Is avoid an affirmation? Are there any avoidances in a medical contract that may occur? 30

Many insurance policies will have a deductible, the deductible can avoid many low claims, sometimes some insurance will be 0 deductible as a highlight to promote, so what is the deductible? Anxious friends can take a look at this:What is the deductible?

Is the less deductible the better?

1. What is the definition of deductible?

Deductible, as the name suggests, is the amount of the deductible. It means that if the money lost by the consumer is within the range of the amount specified by the insurance company, no compensation will be paid; For example, many medical insurance policies now have a deductible of 10,000 yuan, and if you are sick, the cost of hospitalization** is not exceededTen thousandThe insurance company will not pay for it.

Because the deductible can avoid many small claims, the cost of loss claims is greatly reduced, yesReduce the operating costs of insurance companies and reduce the premiums that consumers have to pay。So deductible clauses are widely used in property, health, and car insurance.

There is also a knowledge point about the deductible insurance, which will not be repeated here, so you may wish to take a look if you are interestedWhat is deductible insurance? You'll understand after reading it!

2. Is a 0 deductible product good?

There are some medical insurance on the market with 0 deductible, so if there is 0 deductible, will the insurance company not lose money? The reason for the existence of this kind of product is also due to the fact that in recent years, there have been more consumers who are concerned about deductibles, and insurance companies are taking advantage of the 0 deductibleCatch the consumer's eye, but such a product may not be of high quality, wool out of the sheep, 0 deductible productsThe premium will be much higher than that of ordinary products, and the amount of insurance will also be greatly reduced, so that the role of medical insurance cannot be maximized.

To sum up, it is good to pay attention to the deductible when buying insurance, because the deductible of most products on the market is basically the same, so the impact of this factor can be seen as smaller.

1. What does deductible mean?

Deductible, as the name suggests, is the insurance company's "non-compensatory amount", the concept of deductible generally appears in commercial medical insurance, if the medical expenses incurred do not reach the deductible, the insurance company will not pay. The million-dollar medical insurance on the market basically has a deductible, and the amount is usually 10,000.

So the question is, is the deductible as small as possible? Not necessarily, medical insurance products with low deductibles also have problems such as high premiums, please see my article for details:Is the less deductible the better?

2. Is the deductible a "pit" for millions of medical insurance?

Of course not, a deductible is a reasonable product design that is beneficial to the insurance company and to us consumers.

1.For insurance companies, it is to prevent and control risks and save premiums. Eliminate the high volume of small claims, reduce manpower investment and operating costs, and enable insurers to provide high coverage at lower premiums.

2.For the policyholder and the insured, saving premium expenditures can purchase insurance products with high insurance amounts in a relatively economical way, prompting the insured to strengthen personal health management and strengthen the control of small risks.

So we often see some cost-effective medical insurance on the market, a few hundred dollars can buy millions of medical products, I have sorted out these good products:The top 10 million medical insurance rankings are newly released!

1. How to calculate the deductible of medical insurance?

(1) Medical insurance reimbursement is not included in the deductible

Medical insurance is a supplement to medical insurance, generally after the medical insurance reimbursement is completed, the remaining amount of the insurance company will be reimbursed, that is, in addition to the medical insurance reimbursement, the rest needs to be given by yourself, and the cost is in line with the content of the insurance, included in the deductible.

It should be noted that the amount paid in the social security personal account is equivalent to your own expenses, not social security reimbursement, and this part of the expenses can be included in the deductible.

(1) The deductible is calculated on an annual basis

The deductible of a million medical insurance plan is generally calculated on a yearly basis. Over the course of a year, your medical expenses can be added to calculate the deductible.

In addition, there are some million medical insurance plans with guaranteed renewal cycles ranging from 5 years to 6 years, and their deductibles can also be cumulative, if the amount is reached in advance, the remaining years are equivalent to 0 deductibles.

Like Alipay's "good medical insurance" medical insurance is a 6-year cumulative deductible of 10,000, which is a highlight of this productChinese Insurance [Good Medical Insurance]: There are other flaws behind the cheapness.

(3) The reimbursement part of commercial insurance can be included in the deductible

The part of the expenses that have been reimbursed by other commercial insurance can also be included in the deductible.

In addition to the million medical insurance, there is also a commercial medical insurance that is low-value medical insurance, which is complementary to the million medical insurance. Medical expenses below 10,000 yuan are first reimbursed by social security, then reimbursed with low-level medical insurance, and reimbursed by millions of medical insurance for those above 10,000 yuan, so that all medical expenses can be basically covered.

