Page 394 - Misc Ebook IC 78

The Insurance Times

origin for less than 10 days (k) Tonsillitis and upper
Respiratory Tract Infection including Laryngitis and
Pharyngitis (l) Arthritis, Gout and Rheumatism.

This policy is often deleted by the insurers as the chance
of fraud and exaggeration of bills become very rampant
in case of domiciliary hospitalization.

Q4.b) What is the concept of Bonus-Malus
applicable to Mediclaim Insurance ? What
is the justification of the same ?

Ans: Under a Group Mediclaim Policy, a low claim ratio
discount is allowed on the total premium at renewal,
depending upon the incurred claims ratio for the entire
group insured under the Group Mediclaim Insurance
Policy for the preceding 3 years excluding the year
immediately preceding the date of renewal.

On the same basis, a loading is applied to the renewal
premium for Adverse claim experience. The loading
ranges from 25% to 150%. The Bonus-Malus concept
is introduced to encourage prudent insured by

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