How Do I Become a Medical Reimbursement Specialist?

Supplementary medical insurance is relative to basic medical insurance, including corporate supplementary medical insurance, commercial medical insurance, social mutual assistance, and community medical insurance. It is a powerful supplement to basic medical insurance and an important part of the multi-level medical security system. component.

Supplementary medical insurance

Supplementary medical insurance is relative to

Unlike basic medical insurance, supplementary medical insurance is not enforced through national legislation, but is voluntarily participated by employers and individuals. It is a kind of supplementary insurance that the unit or individual can increase the medical insurance item appropriately according to the needs and possible principles after the unit and employee participate in the unified basic medical insurance.

Basic medical insurance and supplementary medical insurance are not mutually contradictory, but supplement each other and are irreplaceable. The purpose is to provide medical insurance for employees.

Mutual social assistance refers to the social welfare and social assistance activities organized and participated by social groups and members on a voluntary basis with the encouragement and support of the government. Social mutual assistance includes two aspects: 1. Social mutual assistance to provide funds for the recipients. Including social (domestic) donations, overseas donations, mutual aid funds and charity performances, etc. 2. Social mutual assistance in providing services to recipients. Including neighborhood mutual aid, group mutual aid, charity, etc.

Mutual social assistance has the characteristics of voluntary and non-profit. Its funds are mainly derived from social donations and voluntary contributions by members.

Community medical insurance belongs to urban residents' medical insurance.

First, it is conducive to improving labor productivity and promoting the development of production.

Medical insurance is the inevitable result of social progress and production development. in turn,

Interim Measures of Beijing Municipal Enterprise Supplementary Medical Insurance

The "Interim Measures for the Supplementary Medical Insurance of Beijing Enterprises" specifies that enterprises participating in Beijing's basic medical insurance can establish supplementary medical insurance for their employees and retirees (foreign-invested enterprises are limited to Chinese employees), and at the same time extract the supplementary medical insurance premiums. Relevant issues such as payment are specifically stipulated. This measure aims to implement the "Beijing Basic Medical Insurance Regulations" to ensure a smooth transition of the medical insurance system.
The method is as follows:
Article 1 In order to improve the level of medical protection for employees and retirees, these measures are formulated in accordance with the "Beijing Basic Medical Insurance Regulations" (Decree No. 68 of Beijing Municipal People's Government on February 20, 2001).
Article 2 Supplementary medical insurance is a supplementary form of basic medical insurance. Enterprises participating in the Beijing Basic Medical Insurance can establish supplementary medical insurance for their employees and retirees (foreign-invested enterprises are limited to Chinese employees).
The supplementary medical insurance of enterprises is mainly used to solve the medical expenses borne by the retirees personally and the medical expenses that the employees need to pay for their own hospitalization.
Article 3 The portion of the supplementary medical insurance premium that is within 4% of the total employee wages of the previous year is included in the cost.
Article 4 Supplementary medical insurance premiums pay the following expenses incurred by employees and retirees at designated medical institutions and designated retail pharmacies:
(1) Medical expenses when the personal account is insufficient to pay;
(2) The medical expenses that should be paid by individuals in addition to the payment by the basic medical insurance pooling fund;
(3) The medical expenses that should be paid by individuals in addition to the large amount of mutual assistance funds for medical expenses.
Article 5 The payment scope of supplementary medical insurance for an enterprise may be determined by reference to the Beijing Municipal Medical Insurance Designated Medical Administration Regulations, the basic medical insurance drug catalog, the diagnosis and treatment project catalog, the scope of service facilities, and the payment standards. The specific payment ratio is determined by the enterprise.
Article 6 The balance of the supplementary medical insurance premiums of the enterprise for the current year shall be carried forward for use in the next year.
Article 7 Supplementary medical insurance is administered by the enterprise. Enterprises shall formulate specific management measures according to these measures.
The specific management measures of the enterprise supplementary medical insurance and the annual budget plan must be reviewed by the staff (representative) conference, and the joint-stock enterprises must also be reviewed by the shareholders' general meeting and the board of directors. The implementation of enterprise supplementary medical insurance is reviewed by the staff (representative) conference and announced to all staff.
Article 8 Other employers who are not entitled to state civil service medical assistance may establish supplementary medical insurance by referring to these Measures.
Article 9 The employer that establishes supplementary medical insurance shall register with the district or county medical insurance agency in the insurance area before January 30 of each year, and report the capital expenditure of the previous year.
Article 10 The Municipal Labor and Social Security Bureau is responsible for the interpretation of these measures.
Article 11 These Measures shall be implemented as of April 1, 2001.
The issuance of this measure requires a full understanding of the significance of establishing supplementary medical insurance for enterprises, and requires qualified enterprises to establish supplementary medical insurance for enterprises, while highlighting key issues to be resolved.