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GB/T 31596.4-2015Social insurance terminology—Part 4: Medical insurance (English PDF)

社会保险术语 第4部分:医疗保险

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Issued by

SAMR; SAC

Level / Type

National · Recommended

Issue date

June 2, 2015

Implementation date

January 1, 2016

Scope

GB/T 31596.4-2015 is the English-translated version of 社会保险术语 第4部分:医疗保险.

GB/T 31596.4-2015 is the Chinese standard "Social insurance terminology—Part 4: Medical insurance".

Its scope clause reads: 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. Its clauses include basic medical insurance system.

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Document preview — GB/T 31596.4-2015

National Standard of the People's Republic of China

ICS
01.040.01
Classification
A 22

Issued by: State Administration for Market Regulation; Standardization Administration of the PRC

Contents

  • 1 Scope
  • 2 1 basic medical insurance system
  • 3 health insurance for the insured person management
  • 4 Medical Insurance Management pharmaceutical services
  • 5 Medicare Payment Management
  • 6 medical insurance management services organization

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

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

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

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

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

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

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

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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This preview omits tables, figures, formulas and parts of the technical clauses. The complete document — 15 pages — is available in the English PDF.

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GB/T 31596.4-2015

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