Health insurance 101（3）

 2. Definition of disability

Disability refers to the fixed symptoms left on the human body due to injuries and other reasons, and affects normal life and work ability. Common causes of disability include congenital disability, acquired disease, and accidental injury. Income security insurance does not pay insurance money for congenital disabilities, and stipulates that insurance money can only be paid if the definition of total disability stated in the policy is met.

(1) Completely disabled

Total disability generally refers to the permanent loss of all labor capacity and the inability to participate in work (original work or any new work) to obtain wage income.

The total disability payment is generally less than the income before disability, often 75% to 80% of the original income.

(2) Partly disabled

Partial disability is relative to the definition of total disability and refers to partial incapacity. If we regard all disability as total loss of income, partial disability means that the insured can still perform some other occupations with income, and the insurer will pay part of the total disability payment.

Partial disability benefit = total disability benefit × (income before disability-income after disability)/income before disability

(3) Other payment types

Income compensation insurance is an effective compensation for the income loss of the insured, and usually has different types due to different conditions.

Long-term care insurance

Long-term care insurance is a health insurance that provides compensation for the cost of care services for insured persons who need long-term care due to old age, illness, or disability.

The insurance coverage of long-term care insurance is divided into four levels: medical care, intermediate care, care-type care and home care, but early long-term care insurance products do not include home care.

A typical long-term care policy requires that the insured cannot complete two of the following five activities: ①eating; ②bathing; ③dressing; ④toilet; ⑤mobile. In addition, people with cognitive impairment such as Alzheimer's usually need long-term care, but they can perform certain daily activities. To solve this contradiction, all long-term care insurance has made Alzheimer's and Archimedes sick. Other mental disorders are included.

There are several different options for the payment period of long-term care insurance premiums: one year, several years, and life. There are also various exemptions for 20 days, 30 days, 60 days, 90 days, 100 days, or 80 days. The longer the exemption period, the lower the premium.

The premium for long-term care insurance is usually level, and there are also people who increase the premium annually or during each period. The annual premium paid varies greatly depending on the age of insurance, waiting period, insurance amount and other conditions. There is generally an exemption from premium protection, which means that the insurer will be exempted from paying premiums within 60, 90, or 180 days from the beginning of fulfilling the insurance payment responsibility.

In addition, all long-term care insurance policies are guaranteed to renew.

Finally, long-term care insurance has provisions on non-confiscation of value.

Rate

The factors that determine the rate of health insurance premiums include: the incidence of illness, the incidence of disability, the duration of illness, the interest rate, the expense rate, the failure rate, and mortality. Other factors such as the way of business development, underwriting habits, claims principles and the company's main objectives will also affect the health insurance premium rate. Changes in conditions such as hospital management and medical methods, economic development, and geographic environment also have an impact on our prediction of future claims, but these factors are not easy to predict completely and accurately.

1. Flat Rate Principle

2. Ladder rate principle

3. Year-by-year rate change principle

4. Balanced premium principle

Although the above methods have their own advantages, all of them must also consider the issues of risk estimation, cost payment, profit and other passive safety factors.

For the insured who cannot meet the physical health requirements stipulated in the standard clauses but can be covered under conditions, they can be covered according to the sub-standard physical insurance policy. The methods often used when formulating the rates are:

(1) Reduce the payment period of policy income

(2) Reduce policy income

(3) Increase the waiting period

(4) Exclusion of liability or limitation guarantee etc.

Reserve

For one-year or short-term health insurance, non-life insurance is often used to accrue liability reserves, while for long-term health insurance, the probability of loss is age-related, so life insurance is used to accrue liability reserves.