A Matter Of Prudence & Principle
Over lunch today, Beautante and I were discussing how it should be mandatory that the government dispatch a Welcome-To-The-Real-World Pack to all hapless despairing young adults trying to make sense of These Things they are suddenly expected to grapple with when they start working. Inside will be Very Useful Information like how to file/pay your income tax (I have no idea as the company does it for me), a glossary of cheem terms found in insurance documents (like the different riders, co-insurance and deductibles), the How To Book (How To Buy Right Insurance, How To Be Content, How To Cope When Stupid People Are Everywhere etc) and The Sign Book (Signs You Are Growing A Worry Wart, Signs You Are Getting Too Comfortable, Signs You Are Right You Are In A Dead End Job etc). Okay, so I thought of the last two only now but I need My Package can!!!!
Just that morning, and I mean, Morning 2am, I went through my finances and really mulled over the Aviva’s MyShield policy I bought into some months back. I had come across a disturbing article on how it has refused to pay one claimant on the ground of ‘pre-existing condition.’ The claim was rejected because the Aviva plan “excludes all pre-existing conditions regardless of whether there is disclosure or non-disclosure or whether the insured has knowledge of the condition.”
Now how in the world do you conclude in absolute terms that one has a pre-existing condition?
Rival insurers AIA, Great Eastern (GE), NTUC Income and Prudential have no issue with the claim and would have done the payout accordingly.
Should I switch? As far as I see it, well previously, Aviva offers the best value for $, but that was before this article (see below) made me see the light. If I were to play safe, probably I would advise myself to look for AIA MyShield or GE Supreme Health Plus. The latter is definitely cheaper compared to AIA but AIA’s premiums and service give me peace of mind.
I hate growing up. I hate worrying about money: where to find it, where to park it everywhere saved where to spend (heh so witty) it. I should be Hopelessly In Love or something. Sigh. And who can I talk to about my practical doubts instead of airing them to agents who have their economic agenda? Friends are usually as confused and clueless, or couldn’t care any lesser. Anyway I did some homework and dug out some Medisave-approved integrated plan comparisons, plus more links to the aviva story.
I need My Welcome Pack!!!
And as A Matter of Prudence & Principle, I would most likely switch plans and company altogether.
STRAITS TIMES - Jan 31, 2007
'Pre-existing condition' strikes out cancer patient's insurance claim
Plan excludes coverage, but some rival firms say they would have paid
By Finance Correspondent, Lorna Tan
A 45-YEAR-OLD woman diagnosed with breast cancer thought her medical bill was covered by her insurance policy, but a rude shock awaited her.
Backed by medical reports, her insurer Aviva said that the 9cm lump found in her breast had begun growing before her policy took effect.
It refused to pay, saying her cancer was a pre-existing condition at the time that she signed up for her MyShield hospitalisation policy - never mind that she had no idea at the time.
Fortunately for Ms Simone Vaz, her company has paid for the bulk of her medical bills. She also managed to receive payouts from two critical illness policies, one of which she had signed up for at the same time as her MyShield plan.
Still, her case has turned the spotlight on an often-overlooked but vital issue in medical insurance - the definition of a pre-existing condition.
And the details of Ms Vaz's case underline the complexity of the question and the differing approaches of insurers in dealing with the question.
She signed up for a MyShield plan with Aviva here in January last year and it took effect on April 1. Based in Shanghai, Ms Vaz works as a communications manager at a telecommunications firm.
She was not required to take a health test by Aviva.
Prior to that, the last time she had a health check was in 2004 when she applied for her China visa. Ms Vaz had never undergone a mammogram prior to the diagnosis.
The first indication that something was amiss occurred during a spa massage in Shanghai in mid-June last year when she experienced pain.
She saw a doctor in Singapore and was diagnosed as having advanced or 'stage three' breast cancer. The tumour in her breast was removed immediately at Mount Alvernia Hospital.
Her initial medical bill of $15,000 was rejected by Aviva on the grounds that the condition existed before her policy was issued.
Aviva backed this up with medical opinion.
In a letter to Ms Vaz's lawyer, Aviva stated that independent medical specialists had advised that it would have taken three to nine months for the tumour to grow to 9cm from 1cm.
