What are the special clauses unique to health insurance contracts?

(5) Excess insurance clauses. Because the premium of health insurance is compensatory, in order to prevent the insured from making profits due to illness or disability, an excess insurance clause can be stipulated in the contract, that is, for excess insurance, the insurer can reduce the insurance amount, but return the premium part of the excess insurance. (6) Limitation clause of defense cause. Defense refers to the material false information listed in the insurance book. According to this clause, after a certain period of time, unless the insured commits fraud, the insurer shall not consider the policy invalid or refuse to pay compensation on the grounds of material misrepresentation. The typical prescription clauses of defense reasons are as follows: "After the policy takes effect for 2 years, the insurance company can only terminate the contract if it is limited to fraudulent false information; Otherwise, before the policy takes effect, you can't refuse to pay compensation based on the existing status, unless the existing status belongs to the excluded liability listed in the policy. " This clause is similar to the non-defense clause, but the non-defense clause stipulates that after the non-defense period of the policy, even if the major misrepresentation in the insurance policy is fraudulent, the insurance company shall not refuse to pay. . 3. Special clauses of group health insurance Group health insurance is a health insurance contract concluded between an insurance company and a group policyholder (employer or other legal representative), which provides protection for people under the main contract. To this end, the insurer can provide a variety of group insurance in a group health insurance policy, or issue an independent group insurance policy for each insurance policy. The special terms of group health insurance are: (1) existing conditions. The specific content of this clause is different from that of individual health insurance. In group insurance, this clause stipulates that unless the insured enjoys insurance protection within the agreed period, the insurer is not responsible for paying insurance money to the insured's existing situation; However, if the insured has not been treated for a pre-existing condition for three consecutive months, or participated in group insurance 12 months, then the disease is not a pre-existing condition, and the resulting medical expenses or income loss can apply to the insurer for compensation. (2) conversion clause. The conversion clause allows the group insured to buy personal medical insurance after leaving the group, but it does not provide protection. However, the insured may not use this to carry out double insurance. When group health insurance is converted into individual health insurance, the insured usually has to pay higher premiums and there are more restrictions on the payment of insurance money. (3) Coordinating payment terms. This clause is more common in group medical insurance in the United States and Canada, because in these countries, it is more common for the insured who are eligible for various group medical insurance. For example, dual-employee families can enjoy dual-group medical expenses insurance. This clause is mainly to solve the problem of double insurance payment for group insured who enjoy double group medical expenses, and the two policies are stipulated as priority payment plan and second payment plan respectively. The priority payment plan must pay the promised insurance money in full; If the insured amount paid is less than all the reasonable medical expenses that the insured should pay, the insured can ask the second payment plan to fulfill the responsibility of paying the difference in insurance money, and inform the insurer of the priority payment amount of the plan at the same time, and the second payment plan will pay the insurance money according to the coordination payment terms.