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IF2 > Chapter 2 - Health Insurance > Flashcards

Chapter 2 - Health Insurance Flashcards

1
Q

What is a benefit policy?

A

A benefit policy does not provide an indemnity, instead it pays a sum of money in the event of a certain contingency, regardless of weather or not the insured suffers a direct financial loss

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2
Q

Why are the first 21 days excluded?

A

Ensures that the insured is only liable for sickness or disease contracted after the commencement of the policy.

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3
Q 
Under which circumstances will the benefits from a medical expenses policy become payable?
A on diagnosis of a critical condition
B on undergoing a minor surgery 
C when unable to work due to illness
D when unable to work due to an accident
A

B on undergoing a minor surgery

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4
Q

Why are personal accident insurance contracts not contracts of indemnity?

A

Personal accident contracts are benefit policies rather than contracts of indemnity because they seek to provide a sum which is fixed in advance

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5
Q

Age for sickness cover

A

16 to 60

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7
Q

What are the main benefits available under the personal accident policy?

A 
Death
Total loss of sight in one or both eyes
Total loss of one or both limbs
Permanent total disablement 
Permanent partial disablement
Temporary total disablement 
The portable partial disablement 
Medical expenses
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8
Q

When must death occur if the death benefit is to become payable under a personal accident policy?

A

Death must occur within 12 months of the accident

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9
Q

What is the usual geographical scope of
A accident cover
B sickness cover

A

A worldwide

B uk, USA, Europe, Canada, Australia, New Zealand

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10
Q

What are three hazardous activities that are usually excluded from an accident and sickness policy

A 
Motorcycling
Polo
Racing on horseback or wheels
Winter sports or mountaineering using ropes
Aviation
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11
Q

What cover is available to in-patients under medical expenses insurance?

A

In-patients cover provides for hospital charges, specialist fees and additional costs

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12
Q

What do low cost policies limit on medical treatment?

A

Limit the level of hospital accommodation available

Use NHS treatment within 6 weeks of diagnosis

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13
Q

When is a child up to the age of 23 allowed on family personal accident policies?

A

Only if the ‘child’ is living with, or is dependent on, the main policyholder whilst in full time education

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14
Q

Age for accident cover?

A

16 to 70

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15
Q

What is meant by the term ‘accidental’ for personal accident cover

A

Must be a fortuitous event from an identifiable cause

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16
Q

Under accident policy what is the length for usual weekly benefits in weeks

A

104 weeks or 10 years annuity

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17
Q

How long is the sickness policy providing cover for up to for temporarily and total disablement

A

104 weeks

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18
Q

What happens if the insured is sick for less than 7 days

A

No payment is made and it’s a time franchise but of sickness is over 7 days the first initial 7 days are included

19
Q

How long is excluded for sickness at the beginning of the contract

A

21 days

20
Q

How much is paid out for death

A

Must occur within 12 months of the event giving rise to a claim and its £10,000

21
Q

How much is paid out for total loss or sight in one or both eyes

A

£10,000 regardless of whether one or both eyes

22
Q

How much is paid out for total loss of one or both limbs

A

Has to occur within a max of 24 months after the accident. Fixed sum of £20,000

23
Q

How much is paid out for permanent total disablement

A

Not payable to 12 or 24 months after the accident £20,000 or £2,000 for a year for 10 years

24
Q

How much is paid out for permanent partial disablement

A

Percentage of the capital sum paid is on a sliding scale and represent s a smaller percentage

25
Q

How much is paid for temporary total disablement

A

Must be engaging in usual occupation usually paid in a form of a weekly benefit for example £100 a week for a max of 104 weeks

26
Q

How much is paid for temporary partial disablement

A

Usually 40% of the temporary total disablement amount. But can be £100 per week

27
Q

What is the definition of medical expenses

A

Cost of medical, surgical or other remedial attention, treatment or appliances given or prescribed, all hospital, nursing, home as ambulance charges

28
Q

What happens of death following permanent total disablement

A

Benefits aren’t cumulative which means one capital benefit

29
Q

What is an optional extension or personal accident policies

A

Legal expenses but only relates to incidents following bodily injury

30
Q

What are the geographical limits for accidents

A

Worldwide

31
Q

What is the geographical limit for sickness

A

UK, Europe, USA, Canada, Australia and New Zealand

32
Q

What is the age limit for accident cover

A

16-70 years

33
Q

What is the age limit for accident cover

A

16-60 years

34
Q

Can a health policy exceed the age ranges

A

Yes, as long as they can provide proof they are in good health usually from a GP

35
Q

What is the age limit for family personal accident policies

A

Children can be covered from 6 months to 16 years. But if they are in full time education it can be 23 years

36
Q

What are the 7 exclusions for personal accident and sickness

A
  1. Under the influence of alcohol or drugs
  2. Self inflicted injury or disease
  3. Anything that occurred prior to the accident
  4. Involving in sports such as aviation, motor cycling, polo, racing on horseback, winter sports or mountaineering, involving use of ropes
  5. Childbirth, pregnancy, veneral disease or aids
  6. War risks
  7. Sickness occurring within 21 days of the commencement
37
Q

What does it mean by the fact that personal accident and sickness only cover fortuitous losses

A

Must be unlikely and uninevitsble. That’s why pre existing conditions are not payable

38
Q

What does medical expenses insurance do

A

Provide cover for individuals who seek private medical treatment outside the NHS when they are ill

39
Q

What happens to medical expenses insurance when the insured age increases

A

The premium increases

40
Q

What are the 3 standard policy covers for medical expenses insurance

A

Hospital charges- theatre fees, surgical dressings and consultations

Specialist fees- surgeons and anaesthetics fees

Additional costs- ambulance fee and nursing fees

41
Q

Do medical expenses cover long term residential care

A

No

42
Q

What is excluded under medical expenses insurance

A

Any medical conditions the insured has received treatment for in the past 5 years

IF2 (15 decks)

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