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. The medical insurance fund is established through the contributions of employers and individuals. After the insured person has medical expenses, the medical insurance institution will give certain economic compensation.
The establishment and implementation of the basic medical insurance system has gathered the economic strength of units and social members. With the government's funding, sick social members can get necessary material help from the society, reduce the burden of medical expenses, and prevent sick social members from "poverty due to illness".
Function:
1 is conducive to improving labor productivity and promoting the development of production. Medical insurance is the inevitable result of social progress and production development. Conversely, the establishment and improvement of medical insurance system will further promote social progress and production development. On the one hand, medical insurance relieves the worries of workers, makes them work with peace of mind, can improve labor productivity and promote the development of production; On the other hand, it also ensures the physical and mental health of workers and the normal reproduction of labor;
2. Adjust income differences and reflect social equity. Medical insurance is an important means for the government to redistribute income by collecting medical insurance premiums and paying medical insurance service fees.
3. An important guarantee for maintaining social stability. Medical insurance helps sick workers economically, helps to eliminate social instability caused by diseases, and is an important social mechanism to adjust social relations and social contradictions;
4. An important means to promote social civilization and progress. The social system of medical insurance and social mutual assistance embodies a new social relationship of "one party is in trouble and all parties support" by the insured sharing the risk of disease costs, which is conducive to promoting social civilization and progress;
5. An important guarantee for promoting economic system reform, especially the reform of state-owned enterprises.
legal ground
People's Republic of China (PRC) social insurance law
Thirtieth the following medical expenses are not included in the basic medical insurance fund payment scope:
(a) shall be paid by the industrial injury insurance fund;
(2) It shall be borne by a third party;
(three) shall be borne by public health;
(4) Go abroad for medical treatment.
Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.