Medical insurance means that through national legislation, basic medical insurance premiums should be paid in full and on time by employers and individual employees in accordance with the principle of compulsory social insurance. If the payment is not made in full and on time, the basic medical insurance pooling fund will not cover the medical expenses, regardless of personal account. Take the medical insurance payment ratio in Beijing as an example: the employer pays 10% of its total payment base every month, and the employee pays 2% of his/her salary+120 yuan for serious illness as a whole.
Medical insurance is a type of insurance that compensates for medical expenses caused by illness. 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. If an insured accident requires treatment, the insurance premium will be paid in proportion.
In January 2009, the National Medical Insurance Administration launched the national medical insurance electronic voucher system, first piloting it in some cities in Hebei, Jilin, Heilongjiang, Shanghai, Fujian, Shandong, Guangdong and other places.
In 2020, the number of people insured by China's national basic medical insurance was 136131 million, and the insurance participation rate was stable at more than 95%.
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[1].
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, 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 and establishes a medical insurance fund; when the insured becomes ill and goes to a medical institution for medical treatment and incurs medical expenses, the medical insurance will be paid by the medical insurance company. The insurance agency 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 distributed to all members threatened by the same risks, and a centralized medical insurance fund is used to compensate for the economic losses caused by the disease.
Medical insurance has a wide scope of responsibilities, and medical expenses are generally distinguished according to the characteristics of medical services, mainly including doctor's outpatient expenses, drug expenses, 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 fees, but also the expenses for hospitalization, nursing care, hospital equipment, etc.
In February 1998, the State Council issued the "Decision of the State Council on Establishing a Basic Medical Insurance System for Urban Employees" (Guofa No. 44), deploying the comprehensive promotion of the reform of the employee medical insurance system nationwide, requiring that within 1999 A basic medical insurance system for employees has been basically established across the country. [5]
On July 4, 2006, the Ministry of Human Resources and Social Security announced the "Thirteenth Five-Year Plan Outline for Human Resources and Social Security", which proposed the establishment of a unified basic medical insurance system and operation mechanism for urban and rural residents. , stabilizing the payment ratio of hospitalization expenses within the scope of the basic medical insurance policy for employees and urban and rural residents at around 75%.