One
of the different types of insurance coverage is complementary medical
insurance. Due to the fact that human have always been subjected to the risk of
different diseases, inevitably have to bear huge medical expenses, medicine,
operation fee as well as hospital expenses for treatment. In order to help
people who are in these situations, insurance companies have provided different
and various insurance plans for diseases. Also in most of the countries the
government employees or industrial units and manufacturing units use collective
medical insurance plans.
Currently
complimentary medical insurance is one of the most important fields of
insurance in the countries of the world. This type of insurance in Iran is
provide collectively.
Items
under the coverage of medical insurance:
Disease
in medical insurance agreements are defined as any kind of physical complication or undesirable change and
disorder in normal and natural activities of the body members which is
identifiable by doctors and doesn’t haven’t anything to do with the will of the
insured.
Therefore;
the liabilities of the insurer are compensating all the medical and hospital
expenses of each of the insured people which is compensable as per the
agreement and with consideration of the agreed franchise.
In
general the liabilities of the insurer are as per the following:
-
Hospital expenses (general and specialized)
-Para-clinical
expenses
-Labor
expenses
-Lasik
expenses
It
should be noted that more different and various items can also be covers which
should be mutually agreed between the insurer and insured.
Items
outside the coverage of insurer liabilities (exceptions)
Payment
of the following expenses is outside the liabilities of the insurer:
-All
the expenses of cosmetic surgeries and
surgeries for removing the natural and congenital problems.
-All
the expenses of treatments for sterilization
-All
the expenses for abortion, except those which are performed out of necessity as
per the relevant rule and regulations.
-All
the medical expenses related to check ups, except in necessary cases and as per
the explicit recognition of the
physician.
-
All the expences related to mental diseases (except related to mental
treatment)
-All
the expenses resulting from war, strike and riot.
-all
the expenses resulting from accident
-All
the expenses for provision of corset, compression stockings, artificial limbs
to compensate for congenital defects.
-All
the medical expenses resulting from listening to unauthorized people for
intervention in medical affairs, such as Orthopedics and ect.
It should be mentioned, though, with agreement of the
insurer and payment of extra premium, some of the above can be covered and the
insurer liabilities can be increased as well.