Supplementary medical insurance is a branch of personal insurance that covers risks related to health and the costs of human diseases, drugs and surgeries and medical services for which social security insurance does not assume responsibility.
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Types of supplementary medical insurance
Insurance companies offer different types of supplementary insurance, and supplementary medical insurance can be considered as just one of the types of this type of insurance. Supplementary medical insurance has group, individual and family categories, which we discuss below.
1) Group supplementary medical insurance
Most of the supplementary medical insurances are included in this type of group. The employer can provide supplementary insurance to the members of the organization, including official, contracted, contracted and even retired employees, although the number of these people must exceed a certain limit and all those people are covered by insurance Be social with the workshop number of that organization.
In additional group insurance, in addition to the members of the organization, their families such as spouses, children, fathers, mothers and dependents can be covered.
Age conditions of group supplementary insurance
Since supplementary treatment insurances are a sub-branch of personal insurance, therefore the age limit conditions apply to them and if the applicant's age exceeds the permitted limit in the conditions of the supplementary treatment insurance policy, the insurance company does not insure that person or there are special conditions for He will consider. If the groups covered by supplementary medical insurance in the organization are less than 1000 people, the maximum age considered for their insurance is 60 years, and those above this standard age are required to pay higher insurance premiums (50 % higher than the conventional insurance premiums of supplementary group treatment insurance). For people over 70 years of age, the supplementary treatment insurance premium will be doubled.
But if the number of members of the organization covered by supplementary medical insurance exceeds 1000 people, the condition of age limit is canceled and the insurance premium paid for the supplementary medical insurance will be the same for all people. Of course, the important point is that sometimes insurance companies change the age limit conditions according to their internal regulations and consider special restrictions or facilities.
In case of the death of the main insured, his family members and dependents will have the possibility to continue using the supplementary group treatment insurance if they pay the relevant insurance premium.
2) Family supplementary insurance
Some of the insurance companies have provided supplementary plans for family supplementary medical insurance, among these plans, Saman supplementary family medical insurance and cooperative family supplementary insurance can be mentioned. In supplementary family insurance, it is not necessary that the applicant's social security insurance is from a The organization has been rejected and there is no condition for the minimum number of insured persons.
The possibility of paying additional family insurance premiums in installments
The possibility of obtaining a supplementary insurance policy even without the need to have basic social security insurance
Insurance coverage with various liability limits for all family members
General conditions of family supplementary medical insurance
A) Some coverages of supplementary family medical insurance, such as surgery, hospitalization and childbirth, require a waiting period, and the insured can use the relevant coverages after completing this period.
b) People with a history of illness face limitations in using family supplementary health insurance coverage and it is not possible for them to use all family supplementary health insurance coverage.
c) Each member of the family who is covered by supplementary family medical insurance must pay a separate insurance premium.
D) Supplementary insurance for family treatment, due to the fact that it is a sub-branch of personal insurance, has an age limit condition, which you must check with the insurance company before buying, because each of the insurance companies has specific age restrictions and conditions for this. They consider the field of insurance policy.
3) Individual supplementary medical insurance
The new plan provided by the insurance companies, which includes several rates and plans to cover the insurance needs of individuals, and is suitable for people who do not have the possibility of obtaining supplementary medical insurance under the supervision of a certain organization or group. Each person can purchase their own plan according to their appropriate insurance coverage and premium. Currently, only Saman Insurance and Cooperative Insurance companies offer individual supplemental medical insurance plans, each of which has specific insurance conditions. When choosing individual supplementary treatment insurance, the insurer should pay attention to the number of treatment centers under the contract with the insurer.
Different types of supplementary medical insurance
The difference between family medical insurance and group supplementary medical insurance is that the premium paid for family supplementary insurance is higher and the insurance coverage is less, but in the case of individual supplementary medical insurance, full insurance coverage is provided to the insurer. Even in some insurance companies, such as Saman individual supplementary insurance, it is not necessary to have basic insurance, which means that sometimes, if you do not have social insurance premiums, it is possible to obtain individual supplementary insurance.
Also, some people think that by paying an insurance premium by the guardian, it is possible for all family members to use the supplementary insurance coverage of the family treatment, if the nature of the supplementary insurance of the family treatment is the same as the nature of the individual supplementary insurance, but it requires the payment of the insurance premium. There are as many family members as there are, and an insurance policy will be issued in the name of the guardian, in which the names of the dependent members are included. If a family wishes to purchase a separate plan for each of its members, it must purchase individual supplementary insurance for each person. to buy
Supplementary insurance coverage
The supplementary medical insurance coverages offered by different insurance companies can be different. Some insurance companies, in addition to the main supplementary medical insurance coverages, also offer secondary or additional supplementary insurance coverages, which, of course, require higher insurance premiums.
