Xiao Wang and his wife are a couple who are used to traveling abroad for self-service every year. They each have medical insurance and even have real payments. However, whenever they travel abroad, they don’t like to take out travel insurance because they deeply feel that “we have insurance already, so travel insurance does not need it very much…”
Xiao Wu’s couple is the same as them, but they don’t have medical insurance. Every year when they go abroad, they will definitely buy travel insurance to go abroad. Perhaps every family has different values of risk, but in fact, if you lack one of the guarantees when traveling abroad, you will really lose a lot!
Xiao Wang and his wife had medical insurance but no travel insurance
Hassumed that Xiao Wang's couple traveled to Kyushu, Japan this summer. As a result, during the trip, Xiao Wang urgently went to the hospital for five days due to chest pain and nausea, spending about 130,000 yuan in total, and all the trip was completely ruined. He thought that he would definitely be able to apply for compensation after returning to Taiwan, but he didn't expect that when he applied, the insurance premium was 65% off! Only about 84,500 yuan was lost. Why! ?
Although real-paid medical insurance is mainly used to compensate for all self-paid medical expenses incurred by the insured when seeking medical treatment, its rate design is based on the "National Health Insurance" medical status, so Xiao Wang does not seek medical treatment in Japan as a "health insurance status".
According to Article 8 of the demonstration clause of the hospitalization medical expenses insurance policy (real payment type) point out that the insured person does not inpatient treatment as the insurance subject of National Health Insurance ; or goes to a hospital without national health insurance for hospitalization, resulting in the medical expenses not being paid by national health insurance. The company pays ○% (no less than 65%) of the expenses actually paid by the insured person, but the limit stipulated in the above-mentioned insurance terms is still limited.
So, this is why Xiao Wang's claims for hospitalization, medication, surgery, etc. in Japan were 65% off, but he did not have a travel insurance policy, so the rest of the expenses had to be borne by himself.
The consequences of Xiao Wu having travel insurance without medical insurance
And assuming, Xiao Wu's couple went to Huangshi Park, USA this summer. As a result, during the trip, Xiao Wu was not accustomed to the local conditions, vomited, had diarrhea, and had a cold and high fever. When he was in the hospital, he found that he had acute gastroenteritis. After three days of hospitalization, he was discharged from the hospital. As a result, the hospital bill was 40,000 US dollars! It is equivalent to about NT$1.28 million.
When Xiao Wu's wife was helping to apply for a comprehensive travel insurance claim, she thought there was a "surcharge for overseas sudden illness" for the insurance, so the claim for medical expenses should be fine. Unexpectedly, the claim department of the property insurance company found that Xiao Wu had a cold due to gastroenteritis in Tai'an Hospital a month ago, so he refused to pay the claim!
Because, for the definition of "surprising diseases overseas", major insurance companies will prescribe the following statements: "The insured person does not aim to obtain overseas medical care, but must be treated immediately in overseas medical institutions to avoid diseases that damage their health. If this insurance contract takes effect 180 days (some insurance companies set it to 90 days) and has not received treatment for the disease."
Therefore, Xiao Wu suffered gastroenteritis a month ago, which made Xiao Wu's medical treatment this time not within the scope of insurance claims.
After reading these two cases, although Xiao Wang and Xiao Wu are both national health insurance, they can apply for self-appropriate medical expenses for emergency injuries. According to the latest announcement of the Health Insurance Administration in 2018, the maximum amount of daily hospitalization is 5,653 yuan, 2,808 yuan per emergency room, and 932 yuan per outpatient clinic, but no matter how you calculate it, it is better to make sure your medical insurance is enough.
