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A medical insurance contract refers to an insurance contract that provides medical insurance for the insured. The medical expenses covered include medical expenses, examination fees, surgery fees, medicine fees, nursing fees, hospitalization fees, and hospital miscellaneous expenses. Medical insurance contracts can implement compensatory features and apply the principle of compensation for losses. If medical insurance and social insurance produce insurance competition, compulsory social insurance shall give priority to compensation, and medical insurance shall bear compensation for losses other than social insurance compensation. ^[1]

Medical insurance contract

A medical insurance contract refers to

Medical insurance contracts have the following characteristics: ^[2]

The general contents of the medical insurance contract: medical service duration, medical service items and quality, medical service payment methods and standards, rights, obligations and responsibilities of both parties, and liability for breach of contract. ^[3]

According to the different insurance coverage, medical insurance contracts can be divided into outpatient medical expenses insurance contracts, inpatient medical expenses insurance contracts, surgical medical expenses insurance contracts, comprehensive medical expenses insurance contracts, and large medical expenses insurance contracts. ^[2]

The conclusion of a medical insurance contract refers to the state in which the contracting parties have expressed interest and reached a consensus. It describes the process of the parties to an agreement on the contents of the medical insurance contract through negotiation. The signing of any contract must go through two stages of offer and commitment: ^[4]

The termination of a medical insurance contract refers to the intention of one or both parties to the medical insurance contract to eliminate the rights and obligations established in the medical insurance contract. After the medical insurance contract is established, the medical insurance contract can be terminated for the following reasons: ^[4]

(1) Natural termination. The expiration of the medical insurance period ends the insurance liability of the medical insurance institution, which is the most common and basic reason for the termination of insurance.

(2) Termination of the agreement. Before the parties to a medical insurance contract naturally terminate the contract, if the original agreed termination conditions occur, the medical insurance contract will be terminated.

(3) Termination of performance. If the insured unit or the insured person violates the obligations stipulated in the contract, or according to the contract, the medical insurance institution has paid all the indemnities or paid the entire insurance amount, then the medical insurance contract is terminated.

(4) The original is invalid. The insured unit or insured has deceived and concealed the medical insurance contract signed by the medical insurance institution by fraud, concealment and concealment. The medical insurance contract signed by the medical insurance institution is invalid from the beginning.

(5) A third party requests termination. If a third party requests a contract to be changed or cancelled, the medical insurance contract is terminated.