Health Insurance

Health Insurance:

This policy cover fall under 3 groups (Personal Accident, Sickness and Medical Expenses) They are Benefit policies.

a. Personal Accident Cover Provisions: 

             i.     Payments lump sums in the event of accidental death  or bodily injury

           ii.  Payment of a fixed sum of money should a defined event occur  whether or not the insured suffers a direct

                financial loss. 

           iii. Personal accident  can be stand alone contracts but are usually sold as “adds on” to household, motor and

                travel.

           v.  In cases of claims with more than 1 policy effected, each will pay up to each policy sums insured, no

                deductions.

           vi. Underwriter asks about the existence of other policies to manage possible inducement to remain off work.

           vii. Accident cover pays weekly benefits up to 104 weeks if Temporarily Total Disablement due to an accident

           viii. Reduced benefits are paid for Temporarily Partially Disablement.

            ix. An annuity is paid for Permanent Total Disablement

             x. There is a continental scale of  fixed benefits for other injuries for example, sight in 1 eye, loss of fingers

            xi  Death benefit – usually within 12 months of the event giving rise to the claim

    Exclusions:

          1. The insured being under the influence of, or being affected by alcohol or non-prescription drugs

          2. The consequences of a pre-existing infirmity or disease.

          3. Self – inflicting injury or disease including Suicide

          4. Childbirth pregnancy venereal disease or Aids

This policy cover fall under 3 groups (Personal Accident, Sickness and Medical Expenses) They are Benefit policies.

b. Sickness Cover Provisions: 

              i. Weekly benefit paid up to 104 weeks if the insured is disabled from following their weekly

                  occupation due to sickness or disease

           ii. For new policies a franchise period of 21 days is required before compensation is triggered.   

             iii. For renewal policies , a 7 days franchise is required before compensation is triggered.

             v.  Some companies offer health benefits as part of employee remuneration packages.

           vi. Personal accident  can be stand- alone contracts but are usually sold as “adds on” to household, 

                     motor and travel.

              vii.  Death benefit – usually within 12 months of the event giving rise to the claim

           viii. Temporarily Partially Disablement only applies to Personal Accident policies, never for Sickness cover.

Exclusions:

          1. The insured being under the influence of, or being affected by alcohol or non-prescription drugs

          2. The consequences of a pre-existing infirmity or disease.

          3. Self – inflicting injury or disease including Suicide

          4. Childbirth pregnancy venereal disease or Aids

c. Medical Expenses Cover Provisions: 

       i.   Medical Expenses cover for members of the public either under Individual Policies or Group Schemes.

       ii. Covers most expenses of undergoing in-patient or out-patient treatment in private hospitals

       iii. Some companies offer this cover as part of staff and their family benefits .

       iv.  Some policies offer cash benefits instead if the insured prefers to use the NHS in-patient treatment.

Exclusions include: 

         1. The consequences of a pre-existing conditions.

         2.  Lower pre-treatment limits depending on cover.