Health insurance’s principles?
Basic principles are: Risks are shared between those who purchase health insurance on the regular scale that the majorities compensates for the minorities; the b assist the weak; the rich assist the poor.
The health insurance cost of examination & treatment is jointly charged by the health insurance participators and health insurance fund.
Health insurance cost is defined in accordance with the percentage of the salary, redundant salary, payment, allowance, scholar or the minimum salary.
The beneficiary health insurance level is regulated in accordance with the disease levels and the benefit of the health insurance participator.
The health insurance fund is monitored in centralized, unified, overt, explicit way, guaranteed the balance between expense and receipts and under protection of the State.
Do those who have health insurance card and take examination & treatment at a private health facility have right to get the payment in reference to the Health Insurance policy?
Patients who have benefits from the Health Insurance policy if they are examined and treated in accordance with the technical major line at the private health facility which have examination & treatment contract with the Health Insurance agency.
In case that facility does not have a Contract with the Health Insurance agency, those who posses a health insurance card will be directly paid a portion of the expenses in accordance with the optional examination & treatment policy at the Health Insurance agency.
Rights of Health Insurance examination & treatment facilities’?
Health Insurance examination & treatment facilities have the following rights:
- Require Health Insurance organization to provide full, detailed and relevant information of the objectives, examination & treatment expenditure source for the patient who has Health Insurance card at the examination & treatment facilities.
- Have the right to get allowance and examination & treatment expenditure from the Health Insurance organization in compliance with the signed examination & treatment contract.
-Use the expenditure source as stipulated by Health Insurance organization
- Propose with the authorities to handle organizations and individuals who commit the Law on Health Insurance.
Responsibilities of Health Insurance examination & treatment facilities’?
Health Insurance examination & treatment facilities have the following responsibilities:
- Hold the examination & treatment periods of good quality for Health Insurance participators.
- Provide case history, relevant examination & treatment documents and liquidate examination & treatment expenditure for those who have Health Insurance in accordance with the requirement of Health Insurance organization and the authorities.
- Guarantee the adequacy of medicine, vaccine, medical bio-products, medical materials and health services in accordance with the checklist stipulated by the Ministry of Health
- Guarantee the necessary conditions for the Health Insurance agency to implement the acceptance work; collaborate with Health Insurance Organization in the work of propagandizing and clarifying the Health Insurance policy applied to those who possess a Health Insurance card
- Check Health Insurance card, detect and inform the Health Insurance organization about the Health Insurance card infringement and abuse cases
- Manage and use the expenditure from the Health Insurance fund in accordance with the Law’s regulations.
- Organize the work of statistics and report on the Health Insurance as stipulated.
Benefit boundary of Health Insurance participators?
Those who have Health Insurance card are entitled to be paid by the Health Insurance fund if:
- External examination, date of internal treatment.
- Use the medical services, blood, blood products, medicines, chemicals and materials, medical devices;
- Examination, diagnosis, treatment and function recovery.
- Preliminary examination, early diagnosis of diseases;
- Patient transporting service applied to the poor, those of social policy list living in the area of poor economic and social conditions.
Why there must be initial examination & treatment registering facility for Health Insurance participators?
Stipulation about initial examination & treatment registering facility for the insurance participators is to manage health insurance patients better. People with insurance card are managed about health, found out their illness soon and conveniently at health center near the residence address or working place.
That there is initial registration place doesn’t limit interests of the patient because when the illness situation is beyond profession of initial health center, the patient can be moved to higher treatment line.
The initial examination center is a place receiving expenditures for health insurance fund equivalent to the initial registration cards, this expenditure is basis for making payment and final account of examination and treatment cost periodically between health insurance company and examination and treatment center.
How about co-paying the hospital expenses?
This is the fact that the patients who possess a Health Insurance card and Health Insurance fund co-pay the examination & treatment agency which examined and treated for them. In this case, the Health Insurance fund will pay the majority and the patient will pay the minority, depending on the objective group who participate in the Health Insurance program and stipulations by each health services.
What is the stipulated payment of the patient who posses a Health Insurance card?
The Health Insurance participator is paid by the Health Insurance fund the current expense in accordance with the payment stipulated by the State if the examination & treatment expenses are at the right technical line or there is emergency case in health facility who signed the examination & treatment contract.
In case of usage of expensive technical medical equipments, the Health Insurance Fund will pay a portion of the expenses, but not exceeding the expense stipulated by the Ministry of Finance.
In case of people with insurance cards take examination or treatment not at the initial registration place, take examination or treatment as requested, take examination or treatment abroad, the health insurance company will pay directly to the patients a part of the cost.
According to the compulsory regulation on Health Insurance Program, the expenditure for the technical service must be co-paid and the Health Insurance fund will pay a part, the remainder must be charged by the patients. Why is there this stipulation and is it suitable with the principle of the Health Insurance program to share the risk?
The co-payment of the examination & treatment expenditure is common in the world. The goal is to raise the awareness of the patients who have the Health Insurance Card and the examination & treatment facilities, prevent the over-abuse of the treatment regulations, at the same time share the Health Insurance fund of the Community, guarantee it safety. Co-payment in some cases generates big expenditure suitable with the principle of risk share.
In emergency case, to have the benefits of the Health Insurance what procedures do patients have to do?
In emergency cases, the patient is examined and treated at the expenditure generated from the Health Insurance Program at any examination & treatment facilities of the State who signed the contract. However, the patients are expected to show the valid Health Insurance card together with personal identification within 48 hours since the time arriving the hospital.
In emergency cases at the facilities which do not have the contract, the patient have to pay the hospital expenditures and bring the bill, documentation to the health insurance agency to be reduced a portion of the expenditures