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Medical insurance or serious illness insurance, are you really clear?

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1 Net red medical insurance boom


Medical insurance has experienced explosive growth in the past two years, which is due to the strong push of “Net Red Million Medical” and Internet insurance platforms.

High insurance, low premiums, no social security reimbursement, everyone can afford to buy a lot of attractive insurance responsibilities, so many consumers are rushing to insured. Various insurance companies have also launched "Millions of Medical" products one after another.

Today, we mainly come to understand and analyze the medical insurance represented by “Millions of Medical Treatment” and the similarities and differences between medical insurance and critical illness insurance.


2 What is medical insurance?


Medical insurance, full name: medical expenses insurance. It refers to the insurance that guarantees the medical expenses incurred during the medical treatment period, and it is one of the main contents of health insurance.

Health insurance is divided into four categories: medical insurance, sickness insurance, disability income loss insurance, and nursing insurance . Medical insurance and sickness insurance are the most common.

The role of medical insurance is mainly to provide compensation for the medical expenses of the insured. Usually the total amount of medical insurance claims does not exceed the total medical expenses of the insured.

According to the different levels of protection, the author divides the medical insurance in the market into four categories: general inpatient medical care, secondary mid-end medical care, mid-end medical care, and high-end medical care (see the figure below).

Medical insurance classification



3 What is the critical illness insurance?


Major illness insurance is a health insurance product that pays insurance premiums when the insured person has a disease contracted during the insurance period, has reached the agreed disease state, or has performed an agreed surgery.

The fundamental purpose of major illness insurance is to provide financial support for the treatment of serious and costly diseases.

Critical illness insurance also belongs to health insurance and is classified under sickness insurance. In addition to major illness insurance, sickness insurance also includes malignant tumor insurance.

Major illness insurance is not only used to compensate for medical expenses , but more importantly, it is to continuously guarantee the cost of follow-up rehabilitation and compensation for loss of income during the rehabilitation period . It is one-sided and inappropriate to treat critical illness insurance as a medical expense compensation tool.

According to the characteristics of the product and the main functions, the author also subdivided many major disease insurance products on the market into various types, as shown in the following figure.

Critical illness classification



4 common ground


First, the same health insurance

Both medical insurance and critical illness insurance can provide financial support for the insured's physical health loss, which will help restore health.

Second, can provide financial support for major disease treatment

Medical expenses incurred in the case of diseases, disease states, and surgery as stipulated in major disease contracts are also covered by medical insurance. In the case of a serious illness, you can use a critical illness insurance or a medical insurance claim.

The author found that some insured people believe that the protection of medical insurance is more comprehensive and the cost is lower. It is felt that medical insurance can completely replace critical illness insurance as the main means of health protection.

However, as the different types of insurance for critical illness insurance and medical insurance, the main guarantees and problems are different. There are many differences. We should fully understand the similarities and differences between the two types of products, so as to better choose the right ones. product.


5 points of difference


1. Cost compensation type or fixed amount payment type

Medical insurance belongs to the cost compensation type. Generally, the amount of claims does not exceed the total medical expenses, that is , how much is spent and how much is reported .

If there are still deductibles, self-pay ratios, and social security coverage, the cost of reimbursement for medical insurance will be less.

For example, a hospitalization cost 100,000 yuan (all of which are insurance liabilities), of which 80,000 belong to the scope of social security and 20,000 belong to social security. Part of the social security coverage was reimbursed by social security for 60,000 and the remaining 20,000. If you use a medical insurance product that is not limited to social security reimbursement and 100% payment, you can claim the remaining 40,000.

The critical illness insurance is the condition of the contract, and the amount of insurance purchased directly (buy 100,000, pay 100,000; buy 500,000, pay 500,000). There is no requirement for the use of insurance money, the insured can handle it by himself, can be used for disease treatment, and can be used as other ways.


Second, after-the-fact remedy or ex ante support

Medical insurance generally requires the insured to advance medical expenses (except for high-end medical treatment that can be paid directly). After the treatment is completed, apply to the insurance company for claims.

If there is a large expenditure that exceeds the family's ability to withstand, it will inevitably put a huge test on the timely and adequate treatment of family finance and the insured. Including the loss of income during the treatment period, or the loss of income of the family members providing care, cannot be covered.

——A medical insurance insurance application request



Most cases of serious illness insurance are the first time the disease is diagnosed and can be settled (of course, some diseases belong to the surgical responsibility, and some diseases belong to a disease state, otherwise, it is not necessary), and it is not necessarily required to pay the treatment fee first. .

When there is a real major illness, hundreds of thousands to millions of medical expenses are generally needed. At this time, critical illness insurance can really provide support. The medical insurance needs to be paid, and you must first make a huge amount of money. If the family's economic strength is insufficient, it may be affected by the cost problem in the early stage of treatment, and it will be affected in time.


——A certain severe illness insurance liability regulations


——Application for a critical illness insurance policy



Third, insurance liability, disease level requirements are different

The insurance coverage of medical insurance covers a wider range. It does not distinguish between accidents or diseases. It does not distinguish whether it meets the requirements of certain diseases or claims conditions (such as major diseases). As long as it is reasonable and necessary medical expenses, you can apply for claims. The conditions for claims are more general.

At the same time, the subdivided responsibility for medical insurance and the various fee limits are very detailed, and some fees set the limit or the proportion of claims. It does not mean that all claims within the scope of medical insurance can be settled.

The diseases of severe illness are generally more serious, and the required treatment funds, rehabilitation time, and continuous treatment requirements are relatively high.

Relatively speaking, the main responsibility of critical illness insurance is simple. For the definition and standard of primary responsibility, each company is similar and relatively easy to understand.


