Ten most important information about tax-preferred insurance
1. The deduction limit is 2,400 yuan/year (200 yuan/month), and each person can purchase at most one copy
>The so-called personal health insurance tax incentives refer to the part that taxpayers can deduct before tax when calculating taxes for the current year (month) after purchasing commercial health insurance.
To put it simply, if you buy this type of product, you can pay less tax, which is equivalent to buying another medical insurance for yourself at a lower price.
Consistent with previous relevant notices, the method states that the deduction limit is 2,400 yuan/year, or 200 yuan/month, and each person can only purchase one commercial health insurance at most.
The measures stipulate that all enterprises and institutions shall uniformly organize the expenditure on commercial health insurance products purchased for employees, which shall be included in the personal wages and salaries of employees, and shall be regarded as personal purchases, and shall be deducted according to the upper limit of 2,400 yuan.
2. Deny insurance due to "pre-existing medical conditions"
The biggest breakthrough in previous health insurance is that insurance companies are not allowed to refuse insurance because policyholders have "pre-existing medical conditions" and must ensure renewal. Save.
For example, Xiao Zhang suffers from congenital heart disease. The insurance company cannot refuse Xiao Zhang’s insurance because he is already sick and is more likely to incur compensation. Therefore, Xiao Zhang can be said to be “sickly insured” ".
Industry insiders say that this is a breakthrough from the past when individuals were required to inform insurance companies of their personal medical history in advance to avoid moral hazard. The purpose is also to maximize public participation in this insurance.
Of course, if you are sick and take out insurance for the first time, the China Insurance Regulatory Commission allows insurance companies to control business risks by reducing the amount of compensation. At the same time, the maximum amount of compensation paid in the year shall not exceed 20% of the insurance amount in that year.
3. Contains two parts: "mid-range medical care + personal account accumulation"
According to the current product design, personal tax-advantaged health insurance products adopt a universal insurance approach, including "mid-range medical care + personal account accumulation" +Personal account accumulation" two parts of responsibility.
The compensation functions of the two are different. Mid-range medical insurance will be connected with basic medical insurance and supplementary medical insurance, and is mainly used to compensate for medical expenses, accounting for the majority of premiums; personal account accumulation can be used for Expenses for purchasing commercial health insurance (such as long-term care insurance, etc.) when you retire.
4. The maximum lifetime cumulative compensation for one person is 1 million yuan
Specifically, mid-range medical insurance has many breakthroughs in the scope of compensation compared with basic medical insurance.
First of all, 20% of the premium ratio of mid-range medical insurance should be used as health management expenses, which is regarded as claims expenses, and the compensation rate shall not be less than 80%. If the simple loss ratio is lower than 80%, the difference will be returned to the personal account on average.
Secondly, the insurance amount of mid-range medical insurance shall not be less than 250,000 yuan, and the maximum cumulative compensation for one person in his or her lifetime is 1 million yuan, and the proportion of the insured's out-of-pocket medical expenses shall not be higher than 10%. If the insured has not made a large claim for five consecutive policy anniversaries since taking out the policy, the lifetime cumulative compensation limit can be increased to RMB 1.5 million.
At the same time, mid-range medical insurance has an annual deductible of 3,000 yuan for the insured aged 16-40, 5,000 yuan for the insured aged 41-50, and 5,000 yuan for the insured aged 51-65. 10,000 yuan.
Furthermore, the scope of medical expense compensation in mid-range medical insurance is not limited by the basic medical insurance catalogue, but in theory, domestically produced drugs, medical equipment and high-value consumables should be used as much as possible.
Finally, the hospitals covered by mid-range medical insurance are limited to general wards of public hospitals.
5. Such products must be marked with the words "Individual tax-advantaged health insurance" and beware of counterfeiting
The Measures stipulate that personal tax-advantaged health insurance products developed by insurance companies should be marked with "Individual tax-advantaged health insurance". The words "tax-advantaged health insurance" are used 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 being induced to purchase counterfeit products.
6. Individuals can log in to the commercial health insurance information platform to query information
In order to facilitate management, the China Insurance Regulatory Commission organized the development of a unified commercial health insurance information platform for the entire industry, and integrated it with the insurance company’s system Realize docking, accept inquiries and audits from tax authorities, and facilitate individuals to inquire about their own policy status.
Specifically, the platform has the following functions:
(1) Support the underwriting, claims settlement, transfer, etc. of personal tax-advantaged health insurance business;
( 2) Submit relevant statistical data to the insurance regulatory department;
(3) Support the tax department in testing the authenticity of the policy and the amount of tax benefits used;
(4) Can provide Provide policyholders with self-service policy information and account information inquiry services;
(5) Other functions specified by the China Insurance Regulatory Commission.
7. What are the qualification requirements for insurance companies?
Because it involves major people's livelihood issues, the China Insurance Regulatory Commission also has strict regulations on insurance companies that operate personal 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 the end of the most recent quarter, and staff with personnel with professional backgrounds such as medicine. team, with good claims settlement capabilities and risk management capabilities.
8. Companies are not allowed to provide policy loan services for personal tax-advantaged health insurance.
The regulations stipulate that after the insurance company confirms receipt of premium payment from the policy holder, it shall issue a special bill to the policy holder. Certificates can be used for pre-tax deductions for personal income tax, and personal tax-advantaged health insurance products should be provided in all pilot cities with branches.
However, the policy of this product type has a social security nature and does not have the function of pledge loan, so the company cannot provide policy loan services to policyholders.
9. The policy can be transferred to another company for free
In order to facilitate users to choose products, the Measures stipulate that the insured can transfer the policy after the end of the medical expense risk protection liability period. Transfer to another insurance company free of charge. At the same time, the insurance company shall not force or require the insured person to change insurance companies in disguised form.
If the policy holder surrenders the policy, he or she shall repay the preferential tax amount to the tax authorities. The insurance company is the withholding and repaying agent for the repayment of tax.
If the policy is surrendered and then re-insured, the insurance company can underwrite it.
10. No forced tying of other commercial insurance products is allowed
The Measures stipulate that insurance companies design such products to follow the principles of protection-focused, reasonable pricing, and low-profit operations.
When promoting personal tax-advantaged health insurance, you must not mislead the public, reduce or exaggerate the coverage, let alone force the sale of other commercial insurance products.
Rather, health management services should be provided with the purpose of improving the health level of the insured and reducing the incidence rate, and the content and provision of health management services should be clearly defined in insurance products.
The measures also indicate that physical examination fees shall not be included in health management expenses.
Extended reading: How to buy insurance, which one is better, and step-by-step instructions to avoid these "pitfalls" of insurance