Work-related injury insurance refers to the reimbursement of medical expenses for people who have been accidentally injured due to work, or for recurrent parts of old injuries or complications. The conditions for enjoying treatment are different. The scope and proportion of medical insurance reimbursement can not reach the scope and proportion stipulated by industrial injury insurance. In the traditional sense, medical insurance refers to raising medical insurance funds among certain insured people in a certain area through mandatory policies and regulations or voluntary contracts handled by specific organizations or institutions.
Due to the harsh working environment, epidemics and industrial accidents, workers need corresponding medical care. But their wages are low, and it is difficult for individuals to pay medical expenses. Therefore, workers in many places spontaneously organized themselves to raise some money for expenses when they were sick. But this form is not very stable, and the scope is small, and the ability to resist risks is very low.
Medical insurance has the basic characteristics of social insurance, such as compulsion, mutual assistance and sociality. The medical insurance system is usually legislated and enforced by the state, 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.
Expense-based medical insurance is to pay insurance money according to the actual medical expenses incurred by customers and the insurance amount agreed in the policy. The purpose is to compensate customers for medical expenses. When making claims, customers need to issue invoices for outpatient or hospitalization, and the scope of claims is basically the same as that of "social security".
legal ground
People's Republic of China (PRC) social insurance law
Article 12 The employing unit shall pay the basic old-age insurance premium according to the proportion of the total wages of employees stipulated by the state and record it in the basic old-age insurance pooling fund.
Employees shall pay the basic old-age insurance premium in accordance with the proportion of wages stipulated by the state and record it in their personal accounts.
Individual industrial and commercial households without employees, part-time employees who have not participated in the basic old-age insurance in the employing unit and other flexible employees who have participated in the basic old-age insurance shall pay the basic old-age insurance premiums in accordance with state regulations and record them in the basic old-age insurance pooling fund and individual accounts respectively.