Health insurance is for people's health. It is insurance for medical expenses caused by illness or accidental injury or income loss caused by illness or accidental disability. At the same time, health insurance also includes economic compensation insurance for long-term care due to old age, illness or disability. It mainly includes medical insurance, sickness insurance, disability income loss insurance, nursing insurance and medical accident insurance.
Characteristics of health insurance:
1. Insurance period: Except for major diseases, most health insurance, especially medical expenses insurance, is usually a one-year short-term contract.
2. Actuarial technology: The pricing of health insurance products mainly considers disease rate, disability rate and duration of disease (disability). The calculation of health insurance rate is based on the loss rate of insured amount, and the unexpired liability reserve at the end of the year is generally paid according to a certain proportion of the premium income of the current year. In addition, waiting period, deductible, deductible, * * payment ratio, payment method and payment limit will also affect the final rate.
3. Health insurance payment: the principle of payment is applicable to fee-based health insurance, and the amount of insurance claims will not exceed the actual expenditure; However, the fixed payment of health insurance is not applicable, and the payment of insurance benefits has nothing to do with actual losses.
4. Particularity of operational risk: Health insurance deals with injury risk, and its influencing factors are far more complicated than life insurance, and adverse selection and moral hazard are more serious. In addition, the risk of health insurance also comes from medical service providers, and the quantity and price of medical services are largely determined by them, which is difficult for insurance companies to control as payers.
5. Cost sharing: Because health insurance is risky, difficult to control and unpredictable, in health insurance, the insurer often has many restrictions or restrictive clauses on the payment of medical insurance benefits for diseases.
6. Particularity of contract terms: health insurance does not need to designate beneficiaries, and the insured and beneficiaries are often the same person. In the health insurance contract, besides the incontestable clauses, grace period clauses and no loss clauses of general life insurance, there are also some unique clauses, such as existing conditions clauses, conversion clauses, cooperative payment clauses, medical examination clauses, deductible clauses and waiting period clauses.
7. Exclusion liability of health insurance: Exclusion liability of health insurance generally includes death and disability caused by war or military action, disease, intentional suicide or attempted suicide, disease, disability, abortion and death caused by abortion.
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