The main additional insurance coverages offered by different insurance companies are as follows:
Costs of hospitalization, surgery, chemotherapy, radiotherapy, cardiac angiography, all types of stone breakers in hospitals and limited surgery centers and Day Care (Day Care surgeries are surgeries that the duration of post-operative care in medical centers does not exceed one day) .)
City and intercity ambulance costs and other medical emergencies subject to hospitalization of the insured in medical centers or transfer of the patient to other diagnostic and treatment centers according to the order of the attending physician.
The cost of accompanying patients under 7 years old and over 70 years old in the hospital
Additional group supplementary insurance coverages that can be covered if included in the supplementary insurance policy:
Covering the costs of surgeries related to cancer, brain, central nerves and spinal cord (the exception is the spine), gamma knife, heart, lung transplant, liver, kidney and bone marrow
Costs of natural childbirth and caesarean section up to 50% of the annual commitment limit. In this insurance coverage, the limit of the insurer's commitment should not exceed the highest cost agreed with the contracted hospitals. In case of purchase of maternity coverage, coverage of costs related to infertility and infertility treatment and related surgeries such as IUI, ITSC, ZIFT, GIFT, microinjection and IVF is allowed up to the maximum limit of the maternity obligation as an independent coverage.
Covering paraclinical expenses:
Paraclinical costs (diagnostic tests to measure the progress or improvement of the disease and ensure the improvement and improvement of the patient's health), which include mammography, types of scans and endoscopy, echocardiography, stress echo and densitometry, exercise test, allergy test, EMG muscle tape , NCV nerve tape, EEG brain tape, bladder tape, breathing test including spirometry and PFT, audiometry, optometry, eye angiography, Holter heart monitoring.
Costs of outpatient procedures such as dislocations and fractures and casting of body parts, circumcision, sutures, cryotherapy, lipoma oxygen, biopsy, cyst drainage and laser therapy.
A dentist that only includes tooth extraction, massaging, brosage, restoration and filling, root treatment and veneers.
The cost of glasses and medical lenses and hearing aids
Refractive surgery, of course, provided that according to the eye doctor's diagnosis, the sum of visual defects of each eye (degree of myopia or farsightedness plus half of astigmatism) is 4 diopters or more.
Costs of fetal abnormalities and diseases (screening tests)
Preparation of erots
The cost of laboratory services such as diagnostic tests, pathology and pathology and medical genetics, types of radiography, ECG and physiotherapy (except check-up)
Costs of visits, medicine and non-hospital emergency services
Other supplementary health insurance coverage
The cost of procuring natural body organs for transplantation is up to the amount of the basic annual commitment for each policyholder
Insurance coverage of natural risks except for earthquakes in case of higher insurance premiums
All the mentioned insurance coverages have a certain ceiling for the insurer's commitment, and the insurer does not assume responsibility for costs beyond the amount of the committed amount.
Exceptions to supplementary medical insurance coverage:
The following risks are not covered by supplementary medical insurance:
Quit addiction
Suicide
Criminal acts
Damage caused by natural disasters such as floods, volcanic eruptions
Damages caused by war, riot, riot, strike, riot
Cosmetic surgeries unless it is caused by an accident during the validity period of the supplementary treatment insurance policy.
Congenital defects except for the diagnosis of a trusted doctor and a physician with the purpose of treatment
The cost of a private room in medical centers and hospitals, unless the attending physician determines its necessity.
Dental cosmetic procedures such as implants, orthodontics, artificial teeth and gum surgery
Childbirth for the fourth child and more
Supplies and medicines that have a beauty and health aspect.
Costs related to intellectual disability and total disability
Jaw surgery unless necessary due to tumor or accident covered by supplementary medical insurance.
Fertilization and also sterilization unless due to the presence of a tumor or the occurrence of an accident are covered by supplementary medical insurance.
Stomach sleeve, lipomatic and abdomatic and slimming measures for patients whose body mass index is more than 40.
Lumbar disc surgery
All medical expenses are in research stages and the treatment tariff has not been determined by the Ministry of Health, Treatment and Medical Education.
Of course, some insurers cover a number of the aforementioned damages in their supplementary treatment insurance policy by charging a higher premium.
Additional treatment insurance premium
Apart from various tariffs and plans of insurance companies, various factors influence the price of supplementary medical insurance as follows:
A) The limit of obligations and selected insurance coverages
A) Limit of selected insurance obligations and coverages: The more insurance coverages and obligations are selected in the supplementary treatment insurance plan, the higher the cost of supplementary treatment insurance will be.
b) Age of the policyholder: The age of the policyholder is influential in determining the amount of supplementary treatment insurance premium, and usually insurance companies consider different age categories with certain premiums for each.
