(1) According to the payment method, it can generally be divided into three types:
1. Benefit type, the insurance company pays the insurance money to the insured by the contract when the insured suffers from the disease stipulated in the insurance contractor occurs under the conditions stipulated in the contract. The amount of insurance money is determined. Once diagnosed, the insurance company will pay the insurance money in one lump sum according to the insurance amount stated in the contract. The major illness insurance of various insurance companies is a benefit type.
2. Reimbursement type, the insurance company reimburses the various medical expenses paid by the insured according to the proportion agreed in the insurance contract. Such as hospital medical insurance, accident medical insurance, etc. belong to reimbursement type.
3. The subsidy type, the insurance company pays the insurance money according to the actual hospitalization days of the insured and the operation items. Insurance benefits are generally calculated daily, and the total amount of insurance benefits varies depending on the length of hospital stay and the surgical items. Such as hospital medical subsidy insurance, hospital security insurance, etc. belong to the subsidy type.
(2) According to the division of insurance liability, it can also be divided into three types:
1. Sickness insurance(critical illness insurance) with illness as the condition of paying insurance benefits. That is, as long as the insured suffers from a disease listed in the insurance clause, regardless of whether or how many medical expenses are incurred, the insurance company will receive a fixed amount of compensation.
2. Medical insurance with the agreed medical expenses as the condition of paying insurance benefits. That is, when the insured receives medical services, the insurance company will compensate according to a certain proportion and limit.
3. Income protection insurance based on the interruption or reduction of income due to accidental injury or illness as the condition of paying insurance benefits. That is, when the insured loses or reduces his ability to work due to accidental injury or disease, the insurance company will compensate the loss of income according to the agreed standard.
Features of health insurance
1. Continuing Effective Terms
The coverage period for health insurance is usually one year. General health insurance clauses specify the conditions under which the policy lapses and under which conditions it can be automatically renewed. Common methods include the following:
(1) Term insurance policy. This type of policy specifies an expiration date, and once it expires, the insured must re-insure. During the insurance period, the insurer cannot propose to rescind or terminate the contract, nor request to change the premium or insurance liability. However, when the insured re-insures after the expiry of the contract, the insurer has the right to refuse coverage or request to change the premium or insurance liability.
(2) The policy can be canceled. For this type of policy, the insured or the insurer can propose to terminate the contract or change the premium, contract conditions, and coverage at any time. However, when the insurer proposes to terminate the contract or change the contract conditions and coverage, the insured shall still be liable according to the originally stipulated contract conditions and coverage for the insured accident that has occurred but has not been dealt with. The advantage of this policy is that the insurer bears less risk, so its cost is low, and the requirements for underwriting conditions are not strict.
(3)Renewal of insurance. When the insured renews the insurance, there are generally two different renewal clauses, one is the conditional renewal. As long as the insured meets the conditions set out in the contract, their contract can be renewed until a specified time or number of years. The second is guaranteed renewal. This policy provides that as long as the insured continues to pay premiums, the contract can continue to be valid until a specified age. During this period, the insurer cannot unilaterally change any conditions in the contract.
(4) Non-cancellable terms. That is, for both the insured and the insurer, the insurance contract can not be canceled, and the insured cannot request a refund. However, if the insured fails to pay the premium, the insurer can automatically terminate the contract.
2. Strict coverage conditions
The underwriting conditions of health insurance are generally stricter than those of life insurance. Because the disease is the main risk of health insurance, the factors that cause the disease need to be strictly examined. Generally, it is judged based on the medical records of the insured to understand the past of the insured’s body. history, current medical history, and sometimes the family medical history of the insured.
In addition, the occupation of the insured and the geographical location and lifestyle of the insured should also be assessed. In terms of underwriting standards, there are generally the following provisions:
(1) Observation period. Since it is difficult to judge whether the insured has suffered from certain diseases only based on the previous medical records, to prevent the insured who has suffered from the disease from applying for insurance, sometimes an observation period or exemption period is required in the insurance policy, and the observation period is generally half a year. , the insured will not be responsible for medical expenses and income losses due to illness during the observation period, and the policy will not come into effect until the end of the observation period.
(2) Secondary health insurance policy. For the insured who cannot meet the physical health requirements stipulated in the standard clauses, the insurance is generally covered by the sub-health insurance policy. At this time, two methods may be adopted: one is to increase the premium, and the other is to re-specify the coverage. It is not covered until a disease or certain insurance liability is excluded as an endorsement.
(3) Special disease insurance policy. For the special diseases suffered by the insured, the insurer formulates special clauses to cover the specified special diseases.
3. Deductible Clause
One of the main features of health insurance is the deductible clause, which benefits both the insurer and the insured. When it comes to medical expenses, the policy sets out a deductible, which is the minimum amount the insurance will pay. The insurer is only responsible for the excess over the deductible.
There are generally three types of deductibles:
One is the single indemnity deductible. the amount for each indemnity;
The second is the annual deductible amount, which is based on the total annual indemnity. Payment will be made after the amount exceeds one year;
The third is the collective deductible, which is for the insured in the group, and for the same accident, it is calculated by accumulating the expenses of all members.
After the deductible is stipulated, a small number of medical expenses shall be borne by the insured, and a large number of medical expenses shall be borne by the insurer. This practice is based on the underwriting theory that a certain percentage of out-of-pocket expenses motivates the insured to work toward recovery without utilizing unnecessary services and medical equipment; and does not mean that health insurance Taking medicine, hospitalization, and medical insurance is not unlimited.
4. Payment Conditions
In the event of an insured accident of health insurance, the insurer will provide insurance benefits for reasonable and necessary expenses. The expenses that can be paid include outpatient expenses, medical expenses, hospitalization expenses, nursing expenses, hospital miscellaneous expenses, operation expenses, various inspection expenses, etc. Medical expense insurance generally stipulates a maximum insurance amount. The insurer pays the expenses incurred by the insured within the limit of the insurance amount. When the limit is exceeded, the insurer stops paying. In a year, when the accumulated medical expenses exceed the deductible (it can also be calculated on a per-time basis), the insured is eligible to apply for payment of various medical expenses.
5. Insurance rates
The factors that determine the rate of health insurance mainly include disability rate, interest rate, expense rate, etc. The amount of health insurance premium is proportional to the level of disability rate and expense rate, and inversely proportional to the interest rate. In addition, the deductible is closely related to the premium rate, the higher the deductible, the lower the premium; conversely, the lower the deductible, the higher the premium. The rate of health insurance is determined mainly based on the occupation, gender, age, insurance amount, and type of payment of the insured. Among them, the occupation is particularly important. Generally, it is classified according to the size of the occupational risk, and the rate is stipulated, and the age factor is not as important as life insurance.