Please tell me the difference between social security and commercial insurance.

I saw it when I was studying online, and it felt very good, so I saved it. Since you need it, I will look for it. I hope it helps you. . .

Commercial insurance PK social insurance three cases to see what insurance you are suitable for.

(20 10-03- 17 15:38:29)

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Retirees, non-taxpayers under the age of 18, low-income people and other relatively vulnerable groups are often not suitable for buying commercial insurance. The main customers of commercial insurance are generally the backbone of the society, especially "Bai Gujing" (white-collar workers, backbone and elites) aged 25 to 45, as well as gold collars and various bosses. There are many types of insurance provided to them, and there are many insurance companies to choose from, and the amount of protection can be high.

Gradually improve, especially the reform of medical insurance and endowment insurance, it seems that the coverage of "social security" is becoming more and more comprehensive. Then, how should the ratio of social security and commercial insurance be adjusted? How do the two complement each other?

Conceptual explanation

First of all, let's understand the concepts of two types of insurance: commercial insurance and social insurance.

Social insurance refers to a social security system that is enforced by the state through legislation, funded by workers, enterprises or communities, and established by the state to provide material assistance to workers themselves or their immediate family members when they lose their ability to work or temporarily lose their jobs due to old age, work injury, illness, maternity, disability, unemployment and death.

The role of social insurance lies in: providing for the old, getting medical care for the sick, getting medical care for the sick, getting medical care for the injured, and losing income. In other words, when you lose your work, you can get some compensation and relief. Social insurance has the characteristics of compulsory, low level and wide coverage. The principles and standards of insurance compensation emphasize the principle of "social equity", that is, the rights and obligations are not equal and the compensation is not equal, but the same compensation standards are unified in principle. Meet the lower-level needs of social members in life, old age, illness and death, that is, survival needs.

Commercial insurance is a voluntary contractual relationship for the purpose of making profits. When the insured dies, suffers from disability, illness or reaches the agreed age and time limit, he shall bear the responsibility of paying insurance money. It is emphasized that according to our own situation, we should take what we need, strengthen the insurance degree, guarantee different living standards and meet the needs of higher development and enjoyment.

Pensions and health care

If social security is the basic problem of solving food and clothing, then commercial insurance is the supplement and strengthening of social insurance. Commercial insurance can maintain a high standard of living. Let's focus on the similarities and differences between endowment insurance and medical insurance:

Social endowment insurance is based on the per capita salary of the year, and individuals and enterprises each pay a certain proportion, and they will enjoy a certain pension when they enter retirement age in the future. It ensures the basic needs of life, so it is supplemented by commercial pension to avoid a large income gap when retiring.

Social medical insurance is to provide a certain amount of basic medical security. For ordinary people, the medical security provided by social security can only be regarded as the most basic, and it is particularly important to choose appropriate commercial insurance as a supplement.

Commercial insurance &; Similarities and differences of social insurance

Control point commercial insurance social insurance

Qualitative analysis of whether it is profitable or not

For the purpose of pursuing profits, independent accounting, independent operation and self-financing. Only those who voluntarily take out insurance will be guaranteed by the contract, instead of serving the public interest.

The national social security system aims to provide people with basic living security. It is a non-profit organization serving the interests of all members of society and a public welfare undertaking.

Safeguard function

Meet the consumption needs of all levels of society, that is, the enjoyment, development and survival of high schools and low schools can be guaranteed. Differentiation and personalization.

By paying social insurance premiums, the basic needs of social members, that is, survival needs, are guaranteed, so the level of protection is relatively low.

Legal orientation

The scope of protection shall be determined by both parties to the contract through consultation. Civil acts, rights and obligations and insurance relations implemented according to contracts are based on insurance contracts and belong to the category of economic legislation.

The scope of protection is stipulated by the state, and the scope of risk protection is narrow and low. Carrying out government actions according to law is a basic right given to citizens and workers by the Constitution.

Legal orientation

Commercial insurance company. Enterprise behavior, according to market rules, is competitive on the basis of equality (full market competition), and there can be multiple handling companies for the same product.

The government or its established and entrusted institutions are monopolistic government actions, and a specific product can only be operated by a certain institution.

Implementation mode

Implement the principles of equality, mutual benefit, consensus and voluntary conclusion.

Enforcement, the corresponding member has no selection.

Investment income risk

Commercial insurance needs to pursue high returns and high risks in investment and operation. Insurance companies should be self-financing.

The social insurance fund should be absolutely safe because it is the life-saving money of the whole society.

Insurance premium burden state

Individuals are fully responsible for risks including death, disability and illness, as well as the operation and management expenses of insurance companies. Pay attention to efficiency. If you have money, you will invest. If you have no money, you will not be insured.

Security costs are usually shared by individuals, enterprises and the government. The charging standard is relatively low. Insured people pay insurance premiums according to unified standards, and there is no difference in enjoying treatment.

