What are the special clauses in health insurance and its contract?

2. underwriting conditions of health insurance in China's insurance law, health insurance mainly refers to "insurance with the insured's illness, maternity, disability or death as the payment conditions", in which disease insurance is its main content. In the United States and other countries, the original meaning of "health insurance" is sickness insurance, but because of the complex management technology, it is difficult for insurance companies to make profits; At the same time, with the continuous expansion of business scope, health insurance has gradually added new significance. Taking sickness insurance as an example, the general underwriting conditions of health insurance are explained below. Although it does not fully reflect the details of the underwriting conditions of other types of insurance, such as disability insurance, maternity insurance and disability income compensation insurance, it is generally representative. Sickness insurance, that is, health insurance in a narrow sense, as the name implies, is an insurance that covers accidents with various diseases that affect people's health. For business needs, insurers generally limit insurable diseases, which mainly refer to diseases caused by internal causes of the human body, including mental or physical pain or imperfection. To constitute insurable diseases, the following three conditions must be met: (1) diseases with internal causes. Emphasizing that internal factors pose a threat or even harm to people's health is essentially an important standard to distinguish health insurance from accidental injury insurance. The diseases required by health insurance must be caused by some reason inside the human body, that is, the pathological changes of one or more organs, tissues and even systems lead to abnormal functions and produce various pathological manifestations, such as fever caused by pneumonia and diarrhea directly reflected by enteritis. Those that are obviously caused by serious external reasons should be regarded as injuries rather than diseases, so as to strictly distinguish the two types of insurance in insurance theory. But the fact is that many diseases are caused by external factors, such as bacterial infection, climate change, environmental pollution and so on, which seems to blur the boundary between the two. Theoretically, it is generally believed that even if it is basically caused by various external factors, it will inevitably brew in the body for a period of time, causing the influence of various physical and chemical reactions in the body, and then it will attack and form diseases, which is different from injuries. (2) Non-congenital diseases. An important feature of insurance is that the insurer performs the obligation of compensation or payment in accordance with the insurance contract for those insurance accidents that occur during the insurance period. Health insurance requires that the disease occurs within the validity period of the insurance contract. According to this principle, all congenital physical defects, such as blindness, deafness, abnormal internal organs and organ dysfunction, are not covered by medical insurance. For some diseases caused by genetic reasons, such as congenital heart disease and hereditary schizophrenia, there are different provisions in medical insurance laws and regulations in various countries. Most countries classify this content as social insurance, and some local insurance companies will adjust their insurance requirements appropriately to flexibly grasp the underwriting principles. Some latent diseases, such as hereditary tuberculosis and sexually transmitted diseases, are not harmful to people's health if they are not induced. If it happens within the validity period of insurance, it should be regarded as the same as ordinary diseases and generally included in the scope of insurance in practice. Moreover, this disease is regarded as the same nature and type as the disease of automatic change or injury of internal organs, which is qualitatively different from congenital disability. (3) unexpected diseases. The limitation of accidental diseases comes from the assumption that health is the normal state in life and disease is the abnormal state in life. Therefore, the occurrence of diseases should be purely accidental, rather than what people can expect; But this accidental disease can be cured, and once it is obtained, it is not hopeless. Therefore, accidental diseases generally require objective treatment. Through various medical means and measures, we can alleviate the pain, alleviate the illness and finally eradicate the patients. By adding the limitation of accidental diseases to health insurance, all kinds of health hazards such as death, old age and weakness can be eliminated. For those who stay in bed all the year round and rely on various drugs to maintain their lives, health insurance companies usually don't accept it, because this situation doesn't even conform to the original assumption of "normal health". For the protection of "disease normality", the insurer is not only unprofitable, but also may suffer losses. Moreover, contingency not only means that whether the insured will suffer from a certain disease should be uncertain, but also includes what kind of disease is unpredictable, and even when he will be infected or even attack is uncertain. Therefore, health insurance provided by health insurance companies is of great significance to those who want to guard against these dangers and try to find health protection. Compared with the insurable risk of life insurance, the insured object of health insurance has greater uncertainty. Health insurance policies usually stipulate the scope of insurance liability. On the one hand, it is convenient to clarify the rights and obligations between the insurer and the insured; On the other hand, long-term insurance practice has proved that with the progress of science and technology, medical technology is also constantly improving. Once intractable diseases may become common diseases in a few years, and many previously unknown diseases keep emerging and become new intractable diseases. For insurance companies, these are of course mixed. In order to ensure the stability of the business, the most conservative method is of course to list all the known insured diseases in the specific policy, so as to avoid all kinds of disputes and controversies that may arise in the process of claim settlement.