Legal analysis: the type of medical insurance includes the new rural cooperative medical care, urban residents medical insurance, employee medical insurance, self-funded and other cases. According to their own whether to participate in the insurance, the type of insurance corresponding to fill in.
1, the basic medical insurance for urban workers
Basic medical insurance for urban workers by the employer and employee in accordance with state regulations *** with the payment of basic medical insurance premiums, the establishment of medical insurance fund, the insured person is sick, medical expenses incurred by the medical insurance agency to give a certain amount of economic compensation, in order to avoid or alleviate the economic risk of the laborers due to the disease, treatment and so on. risk.
2. New Rural Cooperative Medical Care
New Rural Cooperative Medical Care and Basic Medical Insurance for Urban Residents combine individual contributions with government subsidies, and the standard of treatment is carried out in accordance with national regulations. In addition, the types of medical insurance in China also include commercial medical insurance, allowance-based medical insurance, expense-based medical insurance and public medical care.
3. Basic Medical Insurance for Urban Residents
The basic medical insurance system for urban residents (referred to as residents' medical insurance) is geared toward students at the primary and secondary school levels (including vocational high schools and junior colleges) who are not covered by the basic medical insurance system for urban workers.
Expanded information common medical insurance mainly includes general medical insurance, hospitalization insurance, surgical insurance and comprehensive medical insurance. The details are as follows:
1. General Medical Insurance
General medical insurance mainly provides general medical expenses for the insured to treat illnesses, which mainly includes outpatient expenses, examination expenses, and medicine expenses. This type of insurance premium is relatively low and is more suitable for the general public.
2, hospitalization insurance
General hospitalization costs incurred is more, so most insurance companies will be hospitalization costs as a separate insurance. The cost items of hospitalization insurance are mainly the cost of doctor's treatment during hospitalization, the cost of hospital room, the cost of surgery, the cost of using medical equipment, and the cost of medicine. Among them, the length of hospitalization will directly affect the cost, so the amount of coverage for this type of insurance should be based on the patient's average hospitalization cost.
3. Surgical insurance
Surgical insurance provides coverage for expenses incurred as a result of necessary surgeries required by the patient. This type of policy generally covers all surgical costs.
4. Comprehensive medical insurance
Comprehensive medical insurance is a comprehensive medical expense insurance provided by the insurance company to the insured person, starting from the cost of all the expenses, including hospitalization, medical treatment, surgery and other expenses. However, this type of policy has higher premiums and typically establishes a low deductible and appropriate share of the cost.
Legal basis: "Regulations of the People's Republic of China on Basic Medical Insurance for Urban Workers"
Article 27 The personnel of an employer who pays the basic medical insurance premiums in accordance with these regulations shall enjoy the basic medical insurance benefits.
Article 28 Individual accounts shall be used to pay for medical expenses beyond the scope of payment by the integrated fund; any shortfall in payment by the individual account shall be borne by the individual himself/herself.
Article 29 The medical fees for hospitalization for serious diseases shall be paid as follows:
(1) The starting standard shall be controlled in principle at 9%-11% of the average annual social wage of the employees in cities, counties and autonomous counties in the previous year.
(b) The maximum payment limit is in principle controlled at 3-5 times of the average annual social wage of employees in cities, counties and autonomous counties in the previous year.
(3) Medical fees above the starting standard and below the maximum payment limit are mainly paid by the integrated fund, with a certain percentage borne by individuals. The proportion of medical expenses borne by retirees is appropriately taken care of.
The scope of serious diseases, the specific criteria for the starting standard and the maximum payment limit, and the proportion of medical expenses above the starting standard and below the maximum payment limit to be shared shall be determined by the provincial people's government.
Article 30 The coordinated fund shall not pay for medical expenses below the starting payment standard and above the maximum payment limit.
Article 31 The proportion of individual out-of-pocket payment for diagnostic and treatment items and medicines in the Class B list for which the basic medical insurance fund pays part of the expenses shall be determined by the provincial people's government.