Page 34 - MEDICAL AND HEALTH INSURANCE
P. 34
MEDICAL AND HEALTH INSURANCE
OUTPATIENT CLINICAL INSURANCE
The outpatient clinical insurance policy is usually a rider to a group PMI
policy for large groups under the employee benefit scheme. The program
covers outpatient services provided by the primary care physician of the
company's panel clinics for treatment arising out of illness, sickness,
disease or injury.
The benefits include:
a) consultation and treatment for the usual outpatient ailments
b) supply of prescribed drugs for the necessary treatment
c) diagnostic tests, including laboratory tests and X-rays
It may also extend to cover non-panel clinics on emergency care only,
where panel clinics may not be available.
The normal exclusions include but are not limited to treatment for
congenital disease, traditional and alternative therapies, routine medical
check-ups or screening profile, preventive vaccination or immunisation or
travel immunisation, catastrophic diseases including outpatient cancer
treatment including chemotherapy, radiotherapy, pre-employment check-
up, pregnancy-related and dental treatment.
OUTPATIENT SPECIALIST
In order to seek outpatient specialist treatment in an insured program
there must be a written referral from the primary care physician and from
the company's panel clinics.
The benefits include:
33 | P a g e
