Accident insurance is life insurance that pays benefits on the condition that the insured suffers death or disability due to accidental injury.
Health insurance refers to insurance that pays benefits for losses caused by health reasons through sickness insurance, medical insurance, loss of income insurance for incapacity and nursing care insurance.
What does an accident insurance claim cover?
1. Accidental Death Benefit
Most of the accidental insurance policies have accidental death coverage. If the insured dies due to an accident, the beneficiary can apply for a claim from the insurance company. The insurance company will pay the basic coverage for accidental death, but for minors, there is a limit on the amount of coverage for accidental death. 200,000 yuan is the maximum amount payable for accidental death of a minor aged 0-9 years old, and 500,000 yuan is the maximum amount payable for accidental death of a minor aged 10 years old to 17 years old.
2. Accidental Disability Benefits
Accidental disability is paid according to the proportion, and the proportion is different for different levels of disability. First-degree disability pays the highest percentage, 100% of the basic sum insured; second-degree disability pays 90% of the basic sum insured; third-degree disability pays 80% of the basic sum insured, and tenth-degree disability pays the lowest percentage, 10% of the basic sum insured.
3, accidental medical benefits
Accidental medical responsibility is more practical, generally an insurance policy for accidental medical coverage of most of the 10,000-20,000 yuan, accidental medical claims should consider the amount of coverage, deductible, whether to pay for out-of-pocket expenses, whether to limit the hospital level, the percentage of benefits and other information.
4. Accidental hospitalization allowance
Part of the accidental insurance has the responsibility of accidental hospitalization allowance, if the insured person is hospitalized due to accidental reasons, the hospitalization allowance can be paid. Accidental hospitalization allowance payment should be clear about the insurance contract on the number of days of deductible, single payout days limit, cumulative payout days limit and other information.
The standard of personal accident insurance disability appraisal
The standard of personal accident insurance disability appraisal is based on the Standard of Personal Insurance Disability Appraisal issued by the China Insurance Association (CIIA [2013] No. 88, jointly issued by the China Insurance Association and the Chinese Society of Forensic Science, June 8, 2013).
According to the "Personal Insurance Disability Evaluation Standards", accidental disabilities are divided into 1 to 10 levels, i.e. ***10 disability levels, which are paid out at 100% to 10% respectively, and contain 281 disability items in 8 major categories. If the same accident caused by several different disability levels, the heaviest disability level as the final conclusion of the assessment; if two or more than two disability levels are the same, the disability level in the original assessment on the basis of up to one level, the highest promotion to the first level.