Ms Vaz's claim was rejected not because of non-disclosure on her part.
It was rejected because the Aviva plan excludes all pre-existing conditions regardless of whether there is disclosure or non-disclosure or whether the insured has knowledge of the condition.
Its 'pre-existing condition' clause states that 'any injury, illness, condition or symptom which originated...prior to the policy commencement date whether or not treatment, or medication, or advice, or diagnosis was sought or received' is excluded under the policy.
When contacted on the rationale for its policy, Aviva's chief executive, Mr Keith Perkins, said that by having an objective evaluation on when an illness originated, it is protecting the interests of the majority of its policyholders.
This guards against potential abuse which may lead to higher premiums if claims go up. 'If we rely on what customers know, we'll never know,' said Mr Perkins.
Aviva receives about 5,000 MyShield claims per year and less than 1 per cent of these claims are rejected because of pre-existing conditions.
Currently it has nearly 100,000 MyShield policyholders.
An insurance adviser told The Straits Times that Aviva's policy may come as a surprise to many medical insurance policyholders.
They probably assume that if they are unaware of a given condition at the time they sign up for the insurance policy, they would be covered, he said. And most of the time, they would be right.
A Straits Times check with rival insurers AIA, Great Eastern (GE), NTUC Income and Prudential found that they adhere to this principle and would have paid Ms Vaz's claim.
The clauses of GE and Prudential are similar. Prudential's clause states that 'a pre-existing condition is the existence of any signs or symptoms for which treatment, medication, consultation, advice or diagnosis has been sought or received by the life assured or would have caused an ordinary prudent person to seek treatment, diagnosis or cure, prior to the cover start date of this benefit or the date of any reinstatement'.
GE added in response to queries about Ms Vaz's situation that even if the doctor were able to estimate how long the condition had existed, it 'would not be fair' on the policyholder if the insurer declined the claim.
The clauses of AIA and Income are similar to each other, but more ambiguously phrased. AIA's clause states that 'any pre-existing illnesses, diseases, impairments or conditions from which the insured is suffering prior to the policy date...will not be covered', without specifying if the policyholder needs to be aware that he is suffering from the illness.
However, both insurers told The Straits Times that if a policyholder is genuinely unaware of a medical condition which is diagnosed only after the policy inception, they would pay the claim. AIA added that the insured must not have any symptoms at the time he took up the policy.
Aviva's Mr Perkins disagreed with that approach, maintaining that an independent medical opinion is crucial for an 'objective evaluation of claims'.
'A clause based on customers knowing about an illness cannot be objectively evaluated as it relies on us knowing customers' personal knowledge,' he said.
'I'm not concerned that we're different from other insurers. I'm happy that we are.'
Ms Vaz said Aviva's pre-existing condition clause put an insured person 'at a complete disadvantage'. Her bills have skyrocketed to more than $70,000 due to the operation, chemotherapy and radiation sessions.
She added that her fear was that her health care would suffer due to a lack of finances when she retires or if she is retrenched.
Aviva gave her an ex gratia payment of $3,128 which she has not cashed in yet.
When contacted, a Ministry of Health spokesman said that private insurers can choose to impose additional exclusions on their Shield plans should the insured have any pre-existing illnesses.
The Consumers Association of Singapore (Case) executive director Seah Seng Choon said that in his view, the clause is 'not fair' to customers if they are genuinely unaware and have no intention of omitting information on a medical condition.
He added that if there is such a clause, the insurer should stipulate the timeframe for such pre-existing conditions and highlight the requirement to the consumer.
*
Important Note: To claim $$$, please be confined at least for 6 hours? Shelved for future references.
From unknown source:
I would like to share a recent shocking "insurance claim" experience" and hope that lessonscan be learnt when buying and handling insurance claims. I hope this message can be passed on to your friends and relatives so that they are awared of how to claim insurance successfully.
I helped my father in law recently to claim for his cancer treatment under AIA healthshield "plan A" and got a shock when we receive a letter from AIA claim department stating the following:
" We refer to your claim and note from the medical bills that all consultations and treatments dated... were all done on an outpatient basis. Further, we also note that all bills did not fall within the schedule of outpatient hospital benefits as stated in AIA Healthshiled Policy Contract.
