Let's start with the definition: medical insurance = hospitalization and surgery insurance, excluding outpatient insurance.
Compared with ordinary medical insurance, high-end medical insurance is characterized by high coverage, full compensation for medical items, and many additional services, and the premium will be a bit higher. Here we will mainly talk about how to choose a high-end medical insurance policy with a sum insured of eight million dollars or more
Here are ten points that you can focus on when buying a high-end medical insurance policy. The order of precedence indicates the level of importance.
01
Medicare direct payment
Insurance direct payment means that the insurance company settles the bill directly with the hospital, eliminating the need to pay for it yourself and seek reimbursement from the insurance company.
With traditional health insurance, you have to pay out of your own pocket, even after you've been in the hospital for months, before you can get reimbursed by your insurance company. If you have spent millions of dollars on medical bills and have to wait for six months for reimbursement, I believe that for most families, it is a very big pressure on the flow of money.
The insurance company's direct payment system requires you to apply to the insurance company a few days before you are admitted to the hospital, and then you no longer need to deal with the money or keep your own bills and medical records after the insurance company approves your application. Now some general medical insurance policies are gradually starting to offer direct payment services.
The insurance companies usually have a list of hospitals that are not on the list, and hospitals that are not on the list have a higher probability of rejecting an application for direct payment, so you need to pay special attention to whether there are hospitals on the list that you would like to see on the direct payment list.
02
Regions/hospitals
Each region has its own advantages in terms of medical treatment, and going abroad, even overseas, has become an option for more and more rich people and ordinary families.
High-end medical insurance is generally divided into "global" and "global (except the United States)", because the United States medical costs are particularly high (however, does not mean that the highest level of medical care), including the United States region of the premiums are generally higher than the United States exclusion of twice as much.
In recent years, high-end medical insurance has also introduced the option of "Asian" region, the premium is more competitive, generally lower than the "global (except the United States)" of 20% to 30%, while including Japan, Hong Kong, Singapore and other areas with better medical services, is a very cost-effective option. is a very cost-effective option.
Besides the region, it is important to note that some insurance policies exclude certain hospitals, so when shopping for insurance, you need to check in advance whether your ideal hospital is covered.
03
Coverage and deductibles
Coverage is the maximum amount of medical expenses that can be claimed. As the sum assured increases, the premium rises at a decreasing rate: perhaps the sum assured doubles ten times before the premium only doubles. The reason for this is that although high-end medical insurance is "high-end", it still does not reimburse expenses that are beyond reasonable medical treatment. For example, it is reasonable for a patient to stay in a standard single room with a TV and a toilet, but it is beyond the reasonable range to stay in a sea view room with a swimming pool. Therefore, it is difficult for a patient to spend tens of millions of dollars before he or she passes away within a reasonable range (with the exception of the United States). When choosing the amount of coverage, there is no need to stare at the highest. Rather, choose what suits you best.
The deductible is the amount of money, sometimes a fixed amount, sometimes a percentage, that you are responsible for each year, or each time you are admitted to the hospital. The higher the deductible, the lower the premium. Most people who buy high-end medical insurance can afford to pay millions of dollars in medical bills, and the main reason they buy high-end medical insurance is to control the tail risk, which is the rare case where you have to pay hundreds of millions of dollars in medical bills. In fact, we recommend high-end medical insurance with a fixed deductible of a few tens of thousands of dollars, because while the contingent (when you get sick) expenses go up, the contingent (annual premium) expenses go down, and the contingent expenses are controllable.
04
How much premiums have increased
Current premiums, naturally, are what everyone focuses on, without saying much. As a reference, 10 million dollars of coverage, worldwide (except US), zero deductible, excluding outpatient, dental, and maternity coverage.
The rate of increase in premiums is easy to overlook, and the small difference will have a large impact after ten to twenty years of compounding and accumulation. There are two types of premium increases: one is the increase in annual premium by a certain percentage as you get older, and the other is the overall increase in premium and sum assured with medical inflation. The former can be calculated on your own against the premium schedule, while the latter is more difficult to determine by knowing the past history of premium adjustments for that policy.
05
Organ transplants/kidney dialysis/new cancer treatments
Some high end healthcare policies will have a claim maximum for organ transplants, while others will only cover the transplant recipient's medical expenses, not the provider's (which is often the recipient's responsibility as well), or the cost of preserving and transporting the organ.
Renal dialysis should include out-of-hospital/outpatient dialysis in addition to inpatient dialysis.
