2024 Actual Expense Reimbursement New System! 3 Tips to Review Your Policy and Smartly Cope with Changes in Copy Claims
Starting in 2024, actual expense reimbursement will undergo major changes, and …
To all you lazy fans who want to be lazy but can’t, and those who can’t be lazy but really want to, last September I wrote about my concerns in this article: 【保險】複數實支實付法如果沒有了怎麼辦?, and it really happened.
Maybe you were wondering this month whether to buy indemnity health insurance? Yes, with the extension of original copy claims for indemnity health insurance to October and the new rules for participating insurance policies taking effect in July, everyone seems to have a little more time to consider. But don’t forget, the product may not necessarily be discontinued in October, but may be discontinued at any time, and once it is discontinued, it will never come back!**
So, lazy fans with a budget, remember to fully invest in a copy of indemnity health insurance.
You already know from the name. You can also call it “actual reimbursement,” “reimbursement for what you spend,” or “reimbursement only when used.” The most important thing is that it is based on the principle of indemnity, avoiding the need to pay out of your own pocket when you encounter medical expenses.
But don’t think that the amount on the receipt will be fully reimbursed, because there are more details to understand.
Here is a table to give you a clear overview of the differences between these three types of insurance.
| Insurance Type | Coverage Items | Coverage Scope | Reimbursement Basis | Payment Method |
|---|---|---|---|---|
| Indemnity Insurance | Reimbursement based on receipt items and amounts, including hospitalization, surgery, and miscellaneous expenses. | Relatively Broad | Medical Receipt + Diagnosis Certificate | Reimbursement based on receipt content |
| Surgical Medical Insurance | Reimbursement based on the surgical list, generally the more serious the surgery, the higher the reimbursement. | Average | Diagnosis Certificate | Reimbursement per item |
| Hospital Daily Allowance | Reimbursement based on the number of days of hospitalization, and the amount is also limited. | Limited | Diagnosis Certificate | Reimbursement per day |
According to the Ministry of Health and Welfare’s 111 Annual National Health Insurance Medical Statistics Report, in 2022, families spent NT$65.7 billion (USD $2.02 billion) on out-of-pocket medical and healthcare expenses for hospitalizations. The report also shows that the number of hospitalizations in 2022 was only 1.9 million (those who have been hospitalized, not counting the number of times). Based on this figure, the average cost per hospitalization is NT$240,000 (USD $7,385).
And this is just the average.
Having indemnity health insurance is the most basic thing in insurance planning, but you still need to consider the following factors:
Warning
You don’t have to worry about the above 3 points at all, because in the near future, you may only have the possibility of purchasing one indemnity health insurance policy.
Tip
💰 Directly buy a single policy with a coverage of over NT$300,000 (USD $9,231), and you may feel a little more at ease.
2022 National Health Expenditure (Excerpt)
| Year | Total | Health Care | Hospitalization | Outpatient | Hospital Outpatient | Western Medicine Clinic | Traditional Chinese Medicine Clinic | Dental Clinic |
|---|---|---|---|---|---|---|---|---|
| 2012 | 3,861 | 2,622 | 447 | 1,485 | 487 | 273 | 67 | 659 |
| 2013 | 3,995 | 2,725 | 522 | 1,476 | 476 | 276 | 69 | 655 |
| 2014 | 4,147 | 2,832 | 530 | 1,508 | 479 | 275 | 69 | 685 |
| 2015 | 4,282 | 2,884 | 553 | 1,549 | 480 | 260 | 66 | 743 |
| 2016 | 4,455 | 3,005 | 615 | 1,558 | 477 | 257 | 65 | 759 |
| 2017 | 4,593 | 3,075 | 636 | 1,583 | 502 | 263 | 67 | 751 |
| 2018 | 4,764 | 3,195 | 638 | 1,651 | 500 | 256 | 65 | 831 |
| 2019 | 4,892 | 3,248 | 614 | 1,662 | 499 | 263 | 69 | 831 |
| 2020 | 4,950 | 3,114 | 582 | 1,543 | 450 | 215 | 63 | 815 |
| 2021 | 4,970 | 3,084 | 550 | 1,574 | 464 | 209 | 61 | 841 |
| 2022 | 5,320 | 3,281 | 657 | 1,722 | 497 | 222 | 72 | 931 |
Source: Outpatient, Delivery Institution, and Hospitalization Detail Files from the Multi-Model National Health Insurance Database of the National Health Insurance Administration.
This table is just about the money spent! It simply looks at each average value (point), but what you see is only “National Health Insurance points,” which does not include “out-of-pocket medical expenses.” So what is this table for? It’s to tell you that these items are very expensive because even the National Health Insurance (健保) fees are expensive, so how can out-of-pocket items be cheap?
Tip
💰 Considering that it will not be possible to plan for more than 2 indemnity health insurance policies in the future (unless the rules change), and with the advancement of medical technology, the length of hospital stays is decreasing and the proportion of outpatient surgeries is increasing, I personally would prioritize indemnity health insurance policies that definitely cover outpatient surgeries.
