Page 314 - Ebook health insurance IC27

The Insurance Times

Individual Group

It requires the receipt of the contract or Employees covered receive certificates

policy by the insured or policyowner as of insurance as evidence of their

evidence of coverage coverage

Except spouse and dependents, insured's Members may become eligible for or
coverage normally begins with the cease eligibility for coverage any time
inception of the contract and ceases during the policy period
with its termination

Individual premiums are determined by The actual group experience of the

the characteristic of the person being larger employers is the most significant

insured factor in setting the premium

Pre-existing conditions
Pre-existing conditions are any medical conditions or their related conditions, which are
a consequence of any previous illness that has ever required or would require
hospitalization, medical treatment and/or medication, or has been diagnosed prior to
members' enrolments. These conditions are generally excluded, but some policies cover
them under certain conditions, usually after elapse of a waiting (ie moratorium) period.

Chronic conditions
Chronic Condition is defined as a medical condition of long duration that is seen to be
an ongoing condition without prospect of cure or of being able to return the insured
person to their normal or previous state of health.

As mentioned earlier, indemnity medical insurance policies only cover acute and curable
conditions. Conditions such as hypertension, bronchitis, diabetes, peptic ulcer, sinusitis,
etc are not curable. They require preventive or maintenance treatment, which will only
give relief or control symptoms rather than effect a cure.

318 Guide for Health Insurance