Property insurance and auto insurance have "special terms"! Health insurance, maybe another name?
Common clauses of personal health insurance
1. Updated terms
Renewing insurance is a process in which the insurer and the applicant negotiate on the original contract to determine whether to continue underwriting and conditionally underwrite when the time limit stipulated in the insurance contract expires. Under normal circumstances, when making insurance clauses, the conditions of whether to renew the insurance are written into the insurance clauses, that is, the renewal clauses. The renewal clause of personal health insurance describes two aspects: first, the insurer has the right to refuse to renew or cancel the health insurance policy; The second is the insurer's right to increase the premium of health insurance policy. This shows that the insurer can have the right to refuse or increase the insurance premium after the expiration of the policy according to the degree of danger of the insured or some factors and conditions that lead to the increase of danger. Of course, if there is a guarantee renewal clause in the original policy, the applicant should be allowed to continue to apply for insurance. According to the renewal clause in the insurance policy. Personal medical expenses insurance and personal income insurance can be divided into guaranteed renewal personal health insurance, irrevocable personal health insurance and conditional renewal personal health insurance.
2. Grace period clause
The grace period clause of personal health insurance means that after paying the initial premium, the policy holder is allowed a grace period (such as 30 days and 60 days) to pay the overdue premium without interest. During the grace period, the insurance contract is still valid. In the event of a health insurance accident, the insurer still has to bear the insurance liability stipulated in the contract, but the insurer can deduct the overdue insurance premium and interest from the insurance premium payable. If the premium is not paid after the grace period, the insurance contract will be invalid. The purpose of stipulating the grace period clause is to avoid unintentional invalidity of the insurance contract and protect the insurer's business.
3. Supplementary coverage clause
The reinstatement clause refers to the clause that the insured has the right to apply to the insurer and reach a reinstatement agreement after a period of time (usually two years) because the insurance premium has not been paid, so that the insurer can resume the validity of the insurance policy. To restore the validity of the contract to the insurer, the insured must generally meet the following conditions: ① the insured must apply for reinstatement and provide insurability evidence satisfactory to the insurer; (2) must pay the arrears of insurance premiums and interest; ③ The loan pledged by the policy must be returned; ④ Never surrender or change the policy to term life insurance. The reinstatement of health insurance policy is to restore the legal effect of the contract without changing the rights and obligations of the contract.
Generally speaking, it is more beneficial for policy holders to apply for reinstatement than to buy a new policy again, because: ① With the increase of the insured's age, the rate of the new policy is generally higher than that of the old policy; ② It will take two years for the new policy to have cash value; ③ The procedure of purchasing a new policy is very complicated. Therefore, the insured or the insured will choose reinstatement to regain insurance protection under the same amount of insurance. It is worth noting that the basis of the policy of restoring health insurance is that insurance companies accept unpaid premiums. If the insurer has not completed the evaluation of the reinstatement application after receiving the reinstatement application for a period of time, or the applicant has not applied for reinstatement, but the insurer has accepted the insurance premium owed by the applicant, the policy can still be regarded as automatic reinstatement.
4. Waiting period or observation period or pre-existing condition clause
The waiting period or observation period refers to the period after the health insurance policy is issued, that is, after the insurer provides health insurance protection for the insured for a period of time, the insurer performs the insurance compensation responsibility for the pre-existing condition of the insured. The period from the entry into force of the insurance contract to the performance of the liability for compensation is the waiting period or observation period. In personal health insurance, pre-existing diseases are usually defined as disabilities, first-time diseases or events that were not disclosed in the policy before the signing of the policy. If the insurer does not exclude (exempt from liability) the conditions disclosed by the insured, then the conditions will be guaranteed by the insurer. The purpose of setting the waiting period or observation period in health insurance is to prevent the insured from adverse selection. The waiting period or observation period of health insurance is different in different countries and different insurance products. Whether the insurer has the right to deny or exclude insurance liability during the waiting period or observation period depends on the guarantee of pre-existing conditions.
5. Non-defense clause
An incontestable clause is also called an incontestable clause. It means that after two years from the effective date of the policy, the insurer shall not deny the validity of the contract on the grounds of intentional concealment, negligence, omission or false statement of the applicant or the insured at the time of insurance. The incontestable clause is formulated to protect the rights and interests of the beneficiary and the insured. If the insured has died, it is difficult for the beneficiary to explain the dispute raised by the insurer. If there is no incontestable clause, it is difficult for the beneficiary to get the insurance money paid by the insurer. Of course, there are some exceptions to the application of the incontestable clause, that is, the insurer can still refuse to pay the insurance premium after the policy expires for two years. For example, the beneficiary obtains an insurance policy with the intention of murdering the insured; Physical examination by others on behalf of the insured; There is no insurable interest when obtaining an insurance policy. The insurer may not be liable for insurance. Although the incontestable clause is adopted by most countries in the world, it is not clearly stipulated in China's insurance law. Only when the applicant and the insurer sign the insurance contract, how to deal with the consequences if they fail to fulfill their obligation of truthful disclosure is stipulated. For example, if the insured intentionally or negligently fails to fulfill the obligation of telling the truth, which is enough to affect the insurer's decision whether to agree to underwrite or increase the insurance rate, the insurer has the right to terminate the insurance contract. If the applicant intentionally fails to fulfill the obligation of telling the truth, the insurer shall not be liable for compensation or payment of the insurance premium for the insurance accident that occurred before the termination of the insurance contract, nor shall it refund the insurance premium. If the insured fails to fulfill the obligation of telling the truth due to negligence, which has seriously affected the occurrence of the insured accident, the insurer shall not be liable for compensation or payment of insurance money for the insured accident that occurred before the termination of the insurance contract, but may return it.