Buying insurance, full of hope that it will pay out,
Finally, the tragic situation of being set up without a single point, not experienced people will not understand.
Often because of a word, it will cost you hundreds of thousands of dollars!
Mr. Gongzi served in the Department of Insurance, I heard of such a customer:
Mr. Fu, Zhengzhou, an ordinary cab driver, earning 5,000 a month, his wife in the local electronics factory assembly line work, a month to earn not much, his daughter has just started junior high school.
Because he was a taxi driver, he was prone to all kinds of accidents, so he often bought accident insurance for himself.
At that time he got an accident insurance of 50 yuan for one year with a coverage of 1 million yuan.
According to his description, he felt that the price-performance ratio was very high:
But after looking at it, the salesman told him that he still needed to buy medical insurance, critical illness insurance and life insurance,
And this accident insurance of his would only pay for the total disability, but not the disability.
At the time, he couldn't listen.
Unfortunately,
5 months later, Mr. Fu was running the evening shift when he hit the green belt and ran into the road across the street, which eventually led to the amputation of his left leg.
Mr. Fu initially thought his accident insurance would cover it,
but he was shocked by the results. The one-million-dollar accident insurance policy only covered 12,000 yuan of medical expenses, and not a single penny of the amputation-induced disability.
Mr. Fu was so angry that he called to find the agent who sold him the insurance,
The person pointed to the insurance policy and said: "Look carefully, it is the accidental death and total disability compensation of 1 million, you amputation is only a disability, certainly can not be compensated!
Then this thing, to my insurance company added a lot of trouble,
But Mr. Fu as a consumer, and do not understand these things, the public can not help.
Total disability is total disability, disability is disability,
Amputation of a limb only counts as a grade 7 disability, not total disability.
The real total disability on the insurance contract is:
To get 1 million, unless Mr. Fu both feet are cut off,
The result is now only the left foot amputation, counting the seventh level of disability, according to the reason can be compensated for the amount of 40% of the sum insured, 1 million to compensate for 400,000,
Because he bought the accident insurance only pays for the total disability, not the disability, so this 400,000 can not be taken!
Because the accident insurance he bought only covers total disability, not disability, he won't get the 400,000.
I also feel sorry for him when he turned out like this.
It is said that insurance companies like to play "word games" and Mr. Sun is one of the victims of such "word games".
Sometimes a simple word, total disability and disability, can underpay hundreds of thousands of dollars,
So in the eyes of many people, the insurance company is a liar:
No way, the average person does not understand the insurance, and the terms and conditions of the insurance policy are extremely complex,
Take Mr. Fu's case as an example,
Do you think it's the insurance company's fault?
It's definitely the insurance company's fault,
It's the insurance company's fault for not being patient enough to explain the terms and conditions,
but is it only the insurance company that's to blame?
No, I'm afraid not.
There was nothing deceptive about what was clearly written in black and white in the terms of the insurance policy, and even the salespeople repeatedly reminded Mr. Fu of this.
But we, the consumers,
are not really aware of the real differences caused by this one or two word product.
Mr. Gong has been in the business for more than a decade,
and he has indeed seen a lot of these insurance clauses, where small details can affect the outcome of a payout.
Today, I'm going to take a look at some of these "pitiful" insurance clauses,
and hope that you can avoid stepping into such a pit in the future.
In order to avoid unnecessary attacks, all the product names are hidden here.
The kind of accident insurance that Mr. Fu got is also quite available on the market:
First, let's explain what accident insurance covers.
Accident insurance generally covers three responsibilities: accidental death, accidental disability and accidental medical treatment.
The so-called accidental death, that is, because of the accident hangs, the insurance company will be a one-time compensation for a sum of money, of course, a lot of insurance is also compensated for the total disability, such as severe trauma to the brain, mental retardation to the life can not take care of themselves, or into the vegetative state, and the death of almost, can also be compensated for.
The so-called accidental disability, that is, because of the accidental disability, such as broken arms and legs, the insurance company will be based on the "personal insurance disability assessment standards" to assess a disability level, and then according to the level of compensation for a certain percentage of the insured amount, for example, 10% of the insured amount of the 10th level of disability compensation, 500,000 compensation for 50,000.
The so-called accidental medical care, is because of the accidental injury, to the hospital treatment costs such as surgery, medicine, hospitalization fees, etc., the insurance company will also be reimbursed.