The deductible of insurance refers to:

In addition to the reimbursement of medical insurance and the reimbursement of other insurance companies, the insurance company must pay the deductible amount stipulated in the insurance contract before the insurance company pays the remaining part.

Here's an example:

Xiao Ming is taking out a medical insurance;

The amount of medical insurance is 1 millionDeductible 10,000, the reimbursement rate is 100%.

If Xiao Ming is because of surgery, inThe hospital cost 100,000After that, find an insurance company for reimbursement;

After deducting 10,000 yuan from the deductible of 10,000 yuan, it will be reimbursed according to 100%.

(100000-10000)*100%=90000 yuan

In the end, Xiao Ming can get 90,000 yuan for reimbursement.

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A simple analogy:

Absolute deductible: medical insurance, for example, the absolute deductible is 100, if you spend 200 yuan when you are sick, at this time the insurance company pays for your expenses minus the absolute deductible, which is 200-100 At this time, the insurance company will pay you 100 yuan, and if you spend 99, the insurance company will not pay.

Relative deductible: For example, if it is 200 and you spend 300 yuan, the insurance company will pay you 300 without any deduction, if it is below 200, the insurance company will not pay. Usually the deductible is relatively high.

Insurance deductible period: also known as the waiting period, or exemption period, refers to the specified period when the life insurance contract is in effect, even if an insured event occurs, the beneficiary cannot receive insurance compensation, this period is called the waiting period. The waiting period is to prevent the policyholder from taking out insurance immediately knowing that an insured event will occur, which is also known as adverse selection.

There will be a one-month deductible period for general medical insurance, and 90 days, 180 days, and 360 days for critical illness, depending on the terms of the insurance company.

That is the part to be subtracted from the calculation of compensation. If it is higher than the deductible, the remaining part will be borne according to the agreed proportion, and if it is lower than the deductible, then no compensation will be paid.

If it's an accident. You look at 500 yuan. 100 yuan is not reported (stipulated). 400 yuan must be reported for drugs such as medical insurance. It's not 400 yuan all-inclusive.

The deductible is the amount of the deductible, that is, the amount of loss is within the specified amount, and the insured bears the loss by himself, and the insurer is not responsible for the amount of compensation.

Deductibles usually come in the following forms:

Absolute deductible.

Before the insurer makes a claim, the insured has to bear a certain amount of loss.

Relative deductible.

This is a type of deductible that is often used in marine transportation insurance, and the deductible is expressed as a percentage or a certain amount.

If the loss is less than the prescribed proportion or amount, the insurer is not liable for compensation, but when the loss is higher than the specified proportion or amount, the insurer will compensate for the entire loss.

Disappearing deductible.

Depending on the deductible that disappears, the deductible decreases as the loss increases. In fact, this is not to pay for small losses, and to compensate for large losses in full.

Total deductible.

If all the losses that fall within the scope of the insurance during the insurance period are added together, if the total losses are less than the total deductible, the insurer will not pay any compensation. Once the total loss exceeds the total deductible, the insurer pays for all the excess losses.

Take the total deductible as an example:

Assuming that the annual deductible is 10,000 yuan, if you have not seen a doctor, the balance of the deductible is 10,000 yuan;

If the accumulated medical expenses within the scope of insurance liability for the first visit are 8,000 yuan, the balance of the deductible after the claim for this visit is 2,000 yuan, and the compensation is 0;

If the accumulated medical expenses within the scope of insurance liability for the second visit are 6,000 yuan, the balance of the deductible after the claim for this visit is 0, and the compensation is 4,000 yuan.

1. There is no definition of deductible

No deductible refers to the amount of loss specified in the insurance contract for which the insurance company is not liable for compensation within a certain limit. It refers to the amount of loss agreed in advance between the insurer and the insured, the insured shall bear the loss by himself, and the insurer shall not be responsible for compensation.

Are there any drawbacks to deductible products?

No deductible: the reimbursement threshold is low, **high; There is a deductible: the reimbursement threshold is high, ** low.

Does the deductible matter?

In the face of minor illnesses, the deductible raises the reimbursement threshold, and it may cost thousands at a time, which does not meet the reimbursement standard. Then this part of the money can only be paid for by yourself.

In the face of serious diseases, especially for major diseases, the cost is as little as hundreds of thousands and as much as millions. A deductible of $10,000 is definitely acceptable compared to huge medical expenses.

Therefore, when we choose medical insurance, we should pay attention to the coverage content and renewal part.

