Page 308 - DMGT303_BANKING_AND_INSURANCE

Unit 14: Marine and Motor Insurance

3. Fees of attending doctors Notes
4. Expenses incurred on anesthesia, blood, oxygen, operation charge, surgical appliances,
medicines and drugs, diagnostic materials and X-Ray, dialysis and chemotherapy,
radiotherapy, artificial limbs and cost of organs etc.

Exclusions Under a Normal Mediclaim/Health Plan Policy

The medical policy will not cover the following:
1. Any sickness or illness for first 30 days during the policy
2. Any medical expenses relating to pregnancy

3. Diseases caused by war, invasion or due to nuclear weapons etc.
4. Any expenses incurred for spectacles, cosmetic treatment etc.
5. Medical expenses done for purchasing tonics, vitamins unless incurred as part of a treatment.

Types of Coverages

The major types of coverages are: Comprehensive and Scheduled Plan.
Their meaning and main points of distinction are:

1. Scheduled health insurance plans are more of a basic policy providing access to day-to-
day health care such as going to the doctor or getting a prescription drug. In recent years,
these plans have got the name mini-med plans or association plans. Comprehensive
health insurance cover a vast array of illnesses in the same plan.
2. Comprehensive health insurance pays a percentage (may be 100, 90, 80, 70, 60, 50, percent)
of the cost of hospital.
3. These plans are generally costly because of the high potential benefit payout - Rs.10,000,000
to 50,000,000 is common - and because of the vast array of covered benefits.
4. Scheduled plans are not meant to be effective for catastrophic events. They cannot replace
a comprehensive plan.

5. These plans cost much less then comprehensive health insurance.
6. They generally pay limited benefits amounts directly to the service provider, and payments
are based upon the plan's "schedule of benefits".

7. Scheduled health scheme may also provide for - family package discount in premium,
Cumulative bonus etc.
8. The renewal of insurance without break is essential here.

Special Points of a Long-term Care Insurance Policy

This policy is an extended version of the existing mediclaim/health policy. The period of insurance
is fixed for 5 years and 10 years and premium rates are fixed as per sum insured and based on 5
years and 10 years. This policy covers the individual and group under this scheme for longer
period with low premium rating comparatively.

LOVELY PROFESSIONAL UNIVERSITY 303