Health Insurance

Question 1

What is a benefit policy?

Answer 1

It’s not an indemnity policy but it pays a sum of money in the event of certain contingency, regardless of whether or not the insured suffers a direct financial loss.

Question 2

Why are the first 21 days of taking out the policy excluded in a sickness cover?

Answer 2

The exclusion insures that the insurer is only liable for sickness or disease contracted after commencement of the policy rather than for sickness or disease contracted prior to commencement but subsequently developing

Question 3

When will the benefits from a medical expenses policy become payable?

Answer 3

When undergoing minor surgery

Question 4

A personal accident and sickness insurance has a sum insured what happens next

Answer 4

The sum insured is paid if the insured suffers an accident or is off work due to sickness.

Question 5

What will an accident policy pay?

Answer 5

Capital sums in the event of death or certain specified injuries and usually a weekly benefit or compensation if the insured is temporarily totally disabled by an accident for a maximum of 104 weeks

Question 6

What is a time franchise in regards to sickness benefit?

Answer 6

It means that if you are not sick for more than seven days Benefit won’t be payable. It also means that if you are sick within the first 21 days of taking out a policy it also won’t be payable.

Question 7

Sickness cover provide a weekly benefit if the insured is temporarily totally disabled due to sickness but up to how many weeks

Answer 7

104

Question 8

There are limitations for personal accident and sickness insurance what two are they?

Answer 8

Geographical limits and age limits.

Question 9

Limitations geographical limits

Answer 9

Accidents are covered worldwide however sickness cover is restricted to UK Europe USA Canada Australia and New Zealand.

Question 10

What are the limitations in regards to age limits?

Answer 10

You can be buy insurance to cover you for accidents if you are aged between 16 to 70.

Sickness 16-60

Question 11

What are the specific exclusions in a personal accident and sickness insurance?

Answer 11

Benefits will not be payable if the insured was under the influence of alcohol or drugs, self-inflicted injury or disease, physical defects or infirmity which existed prior to an accident, certain sports and past times, childbirth, pregnancy, sexual transmitted diseases or AIDS, war risks sickness happening within 21 days of the commencement of sickness cover

Question 12

What is medical expenses insurance?

Answer 12

Healthcare insurance that provides cover for individuals who seek private medical treatment outside the NHS when they are ill

Question 13

In a medical expenses insurance policy what is the standard policy cover for in patients ?

Answer 13

The policy will cover hospital charges ( theatre fees, surgical dressings and consultations)

specialist fees ( surgeons and anaesthetists fees)

additional costs ( ambulances and nursing fees)

Question 14

Instead of optional extensions to medical expenses Instead there is a range of standalone policies available offering different levels of cover example

Answer 14

More expensive policy is very generous provision. Low-cost policy limit the level of hospital accommodation available under them and require the member to use the NHS treatment if it can be undertaken within six weeks of diagnosis. This means if you break your leg and the NHS are able to perform surgery in four weeks time then there is no need to make a claim

Question 15

Why are personal accident insurance contracts contracts of indemnity?

Answer 15

They are benefit policies because they seek to provide a son which is fixed in advance for certain specified events.

Question 16

The main benefits available under a personal accident policy include

Answer 16

Death. Total loss of sight in one or both eyes. Total loss or one or both limbs. Permanent total disablement. Permanent partial disablement. Temporary total disablement. Temporary partial disablement and medical expenses.

Question 17

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

Answer 17

It must occur within 12 months of the accident

Question 18

What are hazarded activities that are usually excluded from an accident sickness policy?

Answer 18

Motorcycling, polo, racing on horseback or wheels, winter sports or mountaineering using ropes or guides or aviation other than air travel in a fully licensed passenger carrying aircraft as a passenger.

Question 19

Under a personal accident insurance policy, standard cover normally provides for payment of

Answer 19

benefits whilst incapacitated.

Question 20

Under a personal accident insurance policy, what is the maximum number of weeks for which temporary total disablement benefit is usually paid?

Answer 20

104 weeks

Question 21

Owing to an accident resulting in injury to an arm, a hairdresser is unable to carry out any work for three months. What benefit will be provided under his personal accident insurance policy?

Answer 21

A regular payment for temporary partial disablement.

Question 22

What is normally the main rating factor used when considering an application for personal accident insurance?

Answer 22

Occupation

Question 23

A franchise under an insurance policy means that the

Answer 23

insurer pays the full value of any claim which exceeds a specified amount.

Question 24

In the event of a valid claim under a personal accident and sickness insurance policy, what documentary evidence will an insurer always require in addition to a claim form?

Answer 24

A doctor’s certificate to confirm the nature and duration of the claimant’s disability