I think you can choose social medical insurance.
Social medical insurance is a social insurance system established by the state and society in accordance with certain laws and regulations to provide basic medical needs for workers within the scope of coverage when they fall ill. my country's social medical insurance consists of three levels: basic medical insurance and large-amount medical assistance, corporate supplementary medical insurance and individual supplementary medical insurance. On July 5, 2011, the Ministry of Human Resources and Social Security issued a notice stating that unemployed individuals do not need to pay individual contributions for medical insurance. Social medical insurance means that when workers fall ill, social insurance institutions provide appropriate subsidies or reimbursement for the medical expenses they need, so that workers can restore their health and working ability and participate in the social reproduction process as soon as possible. Social medical insurance is an important part of social insurance and is generally undertaken by the government. The government will use economic means, administrative means, and legal means to enforce and organize management.
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Medical insurance is a type of insurance that compensates for medical expenses caused by diseases. Social insurance that provides necessary medical services or material assistance to employees due to illness, injury, or childbirth, provided by the society or the enterprise. Such as China's publicly funded medical care and labor insurance medical care. The medical expenses of Chinese employees are jointly borne by the state, units and individuals to reduce the burden on enterprises and avoid waste.
Function
Medical insurance refers to insurance that takes the occurrence of medical acts stipulated in the insurance contract as the condition for payment of insurance benefits and provides protection for the insured's medical expenses during the period of diagnosis and treatment. .
Medical insurance
Medical insurance, like other types of insurance, collects medical insurance premiums in advance from people who are threatened by the disease in the form of a contract to establish a medical insurance fund; when insured When a person becomes ill and goes to a medical institution for medical treatment and incurs medical expenses, the medical insurance institution will provide certain financial compensation. Therefore, medical insurance also has two major functions of insurance: risk transfer and compensation transfer. That is, the economic losses caused by disease risks on an individual are shared among all members who are threatened by the same risks, and a centralized medical insurance fund is used to compensate for the economic losses caused by the disease.
Edit the scope of this paragraph
Medical insurance has a wide range, and medical expenses are generally distinguished according to the characteristics of the medical services, mainly including doctor's outpatient expenses, drug expenses, and hospitalization expenses. , nursing expenses, hospital miscellaneous expenses, surgical expenses, various examination expenses, etc. Medical expenses are various expenses incurred by patients for treatment. They include not only doctors' medical expenses and surgical expenses, but also the expenses for hospitalization, nursing, hospital equipment, etc.
Types
Category 1
Medical insurance systems can be divided into: ① Indirect medical insurance systems. The government's social insurance agency signs a contract with private medical institutions. Patients first pay their own medical expenses and then reimburse all or part of their expenses to the social insurance agency. This type of system is mostly found in Western industrialized countries. ②Direct medical insurance system. The government directly owns and manages medical institutions, and workers' medical expenses are fully or partially borne by the state. This type of system is often found in socialist countries. ③Basic medical care. That is, preventive, curative and comprehensive health insurance services. Including nutrition improvement, sanitary water supply, maternal and child care, immunization against major infectious diseases, epidemic prevention and control, and treatment of common diseases. This type of system is mostly found in developing countries. The conditions for enjoying medical insurance are determined according to the period of employment or the period of paying insurance premiums. Normally, the eligibility conditions for medical insurance match those for disease insurance, and those who receive cash subsidies from disease insurance can enjoy medical services. China's current medical insurance system is divided into a publicly funded medical system implemented by state agencies and public institutions and a labor insurance medical system implemented by enterprises. Medical expenses are borne by the state or enterprises. In the late 1980s, a trial was carried out to allow individuals to bear part of the expenses.
Category 2
1. Commercial medical insurance
Reimbursement medical insurance and compensation medical insurance.
Reimbursement medical insurance (ordinary medical insurance) means that the medical expenses spent by patients in the hospital are reimbursed by the insurance company. Generally, it is divided into outpatient medical insurance and inpatient medical insurance.
Compensation 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 individual disease insurance (such as cancer insurance) and critical illness insurance (10, 20, 30 and other major disease insurances).
Related books
The above two types of medical insurance have similarities but also differences. The similarity is that only when you are sick can you get insurance benefits. The main differences are: ordinary medical insurance is comprehensive All types of diseases can be covered by insurance. Special medical insurance belongs to the special category, that is, only certain diseases or operations that are clearly listed in the insurance contract can receive insurance benefits. Medical insurance launched by insurance companies often combines parts of the above two major types of insurance.
2. Subsidy-based medical insurance
In short, subsidy-based medical insurance is an insurance company that provides subsidies to the insured on a per-time and daily basis in accordance with the subsidy standards stipulated in the contract. Or medical insurance that pays premiums on a project-by-project basis. Claim settlement has nothing to do with the actual medical expenses incurred, and no invoice is required. No matter what disease you get or how much you spend on treatment, the compensation standard remains the same. If you purchase insurance from multiple companies, you will be able to receive claims from multiple companies, regardless of how many policies you purchase. This part of the allowance can compensate for other losses other than medical expenses incurred due to hospitalization, such as loss of income due to sick leave, transportation expenses, etc.
