Underwriters, janitors, what kind of customers need physical examination, what kind of customers need to increase fees, what kind of customer companies simply can't accept direct rejection, and what kind of information or proof customers need to provide are all for them to check.
Claim, congestion, which diseases claim the most, which accidents belong to insurance liability, whether to claim, how much to pay, whether to go to the hospital for evidence, are all up to them.
They all have a common feature, that is, they have a deep understanding of medicine and insurance, and they must know a lot about which products to buy and how to buy them.
First of all, we must understand the gap between the mainland and Hong Kong's medical plans. The following will be compared from eight aspects: disease definition, coverage, claim settlement, premium, insurance amount, indisputable terms, yield and medical level:
I. Different definitions of diseases
Mainland insurance has a strict definition of major diseases, taking liver disease as an example. Mainland insurance must meet the following diagnostic criteria for "explosive viral hepatitis":
-A. Hepatic encephalopathy with disturbance of consciousness;
-B. Persistent jaundice and rapid deterioration of liver function;
-C. Diffuse destruction of hepatic lobule structure, leaving only collapsed scaffold structure. In fact, if any of A and B match, the patient can't be saved, let alone both. The diagnosis specified in c can only be the result of autopsy. It is absolutely impossible to get compensation for not dying.
2. Different coverage
Mainland insurance products cover 40 serious diseases+10 diseases in advance, and Hong Kong insurance products cover 56- 100 major diseases+18 diseases in advance (8 kinds are specially designed for children). In addition, Hong Kong products also have early disease protection and multiple disease protection, which can cover 52 additional early diseases and make 5 claims. It is worth noting that there are many diseases that are not covered by mainland insurance, such as:
1. AIDS insurance companies in mainland China will not compensate, and Hong Kong insurance policies can compensate for AIDS infected by blood transfusion;
2. Cancer in situ. The mainland will not pay for this. Hong Kong's insurance policies include breast and uterine cancer in situ, testicular cancer in situ and systemic lupus erythematosus. And pay 20% of the rights and interests first. The balance will be paid when these diseases get worse.
3. Any terminal illness. Not in the mainland, but in Hong Kong. This means that if the insured dies of a new disease, such as SARS or bird flu, the insurance company in Hong Kong will still pay the fee.
3. Different claims
The claim process of medical insurance in Hong Kong is relatively simple. If you are hospitalized due to illness, the insured will send the claim application (downloadable and printable), medical expense invoice, diagnosis certificate of serious illness and other materials to the insurance company, and the insurance company will send a check from Hong Kong. During the whole claim settlement process, the insured need not go to Hong Kong in person at all. Mainland medical insurance may also stipulate that imported drugs cannot be used, while Hong Kong insurance has no similar restrictions at all. Moreover, the insurance in Hong Kong is a global claim. No matter whether the insured is traveling or studying in other parts of the world or being hospitalized due to illness, they can make claims. The business philosophy of "strict underwriting and wide claims settlement" adopted by Hong Kong insurance companies has simple claims settlement and high success rate. Insurance companies in Hong Kong attach great importance to claims, because the quality of claims directly affects the company's image and reputation, as well as customers' confidence in the company. The integrity of Hong Kong society as a whole is high, insurance companies and policyholders trust each other, and the claim settlement process is very simple. However, some insurance companies in the Mainland have damaged the reputation of insurance, making customers feel that all insurance claims in the world are difficult.
4. Different premiums
The average life expectancy in China is 70 years, while that in Hongkong is 85 years. Therefore, at the same age, the premium in Hong Kong will be much lower. In addition, there is a big discount in Hong Kong, and people don't smoke. Sometimes the rate is only 1/2 to 1/3 in the Mainland.
Verb (abbreviation for verb) Different insurance coverage.
Take children's life insurance and critical illness insurance as examples. The maximum insurance coverage in the Mainland is only 6.5438+10,000 (the critical illness insurance coverage under 40 years old exceeds 300,000 or the life insurance coverage exceeds 500,000, which requires a medical examination), and there are about 30 kinds of serious diseases. If a serious illness happens unfortunately, 654.38+10,000 yuan is not enough for treatment in many cases. There is no such restriction in Hong Kong. In Hong Kong, below 18, the insured amount is $250,000, below 40, the insured amount is $450,000.
Different uncontroversial clauses of intransitive verbs
Regarding the "non-controversial" clause, Hong Kong stipulates that insurance companies cannot declare life insurance policies that have been in effect for more than two years "invalid" for any reason. To put it simply, the time limit for an insurance company to defend against reasons such as concealment, omission and false accusation of the insured is two years. After more than two years, the insurance company shall not refuse to pay compensation on this ground. For example, two years after signing the insurance policy, Mr. Li suddenly found himself dying of an insured disease, and his family wanted to apply for compensation. If he is in the mainland, the insurance company may refuse to pay compensation on the grounds that "the insured concealed his illness at that time", but in Hong Kong, once the two-year dispute period has passed, the "indisputable clause" can reject the insurance company's reasons, thus protecting the rights and interests of the insured.
