Introduction to insurance
Commercial medical insurance (Insurance for medical care)
is a part of the medical insurance system, which is voluntary for employers and individuals. The state encourages employers and individuals to participate in commercial medical insurance. It is a for-profit medical insurance operated by insurance companies. Consumers pay a certain amount of money for insurance, and when they have a serious illness, they can get a certain amount of medical expenses from the insurance company.
Insurance channels
Online insurance
With the development of the Internet, a number of online insurance comparison platforms have emerged in China. Consumers can find out the basics of insurance, such as coverage, amount of coverage, premiums, statute of limitations, and so on, online as long as they are happy to do so. The first thing you need to do is to get your hands on some of the most popular products in the world, and then you can get your hands on some of the most popular products in the world.
Agent services
Although more and more insurance channels have come on the scene, the more traditional agent system still has its advantages. Agents know their own insurance company's products very well, and there are many insurance companies that actively train their agents in financial planning and other training, so that the agent is able to design a better protection program for the customer's different occupations, age, family structure and other factors. At the same time, another big advantage of choosing to buy through an agent is that you can get after-sales service such as renewal and claims, forming a long-lasting relationship.
Insurance agents
If the insurance agent can only sell his own company's products, which is not free from overstatement and lack of objectivity, then the insurance agent can recommend different companies, so that consumers can have a comparison, but also more objectively analyze the types of insurance to better meet the needs of the insured. This kind of horizontal comparison between products gives the insured a wider range of choices. This is also the biggest advantage of the insurance agency.
Insurance brokers
An agent is an agent of the insurance company, representing the interests of the insurance company; while a broker is the broker of the policyholder, considering the interests of the policyholder. From this point of view, it is easy to see that insurance brokers are more objective than agents or insurance agencies. This is more conducive to the policyholder finding the right combination of insurance and not being misled by the agent's or agency's preferences.
Bank insurance
Usually, the insurance sold in banks is savings and participating insurance, which is simple and easy to understand, while health insurance and long-term life insurance, which require careful study of the terms and conditions, are seldom seen at bank counters. It is very convenient to buy insurance at the bank, as long as the insurance contract is signed on the spot, and usually at a lower rate.
The main problem
The most prominent problem with current commercial medical insurance is the high price and low level of coverage.
Although the price of medical insurance is beyond the affordability of the people, many insurance companies are still losing money, mainly due to two phenomena:
One is the reverse choice, that is, the insured only go to the insurance company when they know that they are ill, and by all means to conceal the insurance company's examination, the insurance company had to pay for their medical expenses in accordance with the terms of the insurance.
The second is moral hazard, that is, the patient and the hospital jointly deal with the insurance company, the use of minor illnesses, big treatment, open the way of empty medical bills, so that the insurance company to pay a high cost. In many places, there are even people do not hospitalization, only in the hospital false bed fraud insurance premiums.
The purpose of China's health care reform is to establish a health protection system supported by the basic medical insurance, employer supplemental insurance, commercial medical insurance, the three **** with. The new health care reform determined that the unit for the employee to pay 6% of their total wages as a co-ordination fund, the employee to see a doctor for the cost of more than 10% of the local average annual salary, the co-ordination fund began to pay for the cost of the employee, but the maximum payment limit is controlled in the local average annual salary of about four times the average annual salary of the employee.
Types of insurance
With the reform of the health care system, the major insurance companies of the commercial medical insurance coverage is also in line with the situation, and gradually more and more. So, what are the major types of commercial medical insurance, what they are insured, what is not insured, and what are the specific provisions of the insurance? The following is a brief summary of the types of medical insurance:
General medical insurance
This type of insurance is one of the most extensive medical insurance liability, responsible for the outpatient medical expenses and hospitalization of the insured due to illness and accidental injury. General medical insurance is generally underwritten on a group basis or as a rider to an individual long term life insurance policy, and medical insurance benefits are generally paid on an indemnity basis with a maximum limit per occurrence.
Accidental Injury Medical Insurance
This type of insurance is responsible for the medical expenses incurred by the insured due to accidental injuries, as an additional liability of accidental injury insurance. The amount of insurance can be the same as the basic insurance, or can be agreed separately. In general, medical insurance benefits are paid in the form of compensation, which not only stipulates the amount of insurance, i.e. the limit of payment, but also the period of treatment.
Hospitalization medical insurance
This insurance is responsible for the insured's hospitalization expenses due to illness or accidental injury, but not responsible for the insured's outpatient medical expenses, and it can be either by way of compensation or by way of a fixed amount.