Therefore, we regret to advise that there is no claim payable in accordance with the definition stated in the AIA Healthshield Contract which reads:
" A confinement means any continuous period of hospitalization as an in patient and for which a daily room and board charge is incurred for a period not less than six hours."
My father in law was diagnosed and given treatment at National Cancer Centre Singapore, SGH. The consultant did many pre diagnostic teat and scan and when it was ascertained that my father in law is diagnosed with stage 2 cancer, he was treated with a continous course of radiotherapy that stretched for almost 2 months.
The tricky issue here is that the radiotherapy is done as a day treatment and no confinement is needed. Thus, no claims are payable according to AIA definition. But the thing is whether a patient needs to be confined in hospital is the call of the doctor and ironically the medical advances in cancer treatment has now allowed most treatable cancer patients to receive day care treatment so as not to disrupt their lifestyles and livelihood.
I would like to highlight that cancer treatment involved big sum of money and expects to spend recurring medical fees for follow up checks and medicine for the next few years following the treatment. A check with AIA claim department states that things would be different if my father inlaw is confined as the post outpatient fees and costs can be claimable. What a difference just because of the definition of "confinement". So do beware!
The point is no longer about whether my father in law claim is payable but what is more worrying is that many of us out there who thought that we are adequately covered and secured by purchasing medishield or private enhanced medishield to proctect ourselves against big medical bills when major illness strike will end up in rude shock when we cannot claim because of professional decisions given by doctors that are beyond patient control contradicts the claim contract. The question to ask is whether the private enhanced healthshield needs serious review as they are obviously outdated with the advances in medical treatment and procedures or is the MOH & CPF not aware these consequences as highlighted. This is ridiculous especially when I found out that majority of the cancer treatment nowadys are done on a day treatment basis without the need of confinement. If you need to be confined, that means one is terminally ill.
I thought this is an issue our Health Minister and ministry need to look into although they can claim that private medical health insurances are not within the control of MOH. But I bet to differ as medisave are allowed to buy selected private enhanced Healthshield policy. Thus, it is only reasonable to expect MOH or CPF work together to ensure they vet these private policy to ensure that they are still practical, relavant and fair to the patients.If these issues are not resolved, I would urge anyone who is undergoing treatment for any major illness and intends to claim for insurance to insist that the doctor confine them for at least 6 hours to qualify for claims. But then if everyone insists to be confined,valuable bed spaces and medical resources which could be more efficiently ultilised would be wasted. But what other choices does a patient have if he needs to claim for his healthshield nsurance?
Just that morning, and I mean, Morning 2am, I went through my finances and really mulled over the Aviva’s MyShield policy I bought into some months back. I had come across a disturbing article on how it has refused to pay one claimant on the ground of ‘pre-existing condition.’ The claim was rejected because the Aviva plan “excludes all pre-existing conditions regardless of whether there is disclosure or non-disclosure or whether the insured has knowledge of the condition.”
Now how in the world do you conclude in absolute terms that one has a pre-existing condition?
Rival insurers AIA, Great Eastern (GE), NTUC Income and Prudential have no issue with the claim and would have done the payout accordingly.
Should I switch? As far as I see it, well previously, Aviva offers the best value for $, but that was before this article (see below) made me see the light. If I were to play safe, probably I would advise myself to look for AIA MyShield or GE Supreme Health Plus. The latter is definitely cheaper compared to AIA but AIA’s premiums and service give me peace of mind.
I hate growing up. I hate worrying about money: where to find it, where to park it everywhere saved where to spend (heh so witty) it. I should be Hopelessly In Love or something. Sigh. And who can I talk to about my practical doubts instead of airing them to agents who have their economic agenda? Friends are usually as confused and clueless, or couldn’t care any lesser. Anyway I did some homework and dug out some Medisave-approved integrated plan comparisons, plus more links to the aviva story.
I need My Welcome Pack!!!
And as A Matter of Prudence & Principle, I would most likely switch plans and company altogether.
STRAITS TIMES - Jan 31, 2007
'Pre-existing condition' strikes out cancer patient's insurance claim
Plan excludes coverage, but some rival firms say they would have paid
By Finance Correspondent, Lorna Tan
A 45-YEAR-OLD woman diagnosed with breast cancer thought her medical bill was covered by her insurance policy, but a rude shock awaited her.
