I. Compensation for Medical Expenses This kind of medical insurance refers to the expenses of the insured's illness treatment, which can be reimbursed and compensated by the insurance company within the limits stipulated in the insurance company's contract. It should be noted that this kind of cost-compensated medical insurance generally requires the insured to provide the insurance company with the documents of treatment expenses. Therefore, after seeing the disease, the documents should be kept away to prevent the insurance company from "denying". After handing over the documents to the insurance company, the insurance company will pay compensation within the amount stipulated in the contract.
2. Fixed-fee subsidy means that the insurance company pays a fixed amount of compensation in one lump sum or in installments to the insured who is diagnosed with the disease or adopts the treatment method stipulated in the insurance contract according to the disease type or treatment method stipulated in the contract. This kind of insurance generally does not need to provide medical expense documents, which is not contradictory to the current system of medical reimbursement at public expense, and also better allows insurance companies to control business risks, and is increasingly welcomed by everyone.
According to the different forms of the medical process, it can be divided into the following categories: 1. Outpatient medical insurance, which is the insurance company's guarantee for the expenses incurred by the insured in the outpatient treatment of the hospital due to illness. This kind of medical insurance coverage is generally low, the risk is not easy to control, and the expenditure is frequent, so there are fewer varieties. 2. Hospitalization medical insurance is the insurance provided by the insurance company for bed fees, nursing fees, inspection fees, treatment fees and other miscellaneous expenses incurred by the insured during hospitalization due to illness. Why should hospitalization be regarded as an independent guarantee? As we all know, once you are hospitalized, your money will be spent like running water, and you can't do it without some financial compensation. There are two forms of compensation: fee compensation and fixed fee allowance. Insurance contracts limit hospitalization time for different diseases. Third, surgical medical insurance. It is a guarantee provided by the insurance company for the insured who needs surgery due to illness, as well as the expenses such as surgery and anesthesia during the treatment. The insurance company will bear all the expenses of the operation. This kind of insurance can be used as a separate insurance or as an additional insurance.
Classification by insurance disease type: 1. Medical Insurance for General Diseases This is the guarantee provided by the insurance company for the treatment expenses incurred by the insured due to general diseases. But for minor ailments and pains, the insurance coverage is generally not as high as there. Second, medical insurance for special diseases, as the name implies, is the insurance company's guarantee for the treatment expenses incurred by the insured who suffers from major diseases, such as heart disease, cancer and general paralysis. This form of insurance generally has a high coverage and is often provided by paying a fixed fee.
1) On-the-job personnel with local household registration (including blue-printed household registration, the same below); (2) the original rural urban residents with household registration in this city; (three) retirees who have been registered in this city before retirement and paid monthly pension insurance benefits by the municipal social insurance management institution (hereinafter referred to as the municipal social insurance institution); (four) retirees who have been registered in this city before retirement and participated in the overall planning of the original old-age insurance industry, and the social insurance institutions in Guangdong Province pay the old-age insurance benefits on a monthly basis; (5) Persons who registered in this Municipality before reaching the statutory retirement age and did not receive pension insurance benefits on a monthly basis; (six) after reaching the statutory retirement age, with the city's household registration, did not enjoy medical insurance in other parts of China; (7) Other persons who have the household registration in this city, 18 years of age or older, have not reached the statutory retirement age and do not enjoy the minimum living allowance; (8) Foreigners and Hong Kong, Macao and Taiwan personnel registered for employment in this Municipality; (nine) other personnel as prescribed by the municipal government. Upon application by the employing unit, employees who are not registered in this Municipality can participate in comprehensive medical insurance. Hospitalization medical insurance is applicable to the following personnel: mainly non-Shenzhen household registration personnel (1) and non-local household registration personnel; (two) by the municipal social insurance institutions to pay monthly pension insurance benefits of non registered retirees in this city; (3) Unemployed persons registered in this Municipality and receiving unemployment benefits; (4) Persons over the age of 18 who have registered in this city and enjoy the minimum living allowance; (five) other personnel as prescribed by the municipal government. Medical insurance for migrant workers is applicable to non-Shenzhen household registration personnel who have established labor relations with enterprises registered in Shenzhen. Children's medical insurance is applicable to all children registered in all kindergartens, primary schools, junior high schools, senior high schools, technical secondary schools, special schools, technical schools and vocational schools (excluding junior colleges) approved by the departments of education, health, civil affairs, labor and social security in Shenzhen, as well as children under the age of 18 registered in this city. The specific measures shall be formulated separately by the government.
