Page 383 - Ebook health insurance IC27

Sashi Publications

Endorsement :
Document attached to a policy which modifies the policy's original terms. Endorsement
overrides the more general provisions in the policy itself. In a way Endorsement as a
memorandum added to a policy embodying some alteration to the terms of the policy.

Eligibility conditions:
Conditions that insured persons must meet in order to be entitled to the benefits of the
scheme.

Exclusions:
Exclusions are diseases and conditions for which medical expenses are not covered by
the health insurance policy. Exclusions can be of two types - Permanent and First year
or Second Year.

Permanent exclusions are never ever covered by the policy for example,AIDS or
expenses incurred on cosmetic surgery. First Year exclusions are diseases which are not
covered for the first/second year of health insurance cover, but are covered subsequently
for example surgery for cataract is usually not covered in the first year but is covered
starting the second year.

Exgratia payment :
Payments made out of grace and favour, not based on any legal obligation.

Franchise :
A clause or provision in a policy where the insurer pays all losses over a given level i.e.,
franchise, but no losses below that level i.e., falling within the franchise. Contrast with
excess.

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