Million medical insurance is affordable, with coverage reaching several million, making it a necessity for ordinary people’s healthcare needs.
Many assume that once purchased, it guarantees reimbursement for millions in medical expenses. However, the reality is more complicated. There are four lesser-known reasons for claim rejections that everyone should be aware of. Without proper understanding, you might waste hundreds annually and receive no payout during critical illnesses. Here’s what you need to know: 1. Claims During the Waiting Period Million medical insurance doesn’t take effect immediately. There’s typically a 30–90-day waiting period. If you fall ill during this time, claims will be denied. Avoid unnecessary medical checkups during this period to prevent accidental discoveries that could void coverage. In severe cases, insurers may even terminate your policy. 2. Not Meeting the Deductible Most policies have a ¥10,000 deductible. For example, if medical costs total ¥20,000 and insurance covers ¥8,000, you pay ¥10,000 (the deductible), and the insurer covers the remaining ¥2,000. This means million medical insurance is designed for major expenses. Minor illnesses or hospital stays may not meet the threshold. Consider supplemental small-amount medical insurance for smaller claims. 3. Failing Health Disclosure Requirements This is the most common reason for rejections. Many assume they can buy insurance freely, but million medical policies have strict health disclosures. Conditions like hypertension, nodules, or recent abnormal test results must be disclosed. Concealing such information risks claim denials or policy cancellations.If an incident occurs in the future, the insurance company may not only refuse to compensate but also withhold the premiums you’ve paid. Therefore, it’s crucial to take this seriously to avoid significant personal losses.
4. Exclusions from Coverage Even if you meet the health declaration requirements and your out-of-pocket medical expenses exceed the deductible, does that guarantee a smooth claim process for your million-yuan medical insurance? Not necessarily… Beyond the deductible, factors such as whether the hospital meets the policy requirements and whether the medications are covered under the plan also play a role. Let’s explore: 1. Risk of Claim Denial for Non-Compliant Hospitals To avoid claim denials, it’s essential to seek treatment at public hospitals of Grade II or above. The healthcare market includes various institutions—public, private, general, specialized, dental clinics, cosmetic hospitals, and more. Most million-yuan medical insurance policies explicitly require treatment to be administered at public hospitals of Grade II or above within mainland China (excluding Hong Kong, Macao, and Taiwan). Claims for treatment at non-compliant institutions may be denied. (Blue Shield · Long-Term Medical Insurance Policy Terms) Before seeking treatment, verify the hospital’s eligibility through official channels. It’s also wise to familiarize yourself with nearby hospitals to handle emergencies effectively. 2. Risk of Claim Denial for Lack of “External Drug Coverage” The term “external drugs” might be unfamiliar. For example, in cancer treatment, doctors often prescribe specialized or targeted drugs, which are highly effective but extremely expensive. Cancer patients may need to spend tens of thousands monthly on these medications. Despite some being covered by insurance, shortages in hospitals often force patients to purchase them externally. If your million-yuan medical insurance lacks this coverage, the insurer may deny the claim, leaving you to bear the hefty costs. This can be frustrating, especially when you’ve paid for insurance but still face significant out-of-pocket expenses. To confirm whether your policy covers external drugs, review the contract terms. Many products specify this, as shown below: (Blue Shield · Long-Term Medical Insurance Policy Terms) If the terms are unclear, contact the insurer’s customer service before purchasing.Serious reminder: It’s highly recommended to opt for million medical insurance with “external drug coverage.” After reviewing nearly all products on the market, I found that at least 70% of million medical policies lack this feature, with only a few offering it. This can be a significant disadvantage!
