HEALTH INSURANCE

Question 1

For Personal accident and sickness insurance

Answer 1

The sum insured is paid if the insured suffers an accident or is off work due to sickness, Taken out on an annual basis

Question 2

For personal accident element, what is the main rating factor

Answer 2

The Occupation of the proposer, not for the sickness cover

Question 3

with Personal Accident , what is the general practice amongst insurers

Answer 3

The general practice is to group occupation into 4 main classes, so us to impose different premiums to the different levels of accidents/health risk involved

Question 4

A Personal accident and sickness policy is not a contract of indemnity

Answer 4

It is a benefit policy. However this cover is available in units (defined level of cover)

Question 5

Why do insurers try to ensure that any weekly benefit for disablement represent no more than normal earnings

Answer 5

So as in the event of a genuine claim, the insured is not induced to remain off work if the weekly benefits are too high

Question 6

Personal accident and sickness insurance is available as a stand alone policy but is purchased as an add on to which type of insurance

Answer 6

1. Travel Insurance
2. Motor Insurance
3. Household Insurance

Question 7

The Accident cover of a standard Personal accident and sickness policy provides

Answer 7

It provides compensation in the event of accidental death or bodily injury. The event must arise from an accident meaning an identifiable cause and must be fortuitous

Question 8

Under the accident cover, when are capital sums/lump sums paid

Answer 8

In the event of death or specified injuries. This policy provides weekly benefits up to 104 weeks/compensation if the insured is temporarily totally disabled due to an accident

Question 9

When do insurers offer reduced weekly benefits

Answer 9

If the insured is temporarily partially disabled

Question 10

In the event of permanent total disablement

Answer 10

A capital Sum is paid or less commonly a ten year annuity is paid

Question 11

The Sickness cover of a standard personal accident and sickness policy provides

Answer 11

Provides a weekly benefit up to 104 weeks if they are temporarily and totally disabled from carrying on with work due to sickness or disease.

Question 12

The sickness benefit is subject to which franchise

Answer 12

It is subject to the time franchise, usually seven days/ If the insured is sick for less than seven days, no payment is made. They can only claim cover if sickness continues beyond seven days, and the claim will cover the entire period of sickness from the initial seven days

Question 13

Why is the time franchise put in place for sickness cover

Answer 13

It is put in place as thresholds to determine whether claim is payable

Question 14

Sickness cover excludes

Answer 14

It excludes sickness contracted within 21 days of the commencement of the policy period. So that the insurer is only liable for sickness or disease contracted after policy has commenced

Question 15

What are the policy benefits covered for personal accident and sickness policies

Answer 15

1. Death
2. Total loss of sight(1/2)-
3. Total loss of one or both limbs
4. Permanent Total disablement
5. Permanent Partial disablement
6. Temporary total disablement
7. Temporary partial disablement
8. Medical Expenses
9. Payment of benefits

Question 16

What benefits are provided in the death section for personal accident and sickness policy

Answer 16

Death must occur within 12 months of the event giving rise to the claim, payment is 20,000 pounds

Question 17

What benefits are provided in the Total loss of sight (both or one) section for personal accident and sickness policy

Answer 17

Fixed payment of 20,000 pounds, whether one eye or both is lost

Question 18

What benefits are provided in the Total loss of one or both limbs section for personal accident and sickness policy

Answer 18

This is payable if only occurs within a specified period of the accident causing the injury(12/24). Sum payable 20,000 pounds. Whether lost one or both limbs

Question 19

What benefits are provided in the Permanent Total disablement for personal accident and sickness policy

Answer 19

Fixed payment of 20,000 pounds or annuity payment of 2,000 pounds per year for 10 years. Compensation won’t be payable until 12/24 months from the date of the accident

Question 20

What benefits are provided in the Permanent partial disablement for personal accident and sickness policy