Let's take a look at these two insurance policies:
Product A is an accidental total disability or death benefit,
Product B is an accidental death insurance liability,
Accidental disability insurance liability,
Accidental total disability insurance liability,
Accidental total disability insurance benefit,
Accidental total disability insurance benefit,
Accidental total disability insurance benefit,
These two insurance policies are not the same as those of other products. Accidental Death Insurance Liability", "Accidental Disability Insurance Liability" and "Accidental Medical Insurance Benefit".
Comparing the top and bottom, product A has no disability, no medical treatment, and no accidental death.
Disability has already been said, divided into ten levels, each level in accordance with a certain percentage of the amount of compensation, the first level of compensation 100%, ten levels of compensation 10%.
And Mr. Fu's kind of left foot amputation can only be counted as seven levels of disability.
Breaking a leg is pretty serious, right?
How do the two products pay out?
A product A does not pay, because he only pays for total disability and death,
A product B can be based on the seventh degree of disability compensation, 100 million to pay 400,000,
The medical expenses incurred in the middle of this, the product B can also be deducted after the deductible of 100 yuan at 80% reimbursement.
Total disability and disability, the word difference, there is a difference of hundreds of thousands of dollars!
In fact, in addition to the amputation of such accidents,
We more often encountered is the cat scratch dog bite, burns and scalds this kind of accident, the A product is not even insured, counting what kind of accident insurance?
It's a shame that something like Product A is selling like hotcakes in reality, so we must look carefully at buying accident insurance.
Or two accident insurance, the market are particularly hot, the basic responsibility of the insurance are no big problem,
But a look at the exemption part of the insurance notice, but also hidden cats and dogs.
A product said the high altitude accident does not pay, and the definition of high altitude for two meters and above;
B product said the fall from a height of death or total disability only 100,000, and high altitude becomes 10 meters and above.
Two meters and 10 meters are just one number apart,
how different are they?
Let's assume that Lao Wang falls down from two floors (6 meters),
the medical expenses in between, and possible disability payouts,
Product B pays out, while product A does not.
Two meters and ten meters, a difference of one word, could result in a difference of hundreds of thousands of dollars!
Many insurance products, not only the terms themselves,
in the insurance notice, health notification and other places will also set up obstacles,
Here is the dogged operation of narrowing the scope of benefits in the insurance notice,
so that people have to be on guard.
These are two life insurance policies with a simple liability,
Death or total disability pays a penny,
$1 million for $1 million, buy $2 million for $2 million.
But here you should be aware that there are some clauses that do not pay for total disability!
Like the above product A product, only includes the death, and does not compensate for total disability.
So what does that mean?
For example, Wang was unfortunate enough to be involved in a car accident that left him with permanent paraplegia and a total loss of joint skills in all four limbs.
Clause B will pay, but clause A won't.
Products like A are a mudslide in the market.
It's important to realize
that the reason why life insurance pays for total disability is because total disability is essentially incapacitating in terms of severity.
Let's take a look at these descriptions: "blindness," "useless joints in the limbs," "can't chew, can't swallow"
All very, very serious.
So, as a life insurance policy, adding total disability to the payout is very reasonable, and very compassionate and humane.
Thus the vast majority of life insurance products on the market have both death and total disability.
What's even funnier is that product A, which doesn't have total disability on it, sells for more money than product B.
The same $1 million policy for a 30-year-old male with 20 years of premiums to age 60
The A product is $3,130, while the B product is $1,460.
It's expensive, and the liability is poor, and it's a total tax on the IQ.
These are the two critical illness insurance, both said to be able to protect the "cancer secondary compensation",
Cancer is also the contract inside the malignant tumors, cancer is the king of the disease, the survival rate of the country is only 30-40%.
The treatment of cancer is usually three hundred and forty thousand, if the most advanced proton heavy ion therapy, the cost can exceed seven hundred and eighty thousand,
Many people do not have the money, can only give up the treatment, which is one of the reasons that lead to the low survival rate of cancer in our country.
Cancer is not only difficult and expensive to treat, but also easy to recur and metastasize, so a lot of critical illness insurance have the option of a second payout for cancer,
but their second payout for cancer requires a different period of time:
Product A can pay for a second payout for cancer three years after the first cancer, and product B can pay for a second payout for cancer five years after the first cancer.
