Page 158 - Ebook health insurance IC27

The Insurance Times

(xii) Cancellation Clause - Usually this clause can be evoked by the insurer for
reasons of fraud, moral hazard, misrepresentations or non-cooperation of the
insured. Similarly, the customer may also cancel the policy based on policy
conditions andtheinsurancecompany issupposed to refund thepremium. However,
the insurer is liable for any claim that arose before cancellation.

(xiii) Renewability Clause - Generally, the industry's stand, as required by the regulator,
is that the health insurance products will ordinarily be renewed, though the insurers
will not be liable for cases of non-receipt of premium / delayed receipt of premium
/ renewal notice. The company can revise the premiums, terms and conditions of
the product. The renewal is not automatic, and the insured must pay the premium
well before the due date.

Q17. Write short notes on -
(a) Limits of usage of 24 hours of hospitalization - Generally the minimum period

of hospitalization required is 24 hours. However, certain treatment/surgeries
requiring only a day are considered to be exceptions. They usually include Heamo
Dialysis Chemotherapy, Eye Surgery, D&C, Angioplasty, Hernia, Hydrocele, ENT
surgery, Cataract, etc
(b) Room rent - Often, in order to balance medical necessity and luxary, and cost
control to insures, some limits to room charges are imposed, ( say 1% of sum
insured).
(c) Limits of indemnity - It is the maximum liability for any/all claims made during
the policy period, availed by the insured for hospitalization and other related
claimable events. This is stated in the policy schedule, and is also called sum
insured.
(d) Domiciliary Hospitalization benefit - This has historically been offered in

162 Guide for Health Insurance