Surgical medical insurance
This insurance is a single medical insurance, which is only responsible for the medical expenses incurred by the insured due to surgical procedures, no matter whether they are outpatient surgical treatments or inpatient surgical treatments. Surgical medical insurance can be covered on its own, or as a rider to an accident or life insurance policy. In the case of a surgical medical insurance policy that pays by way of compensation, only the sum insured is stipulated as the maximum cumulative benefit limit, while in the case of a fixed benefit surgical medical insurance policy, the insurance company only pays a fixed amount of medical insurance premiums according to the type of surgery performed by the insured[3]p
.
Special Disease Insurance
This type of insurance is based on the insured person suffering from a specific disease as the insurance incident. When the insured is diagnosed with a specific disease, the insurer pays an agreed amount of money to meet the financial needs of the insured. A specialty disease insurance policy can cover only one specific disease or several specific diseases. It can be insured separately or as a life insurance rider. It is generally paid in a fixed amount, with the insurer paying a lump sum in accordance with the insurance amount, and the insurance liability is terminated.
Reimbursement
Currently, there are two main types of commercial medical insurance: hospitalization allowance and expense reimbursement. The former compensates the insured for the loss of hospitalization with a fixed amount per day, which is a good choice because it does not overlap with social security or other types of commercial medical insurance.
Commercial medical insurance only reimburses the actual medical expenses incurred by the insured, and the scope of reimbursement varies from one type of commercial medical insurance to another. Expense reimbursement type of insurance it can reimburse the hospitalization medical expenses, but the scope of reimbursement varies from product to product. Some commercial medical insurance contracts stipulate that the actual medical expenses must be covered by social security in order to be reimbursed. If you have already received compensation from the social security or other social welfare institutions, the insurance company will only pay the remaining part of the cost, and if the social security cannot reimburse you (imported medicines, special medicines, intensive care wards, etc.), this type of commercial medical insurance will not be able to reimburse you, and its function is only to reimburse the proportionate part of the cost that you have to pay out of your own pocket after the social security has reimbursed you. On the other hand, some commercial medical insurance policies provide for the reimbursement of reasonable expenses incurred by the insurer on a pro rata basis or after a certain deductible. [4]p
Distinguishing Social Security
First, the two are different. Commercial medical insurance is a life insurance company using economic compensation means of operation of a kind of insurance, is an aspect of social and economic activities, by the insurer and the insured both sides in accordance with the principle of voluntary signing of the contract to realize the life insurance company can make a profit from it . And social health insurance is the state under the Constitution, in order to protect and promote the health of workers and the establishment of a social security system, is the state or local legislation through the mandatory implementation, does not depend on the will of the individual, at the same time as a kind of social welfare undertakings have a non-profit nature.
Second, the insurance object and role is different. Commercial medical insurance to natural persons as the object of insurance, its role is when the insured citizens due to accidental injury or illness and medical expenses, can obtain a certain amount of financial compensation to mitigate the loss, but not to protect the basic life of the insured, but also does not have the role of maintaining social justice, social health insurance is mainly to the workers as the object of insurance, when the workers due to illness and medical expenses by the The social insurance department or its entrusted units to give basic compensation, is conducive to social stability and maintenance of social justice, in fact, is an aspect of national income redistribution.
Again, the two rights and obligations are different. The rights and obligations of commercial medical insurance is established on the contractual relationship, any one has the full capacity of citizens or legal persons, as long as the insurance contract with the insurance company voluntarily and according to the contractual provisions of the insurance premiums paid, their own or members will be able to obtain the corresponding right to request the payment of insurance benefits, the amount of insurance depends on the amount of premiums paid, that is, the insurance company and the policyholder's rights and obligations between the relationship is an exchange of reciprocity. The relationship between the insurance company and the insured is a kind of reciprocal relationship of equal exchange, which is manifested as more insurance, less insurance, no insurance. On the other hand, the right and obligation relationship of social medical insurance is built on the labor relationship, as long as the workers fulfill the obligation of working for the society, they can enjoy the social medical insurance treatment, sometimes, in order to facilitate the management by economic means and to enhance the awareness of the cost of the workers, they are required to pay a small amount of premiums, but the amount of the insurance benefits they receive and the amount of the premiums they pay are not in a positive proportionality, i.e., the relationship between the right and obligation is not reciprocal. are not equal.