Outpatient large-amount payments are outpatient expenses paid by the medical insurance fund. The cumulative medical insurance outpatient large-amount payment within a year is capped at 20,000 yuan. If the limit is exceeded, the medical insurance fund will not reimburse, and individuals need to pay for themselves. In addition, in addition to outpatient large-amount payments, the medical insurance fund payment also includes retirement supplementary insurance payments, etc. This is a preferential policy that the national social security normally provides to insured persons. For specific reimbursement details, you can consult the local social security department.
The base and proportion of mutual aid funds for large medical expenses. Mutual aid funds for large medical expenses are paid jointly by the employer and the individual. The employer pays 1% of the total salary base of all employees, and individual employees and retirees pay 3 yuan per month
Medical insurance generally refers to basic medical insurance, which is to compensate workers for the risks of disease A social insurance system established for economic losses. A medical insurance fund is established through contributions from employers and individuals. After insured persons incur medical expenses for medical treatment, the medical insurance agency will provide them with certain financial compensation.
The establishment and implementation of the basic medical insurance system has gathered the economic strength of units and social members, coupled with government funding, so that sick members of society can obtain necessary material help from the society and reduce medical expenses. burden to prevent sick members of society from becoming "poor due to illness".
Medical insurance originated in Western Europe and can be traced back to the Middle Ages. With the success of the bourgeois revolution, family workshops were replaced by large industries, and a modern industrial team emerged. Due to the harsh working environment and the occurrence of epidemic diseases and work-related injuries, workers require corresponding medical care. However, their wages are low and it is difficult for individuals to pay for medical expenses.
As a result, workers in many places organized spontaneously to raise part of the funds for expenses when they were sick. However, this form is not very stable, is small-scale, and has low ability to withstand risks. At the end of the 18th century and the beginning of the 19th century, private insurance developed in Western Europe and became an important way for the country to raise medical funds.
Medical insurance has the basic characteristics of social insurance such as compulsory, mutual aid and social nature. Therefore, the medical insurance system is usually legislated and enforced by the state, and a fund system is established. The fees are paid jointly by the employer and the individual, and the medical insurance premiums are paid by the medical insurance agency to solve the problems caused by workers' illness or injury. medical risks.
Commercial medical insurance
can be divided into reimbursement medical insurance and compensation medical insurance.
Reimbursement medical insurance means that the medical expenses incurred by patients in the hospital are reimbursed by the insurance company. It is generally divided into outpatient medical insurance and inpatient medical insurance.
Indemnity medical insurance means that the patient is clearly diagnosed by the hospital as suffering from a disease specified in the contract, and the insurance company pays the patient for treatment and care based on the amount agreed in the contract. Generally, it is divided into individual disease insurance and critical illness insurance.
The above two types of medical insurance have similarities but differences. The same point is that only when you are sick can you get insurance benefits