IC38 HEALTH INSURANCE AGENT EXAM - Study Notes

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  • If a person has more than one policy with different insurers, in the event of accidental death, PTD or PPD, claims would be paid under all the policies.
  • Claim documentation for Permanent Total Disability (PTD) and Permanent Partial Disability(PPD) Claim - a) Duly completed Personal Accident claim form signed by the claimant. b) Attested copy of First Information Report if applicable. c) Permanent disability certificate from a civil surgeon or any equivalent competent doctors certifying the disability of the insured.
  • Claim documentation for Temporary Total Disability (TTD) Claim - a) Medical certificate from treating doctor mentioning the type of disability and disability period. Leave certificate from employer giving details of exact leave period, duly signed and sealed by the employer. b) Fitness certificate from the treating doctor certifying that the insured is fit to perform his normal duties.
  • Independent organizations for managing health insurance claims are known as the TPAs or Third party administrator appointed by Insurers
  • Health Insurance is a contract between the insurer and the insured wherein the insurer agrees to pay hospitalisation expenses to the extent of an agreed sum insured in the event of any medical treatment arising out of an illness or an injury

IC38 Health Insurance

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