China high-end medical insurance was born in the 1990s. At first, it was mainly for foreigners working in China, some China executives and overseas employees. For outsiders, their medical treatment is different from that of ordinary people. They go to the international department and the special needs department, not the general outpatient service, because they can enjoy the same level of medical services as foreign countries through the high-end medical insurance provided by the company.
In recent years, with the rise of new domestic wealth regulations, people's living standards have generally improved, and basic medical insurance has been unable to meet people's needs, and high-end medical insurance has gradually entered the public eye.
First, what is high-end medical insurance?
High-end medical insurance: insurance for high-income people can completely solve medical expenses. Whether it is the special needs department of the best hospital in China (such as the International Medical Department of Peking Union Medical College Hospital), private hospitals, foreign first-class hospitals such as the United States, Japan and Canada, the treatment expenses can be reimbursed.
The advantages of high-end medical insurance are as follows:
1, the coverage is high enough: the coverage of general high-end medical insurance ranges from several million to tens of millions, while the coverage of general critical illness insurance is around several hundred thousand. From the point of view of serious illness, if high-end people have higher requirements on the technology and environment of treatment, they can choose high-end medical insurance that suits them and the most advanced technology in the world to reduce the pain of treatment and improve the survival probability.
2. There are a wide range of hospitals, and outpatient clinics can also be reimbursed: you can choose world-renowned hospitals, international departments and special needs departments of top domestic hospitals, and private hospitals. The doctor's medical expenses and outpatient expenses can be paid directly by the insurance company. At present, most high-end medical insurance also provides a certain amount of Chinese medicine physiotherapy services, which can also be used in daily life.
3. Less reimbursement restrictions: not only are there no restrictions on self-funded drugs, but the expenses of major diseases such as organ transplantation and tumor treatment can be reimbursed 100%, and insurance services including outpatient service, hospitalization, serious illness, dentistry, fertility, health check-up and emergency rescue can also be enjoyed.
4. Direct payment service: Direct payment service is a typical feature of high-end medical care. General medical insurance needs to be paid in advance, and then it can be reimbursed through documents. High-end medical care does not need to spend cash on its own, just use its own high-end medical card and swipe it directly, without paying a penny.
5. High-quality medical services: Not only the hospital facilities are first-class, but also the services are in place, ensuring the privacy and comfort of patients. Experts can provide one-on-one service and provide 24-hour medical consultation and rescue services.
Second, the price of high-end medical insurance.
High-end medical insurance premiums are calculated by age, and can be bought at the age of 0-65. Generally, the older you get, the higher the premium will be. The annual premium ranges from several thousand to several hundred thousand.
Different high-end medical care will also have some differences. The more perfect the protection, the higher the premium of high-end medical insurance. You can choose the high-end medical insurance that suits you according to your own needs and budget.
Third, the difference between high-end medical care and critical illness insurance?
Many people don't understand the difference between critical illness insurance and high-end medical insurance. Today, I will give an example to illustrate the difference between the two:
Suppose someone bought one of the two kinds of insurance and accidentally got cancer, how would the two kinds of insurance be used?
If someone buys critical illness insurance: they feel unwell and go to the hospital for examination. The situation is not good. Will be diagnosed again (if it meets the definition of serious illness, you can apply for compensation from the insurance company with the medical certificate) and be hospitalized (surgery, radiotherapy, chemotherapy, etc.). ). It takes at least a week or more from applying for claims to the insurance company verifying the loan, and some of them have to be postponed, depending on the specific condition. After receiving the compensation, the whole treatment process may have lasted for some time. Therefore, critical illness insurance is not suitable as life-saving money, but only an economic compensation to fill the gap of medical expenses after serious illness and the necessary living expenses due to income interruption.
Suppose someone buys high-end medical insurance: outpatient examinations and so on are all cash-free. When hospitalization is needed after diagnosis, the insurance company should be informed, and after passing the inspection, the hospital will start treatment. After that, all expenses are settled directly by the insurance company and the hospital, and there is no need to pay for it yourself. Of course, some nutritional health products (non-medical necessities) need to pay for themselves. After a period of treatment, he was discharged from the hospital, naturally returning to recuperation, and the living expenses were continued to be solved by the previous ones.
Compared with the two, one needs to spend money to treat the disease first, and will take as much cash as possible during the period, and do whatever he wants, and how to treat it. If he is not satisfied with the medical level at home, he can go overseas as long as he has enough money. Therefore, it is particularly important to make the insured amount as high as possible. For example, the insurance coverage is only 65438+100,000-200,000, so there is little choice. Unless you pay for it yourself, if the insurance amount is several million, you can choose the medical environment and technology you want, and even have money for your postoperative recovery.