The following premiums are based on a 30-year-old female as a reference (premiums may vary depending on the insurance company’s adjustments / reference information does not represent a purchase recommendation)
| Insurance Company | Product Name | Product Code | Annual Premium | Policy Details |
|---|---|---|---|---|
| Allianz Life | One-Year Term Hospital Medical Expense Insurance Rider | HMR1 | NT$7,290 | Indemnity · Insurable Age 0-75 · Maximum Coverage to 75 |
| Taiwan Life | Gold Secure Hospital Medical Health Insurance Rider | 1Q | NT$7,004 | Indemnity · Insurable Age 0-70 · Maximum Coverage to 85 |
| Shin Kong Life | Caring Secure Hospital Medical Health Insurance Rider | U1 | NT$10,973 | Indemnity · Insurable Age 0-65 · Maximum Coverage to 80 |
| Shin Kong Life | Increased Secure Deductible Hospital Medical Health Insurance Rider | U2U3 | NT$507 | Indemnity · Insurable Age 0-65 · Maximum Coverage to 80 |
| Farglory Life | Yong An Kang Medical Health Insurance Rider | RSN | NT$7,831 | Indemnity · Insurable Age 0-70 · Maximum Coverage to 75 |
| Taisin Life | Hospital Medical Expense Health Insurance Rider | HX | NT$5,974 | Indemnity · Insurable Age 0-70 · Maximum Coverage to 84 |
| KGI Life | Xin Kang Tai Hospital Medical Limit Payment Health Insurance Rider | MAHUGA | NT$10,660 | Indemnity · Insurable Age 0-70 · Maximum Coverage to 80 |
| Nan Shan Life | Practice Happiness Hospital Medical Health Insurance Rider | 1HS | NT$5,600 | Indemnity · Insurable Age 0-65 · Maximum Coverage to 75 |
| Cathay Life | Real Wholehearted Hospital Medical Health Insurance Rider | CV1 | NT$7,955 | Indemnity · Insurable Age 0-70 · Maximum Coverage to 80 |
| Nan Shan Life | Super Practice Happiness Deductible Hospital Medical Health Insurance Rider | 1HSD | NT$1,821 | Indemnity · Insurable Age 0-65 · Maximum Coverage to 75 |
| Cathay Life | Good Real Deductible Hospital Medical Health Insurance Rider | WV3 | NT$5,138 | Indemnity · Insurable Age 0-70 · Maximum Coverage to 80 |
| Nan Shan Life | Realize Happiness Partial Burden Hospital Medical Health Insurance Rider | 1HSCO | NT$2,208 | Indemnity · Insurable Age 0-70 · Maximum Coverage to 85 |
| Fubon Life | Wholehearted One-Year Term Hospital Medical Health Insurance Rider | HSK | NT$10,360 | Indemnity · Insurable Age 0-65 · Maximum Coverage to 74 |
| MetLife | Increased New Hospital Deductible Hospital Medical Health Insurance Rider | DHSR | NT$713 | Indemnity · Insurable Age 0-65 · Maximum Coverage to 74 |
| MetLife | New Hospital Medical Insurance Rider | HSRS | NT$1,796 | Indemnity · Insurable Age 0-65 · Maximum Coverage to 74 |
| Taisin Life | Zhen Bao Shun Xin Hospital Medical Expense Health Insurance Rider – Deductible Type (B) | HDBBBN | NT$147 | Indemnity · Insurable Age 0-70 · Maximum Coverage to 84 |
| KGI Life | Super Kang Tai Deductible Hospital Medical Health Insurance Rider Type B | LEGOVB | NT$1,012 | Indemnity · Insurable Age 0-70 · Maximum Coverage to 80 |
| Fubon Life | Secure One-Year Term Hospital Medical Health Insurance Rider | HSU | NT$10,980 | Indemnity · Insurable Age 0-65 · Maximum Coverage to 80 |
| KGI Life | Super Kang Tai Deductible Hospital Medical Health Insurance Rider Type C | LEGOZA | NT$1,975 | Indemnity · Insurable Age 0-70 · Maximum Coverage to 80 |
| Fubon Life | Real Secure One-Year Term Hospital Medical Health Insurance Rider | HSL | NT$1,985 | Indemnity · Insurable Age 0-65 · Maximum Coverage to 75 |
| Fubon Life | Real Whole One-Year Term Hospital Medical Health Insurance Rider | HST | NT$1,650 | Indemnity · Insurable Age 0-65 · Maximum Coverage to 75 |
| MetLife | Bao Jian Kang Hospital Medical Health Insurance Rider | BHSR | NT$5,125 | Indemnity · Insurable Age 0-65 · Maximum Coverage to 80 |
| Shin Kong Life | Secure Hospital Insurance Rider (Newly Revised) | 72D | NT$4,455 | Indemnity · Insurable Age 0-60 · Maximum Coverage to 75 |
| Hong Tai Life | Real Separate Medical Rely Medical Expense Health Insurance Rider | NNHS | NT$6,507 | Indemnity · Insurable Age 0-70 · Maximum Coverage to 75 |
| MetLife | Increased Bao Jian Kang Deductible Hospital Medical Health Insurance Rider | DBHSR | NT$2,522 | Indemnity · Insurable Age 0-65 · Maximum Coverage to 80 |
| Taisin Life | Zhen Bao Shun Xin Hospital Medical Expense Health Insurance Rider – Deductible Type (A) | HDAAAN | NT$268 | Indemnity · Insurable Age 0-70 · Maximum Coverage to 84 |
| Hong Tai Life | Hospital Medical Insurance Rider Type A | HS | NT$2,170 | Indemnity · Insurable Age 0-65 · Maximum Coverage to 75 |
| Key Points | Explanation
| 理賠方式 | 說明 |
|---|---|
| 合併給付 | 住院醫療雜費與手術費合併理賠,減少認定問題,但在門診手術理賠上較弱。 |
| 分開給付 | 住院醫療雜費與手術費分開理賠,各自有理賠上限,可能會出現理賠不足的問題。 |
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