Page 104 - Ebook health insurance IC27

The Insurance Times

Expert individual risk assessment is vital to insurance companies to keep the system
balanced. Underwriters enable insurers to group the same level of expected risks
together, and charge them the same premium. The policyholder should get a cover
at fair and competitive price whereas the insurer should maintain the experience of
its portfolio in line with the morbidity assumptions.

(e) Use of General or Standard Exclusions - The majority of policies impose
exclusions that apply to all the members. These are known as standard/general
exclusions. Insurers basically try to limit their exposure by the implementation of
standard exclusions.

Some common examples are :
(i) All diseases/injuries which are pre-existing when the cover incepts for the

first time.
(ii) Any disease contracted by the insured person during the waiting period

from the commencement date of policy.
(iii) One year- two year exclusions (waiting periods) for diseases like Cataract,

Benign Prostatic Hypertrophy, Hysterectomy for Menorrhia or Fibromyoma,
Hernia, Hydrocele, Congenital Internal disease, Fistula, Piles, Sinusitis or
related disorders.
(iv) War and related perils, Nuclear weapons/materials related peril.
(v) Circumcision unless necessary for treatment.
(vi) Vaccination or inoculation, change of life, cosmetic/aesthetic treatment of
any description, plastic surgery, unless necessary for treatment.
(vii) Cost of spectacles and contact lenses, hearing aids ( normal maintenance
expenses).

108 Guide for Health Insurance