Article 13 Where a health insurance product drawn up by an insurance company contains more than two kinds of health insurance liabilities, an actuary shall judge the main liabilities according to general actuarial principles and determine the product type according to the main liabilities.
Article 14 Disease insurance products in long-term health insurance may include death insurance liability, but the amount of death compensation shall not be higher than the maximum amount of disease compensation.
Health insurance products other than those specified in the preceding paragraph do not include death insurance liability, except for death insurance liability due to illness.
Medical insurance products and disease insurance products shall not include the responsibility of survival payment.
Article 15 A long-term health insurance product shall have a contract hesitation period, and the rights of the insured during the hesitation period shall be clearly defined in the insurance clauses. The hesitation period of long-term health insurance products shall not be less than 10 days.
Sixteenth short-term personal health insurance products can be subject to floating rates.
Rate floating refers to the insurance company's reasonable determination of the specific insurance rate within the range of rate floating on the basis of the benchmark rate when selling products.
Article 17 Where an insurance company submits short-term personal health insurance products with floating rates for approval or filing, the application materials submitted shall include the methods and scope of benchmark rates and floating rates, and shall be signed and confirmed by actuaries according to the principle of prudence.
Eighteenth short-term group health insurance products can adjust the product parameters.
Product parameters refer to the insured amount, minimum compensation amount, compensation ratio, excluded liability, liability waiting period and other matters that can be reasonably adjusted according to the specific conditions of the insured group.
Article 19 Where an insurance company submits a short-term group health insurance product with adjustable product parameters for examination and approval or filing, the application materials submitted shall include the method for adjusting the product parameters, and shall be signed and confirmed by an actuary according to the principle of prudence.
When an insurance company sells short-term group health insurance products with adjustable product parameters, it shall calculate the corresponding insurance premium rate according to the adjustment method of product parameters, and the adjustment of product parameters shall not change the rate calculation method and the basic data required for rate calculation.
If an insurance company sells short-term group health insurance products with adjustable product parameters and needs to change the rate calculation method or the basic data required for rate calculation, it shall re-submit the product for approval or filing.
Article 20 For a health insurance product containing a guarantee renewal clause, the effective time of the guarantee renewal clause shall be clearly stipulated.
For health insurance products with guaranteed renewal clauses, it is not allowed to stipulate that the insurance company has the right to adjust the insurance liability and the scope of liability exemption at the time of renewal.
For health insurance products submitted by insurance companies for examination and approval or filing, the pricing method of guarantee renewal and the calculation method of liability reserve shall be explained in the actuarial report of the products.
Article 21 An insurance company shall respect the insured's right to obtain reasonable medical services when drawing up the terms of medical insurance products, and shall not set unreasonable or contrary conditions in the terms as the conditions for paying insurance benefits.
The disease diagnosis standards agreed by insurance companies in the terms of health insurance products shall conform to the prevailing medical diagnosis standards and take into account the development trend of medical technical conditions. After the health insurance contract comes into effect, if the insured is diagnosed with a disease according to the prevailing medical diagnostic criteria, the insurance company shall not refuse to pay the insurance money on the grounds that the diagnostic criteria are inconsistent with the insurance contract.
Article 22 When designing medical insurance products with cost compensation, insurance companies must distinguish whether the insured has free medical insurance and social medical insurance, and treat them differently in terms of insurance clauses, rates and compensation amount.
Article 23 An insurance company may stipulate in its medical insurance products that it is a condition for the insured to seek medical treatment in the designated medical service institutions.
The outlets of medical service institutions designated by insurance companies shall follow the principle of convenience for the insured and reasonable management of medical expenses, guide the insured to use medical resources rationally and save medical expenses, and do a good job in propaganda and explanation of the insured and the insured.
Article 24 An insurance company shall, according to the actual payment experience of health insurance products, timely revise the rate of newly sold health insurance products, and conduct examination and approval or filing in accordance with the relevant provisions of the China Insurance Regulatory Commission.