[Unlimited Claims vs Unlimited Diseases] Comparing coverage on “unlimited” critical illness insurance

Estimated reading time 6 minutes

10Life Team

18 May 2021
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10Life Team

18 May 2021

Estimated reading time 6 minutes

「無限」就無敵?未來風險難以預知,若保險能提供「無限」保障,當然非常吸引。然而「無限」是指什麼呢?市場上,「無限」概念的危疾保險產品不多,暫時只有友邦AIA的唯一摯保–全面保障(下稱友邦唯一摯保)、忠意香港Generali的加愛無限保(下稱忠意加愛)及跨越無限保(下稱忠意跨越)。雖然這些產品都標榜「無限」,但同中存異。忠意跨越是終身危疾保險;而友邦唯一摯保忠意加愛均設指定續保年期,沒有儲蓄成份,可歸類為定期危疾保險,本文將集中比較後者。

友邦唯一摯保於三大危疾賠償額難料 視乎嚴重程度

客戶一般最關心的三大危疾為癌症、心臟病及中風,佔危疾保險索償約9成,因此我們先比較三大危病的賠償;假設保額為100萬(港元,註1),圖表1列出疾病的嚴重程度。

圖表1
比較三大嚴重疾病(癌症、心臟病、中風)保障

友邦唯一摯保標榜「無限種疾病」保障,賠償額按受保人的患病嚴重情況而定。上述個案中,友邦唯一摯保就第三期肺癌的預計賠償60萬,心臟病發(需搭撟手術)則賠50萬,中風預計可賠100萬(註2)。同樣是嚴重危疾,為什麼賠償差異這麼大?因為計劃是按醫療過程、嚴重程度(註3)來計算賠償,單次賠償介乎10%至160%保額。因此即使是嚴重危疾,也未必能賠償100%保額。如果上述個案再「加辣」,舉例癌症達到第四期、心臟嚴重至衰竭等,賠償額可再提高。不過,受保人要理解這複雜的條件及計算,才可預計賠償額。

反觀,忠意加愛視癌症、心臟病發、中風為嚴重危疾,受保人可得100萬賠償。當受保人確診受保危疾,便可得到100%保額之賠償,無需在危疾之上再「加辣」來計算賠償。所以,受保人只需了解受保疾病的定義,就較容易掌握賠償額。連三大危疾在內,忠意加愛將69種疾病列為嚴重危疾,賠償100%保額。


意加愛對三大危疾無賠償 賠償更較易掌握 

近年危疾病人的存活率提高,病人確診首次危疾後便難以再投保,在漫長人生路上,亦有再次面對危疾的風險,因此不少客戶都著重危疾保險的多重保障。

我們再以個案說明,假設投保人為35歲非吸煙男性,保額100萬,於38歲患第二期腸癌、58歲確診腎衰竭、至70歲不幸中風,見圖2。

對於忠意加愛,於等候期(註4)後,確診受保危疾,每次保險公司都賠100萬,所以3次嚴重危疾總賠償額為300萬。市場上多數定期危疾保險只賠單次,但忠意加愛卻罕有為癌症、心臟病及中風,提供「無限次賠償」。即使其他嚴重危疾,忠意加愛亦至少可賠一次,每次賠償100%保額。

友邦唯一摯保雖沒有就疾病種類設限,但賠償受嚴重情況限制,未必每次都能賠償100%保額。如例子中,第二期腸癌估計賠60萬、腎衰竭預估賠80萬,2次總賠償額為140萬(即140%保額)(註2)。經過兩次索償後,嚴重狀況賠償達到保額120%,保單便會終止(註5),所以往後發生之中風,亦不會得到賠償。

圖表2
比較多次嚴重疾病的保障

危疾後餘生免保費?比較保費豁免細節

延續圖2例子,為什麼受保人所繳的保費也有顯著差別?忠意加愛設有保費豁免機制,例子中受保人只繳付3年保費(約2萬),因確診嚴重疾病,即豁免以後的保費,並可繼續享有終身保障。一般言而,保費豁免條款甚少出現於定期危疾保險,同類產品中,忠意加愛罕有提供保費豁免,豁免所有嚴重危疾後的保費,至保障期完結(100歲)。

