국민건강보험법

소개

최신개정법으로 만든 리포트입니다

목차

1. 국민건강보험법의 목적 ······················································································· 1

2. 건강보험제도의 의의 ·························································································· 1
3. 건강보험제도의 특성 ·························································································· 1

4. 건강보험제도의 법적근거 ···················································································· 2

5. 건강보험제도의 역사 ·························································································· 2

6. 운영구조
1) 보건복지부 ······································································································ 4
2) 국민건강보험공단 ····························································································· 4
3) 건강보험심사평가원 ·························································································· 5
4) 건강보험제도 관련 위원회 ················································································· 6
(1) 건강보험정책심의위원회 ················································································· 6
(2) 재정운영위원회 ····························································································· 6
(3) 진료심사평가위원회 ······················································································· 7
(4) 건강보험분쟁조정위원회 ················································································· 7

7. 적용대상 ··········································································································· 7

8. 보험료 재정 ···································································································· 11

9. 보험급여
1) 보험급여의 종류 ···························································································· 13
2) 급여의 제한 ·································································································· 16
3) 급여의 정지 ·································································································· 17
4) 부당이득의 징수 ···························································································· 17
5) 구상권 ·········································································································· 17

10. 이의신청 및 심판청구
1) 이의신청 ······································································································· 17
2) 심판청구 ······································································································· 18
참고문헌 ············································································································· 19
부록 ··················································································································· 20

본문내용

건강보험은 국민의 질병·부상에 대한 예방, 진단, 치료, 재활과 출산·사망 및 건강증진에 대하여 보험서비스를 제공하여 국민건강을 증진시키기 위한 사회보장제도이다. 일정한 보험료를 적립하여 두었다가 사고가 발생했을 경우에 그 치료비의 일부, 기타의 수당을 지급받아 생활을 보장받는 공제 제도이다.

1. 국민건강보험법의 목적
현행법에서는 국민건강보험법의 목적은 ‘국민의 질병·부상에 대한 예방·진단·치료·재활과 출산·사망 및 건강증진에 대하여 보험급여를 실시함으로써 국민보건을 향상시키고 사회보장을 증진함을 목적으로 한다.’ 이다. 개정된 법에서는 ‘국민보건을 향상시키고 사회보장을 증진함을 목적으로 한다.’라는 부분이 ‘국민보건 향상과 사회보장 증진에 이바지함을 목적으로 한다.’로 변경되었다.

2. 건강보험제도의 의의 건강보험제도는 일상생활에서 발생하는 우연한 질병이나 부상으로 인하여 일시적으로 고액의 진료비가 소요되어 가계가 파탄되는 것을 방지하기 위하여, 보험원리에 따라 국민들이 평소에 보험료를 낸 것을 보험자인 국민건강보험공단이 관리 및 운영을 하다가 국민들이 의료를 이용할 경우 보험급여를 제공함으로써 국민 상호간에 위험을 분담하고 의료서비스를 제공하는 사회보장제도이다.

3. 건강보험제도의 특성
1) 강제적용
보험가입을 기피할 경우 국민상호간 위험부담을 통하여 의료비를 공동으로 해결하고자 하는 건강보험제도의 목적 실현이 어렵다. 또한 질병위험이 큰 사람만 보험에 가입할 경우 보험재정이 파탄되어 원활한 건강보험 운영이 불가능하게 된다. 따라서 일정한 법적요건이 충족되면 본인의 의사에 관계없이 강제 적용된다.

참고자료

· 없음