The other is that you don't have to pay for it yourself, and the insurance company pays directly. Of course, compensation is limited to medical treatment or a part of the prescribed compensation expenses, and no additional funds can be obtained. For example, the critical illness coverage of this high-end medical insurance is 6.5438+million, but the treatment cost is 500,000, so the insured can only get 500,000 medical expenses. If you buy 2 million critical illness insurance, even if the treatment fee is 500 thousand, the insured can get 2 million compensation, which is the difference between the two models.
There are also obvious differences between the two. The general payment period of critical illness insurance is 10-20 years. The insured insists on paying within the prescribed time limit, and can get cash value without serious illness at a certain age. High-end medical insurance is a form of buying one year for one year, and will not be refunded because there is no disease. Therefore, if the guests are still young, they can give priority to critical illness insurance, while some older people, especially those over 50 years old, may consider high-end medical insurance with higher cost performance than critical illness insurance.
Fourth, the "high-end point" of high-end medical insurance.
1, high coverage: most products cover more than 8 million, and some products cover as much as 20 million.
2. Wide coverage: High-end medical insurance can guarantee medical expenses worldwide at the highest level. You can choose the corresponding protected areas according to your own needs, which can generally be divided into Chinese mainland, Greater China (Chinese mainland, Hong Kong, Macao and Taiwan), Asia, the whole world except the United States, and the whole world including the United States.
3. Wide coverage: it can cover all expenses of daily hospitalization and outpatient service, as well as obstetrics, dentistry, ophthalmology, physical examination, vaccines, etc., and fully protect your health.
4. Hospitals are not limited: you can freely choose the public, private or foreign-funded hospitals that suit you, including the international medical departments or special-needs clinics of major hospitals in China, and you can also choose foreign medical institutions for treatment.
5. There are no restrictions on the types of drugs used: imported drugs and reasonable drugs needed for treatment can be used.
6. Value-added services are professional and intimate: 24-hour medical consultation hotline, all-weather private doctor-style high-end services to meet the distinguished needs of customers; Assist in booking to save waiting time; Global medical rescue service, rapid rescue, and staying in the right hospital anytime and anywhere.
7. Direct payment: You can enjoy the direct payment service through the cooperative medical network hospital of the insurance company, that is, you only need to sign at the end of the visit, and you don't need to pay for it yourself. All expenses are settled by insurance companies and medical institutions, which saves the trouble of collecting claims information and claims afterwards.
Five, choose high-end medical care should pay attention to the point.
1, medical insurance direct payment
Direct insurance payment means that the insurance company directly settles accounts with the hospital, which saves the steps of paying for the insurance company's reimbursement.
In traditional medical insurance, medical expenses can only be reimbursed by insurance companies after they are paid out of their own pockets or even several months after leaving the hospital. If the medical expenses cost millions, it will take half a year to be reimbursed, which is believed to be a great pressure on most families.
Direct insurance claims need to be applied to the insurance company a few days before admission. After the insurance company approves, it no longer needs to handle the money problem by itself, nor does it need to keep the bills, medical records and other materials by itself. Now some ordinary medical insurance has gradually begun to provide direct payment services.
Insurance companies generally have a list of direct payment hospitals, and hospitals outside the list are more likely to refuse direct payment applications, so we should pay special attention to whether there is an ideal hospital on the direct payment list.
2. Medical area/hospital
Every region has the advantages of different medical directions, and going to other places or even overseas for medical treatment has become the choice of more and more rich people and ordinary families.
The diagnosis and treatment areas of high-end medical insurance are generally divided into "global" and "global (except the United States)", because the medical expenses in the United States are particularly high (but it does not mean that the medical level is the highest), and the premiums including the United States are generally twice as high as those excluding the United States.
In recent years, high-end medical insurance has also introduced the option of "Asia" region, and the premium is more competitive, generally 20% to 30% lower than that of "the world (except the United States)", and it also includes Japan, Hong Kong, Singapore and other regions with better medical services, which is a very cost-effective choice.
In addition to the region, it should be noted that some insurance will not cover some hospitals, such as United Family, which is extremely expensive. Overseas insurance rarely covers hospitals outside the top three in the mainland. When buying insurance, you need to confirm in advance whether your ideal hospital is insured.
3. Insurance amount and out-of-pocket expenses (minimum expenses)
The insured amount is the highest amount of medical expenses that can be claimed. With the increase of the insured amount, the rising speed of the premium decreases: perhaps the insured amount has doubled ten times, and the premium has only doubled. The reason is that although high-end medical insurance is "high-end", it still does not reimburse expenses beyond the reasonable medical scope. For example, it is reasonable for patients to live in a standard single room with a TV and a toilet, but it is beyond the reasonable range to live in a seascape ward with a swimming pool. Therefore, within a reasonable range, it is difficult to reach tens of millions of expenses before the death of patients (except the United States). There is no need to stare at the maximum amount when choosing the amount of insurance.
