The social insurance - health insurance

What is health insurance?

Health insurance is compensation for diseases caused by a medical insurance. Medical insurance and other types of insurance, is to contract the disease by way of advance to the risk of medical insurance premiums collected to establish the medical insurance fund; when the insured patients to medical institutions and medical and health care costs occur after medical Insurance agencies to give some financial compensation.



As a result, health insurance has two main functions of insurance: the transfer of risk transfer and compensation. That is, the individual's body from diseases caused by the risk of economic losses to all sharing the same risk by the threat of a member of together with the medical insurance fund to compensate by the disease brought about by the economic losses.

What is the basic health care?

Medical staff security system reform goal is to gradually make all urban workers are fat can be a basic medical insurance. "Basic health care," defined as: the vast majority of insured workers to adapt to the necessary medical needs, medical services organizations to adopt appropriate technology available, the medical insurance fund have the ability to pay for medical services. "Basic health care" is a relative areas, with short, regional and rolling, the cost of medical insurance must be consistent with the level of financing for the level of equilibrium. Define the basic medical treatment from the basic technology, essential drugs, infrastructure, basic pay for the four areas.


How individuals pay the basic medical insurance?

According to the national health insurance policy, according to my personal income to pay 2% of the basic medical insurance, and in accordance with the economic development of an appropriate increase in the proportion of individual contributions. Personal medical insurance premiums to be paid by the unit from paying my salary, but the urban self-employed insurance premiums paid by himself.

What is serious is the co-ordination?

Manpower is a serious medical insurance in China as a model, because of conditions at present can only do municipal co-ordination of various parts of the system, there are different approaches, such as serious illness of the Beijing co-ordination of Shanghai Co-ordination of in-patient medical insurance; but Is to follow the development of "small diversion disease, serious co-ordination", that is to set a starting line to pay from several hundred dollars to several thousand dollars, solely on the basis of the local economy and the affordability level of medical treatment, pay starting line The following medical expenses from the burden of individual workers, more than from above to pay part of the social security institutions by the pro-rata payment.

The basic medical insurance cost of health care facilities, including the cost of what?

The basic medical insurance cost of health care facilities, including the main hospital bed charges and the door (urgent) patient observation bed charges. According to the provinces (cities, districts) price sector, in-patient beds and doors fee (urgent) patient observation bed costs include the cost of three categories: First, the ward is the basic daily necessities, such as the allocation of beds, mattresses, bedside cabinets, chairs , Mosquito nets, quilt, sheet, thermos flask, washbasin (barrels), and other costs, and the other is the transport hospital supplies such as stretchers, carts, and other costs, third, water, electricity and so on. These costs, basic medical insurance fund does not pay for a separate, designated medical institutions must not revert to the insured individual charges.

The basic medical insurance does not pay what life services and the cost of services?

The basic medical insurance fund to cover non-life services and facilities costs, including the five main categories: the first is (to) patient transport, emergency fare; Second, the air-conditioning costs, television fees, infant incubator, food Insulation Box fees, electric fees, charges and refrigerators damage public property damages; Third, the accompanying fees, security fees work, wash the rationale fees, out-patient fees brewing; Fourth meals; Fifth, cultural and recreational activities and other special charges to be living services. The reason why the above-mentioned provision of life services and not pay the cost of services, mainly to consider some of these projects is not a diagnosis, treatment and care of the necessary process, such as television, telephone, refrigerator, and so on, although some required, belonging to the individual, but Units or responsibility, such as medical transportation, emergency fares, food costs.

Due to large differences in living conditions all over, and some health care facilities in some places may not be necessary, but in other areas is necessary, such as heating in cold regions to the north is necessary. This type of medical service facilities projects included in the basic medical insurance fund to cover the scope of the provinces (autonomous regions and municipalities) of Labor and Social Security Administration can be combined with local economic development level of the basic medical insurance fund and the affordability of its own provisions.



The principle of the basic medical insurance payment

The basic medical insurance in accordance with the principles on which to pay the cost of drugs?

The basic medical insurance insured the use of Chinese medicine and Western medicine occurred in the cost of drugs beyond the scope of the list of the basic medical insurance fund does not pay, drugs belonging to the directory within the scope of the principle of pay as follows, first, use the "A list" of drugs by Costs incurred by the basic medical insurance payment given to the required standards; Second, the use of "B list" of the drug costs incurred, by a certain percentage of workers pays, then the basic medical insurance payment given to the required standards.



Pieces of Chinese medicine to use what happened the cost of drugs belonging to the directory, basic medical insurance fund does not pay, the directory is not drugs, according to the basic medical insurance payment given to the required standards.

For example, a regional co-ordination of Qifubiaozhun 800 yuan, the maximum limit for payment of 25,000 yuan to co-ordinate the fund within the framework of the burden on the ratio of 10%, B drugs first person pays 20%. Now assume that a trade union in the city occurred in a hospital medical costs 30,000 yuan, of which drug costs 10,000 yuan, 6,000 yuan for the cost of drugs used Group A, Group B 3,000 for the use of the drug costs 1,000 yuan for non-"basic Medical insurance drug list "of the cost of drugs. The workers pay for medical expenses as follows:

1, first of all employees of the individual pays the cost of drugs B:

3000 × 20% = 600 million;

Non-pays "the basic medical insurance drug list," the cost of drugs: 1,000

2, 6000 Group A drugs, the cost of drugs in Group B after the individual pays the remainder of 2200 yuan and other medical expenses

Together with a total of 28,400 yuan, the co-ordination into the scope of the Fund, in accordance with the provisions of the basic medical insurance payment from pay

Standards at a cost of more than 27,600 yuan to co-ordinate the fund to pay rule:

- Starting line to pay by the individual pays or personal account to pay: 800

- Starting to pay above the co-ordination by the Fund: 27600 × 90% = 24840 $

Individual pays: 27600 × 10% = 2760 $.

Based on the above calculation, the union took place 30,000 yuan in-patient medical expenses, the individual pays and personal accounts

The total amount paid as follows: 1000 +600 +800 +2760 = 5160 yuan to co-ordinate the fund to pay for 24,840 yuan.