Page 105 - Ebook health insurance IC27

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(viii) Dental treatment or surgery, unless requiring hospitalization.

(ix) Convalescence, General debility, run down condition or rest cure, congenital
external disease, defects or anomalies, sterility, venereal disease, international
self injury and use of intoxicating drugs/alcohol.

(x) Treatment for AIDS/HIV, or sexually transmitted diseases.

(xi) Charges incurred at Hospital/Nursing Home primarily for diagnostic, X-
Ray or laboratory examination or other diagnostic studies not relevant/
incidental to the treatment undergoing at the Hospital/Nursing Home/
Domiciliary Hospitalization as defined.

(xii) Expenses on Vitamins and tonics unless necessary for the treatment, and
certified by a physician.

(xiii) Treatment related to pregnancy, Caesarean section (unless Maternity
Benefit is covered), and voluntary termination of pregnancy during 12
weeks of conception.

Q8. What is the numerical rating method ? Explain its advantages. What are
its drawbacks or deficiencies?

Ans. This process is adopted, where numerical or percentage assessments are made
on each components of the risk.

Factors like age, sex, race, occupation, residence, environment, build, habits,
personal and family history are examined and numerically scored based on pre-
determined criteria. The facts are not easy to ascertain and prejudice may colour
the reports.

Nevertheless, the basis of the Numerical system is most logical. Minus sign is
given to unfavourable aspects of risk, whereas plus sign is given to the favourable

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