Page 79 - MEDICAL AND HEALTH INSURANCE
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MEDICAL AND HEALTH INSURANCE
Accepted as substandard basis
Rejected.
4.3 UNDERWRITING CONSIDERATIONS FOR GROUP MEDICAL INSURANCE POLICY
Group policy is a yearly renewal policy, and the underwriter will review the group
experience yearly to re-evaluate it on the renewal premium and terms.
The basic considerations for group medical underwriting are as follows:
The nature of the group that has been set up may indicate the purpose of taking
up coverage
Age distribution of the group is a factor of consideration,
Gender distribution of the group
Group size Occupation
Voluntary or non-voluntary participation level
The type of benefits and amount of coverage
Apart from these basic considerations, there are other special considerations for
group medical underwriting as discussed in the following sections
4.3.1 PROVIDER NETWORK
Policyholders have the option to choose their provider network if they are paying
for their claims and to seek reimbursement from insurers later. However, if
guarantee letters are provided by insurers, there would be a listing of panel
hospital that will be provided. In this case, insurers will select hospitals of their
choice to be in the panel as this has a bearing to the cost of claims. The hospital
charges vary among hospitals, depending on their locality and their speciality
offered. The hospital supplies and services vary among the provider network as
they are private entities and not subject to any regulatory control at this juncture.
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