Health insurance, the Chinese abbreviation of health insurance, refers to the insurance that insurance companies pay insurance money for losses caused by health reasons through sickness insurance, medical insurance, disability income loss insurance and nursing insurance.
What does health insurance cover?
There are two main contents of health insurance, one is medical expenses caused by diseases or accidents, and the other is other losses caused by diseases or accidents.
Classification of health insurance types
1, medical insurance
That is, medical expenses insurance refers to the insurance that pays the insurance premium based on the agreed medical expenses, that is, the insurance that provides medical expenses protection. It is one of the main contents of health insurance, including not only the doctor's medical expenses and operation expenses, but also the expenses of hospitalization, nursing and hospital equipment.
2. Sickness insurance
Refers to the insurance with illness as the payment condition, including general illness insurance and critical illness insurance. Usually, the insurance amount of this kind of policy is relatively large, and the payment method is generally to pay the insurance amount in one lump sum immediately after the diagnosis of a special disease.
3. Income security insurance
It refers to insurance with the condition that income is interrupted or reduced due to accidental injury or illness. Specifically, it refers to a form of insurance in which the insurer pays the insurance money in installments within a certain period of time when the insured is disabled due to illness or accidental injury.
4. Nursing insurance
Long-term care insurance is a health insurance that provides compensation for the cost of nursing services for the insured who need long-term care due to old age, illness or disability. The insurance scope is divided into four levels: medical care, intermediate care, nursing care and home care, but the early long-term care insurance products did not include home care.
How much is health insurance a year?
Therefore, depending on the type, age and coverage, the amount is different. But generally speaking, the amount of health insurance premium on the market is based on the principle that the younger the age, the less the insurance cost. Therefore, the average 0-year-old child is about several hundred yuan a year. The older the grade, the higher the cost. Generally, people aged 50 will be insured, and the annual health insurance cost will reach 5000, 6000 or even more. Therefore, if you have the financial ability, the sooner you insure, the more cost-effective.
Matters needing attention in health insurance
1. Exclude things that the insurance company will not compensate: such as pregnancy, abortion, complications caused by the above reasons, lumbar disc herniation, vision correction surgery, etc. Is not within the scope of the claims. For another example, the protection of some medical products is limited to the scope of social medical insurance, but some insurance companies can bear part of the expenses.
2. Choose the medical insurance with guaranteed renewal: During the period of guaranteed renewal, the insurance company shall not refuse to renew the insurance on the grounds that the insured's health status has changed or claims were made in the previous year, or adjust the insurance liability and liability exemption scope accordingly to avoid the embarrassment of "being healthy at ordinary times, getting sick will be gone".
3. See clearly the wait-and-see period and hesitation period: most insurance companies will stipulate a wait-and-see period for hospitalization medical insurance. The wait-and-see period is generally within 60 days or 90 days from the effective date of the contract. The insurance company will not compensate for the medical expenses incurred during the wait-and-see period. At the same time, consumers hesitate within 10 days after receiving the policy. During the period of hesitation, the applicant can propose to terminate the insurance contract, and the insurance company will unconditionally refund all the premiums.
4. Try to choose to calculate the compensation expenses as a whole: Many medical insurances have set a limit for sharing responsibility, and the part that exceeds the limit is not responsible for compensation. Therefore, it is better for the insured to choose a product that can comprehensively calculate the cost, rather than breaking down the reimbursement or subsidy according to each item. In other words, the former is paid according to the overall actual medical expenses of the insured; If reimbursement is classified according to each item, there is a certain reimbursement ratio limit in addition to meeting the upper limit of each item.
Health insurance claim process
1, claim report
If the insured unfortunately suffers from a serious illness within the validity period of health insurance, he needs to check his policy to see if his illness is within the scope of protection and report the case to the insurance company in time. After receiving the insurance, the insurance company will start the claim settlement procedure.
Step 2 accept the claim
After reporting the case, the insured needs to prepare relevant materials required for claim settlement according to the reminder of the insurance company. Generally speaking, the claims of health insurance need diagnosis certificate, outpatient medical record examination report, medical receipt and so on.
3. Claim review
The insurance company will review the claim materials submitted by the insured and make a claim decision according to the real situation of the insured.
Step 4 Pay the claim
After verifying the claims submitted by the insured, the insurance company will inform the insured of the specific claims and pay the insurance money for the claims.