Page 31 - MEDICAL AND HEALTH INSURANCE

MEDICAL AND HEALTH INSURANCE

Hospitalisation of the insured person/participant/covered person shall be

from a new disability if the insured person/ participant/covered person has

fully recovered and does not require any more treatment for the disability

for a period of more than 90 days following the date of discharge from the
last hospitalisation.

BENEFITS OF ‘AS CHARGED' BASIS

In the 'as charged' basis plan, the room & board is capped as stated in the

plan, whereas all the other charges are 'as charged', subject to being

medically necessary and reasonable. Customary charges as stated in the
policy definition will be applicable for what is medically necessary and

reasonable.

A lifetime limit is generally for individual products, whereby the product is

guaranteed renewal and not yearly renewable.

The overall annual limit and lifetime limit refers to the maximum number

of total benefits that the insurer will pay in the policy/certificate year or

lifetime.

2.1.3 MAJOR MEDICAL INSURANCE

Traditionally, the basic hospital and surgical insurance policy has been

adequate for the medical expenses with a relatively shorter length of stay
and the more routine surgical procedures. However, the basic hospital and

surgical insurance policy has proven inadequate for prolonged or

catastrophic illness and injury. Prolonged period of hospitalisation and
major surgery may incur high medical expenses, hence result in

underinsurance. Recognising the protection gap gave rise to the

development of a more complete type of coverage called 'major medical

insurance'.

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