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 the necessary material help from society, reduce the burden of medical expenses, and prevent sick social members from becoming poor due to illness.
Medical insurance, like other types of insurance, collects medical insurance premiums from people threatened by diseases in advance in the form of contracts and establishes medical insurance funds. When the insured goes to a medical institution for medical treatment, the medical insurance institution will give him some economic compensation. Therefore, medical insurance also has two major functions of insurance, risk transfer and compensation transfer. That is, the economic losses caused by individual disease risks are distributed to all members threatened by the same risks, and the economic losses caused by diseases are compensated by centralized medical insurance funds.
Commercial medical insurance can be divided into reimbursement medical insurance and compensation medical insurance:
1. Reimbursement medical insurance means that the medical expenses spent by patients in the hospital are reimbursed by insurance companies, which are generally divided into outpatient medical insurance and inpatient medical insurance;
2. Compensatory medical insurance refers to the fact that the patient is clearly diagnosed by the hospital with 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 and critical illness insurance.
legal ground
People's Republic of China (PRC) social insurance law
Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, medical institutions and pharmaceutical business units.
The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.