Page 75 - MEDICAL AND HEALTH INSURANCE

MEDICAL AND HEALTH INSURANCE

4.1.1 PRE-EXISTING CONDITIONS

Pre-Existing Illness shall mean disabilities before the effective date of insurance that

the insured person has reasonable knowledge of an insured person may be

considered to have reasonable knowledge of a pre-existing condition where the

condition is one for which:

a) The insured person had received or is receiving treatment

b) Medical advice, diagnosis, care or treatment has been recommended

c) Clear and distinct symptoms are or were evident

d) Its existence would have been apparent to a reasonable person in the

circumstances.

In other words, the insurer is not expected to pay for illness or sickness or an injury

that has occurred prior to taking up the insurance cover.

In all individual PMI policies, pre-existing conditions are policy exclusion. Similarly, for
small group policies too, they are standard policy exclusion. However, in big group

treatment, the insurer may waive such exclusion due to the large premium that has

been priced to cover pre-existing illness.

4.1.2 ACUTE ILLNESS AND CHRONIC ILLNESS

It is a disease with an abrupt onset and, usually, a short course. Acute does not mean

new, although many newly diagnosed diseases present with acute symptoms. Nor

does it mean that symptoms are severe. It simply means that symptoms have

developed quickly and that some sort of medical intervention is needed.

The examples of acute illness are Appendicitis, tonsillitis, pneumonia, bronchiolitis,

gastroenteritis, sinusitis, etc.

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