Doubts in Booklet 1 (Ch:1-5,10)

Discussion in 'SP1' started by Kamal Sardana, Dec 24, 2021.

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  1. Kamal Sardana

    Kamal Sardana Active Member

    I have the following doubts. Please help me:

    Q1: What is the meaning of that bold line: "State provide certain healthcare procedures free at the point of delivery, with insurance being mandatory for all other procedures----Insurance as a compulsory complement"

    Q2: April2013-Q7-part(ii) - Calculation of Claim Amount for Mr.E
    Can you please tell me how Linked period is defined. (Is it from the date of Inception of a disease or from the date of Payment of claim)?
    In this question, Deferred period is 4 months and Linked period is 6 months and payment will be 500 per month

    For Mr.E -->
    On 1st November 2010 he got Viral Infection which is recovered on 1st April 2011
    --so we will exclude 4 months i.e. 1-Nov-2010 to 1-March-2011. Hence we will pay only from 1-March-2011 to 1-April-2011 i.e. 500 only

    Then on 1st June 2011, he got Torn Ligament (My question is whether deferred period of 4 months will be counted again or not. If i consider 1-April-2011 the period to start counting Linked Period, then Mr.E is covered under Linked Period and there is no need for deffered again.)
    But book consider Date of Inception of Sickness for the Linked Period (i.e. 1st November 2010)
     
    Last edited by a moderator: Dec 24, 2021
    Kamal Sardana, Dec 24, 2021
    #1
  2. Mark Willder

    Mark Willder ActEd Tutor Staff Member

    Hi Kamal

    I have answered your queries in turn below:

    Q1: This means that the State provides some procedures for free, but individuals need to use insurance to pay for other procedures. For example, visits to a GP or accident and emergency might be provided free by the State, but individuals buy insurance to cover other costs such as prescriptions and dental.

    Q2: I'm afraid that both your suggested definitions for the linked claims period are wrong. The linked claims period starts when the policyholder returns to work. Mr E returns to work on 1/4/11, so the linked claims period starts on 1/4/11 and will end on 1/10/11.

    The purpose of the linked claims period is to encourage policyholder to return to work (this is good for the policyholder as they receive their full wages and also good for the insurer as it stops paying the claim). But the policyholder may be reluctant to return to work as they may not be fully cured and might fall ill again. So the insurer agrees that if the policyholder falls ill again, for a reason linked to the original claim, within the linked claims period that the deferred period will be waived and the claims payments will start immediately.

    In this case this means that if Mr E was still ill with the viral infection and couldn't work on say 1/8/11, then his benefits would start straight away. However, if Mr E remained at work until 1/10/11 and then couldn't work due to the viral infection from 1/11/11, then he would have to wait until the end of the deferred period for payment.

    In the question Mr E doesn't fall ill with a viral infection until 1/12/11. This is more than 6 months after returning to work from the previous viral infection, so the linked claims period is over and he needs to start a new deferred period.

    An important point to note is that the linked claims period only applies to claims that are linked, ie the second claim must be caused by the first claim. It is highly unlikely that the torn ligament has anything to do with the viral infection, and so the linked claims period does not apply, and Mr E must start a new deferred period for the torn ligament.

    I hope these examples help to clarify the concept of a linked claims period.

    Best wishes

    Mark
     
    Mark Willder, Jan 4, 2022
    #2

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