To help you avoid pitfalls, I spent two weeks thoroughly analyzing 714 medical insurance products. Applying strict evaluation criteria, I filtered out those with incomplete coverage and condensed the findings into this essential table. The top 6 products are as follows: Key findings: – For comprehensive coverage: Prioritize Pacific Health’s “Blue Medical” and Ping An’s “Heart Medical.” Both offer 20-year guaranteed renewal and 100% reimbursement for external drugs within the coverage scope. For young buyers, the annual premium is only a few hundred yuan, making it highly cost-effective! – Blue Medical – Pacific Health Insurance – Medical Insurance – 20-year guaranteed renewal – Optional external drug reimbursement – View evaluation – The older version of “Gold Medical” has been upgraded to “Gold Medical 2.0.” Those aged 56-60 may consider it, but note its stricter requirements for “pre-existing conditions.” If health declarations are involved, other products are advised. – Gold Medical 2.0 – PICC Life Insurance – Medical Insurance – 20-year guaranteed renewal – No-claim deductible reduction – View evaluation – “Good Medical·Long-term Medical (Flagship Edition)” is the industry’s first million medical insurance with lifetime coverage. Common illnesses are covered for 20 years, while cancer and 11 cardiovascular diseases are covered for life. However, it is more expensive and excludes common conditions like herniated discs and hemorrhoids. Buyers should take note. – For superior medical experience and ample budget: Consider “Zhen Ai Wu You Special Edition,” which offers 6-year guaranteed renewal and access to better medical environments and services. – Zhen Ai Wu You – Junlong Life Insurance – Medical Insurance – 6-year guaranteed renewal – Practical value-added services – Optional special medical care – View evaluation – For those with minor health issues or elderly parents: Focus on “Yi Xiang Wu You Hui Xiang Edition.” It extends the maximum enrollment age to 69 for individuals and 80 for families, with 5-year guaranteed renewal. Conditions like hypertension and hepatitis B may still qualify, making it elderly-friendly. Try underwriting if applicable. As shown, million medical insurance products are diverse, and health declarations can be complex. For detailed guidance, click the card below to schedule a consultation with a professional advisor. Summary: Today, we highlighted the four most common reasons for claim denials in million medical insurance, revealing that:Million medical insurance is not a panacea. It has its own limitations and does not cover all situations. Relying solely on a million medical insurance plan is insufficient for comprehensive protection.
It is recommended that adults, in addition to million medical insurance, should also secure accident insurance, critical illness insurance, and term life insurance to achieve more holistic coverage. Let’s delve deeper. 5. Is a Million Medical Insurance Plan Enough? What are the specific roles of these four classic insurance types? Here’s a breakdown: – **Million Medical Insurance**: Addresses the issue of “high medical costs” by reimbursing substantial medical expenses at an affordable price. – **Accident Insurance**: Covers medical expenses due to accidental injuries and provides a lump-sum payment in case of accidental death or disability. – **Critical Illness Insurance**: Offers a lump-sum payment upon diagnosis of a covered critical illness, allowing flexible use of funds, such as compensating for lost income during illness. – **Term Life Insurance**: Provides financial support to families if the primary breadwinner passes away, ensuring continuity of care and responsibility. Currently, accident insurance, million medical insurance, and term life insurance are relatively affordable with high coverage leverage, making them suitable for those with tight budgets. Critical illness insurance is more expensive, but options like shorter coverage periods (e.g., until age 70) or transitional one-year products can reduce premium pressure. For more comprehensive protection, here’s a customized plan I designed for Fiona, a female colleague, with an annual premium of just over 4,000 RMB (approximately 358 RMB per month), maximizing cost-effectiveness: **Fiona’s Profile**: She recently turned 30, faces high work stress, frequently stays up late, and has limited savings. She avoids medical check-ups due to anxiety about affording treatment for serious illnesses and fears burdening her aging parents. **Plan Configuration**: 1. Million Medical Insurance**: Ping An’s “Xin Yi Bao” (Plan 2), a reliable product from a major insurer, covers large medical expenses (100% reimbursement above 10,000 RMB, subject to terms) with 20-year guaranteed renewal. – Key Features**: No-claim deductible reduction (minimum 5,000 RMB), zero deductible for 13 female-specific diseases, and up to 100,000 RMB for post-breast cancer reconstruction.2. Personal Accident Insurance
The selected product is Da Hu Jia 6 Flagship Edition, offering a high coverage of 1 million RMB, including 500,000 RMB for sudden death and 100,000 RMB for accident medical expenses (not limited to). This provides comprehensive protection. 3. Critical Illness Insurance The cost-effective Super Mary 12 from was chosen, covering critical illnesses until age 70 with a 500,000 RMB sum insured. Premiums are around 3,000 RMB annually over 30 years. A plan may be added later as income increases. Key features of Super Mary 12 (Junlong Life): – Optional additional critical illness coverage – Practical cancer protection – View detailed review 4. Term Life Insurance The top-tier product Da Mai 2024 was selected, offering 1 million RMB coverage at an affordable price below 600 RMB annually, representing exceptional value. This combination of four major insurance types provides comprehensive yet affordable coverage for diseases, accidents, and death, meeting most adults’ needs and serving as a representative reference. 6. Conclusion While million-RMB medical insurance has gained popularity in recent years, it’s important not to overestimate its capabilities. This article highlights four common claim denial scenarios to serve as cautionary examples. Purchasing an unsuitable million-RMB medical policy may not result in significant financial loss, but the real danger lies in claim denials during critical moments of illness, leading to stressful disputes with insurers and delayed treatment. We strongly recommend thoroughly understanding policy inclusions and exclusions before purchase to ensure adequate protection and build a robust risk management system for yourself and your family.