With cancer therapies becoming increasingly new and expensive, it is important to be aware that newer (only a decade old ......) therapies such as targeted therapies and immunotherapies are included in the definition of "reasonable" medical coverage. The insurance policy is defined as "reasonable" medical treatment.
06
Private care/post-discharge services
Private care refers to caregivers who take care of a single patient with the professional level of a nurse. High-end medical insurance policies generally have a limit on the number of days for private care claims, for example, a maximum of 30 days a year, with more days being better.
During the hospitalization period, the vast majority of the expenses can be fully claimed, and it is the service after leaving the hospital that is the differentiation and plus point of high-end medical insurance. After the hospital follow-up, rehabilitation therapy, psychological counseling, facial repair, home private care, and even end-of-life care, each high-end medical insurance will have different claims standards.
07
X-rays, CTs, MRIs and other tests
After these tests, if hospitalization is not required, some medical insurance policies may not cover them, unless the policy states that tests recommended by the doctor are covered.
08
Outpatient/delivery/dental insurance
These three types of insurance are sometimes bundled with high-end medical insurance, adding to the burden of premiums, and it's better to be able to have the flexibility not to add these items to your medical insurance.
The outpatient insurance that comes with high-end medical insurance is much more expensive than regular outpatient insurance and is not recommended. If you really need outpatient insurance, you can buy a separate general outpatient policy to supplement it. In fact, even the cheap general outpatient insurance, because of its claims restrictions, may also need to see the doctor ten times a year to return to the capital, healthy young and strong people should be careful (not) to buy (must).
Delivery insurance, which covers risks during pregnancy, labor and delivery, and even for newborns, has high premiums, a one-year waiting period (meaning that the first claim can only be made after one year of purchase, which means that at least two years of payment is required to get pregnancy coverage), and low claim limits (rarely more than 200,000 yuan), so it varies from person to person.
Dental insurance is more expensive overall and also needs to be customized.
09
Service
Service covers a wide range of areas, such as whether it's quick to approve direct insurance payments and to settle claims, whether new treatments are quickly updated to cover them, whether good hospitals are gradually added to the list of hospitals settling claims, whether there's a person available at all times to follow up on the claim, whether the online system is good to use, whether there are any specialist doctors to recommend... ...In fact, service is almost the most important aspect of high-end medical insurance. But for the average consumer, it's hard to compare services horizontally, and the only thing you can do is try to find established insurance companies and reliable insurance agents.
No insurance policy can be all things to all people. When choosing an insurance policy, you can focus on comparing two or three aspects of coverage and service that you care about, and consider how much extra premium you're willing to accept for each of those aspects. For aspects that you don't care much about (e.g., not valuing Chinese medicine, vaccines, specialist services), you should not accept additional premium costs for them.
References:
Reference 1
If you buy a high-end medical insurance policy
Do you need to buy a major medical insurance policy?
Casualty insurance generally refers to a lump sum payment in the event of a diagnosis of a serious illness. Unlike medical insurance, which provides a lump sum of cash that can be used at any time, a claim can be settled more quickly when the illness is diagnosed, rather than waiting for the medical bills to be settled, which reduces the pressure on the patient's financial resources; secondly, the claim is a lump sum of cash that can be used at any time, so a claim from a major medical insurance policy can be used as a living expense during the period of the illness, as well as a supplement, as well as a prescription, as well as a traveling expense...
Do you still need to buy a "major medical insurance"? ...Major illness insurance is weakly complementary to high-end medical insurance. Depending on the condition, it's going to vary from person to person.
Quote 2
Who is high-end medical insurance not for?
1. People who find premiums unaffordable. It is recommended to start with basic medical insurance based on affordability and then consider switching to mid-range or high-end medical insurance when your income rises.
2. People who are particularly rich, such as Li Ka-shing and Jack Ma. This type of person is recommended to buy an insurance company.
Elicitation 3
Who is high-end medical insurance for?
People with pre-existing medical conditions, especially those like breast enlargement, gastritis, tumors, etc. which are not particularly serious but can lead to items not covered by insurance. Some high-end medical insurance policies will cover pre-existing conditions, although there will be claim limits. Other high-end insurance policies have the opportunity to remove that exclusion if the disease doesn't flare up for a few years. That's sort of a hidden benefit of high-end insurance. ......
From a consumer income standpoint, in a sample of people I know, those who choose high-end medical insurance generally have annual premiums of 1-3% of their annual income, i.e., generally starting at $300,000 a year.