Critical illness insurance belongs to health insurance. Under the new regulations, we evaluated more than 1000 critical illness insurance products, and screened out the ten best critical illness insurance products on the market. The new definition of serious illness ranking is announced! The first place is it! 》
1, medical insurance
It refers to an insurance in which both parties agree on medical expenses as a condition for paying insurance benefits. When the insured falls ill or has an accident, the insurance company needs to compensate the insured with a corresponding proportion of insurance money according to the agreement. The coverage includes: medical expenses, hospitalization expenses, operation expenses, medical equipment expenses, nursing expenses, etc.
2. Sickness insurance
This kind of health insurance mainly guarantees the serious illness of the insured, and the insured pays the insurance premium in advance. If a serious illness occurs during the insurance period, the insurance company must pay the insurance amount in one lump sum. Usually, the insurance amount of such policies is relatively large.
3. Income security insurance.
It refers to an insurance in which the insurance company must pay the insurance premium in installments within a certain period of time in accordance with the agreement when the insured loses the ability to work due to accidental injury or illness and loses or reduces income.
4. Long-term care insurance
It refers to an insurance that the insurance company provides nursing guarantee and economic compensation when the insured loses the ability of daily living or is sick in old age. The insurance scope is divided into four levels: medical care, intermediate care, nursing and home care. The coverage of health insurance.
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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.
Relevant laws include health insurance management measures.
Classification, Editing and Broadcasting of Insurance Types
medical insurance
That is, medical expenses insurance refers to the insurance that pays insurance money according to 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.
sickness insurance
Refers to the insurance with illness as the payment condition, including general illness insurance and critical illness insurance. Usually, the insurance coverage of this policy is relatively large, and the payment method is generally to pay the insurance coverage in one lump sum immediately after the diagnosis of a special disease [1].
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.
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.
Main source editing and broadcasting
Insurance is divided into two categories: property insurance and life insurance. Health insurance is an independent insurance, paid by individual insurance. [2]
Editing and broadcasting of insurance clauses
In the health insurance contract, in addition to the grace period clauses, recovery clauses and incontestable clauses of general life insurance, the insurer also stipulates some special clauses, namely the unique clauses of health insurance, because the risks of health insurance are variable, unpredictable and risky.
age
People of different ages have different health conditions, and people who are too old or too young have higher health risks than ordinary people. Therefore, age is an important factor that insurance companies should consider when deciding whether to underwrite. Generally, the underwriting age of health insurance is more than 3 years old and less than 60 years old, and in some cases it can be relaxed to 0~70 years old.
In addition, people's gender also has a great relationship. Generally speaking, women's life expectancy is longer than men's, and their health status is better than men's, so men's insurance coverage rate is higher than that of women of the same age.
Physical examination clause
It allows the insurance company to appoint a doctor to carry out a physical examination on the insured who makes a claim, so that the insurance company can evaluate the validity of the claim. The medical examination clause applies to disability income compensation insurance.
Observation period clause
Based on limited data such as medical records, it is difficult to judge whether the insured suffers from a certain disease at the time of insurance. In order to prevent people with pre-existing diseases from taking out insurance and ensure the interests of the insurer, the observation period (mostly half a year) should be stipulated in the policy. During this period, the insurer will not be responsible for the medical expenses or income loss caused by the insured's illness, and the policy will not take effect until the observation period expires.
That is to say, the insurer may refuse to bear the responsibility according to the principle of utmost good faith if the disease broke out during the observation period is assumed to have existed before the insurance. If the subject matter insured is lost due to exemption during the observation period (such as the death of the insured due to illness), the insurance contract is terminated and the insurer will refund the insurance premium after deducting the handling fee; If the subject matter insured is not lost, the insurer shall decide whether to renew the insurance according to the physical condition of the insured, or may terminate the insurance contract on the grounds of increased danger.
Waiting period clause
The so-called WaitingPeriod, also known as deductible period, refers to a period of time from the occurrence of diseases, births, diseases, disabilities and deaths caused by health insurance to the payment of insurance benefits. In the insurance contract of health insurance, "waiting period" is usually added to the clause of "application and payment of insurance benefits", and the time is different.
Deduction compensation clause
In health insurance contracts, medical expenses are generally deductible, that is, expenses below a certain amount are borne by the insured, and the insurer will not pay.
Payment limit clause
In the compensatory health insurance contract, the maximum amount of medical insurance premium paid by the insurer is stipulated, such as the limit of single disease, the limit of hospitalization expenses, the limit of operation expenses and the limit of outpatient expenses.
The insured individuals in health insurance vary greatly, and so do their medical expenses. Therefore, in order to protect the interests of the insurer and most of the insured, the maximum payment limit of medical insurance benefits can be stipulated to control the total expenditure level.
For health insurance with the nature of fixed insurance, such as critical illness insurance, there is usually no compensation limit, but fixed compensation is implemented according to the agreed insurance amount. [3]
Concepts related to editing and broadcasting
Unlike life insurance, health insurance takes a person's life as the insured object. The insured object can be a person's body, health status, physical accident and the body that needs care after the accident, such as long-term illness insurance, short-term medical insurance and short-term accident insurance! Every insurance company's products are different, but they are roughly the same!
Long-term health insurance refers to the health insurance that the insurance period exceeds one year or the insurance period does not exceed one year, but contains the guarantee renewal clause.
Short-term health insurance refers to health insurance with an insurance period of one year or less and without a guarantee renewal clause.
The guarantee renewal clause refers to the contract that after the expiration of the previous insurance period, if the applicant applies for renewal, the insurance company must continue to underwrite the insurance at the agreed rate and the original clause.
Medical insurance in health insurance claims can be divided into cost compensation medical insurance and fixed payment medical insurance according to the nature of insurance claims.
Cost-compensated medical insurance refers to medical insurance that determines the amount of insurance money according to the actual medical expenses incurred by the insured and the agreed standards.
Fixed payment medical insurance refers to the medical insurance that pays the insurance premium according to the agreed amount.
The payment amount of cost compensation medical insurance shall not exceed the actual medical expenses incurred by the insured. [4]
Service mode editing and broadcasting
The payment of health insurance usually includes two parts: compensating the living expenses of the insured when he is unable to work due to short-term illness and providing medical services for the insured. There are three ways to provide medical services:
(1) pay the expenses directly to the institutions providing medical and health services;
(2) The medical expenses shall be paid in advance by the sick insured and then compensated by the insurance institution;
(3) Medical and health care services are provided by insurance institutions or medical institutions directly established by the government.
The sources of health insurance are generally insurance premiums paid by the insured and their enterprises and government financial subsidies. The payment method of insurance premium can be allocated from general tax, or health insurance tax can be levied separately.
Different countries have different levels of medical insurance benefits, and different people in the same country enjoy different benefits. Some give full compensation for medical expenses; Some outpatient expenses are not compensated, but only hospitalization expenses; Some have specific regulations on the amount of compensation for drugs and various services. Generally speaking, patients have to bear a small amount of expenses.