In practice, social medical insurance cannot compensate for all the inpatient medical expenses of the insured. Therefore, if you want to further enhance the health protection ability of individuals or families, you may wish to use some commercial medical insurance that does not conflict with social security claims as the basic medical insurance. A useful supplement to make up for the medical expenses of the difference.
For example, the purchase of reimbursement medical insurance and subsidized medical insurance is an effective way to compensate for medical expenses. The former can compensate for the loss of the following parts of the basic medical deductible line and the proportion of the self-paid line above the deductible line. The latter is the insurance company's fixed subsidy standard in accordance with the contract. During the insured's hospitalization, surgery, etc., the insured pays the insurance premium on a per-time basis, on a daily basis or on a project basis.
Reimbursement-type medical insurance: preferred "super social security"
Reimbursement medical insurance, also known as general medical insurance, pays for medical expenses incurred by accident or illness. The insurance company pays according to the prescribed ratio according to the total amount of medical expenses and medical expenses actually paid by the insured in the medical process. Generally, the two parts of the outpatient and inpatient departments are mainly for the reimbursement of the accidental door emergency costs, various hospitalization expenses, and some outpatient examination expenses related to hospitalization.
In general, there are not many differences in the design of such medical insurance products, but insured people also need to pay attention to some product details and make a comprehensive comparison.
Insured "four see clearly"
First, see the proportion of reimbursement expenses. According to the regulations, each insurance company must distinguish between the insured person's public medical insurance and social medical insurance when designing the cost-compensated medical insurance products. Therefore, in the insurance clause, the social security and non-social security conditions will be clearly explained. The insured can clearly see what they can enjoy in combination with their own situation (the proportion of reimbursement after the social security reimbursement; no social security or failure The proportion of social security direct reimbursement).
Second, we must see the deductible of the product and the claims online. This is also the key to the level of insurance coverage. Under normal circumstances, the lower the deductible is the lower line, the higher the upper limit of the claim amount, the more economic compensation the insured can obtain.
Third, look at the observation period (waiting period). Consumers usually have a waiting period when they first apply for a fee-based medical insurance. If there is a clear agreement in the product terms, "the insured person will not be liable for insurance due to accidental injury or contract within 60 days (except for renewal), due to the hospitalization medical expenses paid for hospitalization in the designated hospital due to illness." This means that the insured person cannot be reimbursed for expenses incurred in hospitalization due to illness, within the first 60 days of the insurance. In addition to the 60-day waiting period, some products may have a waiting period of up to three months. Therefore, for consumers, this deadline is as short as possible.
Fourth, we must see if there is any right to renew. Since reimbursement type medical insurance is usually a short-term product, whether or not to renew the insurance is a relatively big problem. If it is a one-year product, it needs to be insured for customers every year. Some insurance companies will refuse to guarantee or increase the fee in the second year after the claims are generated in the same year, which may lead to the most need for insurance. Losing security at the time, this is obviously not good for the insured. Therefore, it is more secure to choose products that are guaranteed to be renewed. Of course, the premiums for such products are usually slightly higher.
Multiple insurance coverage without repeating claims
It should be pointed out that the reimbursement of reimbursement commercial medical insurance medical expenses follows the principle of compensation and the principle of non-repetitive reimbursement. That is, the part of social security co-ordination and local medical surcharges has been paid directly through social security and local medical co-ordination funds, so commercial insurance is no longer paid, and the proportion of insurance companies reimbursing medical expenses for customers is added. It may exceed 100% of the medical expenses paid by the customer at his own expense.
In other words, repeated reimbursement of reimbursement-type medical insurance with similar coverage for different insurance companies cannot be reimbursed. It is enough for a consumer to purchase a certain amount of insurance at an insurance company. Instead of buying more, it costs more.
"Super social security" protection is more comprehensive
In addition, careful insureds may find that most of the current reimbursement medical insurance is bounded by social security coverage. In other words, for social insurance that cannot be reimbursed, such as imported drugs, special effects drugs, special care wards, etc. excluded from the drug use list, reimbursement medical insurance can not provide protection. However, many insurance companies have introduced the “super social security coverage†expense reimbursement medical insurance for market changes. The insurance liability of the insurance company is often not subject to social security restrictions. Some medications and treatment projects beyond the scope of social security can also be given certain Cost compensation is a priority when shopping.
Finally, the consumer should be reminded that if they have social security, and their unit benefits are better, they can reimburse the employee for all or part of the medical expenses, or have already purchased enough group medical insurance for the employees, basically no longer need to Expenses for reimbursement of medical insurance are purchased separately at your own expense.
Subsidized medical insurance: fixed payment can be superimposed
Subsidy insurance, also known as subsidized insurance or fixed-income insurance. Unlike reimbursement-type medical insurance, subsidized medical insurance has nothing to do with actual medical expenses, and there is no need to provide invoices when making claims. No matter how much you spend on treatment, what kind of illness you get, the insurance company will pay according to the subsidy standard stipulated in the contract. Moreover, there are multiple insurance policies between different insurance companies, and there will be no “overall claims†for reimbursement-type medical insurance, and the claims can be repeated.
For example, if A bought a 200 yuan/day hospitalization subsidy, then how much it costs during the hospitalization period, regardless of how much it is reimbursed in the social basic medical insurance account, the insurance subsidy received every day. Both are 200 yuan; if A Jun buys 200 yuan / day of hospitalization subsidy insurance in both insurance companies, then after hospitalization, they can get a total of 400 yuan / day insurance subsidy.
Science insured three steps
In the specific choice of subsidized medical insurance, you can start from the following aspects:
First of all, pay attention to the scope of protection. In many insurance products, insurance liability will vary depending on the cause of the risk accident. The causes of hospitalization mainly include accidental causes and diseases. These two hospitalization reasons are included in the insurance liability of hospitalization insurance, otherwise the coverage of this hospitalization insurance is not comprehensive enough.
Second, pay attention to the number of days paid and the number of days without pay. There is an upper limit on the number of days of general hospitalization insurance, and some are also set for the number of days without compensation. For the insured, the relevant parameters of the same level of products should be fully compared when insuring. Generally, it is better to choose more days of payment and less days of deductible.
Finally, pay attention to the guarantee period. Similar to insurance-type medical insurance, many subsidized medical insurances have a shorter period of protection, usually around one year. After some products are in the same year, the insurance company will no longer provide renewal service, which makes it difficult for the insured to maintain long-term security. Therefore, it is recommended to choose a product with a longer warranty period or a guaranteed renewal.
In general, subsidized medical insurance and reimbursable medical insurance are two types of medical insurance currently, and there is no conflict between the two. Consumers can choose according to their own protection basis, or supplement with the combination of reimbursement medical insurance + subsidized medical insurance.
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