Medical insurance physicians refer to those who have obtained the qualifications of practicing physicians, practicing assistant physicians or rural doctors, are registered by the municipal health administrative department, are appointed by medical insurance designated medical institutions, and are reported to the municipal human resources and social security administrative department for review and approval. They are based on the registered practice location.
Physicians who provide medical services to people insured by the Municipal Urban Employee Basic Medical Insurance.
Medical insurance generally refers to basic medical insurance, which is a social insurance system established to compensate workers for economic losses caused by disease risks.
A medical insurance fund is established through contributions from employers and individuals. After insured persons incur medical expenses for medical treatment, the medical insurance agency will provide them with certain financial compensation.
The establishment and implementation of the basic medical insurance system gathers the economic strength of units and social members, and coupled with government funding, can enable sick members of society to obtain necessary material help from the society, reduce the burden of medical expenses, and prevent the society from falling ill.
Members are “impoverished due to illness.”
Medical insurance has the basic characteristics of social insurance such as compulsory, mutual aid, and social nature.
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 institution to solve the medical expenses caused by workers' illness or injury.
risk.
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.
Commercial medical insurance can be divided into reimbursement medical insurance and compensation medical insurance.
Reimbursement medical insurance means that the medical expenses incurred by patients in the hospital are reimbursed by the insurance company. It is generally divided into outpatient medical insurance and inpatient medical insurance.
Indemnity medical insurance means that the patient is clearly diagnosed by the hospital as suffering from a disease listed in the contract, and the insurance company pays the patient for treatment and care based on the amount agreed in the contract.
Generally, it is divided into individual disease insurance and critical illness insurance.
According to Article 2 of the "Social Insurance Law of the People's Republic of China", the state establishes basic pension insurance, basic medical insurance, work-related injury insurance, unemployment insurance, maternity insurance and other social insurance systems to protect citizens in the event of old age, illness, work-related injury, unemployment, etc.
The right to obtain material assistance from the state and society in accordance with the law in cases of childbirth, childbirth, etc.