Backed by medical reports, her insurer Aviva said that the 9cm lump found in her breast had begun growing before her policy took effect.
It refused to pay, saying her cancer was a pre-existing condition at the time that she signed up for her MyShield hospitalisation policy - never mind that she had no idea at the time.
Fortunately for Ms Simone Vaz, her company has paid for the bulk of her medical bills. She also managed to receive payouts from two critical illness policies, one of which she had signed up for at the same time as her MyShield plan.
Still, her case has turned the spotlight on an often-overlooked but vital issue in medical insurance - the definition of a pre-existing condition.
And the details of Ms Vaz's case underline the complexity of the question and the differing approaches of insurers in dealing with the question.
She signed up for a MyShield plan with Aviva here in January last year and it took effect on April 1. Based in Shanghai, Ms Vaz works as a communications manager at a telecommunications firm.
She was not required to take a health test by Aviva.
Prior to that, the last time she had a health check was in 2004 when she applied for her China visa. Ms Vaz had never undergone a mammogram prior to the diagnosis.
The first indication that something was amiss occurred during a spa massage in Shanghai in mid-June last year when she experienced pain.
She saw a doctor in Singapore and was diagnosed as having advanced or 'stage three' breast cancer. The tumour in her breast was removed immediately at Mount Alvernia Hospital.
Her initial medical bill of $15,000 was rejected by Aviva on the grounds that the condition existed before her policy was issued.
Aviva backed this up with medical opinion.
In a letter to Ms Vaz's lawyer, Aviva stated that independent medical specialists had advised that it would have taken three to nine months for the tumour to grow to 9cm from 1cm.
Ms Vaz's claim was rejected not because of non-disclosure on her part.
It was rejected because the Aviva plan excludes all pre-existing conditions regardless of whether there is disclosure or non-disclosure or whether the insured has knowledge of the condition.
Its 'pre-existing condition' clause states that 'any injury, illness, condition or symptom which originated...prior to the policy commencement date whether or not treatment, or medication, or advice, or diagnosis was sought or received' is excluded under the policy.
When contacted on the rationale for its policy, Aviva's chief executive, Mr Keith Perkins, said that by having an objective evaluation on when an illness originated, it is protecting the interests of the majority of its policyholders.
This guards against potential abuse which may lead to higher premiums if claims go up. 'If we rely on what customers know, we'll never know,' said Mr Perkins.
Aviva receives about 5,000 MyShield claims per year and less than 1 per cent of these claims are rejected because of pre-existing conditions.
Currently it has nearly 100,000 MyShield policyholders.
An insurance adviser told The Straits Times that Aviva's policy may come as a surprise to many medical insurance policyholders.
They probably assume that if they are unaware of a given condition at the time they sign up for the insurance policy, they would be covered, he said. And most of the time, they would be right.
A Straits Times check with rival insurers AIA, Great Eastern (GE), NTUC Income and Prudential found that they adhere to this principle and would have paid Ms Vaz's claim.
The clauses of GE and Prudential are similar. Prudential's clause states that 'a pre-existing condition is the existence of any signs or symptoms for which treatment, medication, consultation, advice or diagnosis has been sought or received by the life assured or would have caused an ordinary prudent person to seek treatment, diagnosis or cure, prior to the cover start date of this benefit or the date of any reinstatement'.
GE added in response to queries about Ms Vaz's situation that even if the doctor were able to estimate how long the condition had existed, it 'would not be fair' on the policyholder if the insurer declined the claim.
The clauses of AIA and Income are similar to each other, but more ambiguously phrased. AIA's clause states that 'any pre-existing illnesses, diseases, impairments or conditions from which the insured is suffering prior to the policy date...will not be covered', without specifying if the policyholder needs to be aware that he is suffering from the illness.
However, both insurers told The Straits Times that if a policyholder is genuinely unaware of a medical condition which is diagnosed only after the policy inception, they would pay the claim. AIA added that the insured must not have any symptoms at the time he took up the policy.
Aviva's Mr Perkins disagreed with that approach, maintaining that an independent medical opinion is crucial for an 'objective evaluation of claims'.
