Medical insurance is short for medical expense insurance, which refers to insurance that provides coverage for medical expenses, and it is one of the main elements of health insurance. The role of medical insurance is to provide financial help when the insured person incurs large medical expenses. For small medical expenses paid due to general illnesses, they can be regarded as daily living expenses, and medical expenses mainly include doctor's outpatient fees, medication, hospitalization, nursing care, miscellaneous hospital expenses, surgical expenses, and various examination fees. The costs covered by different health insurance policies are generally a combination of one or more of these items.
Medicare only pays for disability caused by illness, so it's important to have a clear understanding of what "illness" means in the context of health insurance. First of all, an illness must be caused by something that is not congenital. Diseases that are present in the body from birth, such as congenital heart disease, are not covered by health insurance. Second, the disease must be internal to the person's body. Certain diseases whose initial cause is external, such as infectious diseases or influenza, are considered to be internal because it takes time for the disease to develop after the external cause has invaded the body. Thirdly, the disease must be caused by chance. As health is the norm in life, diseases must be due to accidental causes and be treatable by drugs, surgery, etc. In other words, there must be a cause for the disease. In other words, there must be a cause of the disease that can still be treated. Natural phenomena such as old age and infirmity, where a person presents a sickly state and can be kept healthy by injections and medication, are not considered diseases because they do not have a cause. What will be described below are several common types of medical insurance, namely, general medical insurance, hospitalization insurance, surgical and special disease insurance, hospitalization allowance insurance, and comprehensive medical insurance.
1. General medical insurance
General medical insurance provides the insured with general medical expenses related to the treatment of an illness. It mainly includes outpatient expenses, medicine expenses, examination expenses, and so on. This type of insurance has a lower premium cost and is more applicable to the general public. Because of the difficulty in controlling expenditures for medicine and examination costs, this type of policy generally has a deductible and cost-sharing provision, whereby the insurer pays a certain percentage of the portion above the deductible, and the cost of insurance is set once a year. The insurer is no longer responsible for expenses incurred for each illness that cumulatively exceed the insured amount.
2. Hospitalization Insurance
Hospitalization expenses are covered as a separate insurance policy because of the often high costs incurred for hospitalization. The main cost items covered by hospitalization insurance are daily hospital fees (bed charges), the cost of utilizing hospital equipment, surgical fees, and medical fees. The length of the hospitalization period will have a direct impact on its cost, so the amount of this insurance should be based on the patient's average hospitalization cost. In order to control unnecessarily long hospitalization, hospitalization insurance generally stipulates that the insurer is only responsible for a certain percentage of all costs, not all of them.
3. Surgical insurance
This type of insurance provides for all costs incurred by a patient who needs to undergo a necessary surgery.
4. Comprehensive medical insurance
Comprehensive medical insurance is a comprehensive medical expense coverage provided by the insurer to the insured, which covers all expenses incurred for medical treatment and hospitalization, surgeries, and so on. This type of policy has a higher premium. A low deductible is generally established along with an appropriate sharing ratio.
5. Specialty Disease Insurance
Certain specialty diseases often bring catastrophic cost payments to the patient, which are difficult for the average residential family to bear. Examples include cancer, heart disease, etc. Therefore, people usually require such policies to have a relatively large sum insured to be sufficient to cover the various expenses incurred by them. The major diseases for which coverage is provided to policyholders can be single, such as malignant tumors, or even certain types of cancers among malignant tumors; or multiple, listing several agreed major diseases, such as malignant tumors, myocardial infarction, uremic poisoning, vital organ transplantation, tetraplegia, cerebral stroke and coronary artery bypass grafting surgery, and so on. Once the insured person is diagnosed with the major diseases stipulated in the policy by a certain level of hospital after 180 days from the effective date of the policy, he/she can apply to the insurance company for a full payment of the insured amount, and the insurance responsibility will be terminated immediately.
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