Answer 20

benefit is provided on the basis of the loss of specified parts of limbs. percentage of the capital sum paid is a smaller percentage than that for the loss of an entire limb

Question 21

What benefits are provided in the Temporary total disablement for personal accident and sickness policy

Answer 21

Compensation is in form of weekly benefits up to 104 weeks e.g 200 pounds per week

Question 22

What benefits are provided in the Temporary partial disablement for personal accident and sickness policy

Answer 22

This means temporary disablement that prevents the insured person from attending a large part of their normal b’ness due to accident, doesn’t apply to sickness. the amount paid weekly is set at 40$ of the temporary total disablement

Question 23

What benefits are provided in the Medical Expenses for personal accident and sickness policy

Answer 23

Covers medical expenses necessarily incurred for treatment following an accident. Expenses include; cost of medical/surgical/other remedial attention/treatment prescribed by a qualified member of medical profession

Question 24

What benefits are provided in the Payment of benefits for personal accident and sickness policy

Answer 24

Maximum paid out in a claim, is limited to the capital sum/annuity benefit provided. It is not cumulative.

Question 25

What does it mean when they say payment of benefits is not cummulative

Answer 25

This means Death arising from permanent total disablement after an accident will only be a single payment. At the same time if permanent total disablement follows payment of temporary disablement no deduction of the sums already paid

Question 26

What is an additional benefit provided by personal accident and sickness policy

Answer 26

Additional benefits are legal expenses cover to pursue actions against negligent third partied following bodily injury

Question 27

What are the limitations of a personal accident and sickness policy

Answer 27

1. Geographical Limits- accident cover is usually world wide but sickness cover is restricted to UK,Europe, USA, Canada, Australia and New Zealand
2. Age Limits- accident cover 16-70 years and for sickness 16-60 years

Question 28

What are the typical exclusions

Answer 28

1. insured being under influence of alcohol/drugs
2. self-inflicted injury/disease
3. physical defects which existed prior to an accident
4. insured engaging in certain sports and pastimes, insurer could charge additional premium
5. Childbirth/pregnancy/VD/AIDs
6. War Risk
7. Sickness occurring 21 days from commencement

Question 29

Medical Expenses Insurance

Answer 29

This provides cover for individuals seeking medical treatment outside NHS

Question 30

Medical Expenses Insurance is usually arranged in what basis

Answer 30

It is usually arranged in group basis by an employer on the behalf of its employees, as employment benefits

Question 31

How is premium for medical expense insurance different from personal accident and sickness policy

Answer 31

Premium for Medical Expense tends to increase as age increases, where as for personal accident and sickness it tends to be fairly static

Question 32

For Medical expenses insurance, Inpatient cover provided are

Answer 32

1. Hospital Charges- theater fees/surgical dressings/consultations
2. Specialist Charges- surgeons/anesthetic fees
3. Additional Charges- ambulance and nursing fees

Question 33

For medical expenses insurance the most expensive policy

Answer 33

The most expensive policy provides the most generous provision and the low cost policy provides more limited benefits

Question 34

How does low cost policy limit the insured

Answer 34

It limits the level of hospital accommodation available under them and require members to use NHS if the treatment can be undertaken within 6 weeks of diagnosis

Question 35

What do low cost policies exclude

Answer 35

They exclude payments that relate to medical conditions an individual has received treatment within five years be for applying to the insurer, and also don’t provide long- term residential care

Question 36

Instead of optional extensions being offered for a medical expense insurance standard policy what is provided

Answer 36

There is a range of standalone policies available offering different level of cover

Question 37

For Geographical limits what is the scope of cover difference between accident and sickness

Answer 37

Accident is covered usually world wide , but sickness is restricted to specific locations and will require additional premium for an extension

Question 38

Personal Accident and Sickness insurance is taken out on what basis

Answer 38

On an annual basis

Question 39

Accident cover for personal accident and sickness puts a time limit on

Answer 39

It puts a time limit from the date of the accident to the specified event