“The icing on the cake” subsidy-based medical insurance. Generally speaking, if you have already participated in social medical insurance, it is more suitable to choose critical illness insurance combined with subsidy-based medical insurance. Subsidy-based medical insurance is not directly related to social insurance. As long as you are hospitalized or have surgery, the insurance company must compensate.
Insurance case Ms. Chen, housewife, 30 years old. For my husband, I purchased one hospitalization medical insurance from one insurance company in each of three insurance companies (subsidy type, 200 yuan/day, hospitalization for illness, 3 days free of charge). 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 compensation for his medical expenses from the social insurance institution, but also three insurance companies paid a total of 36,000 yuan (200 yuan/day*60 days*3) to Ms. Yang’s hospitalization medical allowance.
Analysis: Ms. Yang chose subsidy-based medical insurance for her husband. The biggest feature of subsidized medical insurance is that it is only related to the number of days of hospitalization and does not have any relationship with medical expenses.
When purchasing medical insurance, it is recommended that the first thing to consider when purchasing medical insurance is the issue of reimbursement of medical expenses, and then the issue of compensation for losses caused by hospitalization. Only by consolidating the basic protection can we make plans on this basis. Supplements are the icing on the cake. People with sufficient social insurance coverage can give priority to subsidy-based medical insurance when choosing medical insurance.
Principles of Insurance In insurance science, there is a question about "whether the compensation principle applies to health insurance." This issue cannot be generalized. The compensation principle means that “the compensation received by the insured cannot be higher than its actual loss.” Subsidy benefit medical insurance is not applicable, and the payment of insurance benefits has nothing to do with actual losses. Its design principle is actually to consider the loss of wages due to sick leave during the period of hospitalization of the insured. Therefore, the contract stipulates that subsidies will be paid based on the number of days of hospitalization. It does not consider the actual hospitalization expenses and has nothing to do with actual economic losses. It is a "fixed value insurance" ” kind of.
3. Cost-based medical insurance
Cost-based medical insurance pays insurance premiums according to the insurance amount agreed in the policy based on the actual medical expenses incurred by the customer. The purpose is to compensate customers for their medical expenses. Customers are required to issue outpatient or hospitalization invoices when settling claims. The scope of claims is basically the same as "social security".
How to buy without medical insurance: First, buy a cost-based medical insurance because according to the current medical level, the hospitalization time for general diseases is about 10 days. If you buy a cost-based product, the reasonable hospitalization medical cost is 80 By reimbursing according to the proportion, most medical expenses can be reimbursed. If you buy a subsidized medical insurance product, you can usually only get a claim on the 4th day. If you are hospitalized for 10 days, you can get a compensation of 1,500 yuan based on a daily allowance of 250 yuan. Relatively speaking, the amount of the claim is small, and the compensation is The insured's expenses during the 10 days of hospitalization should be much greater than this number, so it is recommended to buy the expense type insurance first, and then consider purchasing the subsidy type. How to purchase medical insurance: Subsidy-based medical insurance and fee-based medical insurance complement each other. China’s current social medical insurance policy is divided into two parts, one is outpatient and emergency expenses, and the other is hospitalization expenses. Generally speaking, about 80% of outpatient and emergency expenses are borne by yourself. For a hospitalization expense of about 10,000 yuan, 30% of the hospitalization expenses are generally borne by yourself, while for a serious illness hospitalization expense of about 100,000 yuan, 20% is borne by yourself.
In addition, social medical insurance has strict restrictions. New drugs, imported drugs, and expensive drugs are not covered by social medical insurance reimbursement. Social medical insurance will not reimburse medical expenses caused by traffic accidents. In addition, expenses frequently incurred during illness, such as nutrition expenses, nursing expenses, lost work expenses, etc., are not covered by the reimbursement. Therefore, when people with medical insurance purchase hospitalization medical insurance, they may consider purchasing cost-based and subsidy-based insurance. Choosing cost-based hospital medical insurance is also a useful supplement.
4. Social Medical Insurance
The publicly funded medical care and labor insurance medical care established in China in the early 1950s are collectively referred to as employee social medical insurance. It is an important part of the national social security system and one of the important projects of social insurance. Medical insurance has the basic characteristics of social insurance such as compulsory, mutual aid, and social nature. Therefore, the medical insurance system is usually legislated and enforced by the state, and a fund system is established. The fees are paid jointly by the employer and the individual, and the medical insurance premiums are paid by the medical insurance agency to solve the problems caused by workers' illness or injury. medical risks. Medical insurance is a kind of material assistance provided by the state or society when people become ill or injured, that is, a social security system that provides medical services or economic compensation. China's medical insurance has played a positive role in protecting the health of employees and maintaining social stability for more than 40 years. However, with the establishment of the socialist market economic system and the continuous deepening of the reform of state-owned enterprises, this system has been unable to solve the problem of basic medical security for employees under market economic conditions.
