Technical Health Insurance Information

Medical Insurance

(a) Basic intentions and scope of cover

Whereas PA insurance is primarily intended to provide a benefit to the insured in the event of death or injury from accident, medical insurances are intended to cover medical expenses arising from accident or sickness.

Policies usually represent annual contracts, although these may be renewed and days of grace are usually allowed for premiums other than the first one. Practice varies as to cancellation entitlements. Most policies allow cancellation by the insured, but not all grant the same rights to the insurer.  Indeed, with some schemes, the intention is for the contract to be renewable at the option of the insured. Technically, however, this may render such a policy “long-term” in nature.

(b) Limitations and exclusions

1. PA exclusions: As the cover includes circumstances covered by PA policies (e.g. an injury sustained while participating in mountaineering may result in both medical expenses and disablement), nearly all the usual PA exclusions apply (see above). 
2. Special exclusions, including: 
   1. Congenital conditions;
   2. Pre-existing (i.e. prior to insurance) conditions and disabilities;
   3. Birth control/infertility treatment;
   4. Cosmetic surgery;
   5. Routine medical examinations and check-ups;
   6. Dental treatment (unless arising from an accident during policy cover).

(c) Premium basis

Clearly, again remembering the accident content of this cover, the insured person’s profession is important. Remembering also the sickness element of cover, the age and health of the insured person may also play an important part with this kind of insurance. Other considerations include sex, levels of cover and geographical limits.

(d) Other features

1. Group policies: These policies are often on a group or family basis.
2. Variations: Some insurers offer, as standard or available extra benefits, such cover as maternity and dental related expenses.
3. Hospitalization cover: A medical insurance policy may provide a stated benefit per day spent in hospital as an in-patient.  Alternatively, an indemnity cover may be given.