Page 76 - MEDICAL AND HEALTH INSURANCE

MEDICAL AND HEALTH INSURANCE

Chronic diseases are defined broadly as conditions that last 1 year or more and

require ongoing medical attention or limit activities of daily living or both. This type of

illness needs ongoing or long-term monitoring, through consultations, examinations,

check-ups and/or tests and ongoing or long-term control or relief of symptoms. Other
than that it requires rehabilitation or for patient to be specially trained to cope with it.

It is also continues indefinitely and no known cure. It comes back or is likely to come

back." The examples of chronic illness are Diabetes, cancer, arthritis, psoriasis, renal
failure, hypertension, etc. Chronic conditions are long in developing and take time to

be healed. At times, an acute medical condition can progress and develop into a

chronic condition.

While specified Illness mean the following disabilities and its related complications
occurring within the first 120 days of insurance of the person who has:

i. All ear, nose (including sinuses) and throat conditions

ii. Hernias, haemorrhoids, fistulae, hydrocele, varicocele

iii. Endometriosis including disease of the Reproduction system
iv. Hypertension, diabetes mellitus and cardiovascular disease

v. All tumours, cancers, cysts, nodules, polyps, stones of the urinary system and

biliary system
vi. Vertebro-spinal disorders (including disc) and knee conditions.

This means that the insurer is not expected to pay for the mentioned specified

illnesses occurring within the first 120 days of the insurance.

4.2 UNDERWRITING MEDICAL HISTORY

Medical history underwriting is based on the application or proposal form with a
declaration of present or past medical conditions. Underwriting can be defined as the

process of determining whether to accept a risk and, if so, what amount of insurance

the company will write on the acceptable risk, and at what rate.

75 | P a g e