Page 128 - Ebook health insurance IC27
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The Insurance Times
Premium must be fully paid by the Premium may be fully paid by a member
individual orin partby amemberandtheaffinity group
Individual has no bargaining power Group has the bargaining power
May be an adverse selection Reduces the chances of adverse selection
Policy taken for protecting individual Policy may be taken by employers to give
health incentives to employees
Common clauses in health insurance policies
Minimum period of l Most of the policies stipulate that the
hospitalisation policyholder in order to get the claim must be
hospitalised for at least 24 hours.
Criteria for hospital
l In some cases now the company also includes
Limits ofindemnity daycare surgeries which do not require 24 hours
Room rent hospitalisation but must be specified in the policy
l Hospital must be duly licensed and registered
Under supervision of a registered medical
practitioner
l Minimum 15 beds in metro cities and 10 beds in
the smaller towns
This refers to the maximum amount payable for the
treatment expenses of the insured. It is the sum insured
specified in the policy.
Most of the policies impose sub limits where in only a
certain percentage of room rent is payable. For
example 1% of sum insured. If the sum insured is Rs.2
lakhs the amount payable would be Rs. 2000 per day
132 Guide for Health Insurance