Seven. Different rates of return
In terms of yield, the scheduled interest rate for life insurance in the Mainland is set at 2.5%. However, under the expectation of high inflation in the Mainland, the annual interest rate of 2.5% is actually negative. An insurance agent of a domestic insurance Guangzhou branch told the reporter: "In terms of yield, our products are not comparable to overseas insurance policies. Our highest expected rate of return is between 3% and 5%. The dividend rate of Hong Kong policies is generally around 5% to 9%, and it has not been lower than 5% in 65,438+00 years. "
As one of the world's financial centers, Hong Kong has fully developed its investment products, and there are more choices of insurance investment products than the mainland, which is not only safe, but also profitable. Mr. Ke, an agent of an insurance company in Hong Kong, said, "Most of the savings life insurance of some insurance companies in Hong Kong provide a yield of 65,438+00%-20%, in addition to annual cash dividends or fund balances. Dividends depend on the company's operating conditions. "
Eight. Different levels of medical care
The medical level and treatment environment in Hong Kong are better than those in the Mainland. In addition, the examination and diagnosis of mainland doctors is blunt and simple, and the whole process is very complicated: registration, pricing, payment, taking medicine, laboratory testing, making an appointment for instrument inspection, and repeating a set of processes after receiving the inspection results. Doctors in Hong Kong are kind and meticulous in examination and diagnosis, and fully show respect for patients in details. Most other things are handled by nurses, and the part that patients need to handle in person is because the program design is reasonable, people-oriented and the program is very simple. There are a large number and varieties of prescription drugs prescribed by mainland doctors, and the inspection items are complicated; The prescriptions of doctors in Hong Kong are simple and cautious, and are completely based on the necessary needs of patients. Therefore, mainlanders who go to Hong Kong for medical treatment also hope to go to Hong Kong for medical treatment when they are sick and receive better medical standards.
Most importantly, the mainland hospitalization plan can only cover hospitalization in mainland hospitals. The hospitalization plan in Hong Kong can compensate the hospitalization expenses in hospitals around the world.
The medical insurance plan is divided into critical illness insurance plan and hospitalization plan. Critical illness insurance guarantees that customers can get claims when they suffer from major diseases. Once diagnosed, they will pay a sum of money for their own use; The hospitalization plan reimburses customers for their expenses in the hospital.
People have always known the terrible degree of major diseases, but they didn't expect them to be so serious. In fact, the serious illness is getting younger and younger, and it has reached the point where it has to be prevented. Due to smoking, pollution, stress and other reasons, many diseases tend to be younger. It can be said that we have to pay attention to it and buy insurance as soon as possible!
It is even more terrible for young people to suffer from serious illness.
In a chat with a doctor, the doctor admitted frankly that in fact, the incidence of serious diseases is getting younger and younger, and young people suffer from serious diseases, which are more terrible and more difficult to cure than middle-aged and elderly people.
Because the metabolism of young people is faster, for many major diseases, fast metabolism means that cancer cells are more difficult to control. Even if it is controlled, the possibility of recurrence is greater, so the medical expenses are more and the effect is worse.
What is the insurance that must be bought?
Critical illness insurance critical illness insurance critical illness insurance important things say three times! ! ! There is no need to ask the reason, as Wang Shi said, there is no reason, just buy it.
Tell me about your understanding of critical illness insurance.
In my previous career as a doctor, I have seen too many phenomena of poverty caused by illness. Many families borrow money and sell their property to treat diseases, but the money raised may be just a drop in the bucket. As a doctor, I also deeply know that in the face of illness, everyone is equal and anyone can get sick. Of course, I didn't know what insurance was at that time.
After so many years in the insurance company, I realized that both can save people, but doctors use medical skills to save people, and insurance companies use money to save families in financial difficulties. Didn't Dr. Barnard, the founder of critical illness insurance, say that doctors can only save a person's physical life, and insurance can save a family's economic life?
When is the best time to buy?
In my opinion, the sooner the better, there are three reasons:
First, the incidence of major diseases is getting younger and younger. Just received two claims, one sudden death and one myocardial infarction, one post-70s and one post-80s, all young people. Let me tell you another number. The average age of major illness claims in the insurance industry is 42 years old, not 60 or 70 years old as we thought.
Second, the sooner you buy it, the cheaper it is. The premium for a 40-year-old may be 1.5 or even twice that for a 20-year-old, but the period of coverage is shorter.
