Page 322 - Ebook health insurance IC27

The Insurance Times

General Exclusion
A list of general items excluded from the policy. Almost all of the policies in the region
apply the same exclusions. These exclusions are covered in later chapters.

Administration and General Conditions

The condition section is another important part of an insurance contract. Conditions are
provisions in thepolicy that qualify orplacelimitations on theinsurer's promise to perform.
In effect, the condition section imposes certain duties on the insured if he or she wishes
to collect for a loss. If the policy conditions are not met, the insurer can refuse to pay the
claim. Common conditions in a contract include:
- notifying the insurer if a loss occurs,
- filing a proof of loss with the insurer, and
- cooperating with the insurer.

Insurance contracts also contain certain miscellaneous provisions that are common
to all insurance contracts. These provisions treat the relationship between the
insured and insurer, and the relationship and responsibility of the insurer toward
third parties.

These common provisions also establish working procedures for carrying out the terms
of the contract. In medical insurance, some common provisions refer to cancellations,
subrogation, and requirements if a loss occurs, assignment of the policy, and other-
insurance provisions, the grace period, the reinstatement of a lapsed policy, and the
misstatement of age.

326 Guide for Health Insurance