C) Number of insurance providers: If the number of insurance applicants exceeds a certain number, the amount of supplementary treatment insurance premium will be reduced.
Additional medical insurance conditions for groups of less than 50 people
In case of diagnosis by a specialist and trusted doctor of the insurance companies, the insurance company is responsible for paying the cost of medical examinations.
The limit of the insurer's obligations is the same for all members of the family or group in all committed surgeries (including specialized, sub-specialized and general surgeries).
Covering the costs of fixing refractive errors of the eye is outside the responsibility of the insurer and the insurer does not accept any obligation for them.
The insurer can refuse to insure an individual or a group or a family by examining the health examinations and questionnaires of the family members.
It is not possible to pay the costs of natural childbirth and caesarean section and the cost of diseases with a history of treatment before being insured in the first year of the contract.
The insurer must notify the insurer within 5 days at the latest from the time each of the insured is admitted to the hospital and before discharge.
In cases where the insured uses the services of medical centers of the contracting party with the introduction letter of the insurer, the bill of the medical center will be the basis for calculating the committed costs. Otherwise, the related costs will be paid according to the terms of the contracts of the insurer with the hospital.
The insurer is free to choose any hospital in the country and after paying the relevant fee, he must receive and submit the invoice to the insurer along with the certificate of the insurer's trusted doctor regarding the cause of the disease and the description of the treatments.
Supplementary medical insurance deductible
If the policyholder does not use the basic insurance, between 10% and 30% of the medical costs of surgery, hospitalization, childbirth, etc. will be borne by the policyholder under the title of deductible. Otherwise, the deductible is equivalent to the share of the basic insurance. And it will be at least 30%. Of course, the insurer will bear the mentioned expenses by receiving an additional premium from the insurer through deductible coverage, and the deductible for treatment, hospital, surgery and childbirth expenses will be borne by the insurer. Of course, the minimum deductible is never 10%. It cannot be insured and the insurer is required to pay it.
Waiting period in supplementary medical insurance
The waiting period of supplementary treatment insurance is the period of time when the insurer has no obligation to compensate the policyholder's losses. This period starts when the contract is signed. The waiting period is necessary when the supplementary treatment insurance covers the costs of childbirth. The insurer should know that the relevant waiting period The waiting period for the insurance coverage is nine to twelve months. It is recommended that the insurance provider must consider this point of the maternity insurance coverage waiting period before pregnancy.
Payment of supplementary medical insurance
There are two ways to pay for supplementary medical insurance:
1) Going to the medical centers of the contracting party with a letter of introduction: If the insurer has entered into a contract with the medical centers, the policyholder goes to his insurance agency and receives the relevant letter of introduction by presenting a doctor's certificate about the requirement to use the medical service covers, then He goes to the medical centers of the contracting party with the insurer and benefits from the services up to the limit of the insurance commitment with the deduction of the deductible.
2) Receiving fees from the insurance claim payment centers: the policyholder goes to the medical service center of his choice and receives the medical services. Then, he has a limited time period of maximum four months to submit the doctor's certificate and invoice for the medical expenses to the claim payment centers. has the insurance to receive the related cost with the deduction of the deductible and up to the limit of the insurance commitment.
Required documents to receive supplementary medical insurance compensation:
1) The original invoice of the treatment costs, sealed with the seal of the treatment center
2) Original doctor's prescription with official seal
3) Required documents specific to each insurance coverage
Which supplementary individual insurance is better?
The selection criteria for individual supplementary medical insurance include the plans and coverage provided by the insurance companies, the number of medical centers on the contracting party, the number of branches and agencies of the insurance company and the extent of their services, the insurance rate, the amount of the waiting period. Of course, currently, it is possible to obtain individual supplementary insurance only from Saman and Cooperative insurance companies.
Supplementary insurance for treatment of Saman
One of the insurance companies that provides individual supplementary insurance is Saman Insurance Company, which provides supplementary medical insurance in the form of 6 plans with different coverages and limits of obligations. Saman individual supplementary insurance plans include Mehr plan, Nasim plan, Soroush plan, Agate, Vasal design, Shamim design. Saman supplementary insurance is offered to insurance applicants in individual, family and group types. The interesting thing about buying supplementary insurance for Saman treatment is that you don't need to have basic insurance to buy it (insurance from government insurance companies such as social security insurance, medical services of the armed forces, health of Iranians and medical accidents), which in this case, by paying 18% of the right More insurance, it is possible to have supplementary insurance for the treatment of Saman.
Age requirements of Saman supplementary insurance
Applicants for supplementary health care insurance must be in the age range from birth to 70 years old, and it is not possible to issue supplementary health insurance for people over 70 years old.