Everyone is easy to buy the wrong insurance, because the asymmetry of insurance information is very serious, it is easy to fall into the pit, carefully read the following strategy before buying insurance, which can make you spend less money: the top ten million medical insurance rankings are newly released.

3. Why is there a deductible?

Deductibles can reduce many small claims, which in turn reduces the cost of doing business for insurance companies. For example, if you spend one or two thousand at a time, after being reimbursed by social security, the out-of-pocket expenses will not be too high, and ordinary families can generally afford it.

However, for insurance companies, although the cost of a small claim is small, it accounts for a huge proportion, and even some medical expenses of hundreds of yuan are reimbursed, and the total expenses will add up to a very large amount.

In addition, if the insurance product is not operated properly, the rate may be increased for all insured persons or all insured persons of a certain age group, and after the loss reaches a certain level, there may even be a risk of discontinuation.

By setting a deductible, you can reduce the risk taken by the insurance company, and then the risk of the product going out of sale will also be reduced. At the same time, because the operating cost is reduced, it can also be lower.

No, the hospital signed a preoperative agreement to avoid risks and avoid all possible dangers during and after surgery, so as to minimize the risks of the hospital.

The duration of medical treatment is determined on the basis of years of service, and wages are paid at a rate of not less than 80 per cent of the minimum wage.

The principle of calculating the medical treatment period based on the number of years of service of the person.

If the medical treatment period is three months, the accumulated sick leave time within six months shall be calculated; 6 months is calculated based on the accumulated sick leave time within 12 months; Nine months shall be calculated as the accumulated sick leave time within 15 months; 12 months shall be calculated as 18 months of accumulated sick leave; 18 months is calculated based on the cumulative time of illness in 24 months; 24 months shall be calculated based on the accumulated sick leave time within 30 months.

There are two main aspects of the provisions on the medical treatment period in the labor law:

First, the employer shall not terminate the contract "within the prescribed medical treatment period if the employee is sick or injured".

Second, the employer may terminate the labor contract when "the employee is sick or injured not due to work, and after the expiration of the medical treatment period, he is unable to perform the original job or the work arranged by the employer".

However, in such a situation, in addition to the economic compensation given to the worker according to the regulations (according to the number of years the worker has worked in the employer, one month's salary shall be given after one year), a medical subsidy shall also be given to the worker who is not less than six months' salary.

Provisions on the medical treatment period for employees of enterprises who are sick or injured not due to work.

Article 2 The period of medical treatment refers to the time limit within which an employee of an enterprise may not terminate the labor contract due to illness or non-work-related injury, stop working, receive medical treatment and rest.

Article 3 When an employee of an enterprise needs to stop working for medical treatment due to illness or non-work-related injury, he or she shall be given a medical treatment period of three months to 24 months according to his actual working years and the number of years he has worked in the unit

1) Where the actual working experience is less than 10 years, three months for those who have worked in the unit for less than 5 years; Six months for more than five years.

2) Where the actual working experience is more than 10 years, the working experience in the unit is less than 5 years, and 6 months is the actual working experience; 9 months for those between five and ten years; 12 months for between 10 and 15 years; 18 months for between 15 and 20 years; 24 months for more than 20 years.

Article 4 Where the medical treatment period is three months, the accumulated sick leave time within six months shall be calculated; 6 months is calculated based on the accumulated sick leave time within 12 months; Nine months shall be calculated as the accumulated sick leave time within 15 months; 12 months shall be calculated as the accumulated sick leave time within 18 months; 18 months shall be calculated based on the accumulated sick leave time within 24 months; 24 months shall be calculated based on the accumulated sick leave time within 30 months.

Circular of the Ministry of Labor on the Implementation of the Regulations on the Medical Treatment Period for Sick or Non-work-related Injuries of Enterprise Employees.

1. On the calculation of the medical period.

1 The calculation of the medical treatment period shall be calculated cumulatively from the first day of sick leave. For example, if an employee who is entitled to a three-month medical treatment period takes sick leave for the first time from March 5, 1995, the employee's medical treatment period shall be determined between March 5 and September 5, and the accumulated sick leave of three months during this period shall be deemed to have expired.

And so on.

2 During sick leave, public holidays, holidays and statutory holidays are included.

2. On the issue of the medical treatment period for special diseases.

According to the current actual situation, for certain employees suffering from special diseases (such as cancer, mental illness, paralysis, etc.) that cannot be cured within 24 months, the medical treatment period may be appropriately extended with the approval of the enterprise and the competent labor department.