CCTV News: According to the National Medical Insurance Administration, the General Office of the State Council issued the "Guiding Opinions on Improving the Long-term Mechanism for Participation in Basic Medical Insurance" (Guobanfa [2024] No. 38), various places have actively promoted the implementation of long-term mechanisms. In the collection and payment work, many parents raised questions: "I have bought student safety insurance for my children, why do I still need to participate in medical insurance?" In fact, no matter whether my children have bought student safety insurance, they should participate in medical insurance.
1. Do you still need to participate in medical insurance after buying student safety insurance? What is the difference between student safety insurance and medical insurance?
Needed. Student Ping An Insurance is an insurance product set up by various commercial insurance institutions for student groups. The purpose is to protect students' accidents and medical risks during school and reduce the economic losses caused by children's risks in the family. Usually, the coverage is simpler, the coverage is low, and there are generally thresholds for insurance. The full name of medical insurance is "basic medical insurance". It is a social insurance system established by the state for all insured persons in society to seek medical treatment. It has the characteristics of a wide range of protection, high level of protection, and excellent quality of protection. Participating in basic medical insurance can give full play to its advantages of universality and bottom-line protection, ensuring that the student group can seek medical treatment in a timely manner and that medical expenses can be shared.
2. What are the risks of buying student safety insurance only and not participating in medical insurance?
If you do not participate in medical insurance, once a major disease occurs, it will be difficult to cover the high medical expenses by relying solely on the reimbursement of student safety insurance. The capping line for basic medical insurance hospitalization in various places is generally more than 200,000 yuan. You can also enjoy a variety of benefits such as general outpatient insurance benefits, outpatient chronic special diseases benefits, inpatient reimbursement benefits, serious illness insurance reimbursement benefits, medical assistance benefits, continuous insurance incentives and zero fund reimbursement incentives, national medical network settlement guarantees, and direct settlement opportunities for commercial insurance. If you do not participate in medical insurance continuously, there will be a fixed waiting period of 3 months after participating in the insurance. For every additional year of payment, a change waiting period of 1 month will be added, and the medical expenses incurred during the period will not be reimbursed. In addition, every penny charged by the insured person when seeking medical treatment will be supervised by the medical insurance department. If you do not participate in medical insurance, you will lack the help of medical insurance supervision.
3. Why is the cost of medical insurance higher than that of student safety insurance?
This is because compared with student safety insurance, the coverage of medical insurance is wider, the benefits are better, and the reimbursement process is more convenient. From the perspective of coverage, student safety insurance mainly targets students' accidental injuries and medical expenses incurred, and usually requires students' health status when purchasing; while the resident medical insurance that students participate in is not subject to age and health status. The benefits enjoyed according to regulations include general outpatient clinics, "two-disease" outpatient medications, chronic special disease outpatient clinics, general disease hospitalization, "dual channel" drugs, serious illness insurance and other medical insurance benefits. Judging from the amount of benefits reimbursement, there are many reimbursement restrictions for student Ping An Insurance, with the reimbursement ratio starting at 50%, and there is also a deductible limit. The maximum amount of hospitalization reimbursement generally ranges from 50,000 to 100,000 yuan; while the reimbursement ratio of resident medical insurance for hospitalization expenses within the policy scope reaches about 70%, and the annual maximum annual payment limit of the fund can reach about 6 times the per capita disposable income of local residents. From the perspective of the reimbursement process, the reimbursement of student safety insurance usually requires certain certificates and documents to determine, and there is a certain lag in reimbursement; while medical insurance can achieve rapid settlement of "it is happening, it is reimbursement". In many large hospitals across the country, they can also settle directly for reimbursement in other places, which is very convenient. In comparison, although the cost of medical insurance is higher, it is more cost-effective.
4. Can you still buy student safety insurance if you have participated in medical insurance?
Yes. At present, there is still a certain gap between the basic medical insurance and the people's growing medical and health needs. The complementary connection and supplementation of basic medical insurance and commercial insurance can better meet the diverse medical insurance needs of the people. In addition, most students will provide better benefits based on whether the insured participates in medical insurance. For example, students participating in resident health insurance can enjoy a lower medical deductible or a higher medical reimbursement ratio than students not participating in resident health insurance.
The elderly and children are all treasures and must have medical insurance every year. If you buy student safety insurance, you should also participate in insurance for your children and add more protection. Through local medical insurance platforms, WeChat mini-programs, APPs, tax applications, etc., you can pay online fees in a timely and quickly to participate in insurance for your children.