Deductible refers to the amount you have to bear every year or every time you are admitted to the hospital, sometimes it is a fixed amount, sometimes it is a percentage. The higher the deductible, the lower the premium. Most people who buy high-end medical insurance can afford tens of millions of medical expenses. The main reason why they buy high-end medical insurance is to control tail risks, that is, those rare situations that cost hundreds of millions of medical expenses. Individuals recommend high-end medical insurance with a fixed deductible of tens of thousands of yuan, because although the unexpected (sick) expenses have increased, the inevitable (annual premium) expenses have decreased, and the unexpected expenses are also controllable.
4, premium growth rate
Now the premium, naturally everyone will pay attention, not much to say. For reference, the coverage of10 million is zero in the world (except the United States), excluding outpatient, dental and maternity insurance. For a 30-year-old non-smoker, personally, the price of around 10 thousand is more reasonable.
The increase rate of premium is easy to be ignored, and small differences will have a greater impact after ten to twenty years of compound interest and accumulation. There are two ways to increase the premium. One is that with the growth of age, the premium will increase by 2-4% every year. One is that with the expansion of medical expenses, the overall premium and insurance amount have increased. The former can be calculated by itself against the premium table, while the latter is more difficult to judge, so we can know the past premium adjustment history of this type of insurance.
5. Organ transplantation/renal dialysis/new cancer therapies
Some high-end medical institutions will have the highest compensation for organ transplantation, while others will only pay the medical expenses of organ transplant recipients, but not the medical expenses of organ providers or the expenses of organ preservation and transportation.
In addition to in-hospital dialysis, renal dialysis should also include out-of-hospital/out-patient dialysis.
With the rapid development of cancer treatment, when choosing high-end medical insurance, we need to pay attention to whether new therapies such as targeted therapy and immunotherapy are included in the "reasonable" medical scope defined by insurance.
6. Private Care/Post-discharge Service
Private nursing refers to the nursing staff who only take care of one patient and have the professional level of nurses. High-end medical insurance generally has a limit on the number of days for private care claims, such as up to 30 days a year, and the more days, the better.
Most of the expenses during hospitalization can be paid in full, and the service after discharge is the differentiation and addition of high-end medical insurance. After discharge, all high-end medical insurance will have different claims standards for follow-up, rehabilitation, psychological consultation, facial repair, home private care and even hospice care.
7, X-ray, CT, nuclear magnetic vibration inspection, etc.
After these inspections, if hospitalization is not required, some medical insurance may not be compensated; Unless the insurance indicates that the examination recommended by the doctor can claim compensation.
8. Traditional Chinese Medicine/Alternative Therapy (refers to therapies not officially approved by Western medicine)
Traditional Chinese medicine and alternative therapy are generally not guaranteed or have claims restrictions. If we value this aspect, we need to find medical insurance with higher claims limit.
9, outpatient/delivery/dental insurance
These three kinds of insurance are sometimes bound with high-end medical insurance, which increases the premium burden, and it is better to flexibly not attach these items of medical insurance.
Outpatient insurance supporting high-end medical insurance is much more expensive than ordinary outpatient insurance, so it is not recommended to attach it. If outpatient insurance is really needed, you can buy another general outpatient insurance as a supplement. In fact, even the cheap general outpatient insurance, because of its many claims restrictions, may need to see a doctor ten times a year to return to the book, healthy young adults should still buy it carefully.
Maternity insurance covers risks during pregnancy, childbirth and even the newborn. The premium is high, and there is generally a one-year waiting period (that is to say, the first claim can be made after one year of purchase, which means it takes at least two years to get pregnancy protection). In addition, the claim limit is low, and you can choose according to your own requirements.
Dental insurance is more expensive as a whole.
10, service
The service scope is very wide, such as whether the direct insurance claims are approved, whether the claims are settled, whether the new treatment can be quickly updated to the scope of protection, whether good hospitals can gradually join the list of claims hospitals, whether there are special people to follow up at any time, whether the online system is easy to use, whether there are experts and doctors to recommend, and so on. In fact, service is almost the most important part of high-end medical insurance.
No insurance can cover everything. When choosing insurance, you can focus on comparing two or three kinds of protection and services you care about, and consider how much extra premium you are willing to accept in each important aspect. For some aspects that you don't care much about, you shouldn't accept the extra premium cost for them.