The difference between critical illness planning and medical insurance

Legal analysis: the relationship and main differences between the two are as follows: medical insurance solves the basic medical expenses, and the main body of reimbursement is the outpatient medical expenses and hospitalization expenses of non-major diseases. The hospitalization expenses of serious illness and major illness are solved as a whole.

Different concepts

Medical insurance refers to the basic medical insurance premium paid in full and on time by employers and employees according to the principle of compulsory social insurance through national legislation. 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. However, co-ordination of serious illness is a model of medical insurance in China. Due to the limited conditions, it can only be co-ordinated at the municipal level at present. The practice of this system varies from place to place, and they all follow the principle of "minor illness diversion and serious illness overall planning".

Different coverage areas

Co-ordination of serious diseases is only aimed at natural diseases, with narrow coverage and more liability for compensation exemption. Such as work-related injuries, occupational diseases and accidents, are not covered. The coverage of medical insurance includes the objects covered by medical insurance, the proportion of medical expenses and health services. Medical insurance coverage in a narrow sense includes medical services covered by medical insurance, as well as the quantity, forms and restrictions provided by these items.

Pay different fees

Self-funded projects for serious illness include: self-funded drug expenses stipulated by labor insurance and medical expenses; Registration fee, visiting fee, meal fee, special nutrition fee, hospitalization protection fee, intensive care fee, baby fee, air conditioning fee, first aid fee, consultation fee, etc. ; Medical consultation fee, medical insurance fee, high quality and good price fee, etc. Medical insurance reimbursement costs vary according to different insurance products.

For medical insurance, the insured may entrust others to handle it. The customer must carry the valid certificates of himself and the insured when handling. The handling of serious illness as a whole is that the insured workers still meet the conditions of disease as a whole after being treated by the hospitalization system. The doctors at or above the deputy director of the designated hospital shall apply for disease as a whole and fill in the application form for disease as a whole. Insured patients hold

Submit an application form for overall disease identification, discharge records (with the seal of the hospital), relevant inspection and laboratory reports and two one-inch color photos to the employer, which shall be handled by the employer in the medical insurance agency.

Legal basis: People's Republic of China (PRC) Social Insurance Law.

Article 12 The employing unit shall pay the basic old-age insurance premium according to the proportion of the total wages of employees stipulated by the state and record it in the basic old-age insurance pooling fund.

Employees shall pay the basic old-age insurance premium in accordance with the proportion of wages stipulated by the state and record it in their personal accounts.

Individual industrial and commercial households without employees, part-time employees who have not participated in the basic old-age insurance in the employing unit and other flexible employees who have participated in the basic old-age insurance shall pay the basic old-age insurance premiums in accordance with state regulations and record them in the basic old-age insurance pooling fund and individual accounts respectively.

Article 58 An employing unit shall, within 30 days from the date of employment, apply to the social insurance agency for social insurance registration for its employees. If the social insurance has not been registered, the social insurance agency shall verify the social insurance premium it should pay.

Employees-free individual industrial and commercial households who voluntarily participate in social insurance, part-time employees who do not participate in social insurance in the employing unit and other flexible employees shall apply to the social insurance agency for social insurance registration.

The state establishes a national unified personal social security number. Personal social security number is a citizen's identity number.