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GB/T 31596.4-2015: Social insurance terminology -- Part 4: Medical insurance
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Social insurance terminology -- Part 4: Medical insurance
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GB/T 31596.4-2015
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Basic data | Standard ID | GB/T 31596.4-2015 (GB/T31596.4-2015) | | Description (Translated English) | Social insurance terminology -- Part 4: Medical insurance | | Sector / Industry | National Standard (Recommended) | | Classification of Chinese Standard | A22 | | Classification of International Standard | 01.040.01 | | Word Count Estimation | 14,153 | | Date of Issue | 2015-06-02 | | Date of Implementation | 2016-01-01 | | Regulation (derived from) | National Standard Announcement 2015 No.19 | | Issuing agency(ies) | General Administration of Quality Supervision, Inspection and Quarantine of the People's Republic of China, Standardization Administration of the People's Republic of China | | Summary | This Standard specifies the basic medical insurance system, medical insurance for the insured person management, terminology and definitions of medical insurance management services to the pharmaceutical, medical insurance payment management, medical insurance and other aspects of management service organization. This Standard applies to the basic medical insurance sector management, service, academic research and international exchanges. | GB/T 31596.4-2015: Social insurance terminology -- Part 4: Medical insurance---This is a DRAFT version for illustration, not a final translation. Full copy of true-PDF in English version (including equations, symbols, images, flow-chart, tables, and figures etc.) will be manually/carefully translated upon your order.
Social insurance terminology Part 4. Medical insurance
ICS 01.040.01
A22
National Standards of People's Republic of China
Social Insurance Terminology - Part 4. Medical Insurance
Issued on. 2015-06-02
2016-01-01 implementation
Administration of Quality Supervision, Inspection and Quarantine of People's Republic of China
Standardization Administration of China released
Table of Contents
Preface Ⅰ
1 Scope 1
2 1 basic medical insurance system
3 health insurance for the insured person management 2
4 Medical Insurance Management pharmaceutical services 3
5 Medicare Payment Management 4
6 medical insurance management services organization 6
Index 7
Foreword
GB/T 31596 "Social Insurance term" is divided into six sections.
--- Part 1. General;
--- Part 2. endowment insurance;
--- Part 3. unemployment insurance;
--- Part 4. health insurance;
--- Part 5. injury insurance;
--- Part 6. maternity insurance.
This section GB/T Part of 431,596.
This section drafted in accordance with GB/T 1.1-2009 given rules.
This part is proposed by the Ministry of Human Resources and Social Security, People's Republic of China.
This part of the National Social Insurance Standardization Technical Committee (SAC/TC474) centralized.
This section drafted by. Human Resources and Social Security Social Insurance Administration Center, Ministry of Human Resources and Social Security Department of Medical Insurance,
China Medical Insurance Research, Renmin University of China.
The main drafters of this section. Peter Woo, Cao Xia, Xiongxian Jun, Qiu rain Pro Jing Lake, Wang Guodong, Fan Weidong, Huanghua Bo, Sun Liping, Wangfang Lin,
Lishu Chun, Duan Zheng-Ming, Wang Lili, Zhang Jie, Ma, Li Chao.
Social Insurance Terminology - Part 4. Medical Insurance
1 Scope
GB/T 31596 in this section defines the basic medical insurance system, medical insurance for the insured person management, medical insurance for pharmaceutical services
Management, management of medical insurance payments, medical insurance management services organization and other aspects of the terms and definitions.
This section applies to the field of basic medical insurance management, service, academic research and international exchanges.
2 basic medical insurance system
2.1
Basic medical insurance basicmedicalinsurance
Implementation of national legislation, the fund is formed by the insured, employers and government, multi-party financing, the insured person due to illness and medical treatment clinics
Provide financial backing to guarantee their access to basic health care and services of a social insurance system.
Note. The basic medical insurance system, including basic medical insurance system, the new rural cooperative medical system, basic medical insurance system for urban residents.
[GB/T 31596.1-2015, the definition 2.3]
2.2
Basic medical insurance basicmedicalinsuranceschemeforemployees
Implementation of national legislation, for all employers and employees, as well as flexible employment, by both employers and employees serving together
Payment and flexible employment of individual contributions will be mainly financing the social security system to protect the basic medical needs of the insured person.
2.3
Basic medical insurance for urban residents basicmedicalinsuranceschemeforurbanresidents
Implementation of national legislation, for urban residents do not belong to the coverage of basic medical insurance system for workers to individual contributions and government subsidies
The combination of fund-raising in order to protect the social insurance system the insured person's basic medical needs.
2.4
New rural cooperative medical newruralcooperativemedicalcaresystem
NCMS
Implementation of national legislation, for rural residents, individual, collective and multi-government funding fund formed to protect the insured person basic medical needs
Seeking social insurance system.
2.5
Urban and rural residents basic medical insurance basicmedicalinsuranceschemeforurbanandruralresidents
From integration of the basic medical insurance system for urban residents and the new rural cooperative medical system, unified for basic health workers do not belong to
Spa Insurance (2.2) covering a range of social insurance system of urban and rural residents.
2.6
Basic medical insurance fund basicmedicalinsurancefund
By law, the medical insurance for employers and individuals to pay a predetermined amount of health insurance premiums, coupled with government subsidies
And interest income from the collection, provide basic medical security for the insured person special funds.
2.7
Basic medical insurance pool fund socialpoolingfundofbasicmedicalinsurance
Basic medical insurance fund (2.6), the collection by the funds remaining after deduction of personal account funds and interest income from the fund,
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