Classification 1
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.
Classification 2
First, commercial medical insurance 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). Related books
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. Two. Subsidized medical insurance In short, subsidized medical insurance is medical insurance in which the insurance company pays the insurance premium to the insured by the time, by the day or by the project according to the subsidy standard stipulated in the contract. Claims have nothing to do with actual medical expenses, and invoices are not needed. No matter what disease you get and how much you spend on treatment, the compensation standard remains unchanged. If you are insured by more than one company, you can get compensation from more than one company no matter how many copies you are insured. This part of the allowance can compensate for other losses besides medical expenses incurred by hospitalization, such as income loss caused by sick leave and transportation expenses. Subsidized medical insurance "icing on the cake" Generally speaking, if you have participated in social medical insurance, it is more appropriate to choose critical illness insurance with subsidized medical insurance. Subsidized medical insurance is not directly related to social insurance. As long as you are hospitalized or operated on, the insurance company will pay. Housewife Ms. Chen, 30 years old. Insure my husband in three insurance companies 1 copy of hospitalization medical insurance of an insurance company (subsidized, 200 yuan/day, hospitalized due to illness, free of compensation for 3 days). In August this year, Mr. Chen was hospitalized for 60 days due to illness. After leaving the hospital, Mr. Chen not only received some compensation for medical expenses from social insurance institutions, but also paid Ms. Yang a subsidy of 36,000 yuan (200 yuan/day *60 days *3) for hospitalization from three insurance companies. Analysis: Ms. Yang chose medical insurance with subsidies for her husband. The biggest feature of subsidized medical insurance is that it is only related to the length of hospitalization and has nothing to do with medical expenses. It is suggested that the reimbursement of medical expenses should be considered first when purchasing medical insurance, and then the compensation for losses caused by hospitalization can be considered. Only by consolidating the basic security and supplementing it on this basis can we add icing on the cake. People with adequate social insurance can give priority to subsidizing medical insurance when choosing medical insurance. Insurance principle In insurance, there is a question whether the compensation principle is applicable to health insurance. This problem cannot be generalized. The principle of compensation means that "the compensation obtained by the insured cannot be higher than its actual loss". Subsidized medical insurance is not applicable, and the payment of insurance benefits has nothing to do with actual losses. In fact, its design principle is to consider the wage loss caused by sick leave during the hospitalization of the insured, so it is agreed in the contract that the subsidy fee will be paid according to the number of days of hospitalization. Regardless of the actual hospitalization expenses, it has nothing to do with the actual economic losses. It is a kind of "fixed value insurance". 3. Expense-based medical insurance Expense-based medical insurance pays insurance benefits 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". How to buy without medical insurance: first of all, insure the cost-based medical insurance because according to the current medical level, the average hospitalization time of the disease is about 10 days. For cost-based products, if the reasonable hospitalization medical expenses are reimbursed by 80%, most medical expenses can be reimbursed. If you insure subsidized medical insurance products, you will generally get the claim on the fourth day. If the hospitalization days are 10 days, you can pay 1500 yuan according to the daily allowance in 250 yuan. Relatively speaking, the amount of claims is small, and the cost of the insured's hospitalization 10 day should be far greater than this figure. Therefore, it is recommended to insure the expense type first, and then consider buying the subsidy type. How to buy medical insurance: the complementarity of subsidized medical insurance and fee-based medical insurance. At present, China's current social medical insurance policy is divided into two parts, one is the outpatient and emergency expenses, and the other is the hospitalization expenses. Generally speaking, about 80% of the outpatient and emergency expenses are borne by themselves. Generally, 30% of the hospitalization expenses of 1 10,000 yuan shall be borne by oneself, and 20% of the hospitalization expenses of+10,000 yuan shall be borne by oneself. In addition, social medical insurance also has strict restrictions. New drugs, imported drugs and expensive drugs are not covered by social medical insurance reimbursement. Medical expenses caused by traffic accidents shall not be reimbursed by social medical insurance. In addition, the expenses that often occur during illness, such as nutrition expenses, nursing expenses, lost time expenses, etc. , not included in the scope of reimbursement. Therefore, people with medical insurance can consider the complementarity of purchase cost and subsidy when handling hospitalization medical insurance. Choosing hospitalization medical insurance based on cost is also a useful supplement. Four. Social medical insurance The public medical care and labor insurance 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. Since the implementation of medical insurance in China for more than 40 years, it has played a positive role in safeguarding the health of employees and maintaining social stability. However, with the establishment of the socialist market economic system and the deepening of the reform of state-owned enterprises, this system has been difficult to solve the basic medical security problems of employees under the conditions of market economy.
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.