Things to note when buying medical insurance
Medical risks are mainly outpatient medical risks and inpatient medical risks, among which the most important is inpatient medical risks. Therefore, the most practical thing is to first consider purchasing hospitalization medical insurance. How to choose a hospitalization medical insurance product that suits us
1. It must have a guaranteed renewal function.
Hospital medical insurance is generally one-year, that is, the insurance period is one year, and you need to re-insure after one year (called renewal). Precautions for buying medical insurance currently on the market
[1] Many hospitalization medical insurance products do not guarantee renewal. In other words, when customers are young and healthy, there is no problem in renewing the policy every year. But no matter how many years you renew the policy, even if it is 30 or 50 years, once you get sick and a compensation is paid, the insurance company may require additional premiums, exclude the disease, or even refuse insurance when renewing the policy next year. Denial of insurance is legal. Because this is a one-year insurance policy. When one year expires, the insurance contract ends. If you want to continue the insurance next year, you will start a new contract. Both the insurance company and the insured can choose each other. Both parties can negotiate terms, what price and what kind of protection will be used to continue the contract. If they cannot reach an agreement, they can choose not to renew the policy. Therefore, before starting a new contract, it is understandable for the insurance company to evaluate the insured's risk. Insurance covers uncertain risks. If the risk has been determined, it is not insurance, but relief.
If the product purchased has a guaranteed renewal function, after entering the guaranteed renewal period, even if a claim of hundreds of thousands of yuan is made, the insurance can still be renewed in the next year. That is to say, once the insurance company agrees that the insured enters the guaranteed renewal state, the insurance company loses the right to choose the insured, but the insured still has the right to choose the insurance company. As long as the insured requests renewal, The insurance company has no choice but to accept it. 2. It is best to use a fixed payment type. The so-called "fixed payment type" is relative to the expense type. The basis for expense-type insurance compensation is invoices. The amount of compensation may only be less than the actual cost. Fixed benefit is paid according to the insurance amount agreed in advance, regardless of the actual cost. Therefore, it is entirely possible that the insurance company's claim amount is higher than the actual expenditure (of course, it may also be lower). The excess can be used for nutritional expenses, lost work expenses, transportation expenses, companionship expenses, nursing expenses, and for the enjoyment of higher-level and higher-quality medical services such as single wards and expert diagnosis and treatment. In addition, there is often no need to provide original invoices when settling claims for fixed-benefit hospital medical insurance, the procedure is simple, and claims disputes are less likely to arise. It does not conflict with whether you have social medical insurance or medical insurance from other insurance companies. It can be an additional protection. Most insurance companies stipulate that cost-based medical insurance only pays for medical expenses within the scope of social security. According to the cost compensation principle, if the customer has been reimbursed through social security or other institutions, the insurance company will only reimburse the remaining part. Therefore, when purchasing hospitalization medical insurance, you must find out whether you need to provide the original hospital invoice when making a claim. It is best to have fixed-rate hospitalization medical insurance that does not require invoices, especially for those who already have social medical insurance or medical insurance from other insurance companies.
3. It is best to have primary insurance.
If the medical insurance we buy is an additional insurance, we often have to spend a very expensive fee to buy an additional "main insurance" that we may not need at all, even if we are not rejected midway. In the case of insurance, the main insurance may expire or become invalid due to other reasons, and at that time the protection of the additional insurance will no longer exist.
4. It is best to be covered against accidents and diseases.
Some hospitalization medical insurance products currently on the market are only responsible for insurance benefits for hospitalizations caused by accidents, some are only responsible for insurance benefits for hospitalizations caused by diseases, and some are both. All are responsible for insurance payments. Therefore, we must read the insurance terms carefully when purchasing. It is best to cover both accidental hospitalization and illness hospitalization.
5. Try to buy the highest grade.
If you choose a lower grade, you may seem to be saving a little money, but in fact you will suffer a big loss.
6. Purchase all insurance coverage.
If we insure one less insurance liability, the insurance premium will actually be much less, but the compensation will be much less. Therefore, we should try our best to choose “hospitalization”, “hospitalization for major diseases”, “surgery”, “organ transplantation” and “intensive care unit” that we people are most worried about, afraid of and most likely to “lead to poverty” or “return to poverty”. "These 5 insurance responsibilities.
7. Insist on maintenance.
We must change the concept that "it is not worthwhile if you are not hospitalized and do not get compensation." We must be very clear about the purpose of buying insurance. "Is it to get hundreds of thousands of yuan in compensation? If you get What will happen to us if we pay hundreds of thousands of yuan in compensation? We may lose our legs, our arms, and our kidneys will be replaced. Are we willing to do this? Of course not, we hope to buy insurance for once. If we don’t get sick, we hope that all the insurance premiums we pay will be contributed to others. 8. If only fee-based hospitalization insurance is available locally, it is best to choose a total limit rather than an item limit.