Characteristics of the medical insurance management system
Basic medical insurance is extensive, mutually beneficial and compulsory.
“Extensiveness” means that all employers and employees, whether they are state agencies, enterprises, private enterprises, or individual workers, are covered by basic medical insurance.
Mutual aid means that after all employers and employees have paid medical insurance premiums in accordance with regulations, once they are hospitalized or suffer from a long-term chronic disease, the medical expenses will be reimbursed by the overall fund in proportion. Therefore, all medical expenses incurred by the insured person are covered. Medical expenses are not linked to the economic benefits of the unit, and the risk of costs is shared by all insured units and personnel.
“Mandatory means that according to legal provisions, all urban employers and employees must participate in basic medical insurance, so it is different from any voluntary participation in commercial insurance.
Components of the medical insurance management system
The social medical insurance system is composed of three parts: basic medical insurance (individual accounts, overall funds), supplementary medical insurance (civil servant medical subsidies, enterprise supplementary medical insurance) and large medical expense supplementary insurance.
Basic medical insurance It is the foundation of the medical insurance system. The combination of personal accounts and overall funds can protect the basic medical needs of the insured persons. It is mainly used to pay for general outpatient, emergency and hospitalization expenses.
Supplementary Insurance for Large Medical Expenses It is a supplementary form of basic medical insurance and is a life insurance form for large medical expenses established for employees based on the commercial insurance mechanism. Practical experience shows that it is a form of supplementary insurance that insured persons must participate in. The funds are mainly used to pay for medical expenses above the maximum payment limit of the basic medical insurance pooling fund.
Supplementary insurance for large medical expenses It is paid by the employer or jointly by the employer and its employees (including retired personnel). The Provincial Social Medical Insurance Center will centrally insure the costs to commercial insurance companies and supervise the entire compensation process.
Civil Servant Medical Subsidy It is a medical subsidy system established by the state to ensure that the level of medical treatment of civil servants will not be reduced on the basis of their participation in basic medical insurance. Appropriate subsidies are provided for the portion of medical expenses above the maximum payment limit of the unified fund, as well as the portion borne by individuals of hospitalization and long-term outpatient chronic disease medical expenses. Institutions that originally enjoyed public medical care may refer to this measure.
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