The medical insurance system can be divided into: ① Indirect medical insurance system. Government social insurance institutions sign contracts with private medical institutions, and patients pay their own medical expenses first, and then reimburse all or part of the expenses to social insurance institutions. This system is very common in western industrialized countries. ② Direct medical insurance system. The government directly owns and manages medical institutions, and all or part of the medical expenses of workers are borne by the state. This system is quite common in socialist countries. ③ Basic medical care. Namely prevention, treatment and comprehensive health insurance services. Including improving nutrition, sanitary water supply, maternal and child health care, immunization of major infectious diseases, prevention and control of epidemic diseases and treatment of common diseases. This system is very common in developing countries. The conditions for enjoying medical insurance are determined according to the number of years of employment or the number of years of paying insurance premiums. Usually, the qualification of medical insurance is matched with sickness insurance, and those who enjoy cash subsidies from sickness insurance can enjoy medical services. China's current medical insurance system is divided into public medical system implemented by state organs and institutions and labor insurance medical system implemented by enterprises. Medical expenses are borne by the state or enterprises, and the method of individual paying part of the expenses began to be tried out in the late 1980 s. ● Commercial medical insurance Medical insurance is divided into reimbursement medical insurance and compensation medical insurance. Reimbursement medical insurance (general medical insurance) means that the medical expenses spent by patients in hospitals are reimbursed by insurance companies. Generally divided into outpatient medical insurance and inpatient medical insurance. Compensatory medical insurance (special medical insurance) means that the patient is definitely diagnosed by the hospital as suffering from a certain disease listed in the contract, and the insurance company pays the patient's treatment and nursing expenses according to the amount agreed in the contract. Generally divided into single disease insurance (such as cancer insurance) and critical illness insurance (10, 20 and 30 critical illness insurance). There are similarities and differences between the above two kinds of medical insurance. The same thing is that you can only get insurance benefits if you are sick. The main difference is that general medical insurance belongs to various types, that is, all kinds of diseases can get insurance benefits. Special medical insurance is a special category, that is, diseases or operations clearly listed in the insurance contract can get insurance compensation. Medical insurance introduced by insurance companies often combines some of the above two types of insurance. ● Social medical insurance The publicly-funded medical care and labor insurance medical care established in the early 1950s in China are collectively referred to as social medical insurance for employees. It is an important part of the national social security system and one of the important items of social insurance. Medical insurance has the basic characteristics of social insurance, such as compulsion, mutual assistance and sociality. Therefore, the medical insurance system is usually enforced by national legislation and a fund system is established. The expenses are paid jointly by the employer and the individual, and the medical insurance premium is paid by the medical insurance institution to solve the medical risks caused by the illness or injury of the employees. Medical insurance is a kind of material help given by the state or society when people are sick or injured, that is, a social security system that provides medical services or economic compensation.
According to the level of medical expenses, it can be roughly divided into three levels: outpatient service, hospitalization and major diseases. 1. Emergency insurance. Relatively speaking, outpatient service has the highest frequency and the lowest cost. Outpatient and emergency expenses are usually shared by social security, units and individuals. At present, there is only accident emergency insurance for individuals, and there is no comprehensive emergency insurance. There is outpatient insurance in group insurance. 2. Hospitalization insurance. Hospitalization is the most popular health insurance because of its high frequency and high cost. Hospitalization insurance is usually divided into two types: one is hospitalization expense insurance and the other is hospitalization subsidy insurance. Hospitalization expense insurance is used to reimburse various expenses incurred during hospitalization, including bed fees, medical treatment fees, medicine fees, etc. Generally 100% will not be reimbursed, such as 80% or 90%; Hospitalization subsidy insurance is used to make up for the loss of income during hospitalization. Pay a few yuan for each day of hospitalization, such as 50 yuan or 100 yuan. Generally, there is a three-day deductible, and in another year, the maximum compensation is often 180 days. 3. critical illness insurance. The probability of serious illness is relatively lower than that of general hospitalization, but it is more lethal to individuals and families. Middle-aged and elderly friends prefer this kind of insurance. According to the compensation method, it can be divided into reimbursement type (compensation type) and subsidy type (payment type). Reimbursement of various medical expenses and compensation according to actual losses. Such as hospitalization expense insurance and accident emergency insurance. 2. Subsidized type. Pay compensation according to the amount agreed in the insurance contract, regardless of the actual medical expenses. Such as hospitalization subsidy insurance and critical illness insurance.