A Study On The Claim For The Basic Medical Insurance Benefits Of Employees And Its Protection Rules

The basic medical insurance for employees is a compelling social insurance system,but it does not protect the employees' insurance benefits practically.In fact,the medical insurance benefits system that is related to employees' core interest has been completely replaced by the funding-payment system which is made by administrative department.To be specific,the content of the medical insurance benefits including the principle,the scope and the standard which should have been regulated by law is completely decided by the government and its department through normative acts.This leads to employees'right turns out to be "kindness" of the government actually,and the funding-payment capability dominates that how much benefits can be given to employees.There are two main reasons why the two systems are confused:for one thing,there is no right concept of the claim for the basic medical insurance benefits in all laws,administrative regulations and other normative acts.As a result,employees have not built up awareness of the right,and the government controls the quality and quantity of the benefits.For another,the lack of protection rules of the claim,such as the rules of creating the right,the principle of realizing the right and the system of judicial relief,makes it difficult for employees to get the fair benefits.It is necessary to establish the claim for insurance benefits according to the constitution and the social insurance law.The claim for insurance benefits comes from medical security of the constitution which is regarded as a fundamental right.Citizens can ask for medical treatment and financial support when they are ill.At the same time,it also forces the state to fulfill his obligation to ensure medical security.Specifically,legislature shall enact laws,administrative authorities should follow the laws and regulations and judiciary authorities ought to judge cases fairly.The basic medical insurance is the main means of medical security and the claim for benefits makes it possible for employees to get the real benefits.In the legal relationship of the basic medical insurance,the claim for benefits is based on insurance legal relationship,and the legal nature is a claim on public law.Abstract medical security and specific medical cost consist of the whole claim.To be specific,the state shall guarantee that the insured have access to sufficient medical resource and medical service.Besides,every employee is entitled to receive financial support on the medical cost when they face illness.Apart from that,protection rules are a necessity to help ensure the claim.Firstly,the right should follow the principle of legal reservations and definiteness of enabling act.Secondly,the scope of the claim should satisfy the principle of necessary medical care and in line with insurance law principle,and special situations are needed to censor carefully.Thirdly,there should be an effective judicial relief system to make sure that every employee can get fair benefits.Nowadays,it is essential to establish basic medical benefits system which surrounds the claim for benefits of the employees.From legal respect,there should be a separate act of the basic medical benefits of employees and benefits system should also be regulated in a special chapter,which makes the claim enjoy a high legal status.What's more,the principle,the scope and the standard of the benefits shall be clarified by the law.At last,judicial review should be increased so that it can ensure justice to a large extent.