What are the Different Types of Medicare Programs?

Medical insurance generally refers to basic medical insurance, which is a social insurance system established to compensate workers for economic losses caused by disease risks. The medical insurance fund is established through the employer and individual payment, and after the medical expenses incurred by the insured person for medical treatment, the medical insurance institution will give them certain financial compensation.

Medical insurance generally refers to basic medical insurance, which is established to compensate workers for economic losses caused by the risk of disease.

Medical insurance, like other types of insurance, is contractually charged in advance to those who are threatened by the disease

1. 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,

Article 28 of the Social Insurance Law stipulates that medical expenses that meet the basic medical insurance drug catalog, diagnosis and treatment items, medical service facilities standards, and emergency and rescue medical expenses shall be paid from the basic medical insurance fund in accordance with national regulations. ^[4]

1. Outpatient and emergency medical expenses: The medical expenses that meet the scope of the basic medical insurance regulations during the year of working staff (January 1 to December 31) accumulate more than 2,000 yuan.
2. Settlement ratio: 50% will be reimbursed for the dispatched personnel over 2,000 yuan during the contract period, and 50% will be paid by the individual; the maximum amount of reimbursement for the dispatched personnel's outpatient and emergency department reimbursement within one year is 20,000 yuan.
3. The insured should properly keep the outpatient medical documents (including receipts of less than a large amount, the prescription of the prescription, etc.) in the designated hospital as proof of reimbursement of medical expenses.
4. Outpatient medical treatment for three special diseases: insured persons suffering from malignant tumor radiation therapy and chemotherapy, renal dialysis, and anti-rejection drugs after renal transplantation need to be in the outpatient clinic. The hospital issues a "disease diagnosis certificate" and fills in the "Medical Insurance Special Diseases Declaration Examination and Approval Form", which is reported to the District Medical Insurance Center for approval and filing. Out-patient medical treatment and drug collection for these three special diseases are limited to designated hospitals that have approved the visit, and cannot be purchased at designated retail pharmacies. If the medical expenses incurred are within the scope of the outpatient special disease regulations, they shall be settled with reference to hospitalization.
5. Hospitalization.
Medical insurance has to be paid for 20 years to enjoy medical insurance reimbursement after retirement.

The range of reimbursement ratios for medical insurance varies from place to place. Please refer to local policies for details.

The State Council issued in December 1998

In November 2019, Anhui promulgated the "Anhui Province Basic Medical Insurance Guidance Plan for Grouping by Disease Group (Trial)" to fully implement the basic medical insurance payment method based on grouping by disease group. The first batch of 422 disease types and payment methods were announced. From January 1, 2020, there will be a uniform payment standard for urban and rural residents' medical insurance participants when they seek medical treatment at 18 provincial hospitals. ^[1]

If the insurance consumer purchases inpatient medical expense insurance from two different insurance companies, then within the scope of the sum insured, the insurance company will calculate the claim based on the actual expenditure of the insured during the hospitalization period and the sum insured. Most insurance companies will set a certain amount of uncompensated. Above the uncompensated amount, the insurance company pays according to the agreed proportion. After the first insurance company pays, the second insurance company pays the reasonable expenses based on the remaining part. Make a payment. In short, the total compensation paid by the insurance company will not exceed the insurance consumer's medical expenses.

Myth 1: wool comes out of sheep

Some policyholders believe that the annual amount of medical insurance claims is less than the premiums, which is very uneconomical. Therefore, the sickness and hospitalization have to rely on the usual savings. In fact, the key role of medical insurance lies in the prevention and transfer of disease risks. Once a sudden major disease occurs, the individual's ability to resist is limited. Therefore, it is still necessary to transfer the risks borne by commercial medical insurance.

Myth 2: Medical insurance only works if you have a serious illness

In fact, medical insurance does not work only if the insured is seriously ill. When a disease occurs, consumers not only face the burden of medical expenses, but also bear expenses in addition to medical expenses. At this time, reimbursement-type medical insurance specifically for medical expenses can be a worry for policyholders. As for subsidized medical insurance, medical expenses can be subsidized regardless of whether the insured is hospitalized or not.

Misunderstanding 3: Buying less claims when you are young, and expensive premiums when you are old

In fact, consumers can plan ahead for life when they are young, plan for lifelong medical insurance, pay premiums when they are young, and have no worries when they are old. ^[8]