Page 320 - Ebook health insurance IC27

The Insurance Times

or sickness, cover will commence after the employee has been actively at work for a
period of two consecutive weeks. New employees shall be eligible to become insured
members from the first day of the month following the date on which they first become
employees, as defined in the policy.

Dependants (other than newly-born children) are eligible for insurance on the same date
that the insured member, to whom they are related becomes eligible, or on the date the
insured member acquires any such dependant, whichever is the later. Newly born children
are eligible for insurance when they achieve the minimum age stipulated by each policy,
usually 14 days. Parents, sisters, brothers, aunts and uncles are not considers as eligible
dependents.

Limit of Liability
This refers to maximum amount the insurer is liable for compensation. It is important to
note that each company has its own limits and sub-limits, which may vary within each
policy. The overall maximum limit stated in the contract is the maximum amount
recoverable under the policy as a whole by an insured member during any one period of
insurance. These benefits are payable either to the insured member or to the providers
of covered medical services, whose official receipt shall be a valid discharge of the
company's liability. Within each policy, the limits may also be divided into the sub-limits.

Summary of Benefits
Summary of benefits (also called "Table of Benefits") is the most important section of a
policy. It is the operating clause where the actual cover provided and its limitations are
outlined.

324 Guide for Health Insurance