Page 30 - MEDICAL AND HEALTH INSURANCE

MEDICAL AND HEALTH INSURANCE

This group business is a fast-growing segment in the industry as providing

PMI cover for employees is now a corporate social responsibility rather

than something good to have.

You may refer to the section of Group Employee Benefits Scheme for more

detail on the options available in such corporate group policies.

2.1.2 BENEFITS ASSOCIATED WITH HOSPITAL AND SURGICAL INSURANCE POLICIES

Insurers may offer differing PMI products with various benefits. Following

is a general description of the benefits and provisions commonly found in a
complete hospital and surgical insurance policy.

It is mandatory to use the standardised wording contained in the glossary

of terms in all policies/certificates where such definitions, description of

benefits, conditions and exclusions are used (refer to revised HSI guide).

The quantum of the benefits offered generally are categorised as:

a) Traditional with inner limit benefits

b) 'As charged' basis, subject to the overall annual limit/lifetime limit

TRADITIONAL WITH INNER LIMIT BENEFITS

There is a limit specified in every benefit stated as shown for policies with
an inner limit. The payment is on a 'per disability' basis.

Any one disability refers to the single disability and its complications that

result in the insured person/participant/covered person being hospitalised

one or more times.

All hospitalisations shall be considered to be from the same disability if the

insured person/ participant/covered person has not completely recovered

and is still under treatment for that disability and its complications.

29 | P a g e