Applicable principle

In accordance with the principle of equality and voluntariness, decide independently and participate voluntarily. The principle of "personal fairness" is embodied in the form of commercial insurance contracts, that is, more investment and more insurance, less investment and less insurance, and no investment and no insurance.

Enforce by executive order. Emphasis is placed on the principle of "social equity". No matter how much the insured pays, their payment standards are the same in principle.

Sample case 1

Maternity insurance (pregnancy, abortion, medical expenses)

Miss Guan, who works in Zhangjiang Hi-Tech, just gave birth to a baby girl on June 12. She has a lovely baby name "Tong Tong". As a new mother, she moved a lot of insurance contracts and asked me about the hospitalization expenses in the production process, the early inspection fees, and the loss of income for four months after maternity leave, which insurance can be reimbursed.

Expert review

Because the prenatal examination and hospitalization expenses are within the reimbursement scope of Shanghai medical insurance (of course, it is limited to routine examination, excluding the special requirements of pregnant women and the expenses of special wards)

So early pregnancy examination registration, prenatal examination, postpartum visit, etc. All cases are settled according to outpatient treatment, and hospitalization delivery is settled according to hospitalization treatment. The above outpatient and hospitalization expenses can be settled in the hospital with the medical insurance card, and enjoy the corresponding medical insurance benefits, and will not be reimbursed afterwards. After production, you can get a maternity allowance of 3000 yuan from the medical insurance bureau.

At the same time, the group medical insurance purchased by Miss Guan's unit can reimburse the expenses within 7,000 yuan during the whole pregnancy and production process.

Next, through the case of Miss Guan, I will introduce the commercial insurance related to maternity to the ladies who want to be mothers.

At present, there are several kinds of related maternity insurance:

Life insurance covers dystocia and death during production.

2. The baby suffers from congenital diseases or needs to be reimbursed for the cost of congenital surgery. Due to the increasing number of elderly women, the increasing work pressure of women and the influence of the environment, newborns have more congenital diseases than before. Some companies provide some short-term insurance to protect the health of mothers and babies. Insurance is generally required within 4-5 months of pregnancy, and it is only responsible for the safety of maternal delivery and the protection of baby deformity and survival. It provides a certain guarantee for the risk of forced termination of pregnancy and neonatal death, as well as the rescue and treatment of neonatal congenital diseases.

3. Annuity products: A few annuity products or critical illness insurance for women can provide postpartum maternal and infant congratulations.

4, hospitalization and surgery costs, generally do not belong to the scope of commercial insurance reimbursement and compensation. Ordinary life insurance, accident insurance and critical illness insurance all clearly list all kinds of accidents and diseases caused by pregnancy as responsibilities. All commercial insurance clauses clearly stipulate that childbirth is a normal physiological behavior of women, which does not belong to the category of diseases and cannot be reimbursed.

At present, commercial insurance companies have no products specifically responsible for reimbursing medical expenses during pregnancy and childbirth. This kind of product is only available in maternity insurance in social medical insurance.

Example case 2

Make use of the characteristics of social security and commercial insurance to complement each other

Mother Wang is my classmate's aunt. She retired 10 years and is now 65 years old. Since knowing that the author is an insurance salesman, she has been staring at me and asking if there are any good insurance products suitable for her to buy, especially medical insurance. But I'm always speechless. Because there are few insurance products specially designed for the elderly in the market at present, even if there are, there are a lot of additional conditions.

Expert review

Social security is a national welfare undertaking, facing the people of the whole country. Wide coverage, large population, and the pursuit of equal medical conditions for all. China's current national conditions determine that there are many restrictions on social medical insurance, and the benefits for high-income people may not be great. However, medical insurance can take good care of some obvious vulnerable groups, such as retirees (most of them are over 55 or even over 70), non-taxpayers (children, students), 18 years old, freelancers (housewives, part-time social workers) and low-income people (unemployed people, low-income households, migrant workers, etc.). ), although the coverage is limited.

The above-mentioned vulnerable groups often can't afford to buy commercial insurance. They have never thought about buying commercial insurance, some have no purchasing power, and some insurance companies don't like it. Because commercial insurance is operated as a company with the aim of making profits, commercial companies are often more willing to choose those who are young, healthy, have high-income living security, have no bad living habits and have no family hereditary diseases, rather than underwriting the old, weak, sick and disabled low-income people.

Therefore, the main customers of commercial insurance are often the backbone of society, especially the white (white-collar, backbone, elite), gold collar and various bosses aged 25 to 45. For them, it is of course inevitable that there are many types of insurance, many companies to choose from, high coverage and some preferential prices.

Example case 3

Pay special attention to the "absolute deductible" clause in social security.

