The difference between social medical insurance and commercial medical insurance

Generally speaking, a complete medical security system consists of social medical security system (medical insurance), commercial supplementary security (commercial security) and social mutual assistance security (security provided by social organizations such as trade unions). Generally speaking, the complete medical security system of social medical insurance and commercial medical insurance consists of social medical security system (medical insurance), commercial supplementary security (commercial insurance) and social mutual assistance security (security provided by social organizations such as trade unions).

The difference between social medical insurance and commercial medical insurance is mainly reflected in the following aspects:

First, their basic attributes are different. Compulsory social medical insurance is a public welfare undertaking, which is mandatory, and all kinds of employers must participate in the insurance according to law. Commercial medical insurance is commercial in nature, for profit, not mandatory, and mainly relies on the commercial reputation of insurance companies to win customers.

Second, their insurance coverage is different. The former covers a wide range of insurance, covering not only "serious illness" but also "minor illness", which not only compensates the insured for hospitalization expenses, but also compensates his outpatient expenses. The insurance amount of the latter is very small, and generally only a certain amount of compensation is given to the hospitalization expenses of several or a certain disease within its insurance scope.

Three, the two insurance premiums are raised in different ways. The former is shared by the state, units and individuals, and individuals pay in the form of insurance premiums according to a certain proportion of wages, with less burden. The cost of the latter is entirely borne by the insured, and the state and the unit will not share it (except that the employer voluntarily shares it for the workers).

Fourth, their management systems are different. The former is centrally led by the government and specifically managed by local medical insurance institutions. The latter is led by financial institutions and specifically undertaken by commercial insurance companies. As a relatively independent economic entity, insurance companies implement an accounting system of self-management and self-financing.

Five, the insured to participate in insurance conditions are different. The former has no special requirements, and both healthy people and sick people can participate in the insurance (see the relevant documents of the medical insurance system for details). The insurance conditions of the latter are subject to the provisions of the insurance company. Only people with insurance conditions can be accepted by insurance companies.

Six, the two insurance systems give the insured different insurance benefits. The former generally pays according to a certain proportion of medical expenses, the amount is not fixed, it is not entirely based on the insurance premium paid by individuals, and it has the nature of social relief; The latter is generally compensated according to a certain amount, the compensation amount is fixed or within a certain range, and the overspending part is borne by the individual. This kind of insurance is operated by the insurance company according to the principle of large insured amount and has the nature of commercial relief.

In practice, it is impossible for social medical insurance to compensate all the hospitalization expenses of the insured. Commercial medical insurance can be used as a useful supplement to social medical insurance to make up for the losses of the insured. According to the compensation principle of medical insurance, the settlement of medical expenses is based on the actual medical expenses, and the remaining medical expenses after social medical insurance compensation will be settled by commercial insurance companies according to the insurance clauses.