What's the difference between one 3 years and one 5 years?
Medicine has a professional term called "five-year survival rate",
physician's explanation of this term is: if a cancer patient is still alive within five years after receiving effective treatment, it means that the patient's cancer is under effective control, or even to the extent that "the cancer is basically close to being cured". is close to being cured".
In plain English, if a person with cancer does not die within five years after treatment, it basically proves that his cancer has been cured.
We all know that cancer is prone to recurrence and hard to cure,
with a second cancer claim, you can get another claim to continue the treatment in case the first time you have cancer for several years and don't get cured
and you won't give up the treatment because you don't have the money to pay for it.
But what if Wang's first cancer treatment lasted 3 years and he ran out of money,
and when he ran out of money,
Product A paid out 600,000 dollars and product B didn't pay out a penny,
what's the use of a second cancer payout?
If Wang had survived 5 years, he would have been fine, would he have needed a second payout?
3 years and 5 years,
Just one word difference,
Put in reality, there is a real possibility of dragging people alive.
Or the two critical illness insurance:
You look closely,
Product B not only requires five years between second claims for cancer, but also requires that the order of onset of disease follow its rules.
Let's look at the above two provisions, I'll give you a concrete example:
Lao Wang unfortunately got a malignant tumor, five years later unfortunately got a malignant tumor, then no problem, both provisions can pay.
But if Lao Wang first got some other serious illness (such as acute myocardial infarction), and 5 years later got a malignant tumor.
Then sorry,
Product A will pay out, while product B will not.
Do you see the difference?
The problem lies in the fact that Product A has an extra second paragraph,
Product A pays 120% of the sum insured regardless of whether the first time you get a tumor or not, and the second time you get a disease that is a tumor.
But Product B requires you to get a tumor the first time, and the second time you still get a tumor before it pays out, and it doesn't pay out regardless of the number of times you get a tumor if the first serious illness is not a tumor!
So the question is, who controls the order in which they get sick for the same liability?
The above product B, if the first critical illness is not cancer,
You can not use this "second cancer compensation" coverage.
Isn't it obvious that this is a pitfall?
But unfortunately, the product B in the market sells very well, is the inner one called "X Fu", I do not know everyone guessed it.
I didn't realize there was such a big difference in cancer liability.
Everyone must be careful not to get screwed.
These are two million medical insurance, can be reimbursed for special outpatient medical expenses,
such as going to the outpatient kidney dialysis, do cancer radiotherapy chemotherapy.
There are also many treatment options for cancer, not only can you do radiotherapy and chemotherapy,
but you can also take targeted drugs, or use immunotherapy or endocrine therapy.
But not all medical insurance policies will reimburse for these.
For example, product A only reimburses radiotherapy and chemotherapy,
but product B reimburses all the therapies mentioned above.
Don't look at just two more lines, the difference is huge!
We have seen "I am not the God of Medicine" know,
The kind of box of tens of thousands of dollars, eat a few boxes a month, eat a suite of anticancer drugs a year, that is, targeted drugs,
Such an expensive drug, the A product is not reimbursed,
Is it possible that the doctor told you to take targeted drugs, you have to say to him, "No, my insurance is not You're still going to shave my head and give me radiation therapy"?
Buying insurance is about having more choices when treating your illness, not about limiting your choices with insurance.
This kind of medical insurance that only covers radiotherapy for cancer,
Whoever buys it steps on the pit!
The previous two million medical insurance, just on a responsibility to pay less for several cancer treatments,
These two products, that is not even the most basic responsibility.
There are just four responsibilities in a Medicare policy: inpatient hospitalization, special outpatient care, outpatient surgery, and emergency room visits before and after hospitalization.
Hospitalization: bed, meal, consultation, examination, treatment, medicine and surgery will be reimbursed.
Special outpatient care: the vast majority of million-dollar medical insurance will only reimburse three pieces, outpatient kidney dialysis, outpatient malignant tumors and outpatient anti-rejection treatment after organ transplantation.
Outpatient surgery: common surgeries are covered, nothing more.
Pre- and post-hospitalization outpatient emergency care: outpatient emergency care 7 days before and 30 days after hospitalization, such as the cost of emergency treatment before hospitalization or the need for review after discharge, can be reimbursed
But some million-dollar healthcare will sneak in a few missing ones for you,
For example, Product A, has only inpatient medical care and special outpatient services, and general outpatient care and pre- and post-hospitalization outpatient care are not available.
