Health insurance is an insurance that takes the insured's body as the insurance object, so that the insured can get compensation for the expenses or losses caused by illness or accident.
Characteristics of health insurance:
(1) insurance period
Except for serious diseases, most health insurance, especially medical expenses insurance, is usually a one-year short-term contract.
(2) Actuarial technology
The pricing of health insurance products mainly considers the disease rate, disability rate and disease (disability) duration. The calculation of health insurance rate is based on the loss rate of insured amount, and the unexpired liability reserve at the end of the year is generally paid according to a certain proportion of the premium income of the current year. In addition, waiting period, deductible, deductible, * * payment ratio, payment method and payment limit will also affect the final rate.
(3) Pay health insurance
Whether the principle of compensation is applicable to health insurance cannot be generalized. Expense-based health insurance applies this principle and is a compensatory payment. However, the fixed payment of health insurance is not applicable, and the payment of insurance benefits has nothing to do with actual losses.
(D) the particularity of business risks
Health insurance deals with injury risk, and its influencing factors are far more complicated than life insurance, and adverse selection and moral hazard are more serious. In addition, the risk of health insurance also comes from medical service providers, and the quantity and price of medical services are largely determined by them, which is difficult for insurance companies to control as payers.
(5) Cost sharing
Because health insurance is risky, difficult to control and unpredictable, in health insurance, the insurer often has many restrictions or restrictive clauses on the payment responsibility of medical insurance for diseases.
(VI) Particularity of contract terms
Health insurance does not need to specify the beneficiary, and the insured and beneficiary are often the same person.
In the health insurance contract, besides the incontestable clauses, grace period clauses and no loss clauses of general life insurance, there are also some unique clauses, such as existing conditions clauses, conversion clauses, cooperative payment clauses, medical examination clauses, deductible clauses and waiting period clauses.
(7) Except for health insurance.
The exclusions of health insurance generally include diseases, deaths and disabilities caused by war or military action, intentional suicide or attempted suicide, and diseases, disabilities, abortion and death caused by abortion.
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.