Are we responsible consumers? Exclusions and Pre-existing Conditions?

The Onus is On Us, the consumers.

As responsible consumers, we’ve to do our own due diligence and buy products and solutions only when we understand how things work and benefit us.

So consider working with a trusted financial consultant from an independent financial advisory firm to gain clarity, wisdom and guidance on your insurance and investments.

Keep it simple: begin with the end in mind and think about the type of coverage you want and based on your budget or affordability, buy appropriate insurance plans for yourself and your loved ones.

Today, I want to highlight a few important points about getting insurance in general.

  1. Take a Hospital and Surgery plan or a private integrated shield plan as an example. This is a contract between the insured and the insurer with all the terms and conditions stated in black and white in the policy document. By signing the contract, consumers are bound to all the terms and conditions of the contract.
  2. I want to point out that consumers should be aware that all insurance policies have a list of exclusions where the insured cannot make claims.

Let me help you understand what you’re buying to avoid disputes with the insurance companies during claims later on.

a)    Examples of exclusions include injuries caused by natural disasters, riots and self-inflicted injuries under the influence of illegal substances. You cannot claim from your insurance under such circumstances.

b)    There are also terms such as ‘waiting period of 24 months’ and ‘survival period’.

Did you know?

If you’ve MyShield with AVIVA, there’s a waiting period of 10 months in order to claim for inpatient pregnancy complications. This is stated in your policy document.

c)    Most importantly, note the requirement to disclose pre-existing conditions at the point of application.

This means that it is the customer’s responsibility to inform the insurer of any previous medical condition.

Quoting LIA Singapore, “An insurance contract is based on trust. When you apply for health insurance, you must provide all information asked of you.  This could include your age, occupation and any history of illnesses, medical conditions or disabilities.
The insurance company will then assess the given information to decide whether or not to accept your application.

If you do not provide important information in your application, the policy you take up may not actually cover you, and hence the unhappiness which will likely arise when you try to claim for coverage.”

e.g. A benign lump in the breast can be considered as a pre-existing condition.

In my opinion, you should opt for FULL medical underwriting and let the insurer assess your application on a case-by-case basis. Rather than assuming this condition can be covered. Never assume.

Because insurance firms can extract your medical records. And if a doctor can prove that a benign condition or a symptom exists at the time of your application, the insurance firm can refuse your application and/or claim.

Hence it’s best to be upfront and declare any pre-existing conditions as an insurance contract is based on trust. Let the underwriter assess your case and have the insurance company put it in writing that they’ll cover you.

Otherwise, you could face the consequence of contending with the insurance firm when you need to claim later if you didn’t declare any pre-existing condition.

Equally important, it’s our duty to declare and update the insurance company if we discover certain medical conditions after our policy are incepted.  This is also stated as a term in your policy contract.     Let the insurer know in advance and you decide if you want to continue the coverage based on their offers (if any).

My understanding is, clients who have claimed with their insurers for various mild medical conditions that developed after their policies, are still being covered after they’d declared.  Chances are the underwriters will review the insured on a case-by-case basis. 

d)    Other terms and conditions include:

  • co-insurance amount (whereby the customer pays a portion of the hospital bill before he can claim from the insurer)
  • annual and lifetime limits (i.e. the amount that can be claimed within a policy year, and over the entire duration of a policy)
  • if a Letter of Guarantee (LOG) is provided as a feature/benefit in your private shield plan. So far, only 2 firms offer this LOG. Call me at 9231 8779 to help you check for FREE, and review your current medical plans.

To conclude, it’s in your best interests to be prudent and declare your health conditions at the point of application for any insurance to avoid any disputes later on. After all, you’re paying good money on the insurance premiums to protect yourself and your loved ones financially.

Best Regards

Claire Soh



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