Medical Insurance Policy Q&A

Author: Xu Weifan (Editor)
Publisher:
Publish Date: 2004-01-01
Features:
1. Basic Knowledge
What is insurance? What is social insurance? What is the social medical insurance system? What is basic medical insurance? What is the difference between basic medical insurance and commercial medical insurance? What is the difference between the basic medical insurance system and the public medical care system and labor insurance medical care system? What is the coverage scope of basic medical insurance? After an employer participates in basic medical insurance, when do the insured employees start enjoying basic medical benefits? Will the level of protection decline after the implementation of the basic medical insurance system? What are the rights and obligations of the insured units? What are the rights and obligations of the insured employees? What is a medical insurance administrative agency? Why was the medical insurance administrative agency established? What is the relationship between the insured and the medical insurance administrative agency? What is the relationship between the government and the medical insurance administrative agency? What is social supervision of medical insurance? Why should a pooling fund be established? What are the regulations on the supervision of the basic medical insurance fund? What is the pooling unit of basic medical insurance? Why should the basic medical insurance fund be uniformly raised, used, and managed within the pooling region? Why is the basic medical insurance generally based on prefecture-level or higher administrative regions as the pooling unit? Why can the basic medical insurance also be based on counties as the pooling unit? Why should the basic medical insurance implement territorial management? Why should the basic medical insurance funds of Beijing, Tianjin, and Shanghai, the three municipalities directly under the Central Government, be pooled within the city? How should the pooling region be determined for enterprises and employees that operate across regions and have high production mobility, such as railways, power, and long-distance transportation?
2. Enrollment and Payment
Why must all employers and employees participate in basic medical insurance? How do employees enroll in basic medical insurance? How do retired employees enroll? How do employees on internal early retirement enroll? How do employees on leave without pay enroll? Can employees who resign and take up employment in the private sector enroll?
3. Designated Hospitals and Pharmacies
4. Medical Treatment and Medication Purchase
5. Payment and Reimbursement
6. Supplementary Medical Insurance