age
People of different ages have different health conditions, and people who are too old or too young have higher health risks than ordinary people. Therefore, age is an important factor that insurance companies should consider when deciding whether to underwrite. Generally, the underwriting age of health insurance is more than 3 years old and less than 60 years old, and in some cases it can be relaxed to 0~70 years old.
In addition, people's gender also has a great relationship. Generally speaking, women's life expectancy is longer than men's, and their health status is better than men's, so men's insurance coverage rate is higher than that of women of the same age.
Physical examination clause
It allows the insurance company to appoint a doctor to carry out a physical examination on the insured who makes a claim, so that the insurance company can evaluate the validity of the claim. The medical examination clause applies to disability income compensation insurance.
Observation period clause
Based on limited data such as medical records, it is difficult to judge whether the insured suffers from a certain disease at the time of insurance. In order to prevent people with pre-existing diseases from taking out insurance and ensure the interests of the insurer, the observation period (mostly half a year) should be stipulated in the policy. During this period, the insurer will not be responsible for the medical expenses or income loss caused by the insured's illness, and the policy will not take effect until the observation period expires.
That is to say, the insurer may refuse to bear the responsibility according to the principle of utmost good faith if the disease broke out during the observation period is assumed to have existed before the insurance. If the subject matter insured is lost due to exemption during the observation period (such as the death of the insured due to illness), the insurance contract is terminated and the insurer will refund the insurance premium after deducting the handling fee; If the subject matter insured is not lost, the insurer shall decide whether to renew the insurance according to the physical condition of the insured, or may terminate the insurance contract on the grounds of increased danger.
Waiting period clause
The so-called WaitingPeriod, also known as deductible period, refers to a period of time from the occurrence of diseases, births, diseases, disabilities and deaths caused by health insurance to the payment of insurance benefits. In the insurance contract of health insurance, "waiting period" is usually added to the clause of "application and payment of insurance benefits", and the time is different.
Deduction compensation clause
In health insurance contracts, medical expenses are generally deductible, that is, expenses below a certain amount are borne by the insured, and the insurer will not pay.
Payment limit clause
In the compensatory health insurance contract, the maximum amount of medical insurance premium paid by the insurer is stipulated, such as the limit of single disease, the limit of hospitalization expenses, the limit of operation expenses and the limit of outpatient expenses.
The insured individuals in health insurance vary greatly, and so do their medical expenses. Therefore, in order to protect the interests of the insurer and most of the insured, the maximum payment limit of medical insurance benefits can be stipulated to control the total expenditure level.
For health insurance with the nature of fixed insurance, such as critical illness insurance, there is usually no compensation limit, but fixed compensation is implemented according to the agreed insurance amount.