Page 35 - MEDICAL AND HEALTH INSURANCE

MEDICAL AND HEALTH INSURANCE

a) consultation and treatment for the referred ailments

b) supply of prescribed drugs for the necessary treatment

c) diagnostic tests, including laboratory tests and X-rays

Direct access to specialist care is not covered to prevent abuses and an

Insured has to go through the primary care gatekeeper.

This benefit is usually a rider to a group PMI for large groups as part of the

employee benefit scheme and a subsection of the outpatient clinical

insurance.

The same exclusions as in the outpatient clinical will apply for the
outpatient specialist insurance.

MATERNITY INSURANCE

Most PMI policies exclude maternity but it can be made available with an

option to purchase. It is generally an additional cover to a group PMI policy

and in some cases it is also offered as a rider to an individual PMI with an
option to purchase with additional premium.

There is generally a provision that requires the conception to occur more

than a certain number of days or months after the policy effective date.

The usual is a 6-months waiting period, designed to prevent the purchase

of maternity cover solely to cover childbirth expenses.

Generally, the maternity benefits pay only when the pregnancy is

terminated after a probationary period of 10 months and after the policy
effective date.

The amount of maternity benefits offered, differs among insurers and is

usually a specific amount not dependant on the actual incurred expenses.

It is generally classified into two main types of delivery namely:

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