And product B has all four of these basic responsibilities.
Lao Wang went to the hospital to cut an appendix, the money for surgery A product is not reimbursed, B product can be reimbursed
If there is any disease doctor called for a review after discharge, A product is still not reimbursed, B product is reimbursed.
As a million-dollar healthcare,
such a lack of responsibility, you good sense?
The most important thing for a million dollar medical insurance is the renewal condition.
We now see the million medical insurance, usually one year,
The biggest problem faced is,
This year I can buy this million medical insurance, next year I have a change in health or the product off the shelves, then can I still buy?
The best products on the market today are able to do a guaranteed renewal for X number of years,
such as Product A, which has a guaranteed right of renewal.
But the words "guaranteed renewal" are like a "gold standard" that all products rely on.
For example, in Product B, the terms and conditions state that the policy is "continuous", which can be interpreted to mean that it is also guaranteed to renew.
What's the difference?
For example, if you have cancer this year, and you take out a continuous policy next year, you will be able to renew product A, and you will be able to renew product B as well.
There is no difference,
But if the old man gets cancer this year, and both product A and B are dropped next year,
Product A is guaranteed to be renewed for 6 years, and it will still be renewed for all 6 years.
B product off the shelf, there is no way to continuous insurance,
Can only wait for the arrangement of the Department of Insurance, price increases or direct refusal of insurance at the mercy of the people.
Do you see the difference?
For this kind of "continuous insurance" products,
I have no way to ensure that he does not shelve ah, it is very different from the "guaranteed renewal".
There is another category, called renewable, which is also often confused with guaranteed renewable.
Product C, for example, has a clause that says it is "renewable".
Friends, you need to think clearly,
"Can" and "guaranteed" are two completely different concepts.
This is the first time that I've ever seen a product that has been sold in the United States, and I've never seen a product that has been sold in the United States that has been sold in the United States.
Space constraints, I will not continue to cite,
Writing so much, and do not hope that you and I look at the charts here to find the difference,
The key is to learn to avoid pitfalls in the purchase of insurance.
To see the true face of the insurance terms and conditions of the pit, first we have to learn to read the terms and conditions of insurance.
Learning to read insurance terms is impossible, but as consumers, we can learn to read some of the most basic parts,
We need to look at the most important are the enrollment instructions, health notices, and insurance contracts.
Information on insurance
If the insurance is purchased on certain internet platforms, we will usually see that there are instructions on how to take out the insurance.
Buying insurance can't be done indiscriminately,
In order to prevent some people from buying unsuitable products,
The instructions on how to take out the insurance are clearly listed on which groups of people the product is suitable for, which risks are excluded and not insured.
But some insurance policies, if they're going to set you up, will have a lot of unreasonable exclusions or overly stringent standards here.
So, when you buy an insurance policy, understanding its terms and conditions is the first step.
Health information
Insurance is not only not for the faint of heart, but also not for everyone,
especially health insurance, which has certain requirements for a person's health status.
It's common for insurance companies to ask about a policyholder's health, whether he or she has suffered from a disease in the past, or whether he or she has ever made a claim before taking out a policy.
This step is designed to screen out people who are at high risk of getting sick. If people who are already sick come to buy insurance,
eventually either the insurance company pays through and everyone's policy goes unaffordable, or everyone's premiums go up, and buying insurance loses its meaning.
Health notification must be taken seriously, for each disease,
If you feel that you have or very similar, never hard to buy,
Online to buy can go to the intelligent underwriting, can not be sure to apply for manual underwriting, and offline to buy directly apply for human underwriting on the line.
The insurance contract
We will receive the insurance contract after paying the premiums for a certain period of time,
This is the most complicated clause and also the place with the most pitfalls.
When we get an insurance contract, we mainly look at the coverage and exclusions provided in it.
The liability is like this:
It details how to pay for the insurance during the waiting period,
After the waiting period, how to pay for the major illnesses, how to pay for the medium illnesses, how to pay for the minor illnesses.
Pay attention to see clearly here is the amount of compensation or compensation premiums,
Life insurance is only the death of a total disability or both, medical insurance responsibility there is no missing,
Or like the previous list of cancer secondary compensation in the end can not be compensated.
