the administrative structure of Beijing, each district and county will separately bid for business from commercial insurance companies according to the large-amount medical expense mutual assistance system. Each district and county can choose different commercial insurance companies to operate. The advantages of social bidding are: it conforms to the operating laws of the market economy and can promote market competition, thus promoting the overall improvement of commercial insurance companies' service levels and competitiveness; at the same time, the majority of insureds can obtain better quality services and affordable price conditions. Option 2, insurance method
That is, insurance companies operating medical insurance in Beijing will set up a large medical expense insurance insurance management department to determine the operating mechanism and operating procedures, and clarify the costs of each company. The sharing and benefit sharing system provides insurance services to the insured with large medical expense insurance. Basic medical insurance agencies communicate and cooperate directly with the National Insurance Management Department.
Insurance premium = risk rate, risk fee, insurance factor, pharmaceutical price increase index, management fee, risk reserve. 8. Supply-side control and demand-side control of medical expenses are important links to ensure the normal operation of supplementary medical insurance. Effective cost checks and balances should be established between basic medical insurance management agencies and insurance companies, as well as medical institutions and insured persons. 9. The supplement of the medical insurance system should be regarded as an important content and gradually improved.
Extended reading: How to buy insurance, which one is better, and step-by-step instructions to avoid these "pitfalls" of insurance