What is comprehensive medical insurance?

Comprehensive medical insurance refers to a comprehensive medical expense insurance provided by the insurer for the insured. Its cost range includes all expenses such as medical expenses, hospitalization expenses and operation expenses. This kind of policy has a higher premium rate. This kind of policy usually needs to determine a lower deductible and an appropriate sharing ratio (such as 85%). ).

Characteristics of comprehensive medical insurance

Compared with general medical insurance, comprehensive medical insurance is characterized by:

(1) has a wide coverage. Comprehensive medical insurance provides a wide range of protection for all kinds of hospitalization and outpatient expenses, and its insurance liabilities generally include: hospitalization bed fees, examination fees, operation fees and medical expenses. In addition, the insurance liability of comprehensive medical insurance also includes compensation for outpatient medical expenses and some rehabilitation treatment expenses, such as artificial limbs, artificial joints, wheelchairs and ambulances. For the above medical expenses, the payment limit of comprehensive medical insurance is relatively high, and even there is only one total insurance payment limit, which is different from the basic medical insurance. The exclusion liability of comprehensive medical care is also much less than that of basic medical insurance.

(2) The premium is high. Due to the wide coverage, the premium of comprehensive medical insurance is higher than that of general medical insurance.

(3) Risk sharing. In the comprehensive medical insurance contract, a relatively low deductible will be determined, and the cost sharing ratio between the insurance company and the insured will be stipulated, and the insurance company and the insured will share the cost risk together to control the cost and prevent moral hazard.

(4) Complementarity. Formally, comprehensive medical insurance mainly includes comprehensive high-value medical insurance for serious illness and supplementary high-value medical insurance for serious illness which is connected with general medical insurance. From the content point of view, the insurance liability of some comprehensive medical insurance also includes the cost of preventive health care services. It can be seen that the main function of comprehensive medical insurance is to provide more adequate medical security for those individuals or groups without social security. Therefore, such products generally have no single limit of medical service expenses, but only the total compensation limit.