A few days ago, a reader came to me and said that she had breast nodules when she was insured. When making health notification, she asked the salesman if he needed to inform the insurance company. The salesman told her that it doesn't matter, and it will affect underwriting. Even if it is not filled in for two years, the insurance company will pay for it.
So this reader really chose among related inquiries? No? !
It was not until she read our popular science articles these days that she became nervous and asked me what to do.
In the past, this situation was too numerous to mention. Every time I see it, it's irritating. Finally, we made a supplementary explanation for readers. Although it will increase the cost in the future, it at least solves the hidden danger of non-compensation.
The importance of health information is not much to say. There are many related contents in the past articles.
Let's talk about it today Did the salesman say that? Will the insurance company pay in two years? , what is the situation.
What is the one-year and two-year incontestable clause?
Insurance is an exotic product in China, which is different from some developed countries. Wide in and strict out? You can simply inform when you apply for insurance, and the claims will be reviewed by professionals.
This kind? High school students sell insurance master students to settle claims? This phenomenon has caused many consumers to have many problems in claims settlement and are dissatisfied with insurance companies.
In order to prevent insurance companies from indulging their agents, doing nothing in underwriting and refusing to pay profits after obtaining premiums, the Insurance Law was amended in 2009, adding an incontestable period of two years.
Article 16 of the Insurance Law stipulates that if more than two years have passed since the contract was established, the insurer shall not terminate the contract; In the event of an insured accident, the insurer shall be liable for compensation or payment of insurance benefits.
Many salesmen use this as evidence that insurance companies have to pay for more than two years. But the connotation of Article 16 is far from being taken out of context? Over two years? It's as simple as that.
Second,? Two years later, you have to pay for it? Is it true?/You don't say. /You don't say.
If after two years, the insurance company will pay compensation anyway, what are the irrefutable terms and conditions? Insurance fraud clause? What is the difference? How can the state introduce such a law, is it to encourage people to cheat insurance despite illness?
You know, article 16 says. If the contract has been established for more than two years, the insurer shall not terminate the contract and shall bear the insurance liability? After that, followed by other explanations:
That is to say, as long as it can be proved that the insured has the subjective motivation to insure the disease, no matter how many years the insurance has been insured, the insurance company has the right not to pay compensation and the premium does not have to be refunded.
Therefore, whether it is a friend misled by the salesperson or a friend who has really been lucky enough to wait for two years, you can wake up. It is not reliable to insure against illness. I suggest telling the truth. If it has been insured, it can also be supplemented.
Third, the application of the incontestable clause.
Some people may ask, what is the practical application of the incontestable clause?
Here's a brief explanation:
1. Suitable for long-term risks.
The defense period of an insurance company is two years, so this article is only meaningful for insurance products with more than two years. In most cases, it is used to discuss cases of critical illness insurance.
Most of the popular property insurance and millions of medical insurance in the market are actually one-year, especially millions of medical insurance, regardless? Guarantee renewal? How many years, its essence is one-year short-term insurance, this clause does not apply.
2. It is applicable to the situation that the facts that are not truthfully told can affect the underwriting decision of the insurance company.
If you don't tell me about the cold and fever, and it's not enough for the insurance company to refuse insurance or increase the cost, then the insurance company has no right to ask for the termination of the contract, and naturally there will be no dispute.
In other words, not all trivial problems will lead to refusal of insurance, so don't worry too much.
3. It is applicable to the case that the disease has not been diagnosed truthfully after two years of insurance.
The minor illness that has not been truthfully informed is A, and the serious illness that needs to be settled after the development of A is B, according to? Two-year incontestable clause? , this kind of situation is to compensate:
That is, the insured already knew that he got an A, but he didn't tell him for various reasons. After two years of insurance, A gradually developed into B, and the insurance company had to pay for it.
If the insured knows that he got B before the insurance, the insurance company has the right to terminate the contract and not refund the premium; If the insured conceals A and gets B within two years of insurance, usually the insurance company will terminate the insurance contract.
In fact, the incontestable clause still has a lot to discuss, but it can't be expanded because of space reasons. I would like to remind you that you must tell the truth when buying insurance, and don't expect to wait two years for treatment. After all, disease waits for no one, and health is the most important thing.