Borrower insurance · Guide
Mortgage insurance exclusions: back, mental health, sports, professions – what voids a guarantee
General, specific, and buy-back exclusions: what is never covered, what can be reinstated for a surcharge, and the combination that the law prohibits.
A mortgage insurance exclusion removes coverage for a specific cause of loss: back conditions, mental health conditions, and risky sports and professions are the most common. General exclusions are set out in the policy schedule, while specific exclusions appear in the special conditions. Many can be reinstated for an additional premium, sometimes subject to a hospitalisation condition.
By Sandy MASCART, mandataire d'intermédiaire en opérations de banque et en services de paiement ORIAS 26000541 sous le mandat de CDV PATRIMOINE & ASSURANCE (ORIAS 14005573)
Key points
- An exclusion removes coverage for a specific cause of loss; it differs from a deductible, a limit, or a maximum age, which operate differently.
- General exclusions apply to all insured persons under the contract; specific exclusions are applied to a particular file, following a review of the declarations.
- Back and mental health conditions are among the most common exclusions in policy schedules, and they are most often reinstated for an additional premium.
- The law prohibits combining a price increase and a guarantee exclusion for the same pathology falling under an aggravated health risk.
- An exclusion only leads to a refusal of the transfer of insurance if it affects an equivalence criterion retained by the bank and communicated in advance.
An exclusion is not visible on the brochure: it appears on the day of the claim that it excludes. Identify it before signing, to have it bought back, clarified or to change the contract. The whole subject: the borrower insurance file. Refusal or surcharge linked to health: the AERAS agreement and the health questionnaire.
What is an exclusion, exactly?
An exclusion removes a specific cause of loss from the contract: everything else is covered, but not that one. It must be written in the contract to be opposable to you.
Do not confuse it with the deductible (a period), the limit (an amount) or the age limit (a date).
The code requires an exclusion to be formal and limited, very apparent (articles L. 113-1 and L. 112-4 of the Insurance Code). Vague clause? Have it clarified in writing.
General, specific, buyable: what is negotiable
- General: in the notice, for all insured persons.
- Specific: applied to your file, in the specific conditions or the insurance certificate.
- Buyable: some are lifted against an additional premium, others never. Intentional fault is excluded by law (article L. 113-1, second paragraph, of the Insurance Code).
The seven exclusions to look for before signing
| What is excluded | Family | Is it buyable? | Usual counterpart | Where it is written |
|---|---|---|---|---|
| Ailments of the back and spine | General | Most often yes | Additional premium, sometimes subject to a condition of hospitalisation or surgical intervention | Notice, excluded risks section |
| Mental and psychiatric ailments | General | Often yes | Additional premium, often subject to a condition of hospitalisation | Notice, same section |
| Sports and risky activities | General | Yes, by extension | Prior declaration of the activity and additional premium | Notice, plus the activities questionnaire |
| Risky professions and specific professional acts | General | Sometimes | Additional premium, or maintenance of the exclusion | Notice, professional section |
| Stays and travel outside the covered geographical zone | General | Sometimes, by extension | Additional premium | Notice, territoriality clause |
| Intentional acts, war, riot, nuclear risks | General | No | None: these clauses are not negotiable | Notice, at the head of excluded risks |
| Pathology or history declared at admission | Specific | Depending on the insurer | Additional premium in replacement of the exclusion | Specific conditions or insurance certificate |
- Back and psyche are two common causes of cessation: an incapacity that excludes both without reinstatement covers very little.
- Sport and profession are assessed on the date of the event: reread these clauses when your life changes.
- Suicide has its own clause: note its exclusion period and the case of the loan for your home.
Surcharge and exclusion: cumulative application prohibited
For the same established aggravated risk pathology, on a loan falling under the AERAS agreement, the insurer chooses: surcharge or exclusion, never both.
The same pathology behind the surcharge and the exclusion? Request the basis in writing.
Right to be forgotten and AERAS: an exclusion must be justified
Le délai court à compter de la fin du protocole thérapeutique, jamais du diagnostic ni de l'annonce de la rémission. Il s'agit d'un plafond : la grille de référence de la convention AERAS fixe, pathologie par pathologie, des délais qui peuvent être plus courts.
- En vigueur depuis le
- Source
- Article L. 1141-5 du code de la santé publique — Légifrance
De plein droit : aucune adhésion à demander, aucun formulaire à réclamer, aucune case à cocher.
- En vigueur depuis le
- Source
- Article L. 1141-2 du code de la santé publique — Légifrance
Does a specific exclusion target what you did not have to declare? Request in writing on which declaration it is based.
Can an exclusion lead the bank to reject your contract?
Yes, if it affects an equivalence criterion that your lender has communicated to you in advance. Please ask which criterion in its grid the refusal relates to.
Le prêteur
Le prêteur vous indique, garantie par garantie, ce qu'il exige, et vous rappelle les critères qu'il retient pour apprécier l'équivalence : c'est cette liste-là qu'il faut lui demander.
- En vigueur depuis le
- Source
- Article R. 313-23 du code de la consommation — Légifrance
Resolve the exclusion before the transfer of the loan, otherwise the cheaper contract will be rejected. See the equivalence of guarantees and the Lemoine Act.
Where to read your exclusions
- The information sheet: the general exclusions, guarantee by guarantee.
- The special conditions or the insurance certificate: your specific exclusions. This is the shortest, and the most important, section.
- décès
- perte totale et irréversible d’autonomie (PTIA)
- incapacité temporaire totale (ITT)
- invalidité permanente totale (IPT)
- invalidité permanente partielle (IPP)
- perte d’emploi
La lecture se fait famille par famille : une même cause peut être exclue d'une garantie et couverte par une autre dans le même contrat.
- En vigueur depuis le
- Source
- Légifrance
Buying back an exclusion
Please request in writing: which exclusion, under what condition, and for what premium. Then, please check for three pitfalls:
- a conditional buy-back linked to a hospitalisation or a period of incapacity;
- a partial buy-back, lifted for one guarantee but not for the other;
- a lost buy-back when you change insurance.
A refusal to buy back an exclusion does not close the matter: another insurer may not impose the exclusion.
To be confirmed in writing before signing
- The general exclusions of each guarantee.
- The specific exclusions of your case, and the declaration on which they are based.
- Those that can be reinstated, and under what conditions.
- Whether a surcharge and an exclusion target the same pathology.
- Those that affect an equivalence criterion of your bank.
Review the bank's requirements by telephone while there is still time to act.
This article is for informational purposes. The activity of insurance intermediation is carried out as an ancillary activity to the activity of intermediation in banking operations: it does not constitute an offer of insurance, nor personalised advice on a specific contract.
Create your file: the insurance is settled with the loan.
Sources
Read next
- Home loan insurance in Lyon: Sandy MASCART
- Mortgage in Lyon: frequently asked questions
- Mortgage insurance refused or surcharged: the AERAS agreement, appeals and solutions Refusal, exclusion or surcharge: the three levels of AERAS review, the capping mechanism, appeals, and the realistic alternatives when nothing works out.
- Health questionnaire: when it truly disappears, and when it returns The exemption is calculated per insured person, on their share of the cumulative outstanding balance: the table that tells you, person by person, if exempt.
- Equivalence of guarantees: the criteria the lender selects, and how to challenge them Who selects the equivalence criteria, where to find your lender’s list, how to read a refusal letter, and the deadlines running against the lender.
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