Methods of paying supplementary insurance premiums for treatment of Saman
In the supplementary health insurance, the insurance premium is calculated annually and the policyholder can pay it in cash or in installments. A 10% discount will be given to the policyholder in case of purchasing Saman individual treatment supplementary insurance in cash.
Waiting period of individual supplementary insurance of Saman
Each of Saman's individual supplementary insurance plans has a three-month waiting period for inpatient and surgical services and a nine-month waiting period for childbirth, that is, to cover the mentioned cases, at least three and nine months must have passed since the insurance period.
Methods of receiving medical expenses from Saman Insurance Company
1) Refer to the contracting party's medical centers with an introduction letter
If medical centers have a contract with Saman insurance company, the insured will only pay the expenses outside of Saman insurance's obligation and there is no need for a deductible, although the share of Saman insurance company does not exceed the maximum limit of the introduction letter.
If the medical center has not signed a contract with the Saman insurer, the insured will pay the expenses outside the obligation and the excess of the ceiling in addition to the deductible.
2) Refer to the medical centers of the contracting party without an introduction letter
The damage is paid according to the tariff of the medical service center and the difference is subject to deductions.
3) Refer to the centers of the contracting party
The insurer is required to submit his medical documents no later than 4 months after the date stated in the medical documents so that the procedures for paying the medical damages are processed. After the documents are approved, the medical expenses will be paid. And the excess tariffs are deducted.
The original invoice of the amount paid by the insurer with the date and stamp of the authorized medical service center
A copy of the answer based on the paraclinical action or the doctor's order (the original paraclinical documents will not be returned, so only send the copy of the paraclinical documents to Saman Insurance Company to receive the relevant damages.)
Buying additional medical insurance (individual medical supplementary insurance and family medical supplementary insurance)
a) After entering the details in the specified boxes, compare the prices of supplementary insurance for individual treatment and supplementary insurance for family treatment from different companies providing this insurance policy. For example, you can choose Saman individual supplementary insurance, Saman family supplementary insurance, supplementary insurance The cooperative pointed out.
b) Finally, according to your priorities and needs and the insurance plans provided, choose one of the companies providing individual supplemental insurance and family therapy supplemental insurance available on the insurance.com website.
c) Finally, after entering your personal information and uploading the scan of your birth certificate, national card and basic treatment booklet (if any), pay for the online purchase of supplementary insurance for individual treatment and supplementary insurance for your family.
d) Purchased supplementary treatment insurance policy will be issued in the shortest possible time and will be sent anywhere in the country for free.
?Why choose insurance.com to buy supplementary medical insurance
Insurance.com online brokerage is a system for querying, comparing and buying insurance online. You can easily inquire and compare all types of insurance policies of authorized insurance companies of Central Insurance by entering this site. In addition, it is possible to call 0214372 and receive free and completely unbiased guidance and specialized insurance information from insurance.com experts to choose the best supplementary insurance. After receiving insurance information, checking and buying the cheapest insurance suitable for your conditions, you will receive your insurance policy at home for free in the shortest possible time.
How much is the registration fee for supplementary medical insurance?
You can inquire about the price of the best supplementary medical insurance according to your conditions (age, having a basic insurer and the number of dependents) and see how much your insurance premium will be to buy this insurance through the insurance.com website.
?Do I have the possibility to be insured alone or should I be insured by the workplace
Yes, it is possible to purchase individual supplementary medical insurance from some insurance companies. You can buy individual supplementary medical insurance online through the insurance.com website.
If you don't have basic insurance, is it possible to buy supplementary medical insurance individually?
Yes, you can get insured by paying more premiums.
?Is LASIK surgery insurance covered
Yes, in plans that cover refractive errors, LASIK surgery is covered by medical insurance.
Is a person who is pregnant covered by medical insurance? Is the cost of childbirth and hospitalization covered by medical insurance?
A pregnant person can be covered if the condition and health of the pregnancy is confirmed by the trusted doctor of the insurance company - the cost of childbirth cannot be paid due to the 9-month waiting period.
?How to get additional insurance
You can use supplementary medical insurance services by purchasing supplementary medical insurance either individually or as a group (corporate).
?Can I use supplementary insurance for childbirth
What is the difference between life insurance and supplemental insurance? Yes, one of the coverages is maternity supplemental medical insurance. But to use it, you must purchase additional insurance before pregnancy; Because most supplementary medical insurances have a waiting period and you cannot use supplementary insurance before the end of this period.
?What is the difference between life insurance and supplementary insurance
Life insurance offers various coverages and is considered a suitable option for investment and retirement. But supplementary medical insurance only covers diseases and medical services and does not include additional services in its coverage.