Fourth, the renewal regulations are different

In the case of the usual critical illness insurance products, the guarantee period is lifelong (except for regular heavy illnesses). The maintenance period is valid for life regardless of whether the payment period is completed or not. Naturally, there is no obstacle to renewal.

However, there are also shortcomings in the critical illness insurance. Most of the critical illness insurance is a one-time claim. After the contract is completed, the insured will no longer have the protection of serious illness. In recent years, new products that have been repeatedly paid for heavy illnesses are also a way to solve multiple claims for serious illnesses.

The current medical insurance products are almost all short-term health insurance, and there is no strict "guarantee renewal" clause. Although many companies are committed to renewing their insurance to 80, 85, 99, etc., there is actually a risk that they cannot be renewed.

We review the “Health Insurance Management Measures”. Most of the current medical insurance products are short-term health insurance products that do not contain the “guarantee renewal” clause, which means that the insurance company has the right and may stop selling or no longer accept according to market conditions. Renewal. Even companies that have the conditions to write "guarantee renewal" clauses (life insurance, health insurance companies) basically do not join the clause, but also because of their own risk aversion considerations, after all, the changes in medical and disease risks are large, actuarial It is also more difficult.


Health Insurance Management Regulation Article health insurance according to the insurance period is divided into long-term health insurance and short-term health insurance.
Long-term health insurance refers to health insurance that covers more than one year of insurance or that does not exceed one year during the insurance period but contains guaranteed renewal terms.
Short-term health insurance refers to health insurance that covers one year and less of the insurance period and does not contain guaranteed renewal terms. The guarantee renewal clause means that after the expiration of the previous insurance period, the applicant shall file an application for renewal, and the insurance company must continue to underwrite the contract in accordance with the agreed rate and the original terms.
Article 7 A life insurance company and a health insurance company established according to law may, after being approved by the China Insurance Regulatory Commission, operate a health insurance business. Insurance companies
other than those specified in the preceding paragraph may be operated by the China Insurance Regulatory Commission and may operate short-term health insurance business.

——A medical insurance renewal policy



V. Differences in exemption clauses

The exemption clauses for critical illness insurance are relatively fixed and relatively simple. They are generally eighty-nine. The difference between the exemption clauses of various critical illness insurances is not too great.

——Exemption from liability for a major illness clause


Due to the detailed sub-responsibility requirements of medical insurance , the provisions of various fee limits are very specific, and the differences in insurance liability settings are enormous. Therefore, the liability for medical insurance clauses is exempted, and the differences between companies and different products are also very large. The medical insurance exemption clause is particularly meticulous and must be carefully studied.


——A medical insurance clause liability exemption


Six, the difference in rates

Medical insurance is generally a natural rate . Buy one year and keep it for one year. Premiums continue to grow with the age of the insured (and may continue to decrease during the minor years) and continue to pay until the end of the coverage period. Young people's premiums are generally very cheap, but by the age of 50 or 60, or even 70 or 80, premiums are relatively expensive.

In this case, some policyholders may choose not to renew their insurance due to premium issues, which is also a possible risk for us to buy medical insurance.

Critical illness insurance is generally a balanced rate . The annual premiums, payment deadlines, and guarantee periods are determined from the outset, and the total amount of guarantees is also determined. Relative to medical insurance, critical illness insurance products are more certain for the targeted protection of major diseases.

In summary, the author mainly draws a conclusion.

Medical insurance is irreplaceable for critical illness insurance;

Critical illness insurance is irreplaceable for medical insurance;

Their respective roles are unique.


6 Summary and recommendations


First, medical insurance and critical illness insurance have different functions and complementary functions.

Major illness insurance is the most important solution for the risk of serious illness. Families considering the risk of insurance transfer to critical illness are generally unable to afford the risk or affordability of serious illness. At this time, the insurance premium paid by the critical illness insurance is particularly important.

The main role of medical insurance is to cover the affordability of the family's economic ability, general illness, accidental hospitalization expenses reimbursement (such as annual hospitalization costs of 20,000 or hundreds of thousands, depending on the family's economic ability). Medical insurance can cover major disease responsibilities, but only if the family has the ability to advance: the first treatment cost of severe illness, the cost of follow-up rehabilitation treatment, but the loss of income during the period is borne by itself.

The two are not opposites. The combination of the two can provide differentiated protection and cover a wider range of insurance liabilities. The general hospitalization expenses for non-heavy illnesses can be solved by medical insurance. The cost of major diseases, first use critical illness insurance, and then use medical insurance. It is not better to achieve stronger protection.


Second, consider the order of health insurance

According to the principle of low frequency and high risk of priority transfer, the risk of major diseases should be the first choice for ordinary families to consider health protection. Super local tyrants may not consider it.

Medical insurance is also an important option for ordinary people to consider health insurance. It is not as urgent and important as critical illness insurance, but the supplementary protection provided is also very important.

For very wealthy families or high-net-worth families, they have sufficient funds to solve the problem of seeing a doctor. The role of critical illness insurance may not be so important. At this time, the value of high-end medical insurance products may be more optimistic (medical direct payment services, provision of high-end medical resources, etc.).


Third, can not take medical insurance as a serious illness insurance

For ordinary people/ordinary families, medical insurance is not suitable as the only health insurance plan. We should not be immersed in the protection of the “million medical care” vain, or try to solve all health insurance with only mid-end medical insurance.

The role of each type of product is limited, and different risks require different solutions. Major illness insurance cannot be applied to all situations, as is medical insurance.

In short, insurance should be matched as needed. Different family situations and different needs correspond to different solutions. Insurance products are only tools for solving problems.



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