2, scope:
The scope of medical insurance is very wide, medical expenses are generally in accordance with the characteristics of its medical services to distinguish, mainly contains the doctor's outpatient costs, medicine, hospitalization costs, nursing costs, hospital miscellaneous expenses, surgical costs, various inspection costs. Medical cost is the patient to cure the various costs incurred, it not only includes the doctor's medical and surgical fees, but also includes hospitalization, nursing, hospital equipment and other costs.
3, Types:
Classification I
The medical insurance system can be divided into:
① Indirect medical insurance system. The government's social insurance agency signs a contract with a private health care provider, whereby the patient pays out-of-pocket for medical care and then reimburses the social insurance agency for all or a portion of his or her expenses. This type of system is mostly found in western industrialized countries. ② Direct medical insurance system. The government directly owns and manages medical institutions, and the state bears all or part of the medical expenses of workers. This type of system is mostly found in socialist countries. ③ Basic medical care. Preventive, curative and comprehensive health insurance services. It includes nutritional improvement, sanitary water supply, mother and child care, immunization against major infectious diseases, prevention and control of epidemics, and treatment of common diseases. Such systems are mostly found in developing countries. The conditions for entitlement to health insurance are determined by the duration of employment or the period for which premiums are paid. Usually, the eligibility conditions for medical insurance match those for sickness insurance, and those who receive cash benefits from sickness insurance are entitled to medical services. China's current medical insurance system is divided into a publicly-funded medical care system practiced by State organs and institutions and a labor insurance medical care system practiced by enterprises. Medical expenses are borne by the state or by enterprises, and in the late 1980s a scheme was introduced on a trial basis whereby individuals bear part of the costs.
Category II
I. Commercial medical insurance Reimbursement medical insurance and compensation medical insurance. Reimbursement medical insurance (general medical insurance) means that the patient's medical expenses spent in the hospital are reimbursed by the insurance company. It is generally divided into outpatient medical insurance and inpatient medical insurance. Indemnity medical insurance (specialized 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 for the patient's treatment and care according to the amount agreed upon in the contract. There are generally two types of medical insurance: single disease insurance (e.g., cancer insurance) and major disease insurance (major disease insurance for 10, 20, and 30 diseases, etc.). These two types of medical insurance have similarities but also differences. The similarity is that you can only get insurance benefits if you are sick, while the differences are: general medical insurance is all-encompassing, i.e., all types of illnesses can be covered by the insurance. Specialized medical insurance is a specialized type, i.e., only certain diseases or surgeries specified in the insurance contract are covered. The medical insurance launched by the insurance company will often combine part of the above two types of insurance to combine into. Allowance-paying medical insurance In short, allowance-paying medical insurance is a kind of 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 standard stipulated in the contract. Claims are not related to actual medical expenses incurred and no invoice is required. Regardless of the disease and the amount spent on treatment, the standard of payment remains the same. If you are insured with more than one company, you can receive claims from more than one company, and the benefits are paid regardless of the number of policies taken out. This part 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 costs, etc. Benefit-paid health insurance is the "icing on the cake". Generally speaking, if you are already covered by social health insurance, it is more suitable to choose a critical illness insurance policy together with a benefit-paid health insurance policy. Benefit medical insurance is not directly related to social insurance, as long as the hospitalization or surgery, the insurance company must pay compensation. Ms. Chen, a housewife, 30 years old. She took out 1 hospitalization medical insurance policy (allowance type, RMB200/day, hospitalization for illness, 3-day deductible) of an insurance company for her husband with each of the three insurance companies. In August this year, Mr. Chen was hospitalized for 60 days due to illness. After being discharged from the hospital, Mr. Chen not only received partial payment of medical expenses from the social insurance institution, but also the three insurance companies*** paid Ms. Yang RMB 36,000 (RMB 200/day*60 days*3) in hospitalization medical allowance. Ans: Ms. Yang chose an allowance-based medical insurance for her husband. The most important feature of allowance-based medical insurance is that it is only related to the number of days of hospitalization, not the medical expenses. The first thing to consider when purchasing medical insurance is the reimbursement of medical expenses, followed by the compensation of damages incurred due to hospitalization. Only when the basic protection is solid and complementary to the basic protection can the icing on the cake be added. For those who have sufficient social insurance coverage, they can give priority to the benefit-paying type of medical insurance. Insurance Principle In insurance science, there is a question about whether the principle of compensation applies to health insurance. This question cannot be generalized. The principle of indemnity means that "the insured cannot be compensated more than his actual loss". This is not the case with benefit-based health insurance, where the benefits are not related to the actual loss. The design principle is actually to consider the insured person in the hospital, due to sick leave caused by the loss of wages, so the contract agreed to pay the subsidy cost according to the number of days of hospitalization, it does not take into account the actual hospitalization costs, and the actual economic loss has nothing to do with, belongs to a kind of "fixed-value insurance".
Oops, I don't even want to copy the /view/34297.htm big brother to see for himself