Page 146 - Ebook health insurance IC27
P. 146
The Insurance Times
In group insurance, there are usually no specific health questions recorded from
the individual member, rather, the risk and the premiums are determined by the
claims experience and the nature of the group.
The group is insured based on the master policy contract entered between the
group organizer (employer-employee group or affinity group) and the insurance
company based on the details of the members provided. Some of the details that
are usually recorded are
(a) nature of the group
(b) number of members
(c) age group of members
(d) income details
(e) nature of work and
(f) geographical spread.
Q7. What is the usual coverage and exclusions in hospitalization indemnity
plans?
Ans. This coverage is available on both individual and group basis. These policies
usually reimburse the following benefits:
(i) Hospital costs
(ii) Accommodation costs, nursing care, operation theatre expenses
(iii) Specialist consultations and physiotherapy received as in-patient
(iv) Specialist Fees
(v) Surgeon's and Anesthetist's fee for in-patient and day care operations
(vi) Physician's fee for in- patient treatment.
Most products may reimburse diagnostic tests, chemotherapy, radiotherapy and
150 Guide for Health Insurance