'A clause based on customers knowing about an illness cannot be objectively evaluated as it relies on us knowing customers' personal knowledge,' he said.
'I'm not concerned that we're different from other insurers. I'm happy that we are.'
Ms Vaz said Aviva's pre-existing condition clause put an insured person 'at a complete disadvantage'. Her bills have skyrocketed to more than $70,000 due to the operation, chemotherapy and radiation sessions.
She added that her fear was that her health care would suffer due to a lack of finances when she retires or if she is retrenched.
Aviva gave her an ex gratia payment of $3,128 which she has not cashed in yet.
When contacted, a Ministry of Health spokesman said that private insurers can choose to impose additional exclusions on their Shield plans should the insured have any pre-existing illnesses.
The Consumers Association of Singapore (Case) executive director Seah Seng Choon said that in his view, the clause is 'not fair' to customers if they are genuinely unaware and have no intention of omitting information on a medical condition.
He added that if there is such a clause, the insurer should stipulate the timeframe for such pre-existing conditions and highlight the requirement to the consumer.
*
Important Note: To claim $$$, please be confined at least for 6 hours? Shelved for future references.
From unknown source:
I would like to share a recent shocking "insurance claim" experience" and hope that lessonscan be learnt when buying and handling insurance claims. I hope this message can be passed on to your friends and relatives so that they are awared of how to claim insurance successfully.
I helped my father in law recently to claim for his cancer treatment under AIA healthshield "plan A" and got a shock when we receive a letter from AIA claim department stating the following:
" We refer to your claim and note from the medical bills that all consultations and treatments dated... were all done on an outpatient basis. Further, we also note that all bills did not fall within the schedule of outpatient hospital benefits as stated in AIA Healthshiled Policy Contract.
Therefore, we regret to advise that there is no claim payable in accordance with the definition stated in the AIA Healthshield Contract which reads:
" A confinement means any continuous period of hospitalization as an in patient and for which a daily room and board charge is incurred for a period not less than six hours."
My father in law was diagnosed and given treatment at National Cancer Centre Singapore, SGH. The consultant did many pre diagnostic teat and scan and when it was ascertained that my father in law is diagnosed with stage 2 cancer, he was treated with a continous course of radiotherapy that stretched for almost 2 months.
The tricky issue here is that the radiotherapy is done as a day treatment and no confinement is needed. Thus, no claims are payable according to AIA definition. But the thing is whether a patient needs to be confined in hospital is the call of the doctor and ironically the medical advances in cancer treatment has now allowed most treatable cancer patients to receive day care treatment so as not to disrupt their lifestyles and livelihood.
I would like to highlight that cancer treatment involved big sum of money and expects to spend recurring medical fees for follow up checks and medicine for the next few years following the treatment. A check with AIA claim department states that things would be different if my father inlaw is confined as the post outpatient fees and costs can be claimable. What a difference just because of the definition of "confinement". So do beware!
The point is no longer about whether my father in law claim is payable but what is more worrying is that many of us out there who thought that we are adequately covered and secured by purchasing medishield or private enhanced medishield to proctect ourselves against big medical bills when major illness strike will end up in rude shock when we cannot claim because of professional decisions given by doctors that are beyond patient control contradicts the claim contract. The question to ask is whether the private enhanced healthshield needs serious review as they are obviously outdated with the advances in medical treatment and procedures or is the MOH & CPF not aware these consequences as highlighted. This is ridiculous especially when I found out that majority of the cancer treatment nowadys are done on a day treatment basis without the need of confinement. If you need to be confined, that means one is terminally ill.
I thought this is an issue our Health Minister and ministry need to look into although they can claim that private medical health insurances are not within the control of MOH. But I bet to differ as medisave are allowed to buy selected private enhanced Healthshield policy. Thus, it is only reasonable to expect MOH or CPF work together to ensure they vet these private policy to ensure that they are still practical, relavant and fair to the patients.If these issues are not resolved, I would urge anyone who is undergoing treatment for any major illness and intends to claim for insurance to insist that the doctor confine them for at least 6 hours to qualify for claims. But then if everyone insists to be confined,valuable bed spaces and medical resources which could be more efficiently ultilised would be wasted. But what other choices does a patient have if he needs to claim for his healthshield nsurance?
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