In general, the health insurance fund can only reimburse the medical expenses within the scope of the health insurance, if the patient chooses to buy drugs or services outside of the health insurance, they need to bear the corresponding costs, the so-called out-of-pocket expenses. It is important to note that medical insurance out-of-pocket expenses refer to cases where the patient chooses to pay out-of-pocket expenses within the scope of medical insurance, not cases where the patient is not enrolled in medical insurance and pays out-of-pocket expenses. In addition, some hospitals or doctors may sell patients drugs or services that are not covered by health insurance, and if patients choose to buy them, they will also need to cover the costs themselves.
The role of health insurance:
1, can stabilize social life;
2, can achieve redistribution;
3, can promote economic development;
4, most areas of the purchase of a car to buy a house and social security linked to the requirement that only to pay social security for a certain period of time, before you can buy a car to buy a house in the local area;
5, the workers' compensation insurance The use of the payment of treatment costs, living care costs, disability benefits and disability allowance;
6, the use of maternity insurance, you can enjoy maternity leave, maternity allowances and source matching maternity grants.
In summary, in the process of medical treatment, patients need to understand the health insurance policy and their own health insurance coverage, according to the actual situation to choose, to avoid unnecessary out-of-pocket expenses.
Legal basis:
Article 4 of the Social Insurance Law of the People's Republic of China
Employers and individuals within the territory of the People's Republic of China pay social insurance premiums in accordance with the law, and have the right to inquire about the payment records and records of individual rights and interests, and to request the social insurance agency to provide social insurance counseling and other related services.
Individuals enjoy social insurance benefits in accordance with the law, and have the right to supervise the payment of contributions for them by their own units.
Article 7
The social insurance administrative department of the State Council is responsible for the administration of social insurance throughout the country, and other relevant departments of the State Council are responsible for relevant social insurance work within their respective areas of responsibility.
The social insurance administrative departments of the local people's governments at or above the county level are responsible for the administration of social insurance in their respective administrative areas, and other relevant departments of the local people's governments at or above the county level are responsible for the relevant social insurance work within their respective areas of responsibility.
Article 10
Employees shall participate in basic old-age insurance, and the employer and the employee*** shall pay the basic old-age insurance premiums together.
Individual industrial and commercial households without employees, part-time workers who have not participated in basic pension insurance with their employing units, and other flexibly employed persons may participate in basic pension insurance and pay basic pension insurance premiums by themselves.
The methods of pension insurance for civil servants and staff members administered under the civil service law shall be prescribed by the State Council.