The medical insurance management system is as follows: 1. Medical institutions should carefully check the "Medical Guarantee" and IC cards of insured persons, and do a good job of registration and payment; 2. Medical insurance benefits cannot be enjoyed repeatedly.
Insured persons should present their medical insurance certificates to seek medical treatment and purchase medicines, and actively present them for inspection.
Insured persons have the right to require designated medical institutions to truthfully issue expense receipts and relevant information.
Insured persons shall enjoy medical security benefits in accordance with regulations and shall not enjoy them repeatedly.
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 employer and individual contributions. 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 has gathered the economic power of units and social members, coupled with government funding, so that sick members of society can obtain necessary material help from the society, reduce the burden of medical expenses, and prevent the social impact of the disease.
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 to establish 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 shared among all members who are 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.
Legal Basis Article 29 of the "Social Insurance Law of the People's Republic of China" The part of the medical expenses of the insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance agency and the medical institution and pharmaceutical business unit.
The social insurance administrative department and the health administrative department should establish a settlement system for medical expenses in other places to facilitate insured persons to enjoy basic medical insurance benefits.