I am 30 years old and my company has paid social security. Is it necessary to buy critical illness insurance?

We all know that social insurance includes five insurances, but in our life, medical insurance among the five insurances should be used the most. As for medical insurance, it is generally treated in hospitals and can be reimbursed when sold in pharmacies, but no one knows the specific details of the insurance.

Recently, many people don't know much about the V chart of medical insurance reimbursement forwarded by friends. Duobao Fish decided to explain it to you!

First of all, we need to know the reimbursement ratio of social security and medical insurance:

Take Beijing Medical Insurance Card as an example.

Simply put, there are certain thresholds and reimbursement ratios for outpatient reimbursement of social insurance and medical insurance, with a maximum of 20,000; In addition, both social insurance and medical insurance have a certain deductible line and reimbursement ratio, and the maximum limit is100000. Once it exceeds100,000, it is the scope of reimbursement for serious illness, with a maximum of 300,000.

The V-chart of medical insurance reimbursement mentioned by users is to classify and refine medical expenses and analyze the medical insurance reimbursement of social insurance.

Therefore, Bian Xiao made the following decomposition, which is as follows:

fee-for-service

The V-shaped area represents all our medical expenses. Are they all reimbursable?

Suppose that Sister Ma spent 400,000 yuan in hospital, then this red part represents that Sister Ma spent 400,000 yuan on medical expenses.

Remove payment line

Medical insurance reimbursement is the deductible line, and the following parts of the deductible line are borne by themselves. The deductible lines of outpatient and inpatient are different, and the deductible lines of different regions and hospitals are also different. Generally, the deductible line is set at 300- 1800 yuan.

Take social security and medical insurance in Beijing as an example. Sister Ma will divide 400,000 medical expenses from hospitalization expenses, deduct deductibles when reimbursing outpatient expenses, and the rest can be reimbursed. In the same way, the hospitalization fee is the same.

ceiling

Can the above expenses be fully reimbursed at the deductible line? No, social security and medical insurance reimbursement is limited, that is, the capping line, and the part that exceeds the capping is also borne by yourself.

The boundaries between social insurance and medical insurance are different in different regions. Different types of social insurance have different ceilings. Generally, the maximum reimbursement for hospitalization is 30 thousand yuan, and the maximum reimbursement for outpatient service is 20 thousand yuan.

Sister Ma is ill and hospitalized for more than 300,000, and she needs to bear the extra part.

Self-funded part

Below the capping line, the expenses after deducting the deductible line shall be reimbursed. The answer is definitely not. As Duobaoyu said above, social security and medical insurance reimbursement is a reimbursement ratio, that is, you have to bear part of the reimbursement amount, that is, the proportion of your own expenses.

Different regions, different types of social insurance and hospitals have different levels, but the self-payment ratio is different, which is generally set at around 10%. Items reimbursed by Sister Ma: outpatient reimbursement = (outpatient medical expenses-deductible line) ×( 100%- self-payment ratio); Hospitalization reimbursement = (capping line-deductible line) ×( 100%- self-payment ratio).

Paid content

Do you think after deducting some, the rest should be reimbursed? Social insurance Medical insurance has strict regulations on drugs and treatment items. This means that some imported drugs, special drugs, medical equipment and medical services are used in the treatment process. Not to mention the high cost, social security and medical insurance are not reimbursed at all. This is called the self-paid project, so the middle part is part of the actual reimbursement.

Ma Jie: Hospital reimbursement = (capping line? -? Pay line? -Self-funded content) ×( 100%- self-funded proportion).

After such heavy calculation and deduction, minor illnesses can still be reimbursed, because some self-funded items are difficult to use. Once it is a serious illness, conceit will account for a large proportion. In fact, after reimbursement, patients still have to bear a lot of medical expenses. What should I do?

commercial insurance

Nowadays, the role of commercial insurance can not be ignored. Social insurance and medical insurance cannot be reimbursed, and commercial insurance can be reimbursed and compensated twice.

Deductible: Many medical insurances now have outpatient reimbursement, accident outpatient reimbursement and disease outpatient reimbursement, so that you can reimburse deductible and reduce expenses.

Out-of-pocket part: most hospitalization medical insurance includes hospitalization allowance, and a certain amount is paid to patients every day for compensation.

Outside the content of self-funded funds and capping line (maximum limit): Because both are involved, it is generally a serious illness or disease, and health insurance and critical illness insurance can be insured. Once diagnosed, pay immediately. For example, millions of medical insurance (1 year) can be reimbursed for disease treatment; Critical illness insurance has advantages and disadvantages. Once diagnosed and in line with the insurance contract, compensation will be paid according to the agreed insurance amount to help treatment, later rehabilitation and make up for losses.

Multi-insurance fish reminder: social insurance and medical insurance will be reimbursed after the incident, that is, it will cost a lot of money to reimburse, and commercial insurance will pay first and then treat.

Therefore, it is unrealistic to reimburse most medical expenses in social security, especially after suffering from a serious illness or illness. High medical expenses need to be paid at one's own expense, but after joining commercial insurance, it can resist the shortcomings of high medical expenses for serious diseases, and everyone needs to pay attention.

Please refer to this link for more information about the importance of commercial insurance. Is it reliable to buy commercial insurance?