Question 4 (12 Marks)

a. State five common exclusions typically found in a health insurance policy.

6 marks

b. Lily purchased a health insurance policy for her 3-year son.

Nine months later, Lilys son was admitted to a private hospital as his skin bruises easily with bleeding gum taking a long time to heal after losing a teeth. At hospital, Lilys son was diagnosed with hemophilia which is usually an inherited bleeding disorder in which the blood does not clot normally.

Subsequently, Lily lodged a medical claim with the insurance company for the hospital expenses that she has incurred for her son. However, the insurance company declined Lilys claims and did not pay any compensation for the hospital expenses incurred by Lily relating to her sons illness.

What reason justifies the insurance company to decline Lilys medical claim

relating to her sons hospital expenses? Which exclusion the insurance company

has used to reject Lilys medical insurance claim? Briefly explain.

6 marks