1, Physical Examination Clauses When the insured claims, the insurer has the right to ask the insured to have a physical examination at a designated doctor or medical institution, so as to judge whether to settle the claim and confirm the specific compensation amount. This clause applies to sickness insurance and disability income loss insurance in health insurance.
2. deductible clause the word deductible is very common in health insurance contracts, and it is also one of the most important differences between health insurance and other life insurance. When the insured has an insured accident agreed in the contract, he needs to pay part of the medical expenses in advance, which is the deductible, and the part of the medical expenses other than the deductible is compensated by the insurance company.
3. Payment Limit Clauses Although health insurance can reimburse medical expenses, it does not mean that the insured will pay the actual medical expenses in full. The payment of health insurance is usually limited. The insurance company bears the part within the limit, and the part exceeding the limit needs to be borne by the insured himself.
4. Proportional payment clause The part of medical expenses that exceeds the deductible is actually shared by the insurer and the insured according to a certain proportion. Generally speaking, the proportion of out-of-pocket payment that the insured needs to bear is generally 20%-30%, and the rest is borne by the insurance company.
5. The waiting period clause, also known as the observation period, basically exists in the health insurance contract, and the waiting period exists to control moral hazard. Within a period of time after the insurance policy comes into effect, if the insured suffers from medical expenses or income reduction due to illness, the insurer shall not be responsible for compensation. Generally speaking, the waiting period for one-year short-term health insurance is 30 days, and that for long-term health insurance is 90 days-180 days. 6. Beneficiary clause Generally speaking, the beneficiary of a health insurance contract is the insured himself, but if the insured dies unfortunately, his insurance money will be taken as the insured's inheritance and inherited by his legal heir.