In order to control unnecessarily long hospitalization, this type of policy usually stipulates that the insurer is only responsible for a certain percentage (e.g. 90%) of all costs.
Some common terms and conditions of hospitalization insurance:
Insurance Liability:
If, during the validity period of this supplementary contract, the insured person suffers from an accidental injury, or suffers from a disease (renewal of the policy is not subject to the 90-day disease observation period) after 90 days from the effective date of the supplementary contract, and is diagnosed as having to be, and has been, hospitalized in a hospital designated or recognized by the Company, the Company shall be liable for The Company shall pay the medical insurance benefit for the medical expenses incurred during hospitalization within 90 days from the date of hospitalization as follows:
I. Drugs. The Company shall pay 75% of the actual cost of medicines incurred by the insured person, but the limit of payment for this item shall be 45% of the sum insured of this supplementary contract.
II. Hospitalization Expenses. The Company shall pay 85% of the hospitalization expenses actually incurred by the Insured Person, subject to a benefit limit of 6% of the Sum Insured of this Supplemental Contract.
III. Treatment Costs. The Company shall pay 80% of the treatment cost actually incurred by the insured person, but the benefit limit of this item shall be 30% of the insurance amount of this supplementary contract.
IV. Examination fee. The Company shall pay 75% of the examination fees actually incurred by the Insured Person, subject to a benefit limit of 14% of the Sum Insured under this Supplemental Contract.
V. Material expenses. The Company shall pay 75% of the material costs actually incurred by the Insured, subject to a benefit limit of 5% of the sum insured under this supplementary contract.
VI. The accumulated medical insurance benefits paid by the Company in each insurance year shall be limited to the insurance amount of this supplementary contract. If the insured person is hospitalized in more than two insurance years, the Company shall pay the medical insurance benefit up to the insurance amount of this supplementary contract in the year when the insured person starts to be hospitalized.
VII. The Company shall not be liable to pay the medical insurance benefit for the portion of the medical expenses that should be borne by others due to injuries caused by others.