Xiao Nuo answer:
Hello!
Compared with life insurance and personal accident insurance, health insurance has its special provisions. These provisions specifically include:
1. Age limit for insurance
The occurrence of diseases is closely related to people's age, so all kinds of health insurance usually have strict restrictions on the age of the insured. Generally speaking, the insurance age is 3-60 years old, and a few types of insurance will relax the insurance age to 0-70 years old; It can also be stipulated that the age of the insured shall not exceed 70 years old or 75 years old when the insurance expires.
2. Gender discrimination between men and women
The gender difference between men and women is not only a simple biological significance, but also shows obvious differences in some special events in real life. For example, studies have shown that in terms of life expectancy, the average life expectancy of men is not as long as that of women, in other words, women live longer than men; But as far as health self-concern is concerned, women are obviously more concerned about their own health than men, which means that women are more willing to go to the hospital than men. This is reflected in the fact that when applying for health insurance, other conditions are exactly the same, and the insurance premium of women may be higher than that of men under the same amount of insurance. On the contrary, when taking out life insurance, the insurance premium of men is higher than that of women.
3. Provisions on the payment method of insurance money
There are three main payment methods of health insurance benefits, namely: cost compensation or reimbursement, fixed payment and hospitalization subsidy. It should be pointed out that in order to prevent the insured from obtaining additional benefits through insurance, according to the principle of loss compensation, the insurer has the right to exercise subrogation for cost-compensated health insurance. That is, the insured's insurance accident is caused by the third party's responsibility. After the insured has incurred medical expenses, if the medical expenses have been fully or partially compensated by the third party, the insurance company may no longer pay the insurance money or only pay the difference after compensation by the third party. If the insurance company has paid the medical insurance premium, the insured will transfer the right of third-party claim to the insurance company, and the insurance company will recover it on its behalf.
4. Other provisions
Because of its particularity, health insurance is easy to cause moral hazard of a few people with ulterior motives. In order to control adverse selection and moral hazard to the maximum extent, insurance companies usually make some special provisions, such as the provisions of the observation period, the provisions of the deductible, and the provisions of the insurance ratio, and so on.
Therefore, when applying for insurance, the insured and the insured should pay attention to the provisions of health insurance to avoid disputes in the future.