Group medical insurance contracts for reimbursement of hospital and surgical expenses

1. Parties: This section will identify the parties involved in the contract, typically the insurance company and the group or company that is purchasing the insurance for its employees.
2. Coverage: This section will outline the specific medical services and expenses that the insurance company will cover. It may include hospitalization, surgery, lab tests, diagnostic imaging, and other medical services.
3. Exclusions: This section will outline what is not covered by the insurance policy, such as cosmetic procedures, experimental treatments, or certain elective surgeries.
4. Premiums: This section will outline the payment terms for the insurance policy, including the amount of the premium, how often it must be paid, and any penalties for late payments.
5. Deductibles: This section will outline the amount that the insured person must pay out-of-pocket before the insurance company will start covering expenses.
6. Copayments: This section will outline the portion of the medical expenses that the insured person must pay out-of-pocket, usually as a percentage of the total cost.
7. Claims procedures: This section will outline the process for submitting claims, including deadlines, required documentation, and how claims will be reviewed and paid.
8. Termination: This section will outline the circumstances under which the insurance policy may be terminated, including non-payment of premiums, fraud, or changes in the employment status of the insured person.
9. Applicable law: This section will identify the laws and regulations that govern the insurance policy and any disputes that may arise.

Keep in mind that this is a general outline and that the specific terms and conditions of a group medical insurance contract for reimbursement of hospital and surgical expenses will vary depending on the insurance company, the group or company purchasing the insurance, and other factors. It is important to review any contract carefully before signing and to consult with a legal or financial advisor if necessary.