The ten most important points about tax-advantaged insurance
1, the deduction limit is 2400 yuan/year (200 yuan/month), and each person can buy up to one
The so-called individual health insurance tax incentives, refers to the portion of the taxpayers who can be tax deductible in the current year (month) when the tax is calculated after purchasing the commercial health insurance.
Simply put, by buying this type of product, you can pay less tax, which is equivalent to buying yourself another health insurance policy at a lower price.
In line with previous relevant notices, the approach says the deduction is limited to 2,400 yuan per year, or 200 yuan per month, while each person can only buy a maximum of one commercial health insurance.
The approach stipulates that expenditures on commercial health insurance products purchased for employees by the unified organization of each enterprise and public institution should be counted as part of the employees' individual salaries and wages, treated as if they were purchased individually, and deducted in accordance with the ceiling of 2,400 yuan.
2, not due to "past medical history" refused to insure
The biggest breakthrough in the previous health insurance is that the insurance company shall not refuse to insure the insured because of "past medical history", and to ensure the renewal of the policy.
For example, Zhang suffers from congenital heart disease, the insurance company can not refuse to insure Zhang because he is already sick, more likely to pay the reason, so Zhang can be said to be "with the disease insurance".
Industry insiders say this is a breakthrough from the past, when individuals were required to notify insurers of their medical history in advance to avoid moral hazard, and is designed to maximize public participation in the insurance.
Of course, if the first time with the disease insurance, the CIRC allows insurers to control business risks by reducing the amount of benefits, while the maximum amount of benefits paid in the year shall not exceed 20% of the amount of insurance in the year.
3, including "mid-range medical + personal account accumulation" two parts
According to the current product design, individual tax-advantaged health insurance products to take the universal insurance approach, including "mid-range medical + personal account accumulation" two parts of the responsibility.
According to the current product design, the individual tax-advantaged health insurance product adopts the universal insurance method, which contains two parts of responsibility: "mid-range medical care and personal account accumulation".
The payout functions of the two are different, the mid-range medical insurance will be connected with the basic medical insurance and supplemental medical insurance, mainly used to compensate for medical expenses, accounting for a large proportion of the premiums; personal account accumulation can be used for the purchase of commercial health insurance when retiring (e.g., long-term care insurance, etc.) expenses.
4, a person lifetime accumulation of up to 1 million yuan
Specifically, the mid-range medical insurance in the scope of benefits compared with the basic medical insurance has a number of breakthroughs.
First of all, 20% of the proportion of premiums for mid-range medical insurance should be used as health management expenses, which are regarded as claim expenses, and the payout rate should not be less than 80%. If the simple claim rate is lower than 80 percent, the difference is to be returned evenly to the individual account.
Secondly, the coverage amount of the mid-range medical insurance shall not be less than RMB 250,000, with a maximum of RMB 1 million for one person's lifetime accumulation, and the insured's out-of-pocket payment for medical expenses shall not be higher than 10 percent. If the insured person has not had a major claim for five consecutive policy anniversaries since enrollment, the lifetime aggregate limit can be raised to RMB 1.5 million.
Medium-range medical insurance, meanwhile, is set with an annual deductible of 3,000 yuan for insured persons aged 16-40, 5,000 yuan for insured persons aged 41-50 and 10,000 yuan for insured persons aged 51-65.
Moreover, the scope of medical expense reimbursement for mid-range medical insurance is not limited by the basic medical insurance catalog, but in theory, domestic drugs, medical equipment and high-value consumables should be used as much as possible.
Finally, the hospitals for mid-range medical insurance are limited to the general wards of public hospitals.
5, such products need to be labeled "individual tax-advantaged health insurance", beware of counterfeiting
Methods provide that insurance companies to develop individual tax-advantaged health insurance products should be labeled "individual tax-advantaged health insurance", and other types of health insurance to distinguish. The new rules stipulate that insurance companies should label their individual tax-advantaged health insurance products with the words "individual tax-advantaged health insurance" to distinguish them from other types of health insurance.
Therefore, individuals should pay attention to the above information when purchasing to prevent individual companies from inducing them to buy fake products.
6. Individuals can log in to the commercial health insurance information platform to inquire about information
To facilitate management, the CIRC has organized the development of an industry-wide unified commercial health insurance information platform, which is docked to the systems of insurance companies, and accepts inquiries and audits by the tax authorities, while facilitating the inquiry of individuals about their own policy status.
Specifically, the platform has the following functions:
(i) supports underwriting, claim settlement and transfer of individual tax-advantaged health insurance business;
(ii) reports relevant statistical data to the insurance regulator;
(iii) supports the tax authorities in examining the authenticity of the policy and the amount of tax-advantaged usage;
(iv) can provide the policyholders with self-service inquiries on policy information and account information;
(v) other functions stipulated by the CIRC.
7. What are the qualification requirements for insurance companies?
Because it involves major livelihood issues, the CIRC also has strict requirements for insurance companies operating individual tax-advantaged commercial health insurance.
For example, the company should be a professional health insurance company or should have a specialized health insurance department, with a solvency of not less than 150% at the end of the previous year and at the end of the most recent quarter, a team of personnel with medical and other professional backgrounds, and better claims handling and risk management capabilities.
8, the company shall not provide individual tax-advantaged health insurance policy loan services
The scheme stipulates that insurance companies shall issue special documents to policyholders after confirming receipt of their paid premiums for pre-tax deduction of individual income tax, and shall provide individual tax-advantaged health insurance products in all pilot cities with branches.
But the policy for this product type is social security in nature and does not have the function of a pledge loan, so the company cannot provide policy loan services to policyholders.
9, the policy can be transferred to another company free of charge
To facilitate the user to commodity choice of products, the approach stipulates that the insured can be in the medical expenses risk coverage liability period ends, the policy will be transferred to another insurance company free of charge, at the same time the insurance company shall not be mandatory or disguised requirements of the insured person to change the insurance company.
If the insured surrenders the policy, he or she should pay the tax credit back to the tax authorities, and the insurance company is the obligor to withhold and pay the back tax.
And if the policyholder surrenders the policy and then re-enrolls, the insurance company can underwrite the policy.
10, shall not be forced to sell other commercial insurance products
Methods stipulate that the insurance company on the design of such products to follow the protection of the main, reasonable pricing, the principle of operating at a small profit.
The publicity of individual tax-advantaged health insurance shall not mislead the public, reduce or exaggerate the scope of protection, and shall not be forced to sell other commercial insurance products.
Rather, health management services should be provided with the aim of improving the health of the insured and reducing morbidity, and the content and provision of health management services should be clearly defined in the insurance products.
The approach also states that the cost of medical checkups shall not be included in health management expenses.
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