1, existing conditional clause. This clause stipulates that when the insurance coverage available to the insured has expired, the insurer will no longer be responsible for the existing situation of the insured; However, if the insured has not been treated for a pre-existing condition for three consecutive months, or has participated in group insurance for 12 months, then the disease does not belong to the scope of pre-existing conditions, and the insurer is responsible for the medical expenses or income losses caused thereby.
2. Conversion clause. When the group insured wants to apply for personal medical insurance after leaving the group, they don't need to provide guarantee. The insured can't use it for double insurance. After the group health insurance is converted into individual health insurance, the premiums paid by the general insured will increase, and the restrictions on the payment of insurance benefits will also increase.
3. Coordinate payment terms. It mainly solves the problem that the group insured who enjoys double group medical expenses enjoys double insurance payment. Two kinds of insurance policies are defined as priority payment plan and second payment plan respectively.
To sum up, the difference between group health insurance and individual health insurance is mainly manifested in underwriting methods and rates. The special clauses applicable to group health insurance include existing status clauses and conversion clauses.