The exclusion clause looks like this:
It lists which cases are not compensated,
Generally speaking, the exclusion clause is mainly to exempt those who intentionally committed suicide, the insured intentionally injured to fraudulent insurance situation,
Or the insured because of the illegal crime, the war and nuclear explosions and other problems caused by the insurance.
In essence, it is not a big problem, mainly because I am afraid that some insurance clauses go too far and exempt what should not be exempted.
Insurance is a very specialized field,
Even if we know how to read the terms of the insurance policy, it is still difficult to understand because there are too many terms.
This time we can go to some professional medical website such as Clove doctors, micro letter program such as Tencent medical dictionary to understand the professional medical knowledge,
If it is unable to see which one of the responsibility is good or bad, you can also go to the Internet to read a lot of professionals to write the insurance assessment,
Never again, you come to me to ask me is also OK.
I guess after reading the article everyone would say so, insurance is just two no-no's: this no-no and that no-no.
Is insurance all about denials and making money?
Of course not!
The insurance company's profit comes from three differences:
Deadlier: the difference between the expected rate of insurance and the actual rate of insurance. For example, if 10 out of 100 people were expected to be insured, and only 5 were actually insured, there would be a surplus of premiums collected in order to pay out 10 people, and the insurance company would make a profit, and refusing to pay out the claims would make the actual number of people insured less than 10, and thus make a profit.
Fee differentials: It costs the insurance company money to run each product and operate stores across the country, and if costs are saved, then the insurance company can realize a relative profit.
Spreads: For some financial insurance products, the insurance company will give us a return, but at the same time the insurance company will also invest out to get a return after collecting our premiums, just like the bank deposit and loans, as long as the insurance company to do the "loan proceeds" than to give us a "deposit proceeds", the insurance company can realize a relative profit. As long as the insurance company makes the "loan proceeds" higher than the "savings proceeds" they give us, they can make money.
In reality, insurance companies design a product, usually already expected that this product covers the population of the insurance rate,
For example, the domestic life insurance are in accordance with the OCI issued the "Chinese life insurance industry experience life table" on the probability of death to design the product,
Products designed to assume that the probability of insurance at the beginning of the probability of insurance and the probability of the actual insurance is almost the same, so the "death gap" is the same as the actual probability, so the "death gap" is the same as the probability of the actual insurance. The "deadweight difference" is basically unprofitable.
What if the insurance company refuses to pay?
Insurance companies aren't that fond of denying claims.
Two reasons:
Data-wise, insurance companies don't have a high denial rate.
Public found the first half of 19 years of each insurance company's claim amount and claim rate on it,
You can see, both large and small companies, the lowest claim rate is above 97%, generally in 98%, 99%,
Insurance companies are not relying on the refusal of claims to make a profit.
Motivationally, insurance companies don't always want to deny claims, either.
The insurance industry is a highly competitive industry, and consumers buy insurance so infrequently that it's hard to talk about branding.
If a particular insurance company gives consumers the impression that it is all about denials, denials, denials, it's easy for consumers to move on to another company.
On the contrary, I've seen too many cases where insurance companies pay out when they shouldn't, for no other reason than their reputation.
So why are insurance terms so different?
Mostly, it's the actuarial team that designs the insurance products, who deem certain liabilities to be prone to long-tail risk (paying out a lot more in the future) or moral hazard (the potential for fraud),
and in the insurer's shoes, they redact those clauses.
But such modifications objectively also lead to consumers' normal protection needs are not met, a kind of "one-size-fits-all" meaning,
This is something that can not be helped.
What we need to know is that the insurance we buy is essentially a contract with the insurance company,
Contracts written on the compensation, the contract is not written on the compensation, the insurance company to earn money does not rely on the refusal to pay.
What we really need to learn,
is to read the terms and conditions, avoid those who are not covered by the insurance policy, and buy the one that is really inexpensive and of good quality for us.
As a member of the industry, I can't hold the hands of all the actuaries and say, "You, don't change it."
What I can do is to look at the terms and conditions a little bit more carefully every time I make a recommendation,
and do my best to remind people and help them.
This is the reason why Gongzi has been writing and sticking to the road of insurance popularization.
Your kudos are my motivation to keep going.
Above.
Everyone still do not understand, you can leave a message or private message, the code is not easy, if you think it is useful, you can click a like, is to give me encouragement.
Concerned about wantonly big wealth son. Buy the right insurance, save half the money!