Page 92 - Ebook health insurance IC27

The Insurance Times
 Stop adverse claim experience
 Responsible market conduct by insurers
 Discipline in underwriting
 Setting up Administration standards for group schemes
A Comparison of Individual & Group Medical Insurance
Individual
It provides coverage to an individual who
owns the contract of insurance
Insured person is the policyowner
It often includes the policyholder's family individuals who have a specific
members
It is usually owned by the insured. There
are some cases where an individual
purchases the insurance for spouse or
dependent children only
It covers any individual who legally
qualify for contracting and his spouse and
eligible dependents
No limitation on the number of
participants
Acceptance for coverage is determined
by the characteristics of a person being
insured, rather than those of the
policyowner
It requires the receipt of the contract or
policy by the insured or policyowner as
evidence of coverage
9 6 Guide for Health Insurance
Group
It provides coverage to a number of
persons under a single contract (known
as the master contract).
The policy owner is an employer or any
other organization
It provides benefits to a group of
relationship (for example, employment)
to the policy owner
Someone other than the person insured
owns it
To avoid anti-selection, most of policies
usually cover full-time employees
Usually a minimum number of
participants is required
The underwriting is focused on the
characteristics of the group, rather than
those of the individual members
Employees covered receive certificates
of insurance as evidence of their
coverage