Zhang Dajie, who lives in the east of the city, has worked for 23 years and has been serving a large state-owned enterprise as a production manager. Although the salary is not much, but there are many benefits, the unit not only handled five insurances and one gold, but also handled supplementary medical insurance and supplementary endowment insurance. Last year, I participated in the group medical insurance of an insurance company in China.

Recently, Sister Zhang unfortunately suffered a minor traffic accident, which induced her to go to the hospital for treatment the year before last. She stayed in the district central hospital near her home for 63 days, and spent a total of 92,000 yuan (including 7,788 yuan for surgery, hospitalization, bed fees and laboratory tests, including 9,500 yuan for treatment of traffic accidents).

Expert review

Zhang Dajie, who is diligent and honest in his work, took part in hard work and inevitably suffered from some chronic diseases and even occupational diseases. It is very unfortunate that Zhang Dajie was hospitalized for 63 days under the induction of unexpected circumstances. Both physical pain and mental torture are unfortunate. But for Zhang Jie, fortunately, although it cost 92,000 yuan, these expenses did not make her bear any economic burden at all. Not only that, there is an extra income of 9450 yuan. Why on earth is this? Let's carefully analyze this seemingly special case, which is likely to happen around us.

First of all, we know that there are two reasons for Zhang Dajie's hospitalization, one is the injury caused by traffic accidents, and the other is the treatment of induced diseases. From the perspective of commercial insurance and social medical insurance, the second reason is not within the scope of "refusal to pay compensation" and "irresponsibility", so it is within the scope of both claims.

However, it is not difficult to find that medical expenses caused by traffic accidents cannot be reimbursed in social security. At the same time, because the traffic accident has escaped, it can only be borne by Zhang Jie herself. Therefore, the treatment cost of 9500 yuan cannot be reimbursed in Zhang Dajie's medical insurance card.

Among the commercial insurance products operated by insurance companies, almost 65,438+0,000% of medical insurance and comprehensive accidental injury insurance can bear the "reimbursement responsibility" of accidental injury medical expenses, although there will be a maximum limit for each specific item (that is, the maximum premium that insurance companies often say). Among the medical expenses, the group medical insurance of an insurance company reimbursed 8550 yuan, and 950 yuan paid for it at his own expense. (Relative deductible 5%, absolute deductible 500 yuan. Most of Zhang Dajie's remaining medical expenses of 82,500 yuan were reimbursed by social medical insurance. First of all, what Zhang Dajie needs to be conceited is 1.542 yuan, and then the remaining 80,958 yuan is reimbursed at a rate close to 85%.

Because Zhang Jie participated in a group insurance, there was a benefit of 150 yuan's daily hospitalization subsidy, and the daily subsidy amount reached 9450 yuan (63? 50)。

The part of social security reimbursement higher than self-payment 1542 yuan is operated according to 60% reimbursement for outpatient and emergency services and 85% reimbursement for hospitalization, while most expenses in Zhang Dajie occur in the hospitalization stage rather than the outpatient and emergency services, so the proportion is close to 85%.

Sister Zhang is 45 years old and enjoys the treatment of middle-aged people (born between 56 and 65 years old) in social security. The ceiling of hospitalization reimbursement is 4 times of annual salary 1580 16 yuan (4? 2? 292)。

summary

abstract

In the concept of ordinary people, we seem to think that medical insurance in social security can reimburse part of the expenses and cover all the expenses. Social security is actually a low-level average national welfare system covering the whole society, which takes the form of insurance without package. Therefore, in the social security reimbursement system, there are various forms of absolute exemption, such as registration fees, medical records fees, magnetic card fees, nurses' nursing fees, meals and other service fees, as well as some drugs (drugs outside the catalogue, imported drugs, drugs at their own expense, new drugs and precious drugs), self-funded inspection fees (including special filming fees), imported equipment and self-funded materials (imported steel nails, steel plates, etc.).

Some advanced inspection fees can be reimbursed about 90%, with an absolute deductible of 10%. Class B drugs in the medical insurance drug list can be reimbursed 80% to 90%, and the absolute exemption rate is 10% to 20%.

Only some basic common tests (such as electrocardiogram, chest X-ray, blood routine, etc. ) and basic common drugs (such as Class A drugs in the medical insurance catalogue) can be fully reimbursed by medical insurance.

As Zhang Jie and her colleagues said, I have always felt that my social security is enough and I can reimburse everything. Now I know that social insurance and commercial insurance have their own advantages and need to be combined to complement each other to help us ordinary people face the high cost of surgery and hospitalization.

Commercial insurance and social insurance can completely complement each other and make up for their respective shortcomings.

To annotate ...

Medical drugs are divided into drugs in the medical insurance catalogue and drugs outside the medical insurance catalogue, among which drugs in the catalogue are divided into class A drugs that can be reimbursed 100% and class B drugs that can be reimbursed 80% to 90%).