Student social security card-one old and one young.

The so-called "one old and one young" is the medical insurance for serious illness of students and children and the medical insurance for serious illness of the elderly in cities and towns. The medical insurance for serious illness of students and children was implemented from September this year 1, and the latter was implemented from June this year 10.

During the enrollment process, some parents asked: If you have already bought commercial insurance, can you not buy social security? What is the difference between "one old and one small" and the corresponding commercial insurance? What about the children who used to participate in the Red Cross Children's Mutual Fund?

This newspaper interviewed the medical insurance department of the Municipal Labor and Social Security Bureau and relevant persons of insurance companies on these issues, and made a detailed interpretation for readers.

The difference between social insurance and commercial insurance

Difference one

Social insurance-non-profit

Commercial insurance-making money

According to Jiang Jiyuan, director of the Medical Insurance Department of the Municipal Labor and Social Security Bureau, the most essential difference between social insurance and commercial insurance is non-profit.

Social insurance is unprofitable insurance, and the premium it raises can only be used for the insured and the fund is special.

In addition, the expenses of social insurance agencies are paid by the government, and two lines of revenue and expenditure are strictly implemented.

Commercial insurance is for profit, and the commission of insurance agent and the operating cost of insurance company should be paid from the insurance premium of the insured.

Difference 2

Social insurance-unconditional

Commercial insurance-required

Jiang Jiyuan said that people do not need a medical examination to participate in social insurance. In other words, social insurance does not exclude people with diseases, even if they are seriously ill, they can still participate in insurance.

Commercial insurance is to prevent sick people from participating in insurance, or to raise the premium of sick people. Commercial insurance is to establish a risk protection system among healthy people.

Difference three

Social Insurance-Annual Report

Commercial insurance-one-off.

According to reports, the guarantee standard of "one old and one small" in critical illness insurance is: the threshold for reimbursement for the elderly is 1.300 yuan, and the excess is reimbursed at the rate of 60%. The cumulative maximum payment in a medical insurance year is 70,000 yuan.

The threshold for reimbursement of students and infants is 650 yuan, and the excess is reimbursed by 70%. The cumulative maximum payment in a medical insurance year is 1.7 million yuan.

The above provisions can generally be understood as: social insurance is settled annually, and the next year can enjoy the same treatment. Although the maximum annual reimbursement amount is 6.5438+0.7 million yuan (for children) and 70,000 yuan (for the elderly), it can still be reimbursed so much in the second year, which solves practical difficulties and reduces risks for people who are really sick.

According to Jiang Jiyuan, in order to let citizens actively participate in insurance, some incentive policies may be introduced in the future. For example, continuous participation in insurance may increase the reimbursement ratio.

In commercial insurance, critical illness insurance is only insured once, that is to say, it is a one-time payment: hospitalization medical insurance can reimburse multiple hospitalizations within the insured amount.

Difference 4

Social insurance-government help

Commercial insurance-out of pocket

The "one old and one small" critical illness insurance is jointly funded by the government and individuals. For the elderly, the government is the "big head", that is, the funding standard for urban elderly medical insurance is 1400 yuan per person per year, in which individuals pay 300 yuan and the financial subsidy is 1 100 yuan; The funding standard of medical insurance for serious illness of students and children is 100 yuan per person per year (calculated by academic year), in which individuals or families pay 50 yuan and financial subsidies are given to 50 yuan.

Commercial insurance is entirely funded by the insured himself.

Expert support insurance

Social security provides basic protection.

Increasing commercial insurance is icing on the cake.

Then, for children, if they buy the "one old and one young" critical illness insurance, don't they need to buy commercial insurance? Wang Yanan, financial consultant of China Ping An Insurance Company, said that social security is a basic guarantee for citizens and one of the government's welfare policies, so it is suggested that everyone should buy insurance.

But because social security is the basic guarantee, it is impossible to meet everyone's security requirements. In addition to basic security, citizens can also choose commercial insurance for themselves to make up for the lack of social security. For example, medical insurance for students and children with critical illness only reimburses 70%. If you choose the corresponding commercial insurance for your child as a supplement, you can also reimburse the remaining 30%. In other words, commercial insurance is the icing on the cake for children's disease protection.

Seek social security reimbursement first when you are in danger.

And then claim compensation with the diagnosis certificate.

In some insurance companies (such as Ping An in China), if there is social security to invest in commercial medical insurance, the premium will be less than that without social security. After the insured is sick, he should first seek social security reimbursement, and then seek compensation from the insurance company with a copy of the hospital diagnosis certificate. The insurance company will reimburse the part that is not reimbursed by social security. In terms of medical insurance-related claims, the insured will not be allowed to make money.

Special reminder

Children's mutual fund completes the mission of "being laid off"

The children's mutual fund raised by the Red Cross in schools and kindergartens ended and was underwritten by the "one old and one young" critical illness insurance. That is, from September 1 day, students and children will only participate in medical insurance for serious illness of students and children. According to reports, the reimbursement rate of "one old and one young" in critical illness insurance is almost twice that of "children's mutual fund".

The insurance period is valid from September 1.

Most students and children are insured after the start of school in September 1, but the validity period starts from September 1. In other words, as long as the payment is made before September 30, if you get sick on September 2, you can also enjoy reimbursement. Just because the relevant data is not established, the insured needs to pay in full first, and then only need to pay his share.

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.