其實,友邦唯一摯保也有保費豁免措施,但要符合嚴格的條件才可全數豁免往後保費(註6),保障期僅限至85歲。圖2例子中,當受保人索償第二期腸癌(賠60%保額),賠償不足100%保額的情況下,就只可豁免部分保費,即隨後的60%保費可獲豁免。但在第一次及第二次索償之間,受保人於20年內仍要支付約9萬保費。

未知疾病賠償 還看嚴重程度

針對常見的危疾個案,按受保危疾作賠償的忠意加愛,賠償額相對易於掌握,三大危疾更可得無限次賠償;而按嚴重程度賠償的友邦唯一摯保,消費者就要了解計劃所指的嚴重、很嚴重、極嚴重程度,才可計算賠償額。當然,友邦唯一摯保賣點是無限種疾病,包括未知疾病。以新冠肺炎為例,如果友邦唯一摯保的受保人因新冠肺炎而住院連續10日或以上、並連續入住連續3日或以上入住深切治療病房,便可賠償50%保額(註2,7);但如果受保人只是住院,將不獲賠償。至於忠意加愛,若因為新冠肺炎導致肺功能損失至指定程度,如永久性及不可逆轉地下降(註8),將賠償100%保額。

忠意加愛一樣,文章開首提到的忠意跨越亦無限次賠償三大危疾,但後者是終身危疾保險,受保人在自選年期內繳付保費完畢後,便可享有終身保障,首次嚴重危疾索償後也享有保費豁免。由於我們無法預料危疾早來或遲來,如果危疾遲來,終身危疾保險的保費或早已繳完,但受保人仍有終身保障。試想想,若家長為小朋友投保,即使短期內患危疾的機會很低,但正因為風險較低,小朋友的保費亦較低,到供款完畢時,孩子大概長大成人,便得到終身保障,享無限次賠償,這正是終身危疾保險的優勢。

10Life分別比較定期危疾保險及終身危疾保險,詳情請瀏覽《產品解碼器》。

註:

  1. 本文之貨幣為港元。
  2. 文中,當計算友邦唯一摯保的賠償時,10Life為個案假設了所需的醫療過程,再詮釋有關計劃之保單條款,計算出上述個案的預計賠償額。該預計賠償額僅供參考,未有向有關保險公司核實。
  3. 友邦唯一摯保﹕4x3賠償計分表考慮4種醫療過程(手術、治療、嚴重住院、殘廢)及對應的3種嚴重程度。由於計劃沒有指定疾病,只要符合指定嚴重狀況,原則上可保障無限種疾病。
  4. 忠意加愛就同一癌症,不論復發、擴散或持續,設有3年等候期,但全新癌症或其他疾病的等候期則為1年。
  5. 友邦唯一摯保﹕整份保單的賠償上限為160%保額,由嚴重狀況賠償(120%保額)及極嚴重狀況之額外賠償(40%保額)組成。但當嚴重狀況賠償達至120%保額,保單便結束。
  6. 友邦唯一摯保﹕若受保人嚴重狀況賠償達100%;或極嚴重狀況之額外賠償達40%保額,可獲豁免保費。
  7. 友邦唯一摯保﹕於新冠肺炎之嚴重程度累積分數: 住院治療10日以上+1分、連續3日入住深切治療病房+2分、符合嚴重住院+2因素分, 累積5分,應付賠償為50%保額。
  8. 任何肺部疾病導致肺部功能永久性及不可逆轉地下降,從而需長期吸氧以治療低氧血症,並且在適當的藥物治療下,第一秒最大呼氣量(FEV 1)的測試結果持續相等或少於 1 公升,及已持續最少三(3)個月。診斷須由胸肺科專科註冊醫生證實。倘若診斷出的肺部疾病並未符合與肺部相關的其他嚴重疾病的任何定義,保單則會按肺功能損害而支付保障。
  9. 以上資訊由10Life提供,僅供參考,並不是銷售提議。以上資料更新至 2021年5月20日。

Disclaimer

10Life Product Comparison and 10Life Insurance Ratings are developed by 10Life Financial Limited, an authorised insurance broker company licensed with the Insurance Authority under License Number FB1526. 10Life Product Comparison and 10Life Insurance Ratings are developed for generic customer segments using mathematical calculations based on product information, facts and data, and are not influenced by any partnerships with or fees received from insurance companies.

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