What does the social basic medical insurance include?

Social medical insurance includes basic medical insurance and large medical assistance. Medical insurance generally implements the principle that eligible insured persons enjoy equal medical opportunities and treatment. Medical insurance usually provides services to the insured in the form of medical insurance fund paying part of medical expenses.

The basic direction of the development of social medical insurance mainly includes the following points:

(1) Seek a proper balance between equality and economic efficiency, that is, "inject some rationality into equality and some humanity into efficiency".

② Comprehensive national insurance system.

③ Low-level and multi-level medical care.

④ Diversified financing channels.

⑤ Cancel the personal medical insurance account, and leave this part of the money to the unit or individual to freely choose the investment direction, such as purchasing supplementary medical insurance from commercial insurance companies.

⑥ Multi-party checks and balances mechanism under total control. ⑦ Moderately competitive market under the active intervention of the government.

Medical characteristics:

1, universal

In principle, the coverage of medical social insurance should be all citizens, because the risk of illness is inevitable for everyone, while the risks of old-age care, unemployment, work-related injuries and childbirth are mainly workers, and not everyone will encounter unemployment, so the probability of work-related injuries is even smaller. Therefore, medical social insurance is the most widely covered and frequently used insurance in the social insurance system.

It involves a wide range and is also very complicated.

Medical social insurance is not only related to the economic development stage and productivity development level of the country, but also related to the demand and supply of medical and health services. In order to ensure the rational use and normal operation of medical insurance funds, there is still the problem of designing necessary institutional mechanisms to reasonably guide and control the behaviors of beneficiaries and providers of medical services. These are not available in other social insurance.

3. It is short-term term insurance.

Because the occurrence of diseases is random and sudden, the compensation provided by medical social insurance can only be short-term and regular, unlike other social insurances such as pension insurance and maternity insurance, which are long-term, predictable or one-off. Therefore, medical social insurance is also different from other social insurances in financial treatment.

4. Medical expenses are difficult to predict and control.

Due to the influence of many factors, the medical expenses vary greatly and are difficult to master.

5, the fund should be earmarked.

The medical insurance fund raised in a certain way will only be settled according to the relevant provisions of the treatment when the insured is sick or injured at work, and at the same time enjoy medical services. The medical treatment he enjoys has nothing to do with his salary level, and he is absolutely not allowed to use it, which truly realizes earmarking.

Medical insurance is insurance to compensate medical expenses caused by diseases. Social insurance in which employees are provided with necessary medical services or material assistance by society or enterprises due to illness, injury or childbirth. Basic medical insurance includes general medical insurance, hospitalization insurance, operation insurance, comprehensive medical insurance and special disease insurance.

General medical insurance: General medical insurance provides the insured with general medical expenses related to the treatment of diseases. It mainly includes outpatient expenses, medical expenses and inspection expenses. This kind of insurance has low premium cost and is more suitable for the general public. Because it is difficult to control the expenditure of medical expenses and examination expenses, such policies generally have deductibles and cost-sharing clauses, and the insurer pays a certain proportion of the above deductibles and the annual insurance fees. When the accumulated expenses of each disease exceed the insured amount, the insurer is no longer responsible.

Hospitalization insurance: Because hospitalization expenses are often high, hospitalization expenses are regarded as a separate insurance. The expenses of hospitalization insurance mainly include daily hospitalization expenses (bed fees), hospital equipment use fees, operation fees and medical expenses. The length of hospitalization will directly affect its cost. Therefore, the insured amount of this kind of insurance should be determined according to the average hospitalization expenses of patients. In order to control unnecessary long-term hospitalization, hospitalization insurance generally stipulates that the insurer is only responsible for a certain proportion of all expenses, not all.

Surgery insurance: This insurance covers all expenses incurred by patients who need necessary surgery.

Comprehensive medical insurance: comprehensive medical insurance is a kind of comprehensive medical expense insurance provided by the insurer for the insured, and its cost range includes all expenses of medical treatment, hospitalization and operation. The insurance premium of this kind of policy is higher. Generally speaking, the lower deductible is determined together with the appropriate assessment rate.

Special disease insurance: some special diseases often bring catastrophic expenses to patients, which ordinary families can't afford. Such as cancer and heart disease. Therefore, people usually require that the insurance coverage of such policies be relatively large to cover all kinds of expenses incurred. Provide protection for the insured, which can be a single item, such as malignant tumor, or even some cancers in malignant tumor; It can also be a number of items, and the agreed items are listed one by one, such as malignant tumor, myocardial infarction, uremia, importance, quadriplegia and so on.

To sum up, the lack of labor ability and sources of livelihood increases the economic burden of families, and the state will provide social insurance premiums as a guarantee. Nevertheless, in case of serious illness, social insurance premium is only a drop in the bucket, and families with conditions can choose commercial insurance.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 24

The state establishes and improves the new rural cooperative medical system. Measures for the administration of the new rural cooperative medical system shall be formulated by the State Council.