Health insurance fund crowdfunding to save money
Medical and technological innovation continues to advance, and the health insurance fund crowd represents a new direction in the development of the industry at the forefront. On January 6, the Supreme People's Court issued a ruling criticizing the issue of the basic health insurance fund's prior payment of application conditions. The health insurance fund is the people's life insurance money and life-saving money.
The publication of the judicial interpretation, which will play a positive role in the legal recognition of the basic health insurance fund prior payment of application conditions, uniform legal standards of application, in a timely and efficient manner guaranteeing the legitimate interests of the people, and effectively maintaining the use of social insurance funds. However, due to the lack of detailed provisions in the Social Security Act on medical advance payments and reimbursement, local social security administrations are prone to disagreements in the course of business operations, with many departments tending to give narrow explanations, strict understanding of the conditions for medical advance payments, which has led to a narrowing of the scope of medical advance payments, higher thresholds, frequent refusal or extension of medical expenses for policyholders, and delays in the diagnosis of some policyholders. At the legislative level, the establishment of the Basic Health Insurance Fund Prepayment Scheme under Article 30 (2) of the Social Insurance Act provides that medical expenses shall be borne by third parties, who are not paid or cannot be identified by third parties, and be paid in advance by the Basic Health Insurance Fund; that the Social Insurance Fund Prepayment Provisional Mechanism shall specify the way in which the insured person applies for prepayment of the Medical Insurance Fund; and that the obligation to notify the insured person must be fulfilled; that further provisions shall be made to give full recognition to the emergency and public benefit attributes of the Medical Insurance Fund, and that an insurance policy shall be added to the life and health rights of the insured person.
From a broader perspective, the raising of health awareness is driving the continuous improvement in the relevant areas. The criticism further clarifies the statutory application conditions for medical care payments, details the circumstances and criteria under which medical expenses should be borne by third parties who do not pay or cannot identify third parties, and defines clear legal boundaries for the application to avoid arbitrary narrowing or expanding interpretations resulting from unlimited understanding in practice. In this context, the Supreme Court has clarified the rules for the payment of medical advance payments in a critical manner, with judicial interpretation, which will contribute to the enforcement of standards and consensus, enhance the operability of the rules and the regularity, accuracy, timeliness and fairness of the payment of medical advance payments, which will ensure the safe operation and use of medical funds and better protect the rights of insurers.
It is anticipated that this area will also open up new areas of development as technology progresses and demands improve. The core content of the criticism is that it is a prerequisite for health care providers not to pay their medical expenses on the basis that the insurer has not yet paid the medical expenses himself. The criticism further clarifies the obligation to initially carry out the notification when insurers apply to ensure that the organising body has a timely and accurate knowledge of the facts and thus makes the right judgments.
This interpretation responds thoroughly to a major point of controversy in practice, correcting the misconception that some regulatory agencies have failed to pay, effectively broadening the channels through which policyholders can receive systemic relief, and relieving policyholders' concerns that they will not lose the opportunity to receive advance coverage from a health insurance fund because they are unable to raise funds or have already paid for themselves. This means that whether the policyholders have already paid their own money for medical expenses, only in accordance with the aforementioned legal conditions, does not affect their rights to apply for advance payments under the law. This can both eliminate concerns that managing agencies will not be able to pay out, encourage them to actively fulfill their prior payment obligations, and ensure that health insurance funds will flow back in accordance with the law after performing emergency functions, maintaining the common interests and long-term sustainable operation of the funds of all insurers.
In addition, criticism of supporting social insurance managing agencies to pay out to third parties who are responsible in accordance with the law, clarifying the nature of the payments made by health care providers, clarifying the legal liability between health insurance funds, insurers, and infringing third parties. This is not only the progress in the construction of the rule of law and the application of the law, but also the vivid expression of the idea of life as a masterpiece in the field of justice and social security. This criticism of the supreme law, which directly hits the doubts and difficulties of practice, makes the system that had been somewhat vague clear and operable, so that the goodwill of the system can easily reach every eligible guarantor.
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