质疑与重构——健康保险合同中等待期条款的正当性

Question and Reconstruction: the Legitimacy of Waiting Period Provision in Health Insurance Contract

我国现行健康保险合同中的等待期条款异化为确定保险责任开始时间的条款,即保险人对于等待期后发生的保险事故才承担保险责任,其背离等待期条款存在的价值目标,导致保险人和被保险人利益失衡。因此,应当重构健康保险合同中等待期条款的适用条件,增强其正当性。

In current Chinese health insurance legislation and practice, waiting period provision has dissimilated into a starting time clause of insurance liability, that is, only the accident after waiting period is to be covered by insurance company. The provision violates the target of its existing value, and leads to the imbalance of interests between the insurer and the insured. Therefore, the applicable conditions of waiting period provision in health insurance contract should be reconstructed to intensify its legitimacy.