Third, the younger you are, the better your health is, and the easier it is to pass the underwriting. A 30-year-old person may buy 700,000 critical illness insurance without a medical examination, but a 45-year-old person may need 300,000 medical examinations. If you want to buy higher insurance, check this and that. Needless to say, it may not pass.
How much is enough to buy?
This problem, like buying a car, I think the higher I can buy, the better. Of course, this is a bit unrealistic, and if you really buy enough, the budget is also a problem. Realistically speaking, I think we should buy at least 500 thousand. In fact, I bought 200,000 to 300,000 at first, but something happened around me that touched me. My friend's wife had a benign brain tumor and spent two months in the ICU of Tiantan Hospital, which cost 700,000 yuan. I heard that the family has started selling houses, and I don't know when it will end. I can't even imagine what would happen if this happened to me. The money for medical treatment, mortgage, children's daily expenses at school and home, and the money for follow-up rehabilitation are simply bottomless.
We must clarify a concept here, that is, critical illness insurance is not only the money for medical treatment, but also the cost of rehabilitation care and the loss of family income.
I now have 700,000 critical illness insurance and 300,000 cancer insurance, and I plan to buy high-end medical insurance in the future. Is it expensive? Not much at all, actually. Tell you a secret, there is a big coffee in the industry who tells people the concept of critical illness insurance everywhere. His critical illness insurance coverage is 20 million, hehe. ...
Who should buy it most?
First of all, insurance is to prevent non-financial risks that seriously affect family goals and even collapse instantly. So, who had an accident, and what would have such a devastating impact on the family? Of course, it is the mainstay of the family economy, that is, the person who earns the most money at home. So, there are only two things, accidents and diseases, right? If the work is not smooth and the investment fails, as long as the people who make money are still there, it will not have a devastating impact. As the saying goes, staying in the green hills is not afraid of burning without firewood.
This leads to the correct order of buying insurance:
First, it must be the adults first, and something happened to the child. We are hurt emotionally, but it has no effect on the economy. As long as the family's economic pillar is healthy and safe, the source of family survival will not be broken, and we can continue to earn money to treat our children.
Second, the guarantee function of insurance must be the first, and this risk transfer function can only be realized through insurance. Financial management, savings and investment should be considered after you have bought enough protection. Without 1, more zeros are useless. That's the reason.
The more kinds of serious diseases, the better?
To be honest, I have never paid attention to the types of serious diseases. According to the regulations of insurance industry association, critical illness insurance must include six compulsory diseases, malignant tumor, acute myocardial infarction, stroke sequelae, major organ transplantation, coronary artery bypass grafting and end-stage renal disease. Malignant tumor alone covers almost 60% ~ 80% or even more of all critical illness claims.
Nowadays, many companies split some diseases or list cancer details for gimmicks, and it is meaningless to claim to protect hundreds of cancers. Malignant tumor itself covers all cancers. So when I buy critical illness insurance, I don't care whether it's 35 or 60. There is no need to pay more for those diseases with extremely low incidence. Some of us don't even buy critical illness insurance, but only buy special cancer insurance, or a combination of the two.
Can I pay for the bulk purchase?
Different from expense reimbursement insurance (reimbursement refers to the money that cannot exceed the actual cost), critical illness insurance is a fixed compensation insurance. To put it simply, when this person is diagnosed with an agreed disease, such as malignant tumor, the insurance company pays in one lump sum, which has nothing to do with the actual cost, but only with the amount of critical illness insurance he has purchased. Because human life and body are priceless, the insurance company should compensate you according to the insured amount, and the claims between companies do not affect each other.
For example, this person unfortunately got thyroid cancer, and actually only spent 6.5438+million, but he bought 500,000 cancer insurance in Company A and 300,000 critical illness insurance in Company B, so he always got 800,000 claims. With this money, he doesn't have to rush back to work to earn money, he can have a good rest at home, and then return to the rivers and lakes after his health is fully recovered, and his daily expenses at home are also available, which is why we have always stressed the need to buy enough critical illness insurance protection.
Don't take chances that you and your family won't get seriously ill. After the care of medical resources, national leaders have not escaped the clutches of the disease, let alone ordinary people.
No one is poor because of buying insurance, but many families are in a hopeless situation because they don't have enough serious illness insurance. Get insurance while it's still early and healthy!
How to buy insurance in Hong Kong?
At present, many people (especially online) say that they can sell insurance in Hong Kong. In fact, most people are not qualified as legal insurance brokers in Hong Kong and have no legal working relationship with insurance companies. Buying insurance through these people does not guarantee the correct choice of products and long-term after-sales service. Therefore, if you buy insurance in Hong Kong, you must look for an insurance broker in Hong Kong to ensure your own interests.
AXA AXA medical insurance is your first choice.