Page 98 - MEDICAL AND HEALTH INSURANCE

MEDICAL AND HEALTH INSURANCE

a) Take over the full underwriting of the portfolio in terms of responsibilities and

liabilities of the existing insurance company

b) Offer new terms that are identical to the old ones at same premium or different

premium
c) Offer 'no worse' terms and switch to an equivalent but not identical policy

d) Offer a switch but apply new underwriting terms.

5.4.3 CHANGE OF INSURER

Policyholders have the right to choose their insurance company for their coverage. It
is permissible if the new insurance company offers to take over the risk to provide

continuity of cover. In this instance, the new insurance company will offer the

'takeover policies condition' to make sure the policyholder on the switch of insurance
company that in the event of claim, it would still be payable for the existing disability

as if there is no change.

5.5 CONTRIBUTION, RECOVERIES, AND CLAIMS MANAGEMENT

In claims management there should be a claim recovery system to retrieve all

legitimate recoveries to assist in increasing the net profit. The personnel must be

trained to determine the recoveries with proper systems of monitoring and follow up.
The recoveries can be in the form of contribution as per policy condition, whereby if

the Insured has more than one medical and health insurance policy, the liability of the

company should be in the ratio of the total sums insured.

The other third-party recovery is known as 'subrogation', whereby if the Insured has
suffered a disability caused by third-party actions or inactions and the insurer has paid

for the loss, the insurer has the rights to recoup the costs from the third-party. The

97 | P a g e