Insurance can also be bought together? Four risks that individuals can pool enough people to buy Medical Insurance in groups

writing | William Zhu

 

With the continuous development of the insurance market , More and more people begin to pay attention to health insurance 、 Medical insurance . There are also many people planning to buy , They have even begun to study medical insurance . After a preliminary understanding of the market , You will find out , Medical insurance can be divided into individual insurance and group insurance . among , The insurance company is based on the judgment of risk , The premium of group insurance will be significantly lower than that of individual insurance .

Based on this , There is an understanding in the market , That is, you can buy insurance in groups , Or say “ Insurance group purchase ”, Put individuals together to buy Group Insurance , In this way, we have a good guarantee , There are also affordable prices . But is this really possible ？

What is a group person / Medical insurance ?

Generally speaking , Group insurance means insurance provided by the company 、 Enterprises or social organizations （ Legal personality ） As an insured , For the company's employees and their families （ Spouse and children ） Medical insurance or life insurance purchased .

The more common ones in the market are employee welfare insurance （ Supplementary medical insurance ）, And group high-end medical insurance .

Are there any requirements for the number of people in group medical insurance ？

Generally speaking , The minimum number of insured persons for group high-end medical insurance is 3 Employees , And enterprise employee welfare insurance （ Supplementary medical insurance ） The minimum number of insured persons is 20 Employees （ In some special cases , Can be reduced to 10 Employees ）.

In group medical insurance , Does the insurance company have any requirements for the insured ？

The requirements of the insurance company for the insured are employees and their spouses or children . Take the group medical insurance clauses of AXA Tianping Property Insurance Co., Ltd. as an example ：

Qualification of the insured

If you are in good health 、 Natural persons who can work or live normally and meet the following requirements , With the consent of the insurer , May be the insured of this contract ; The insured of this contract includes the main insured （ Interpretation 6 ） And the subsidiary insured , Spouse of the principal insured （ Interpretation 7 ） And children （ Interpretation 8 ） May act as a subsidiary insured . Unless otherwise specified , The expressions related to the insured in the following clauses are fully applicable to the primary insured and the subsidiary insured .
（ One ） The age of the principal insured at the time of the first application （ Interpretation 9 ） Should be 18 From one year old to 65 One year old . Spouse and children as affiliated insured , The age of the spouse at the time of initial insurance coverage shall be 18 From one year old to 65 One year old , The child's age at the time of first insurance coverage shall be after birth 15 Day to 18 One year old , among , When the child is a newborn , Should be discharged completely . With the consent of the insurer , The maximum age of the principal insured and his / her spouse at the time of renewal may be up to 75 One year old ; The unmarried children of the principal insured are full-time students , The maximum age for renewal is 25 One year old .
（ Two ） The principal insured shall be the active employee of the applicant at the time of insurance application .
The subsidiary insured shall meet the following conditions at the same time （ Except for the newborn affiliated insured who meets the foregoing agreement ）：
1． The affiliated insured shall have the ability of daily living ;
2． The affiliated insured did not receive treatment in the hospital on the effective date of the insurance contract .

The above clauses can be summarized as ：

1. The primary insured must be a working employee , Age 18~65 Between the ages of
2. The dependent insured may be a spouse , Age 18~65 Between the ages of
3. The dependent insured may also be a child , Age after birth 15 God ~18 Between the ages of , If you are a full-time student , It can be relaxed to 25 year .

Can an ineligible insured join a group policy ？

When the insurance company reviews the insurance , It is generally required that ：

1. Insurance application and quotation confirmation sealed by the company
2. The list of the insured stamped by the company , Including employees 、 Identity information of spouse and children
3. Health status questionnaire signed by the insured

We can see , When the insurance company reviews the enrollment , Generally, it is not intended to confirm whether an insured is really an employee of the company , Whether it is the spouse or child of the employee . Only the list of personnel stamped by the customer's company .

therefore , If you encounter some non compliant insurance brokers or agents , In the name of group insurance , Selling personal medical insurance to you . But you will not have a personal insurance policy or insurance contract , You can't get the insurance invoice with your name and title .

Insurance policy （ Gather people to buy group insurance policy ） Is there any risk ？

1. The legitimate rights and interests are not guaranteed
You don't have any insurance contract or policy , In the event of an insurance dispute , You cannot provide your insurance certificate to the insurance company or the China Banking Insurance Regulatory Commission , Your legal rights and interests will not be protected .

2. Unable to provide complete claim settlement materials
Maybe someone will say ,“ After I put together the insurance policy , You can also apply for a claim , I also got the compensation ”, But when insurance companies deal with claims , Have the right to ask you to provide the following materials ：
 Your labor contract with the company
 Your tax bill for the company
 Your social security record in the company
 Marriage certificate between your spouse and you
 The child's birth certificate

The insurance company will randomly select some claims to claim for these materials according to the size of the claim amount . If you buy group insurance with a single policy , These materials are not available . Then you will not be able to get a claim .

3. The renewal fee has increased significantly

Generally speaking , The increase of individual insurance renewal mainly depends on the overall operating profit of the insurance company , Not personal claims .

For group insurance , The increase of renewal fee largely depends on the claims settlement of the group every year . If a member of the group has a very high claim , That will affect the premium of each subsequent member .

for instance , The normal increase for a group policy should be 5%, And one of the insured has a very high claim amount , As a result, the claim settlement rate of the whole group has become very high , Then the insurance company will raise a proposal for the renewal of the group 20% even to the extent that 30% The gains , The increase will be apportioned to each member . That would be unfair to other members with low claims . In the long run , At the beginning, the insurance premium for the order matching 2 Years may be cheaper than personal insurance policies , However, due to the poor settlement of claims by some members of the order collage ,3 There will be no advantage in the insurance premium of single purchase after , Sometimes even more expensive than personal insurance .

4. The risk of changing an insurance policy

Someone will say , If the increase is very high , Let's change an insurance company and continue to spell the bill . Here we need to know , When we are insured , The insurance company will ask everyone to fill out a health questionnaire in order to understand everyone's past medical history . Generally speaking , The insurance company will exclude the medical expenses of those past diseases . Once we change the insurance company , The new insurance company will exclude the diseases that occurred in our previous insurance policies . therefore , Care should be taken when changing insurance companies .