Wednesday, May 19, 2010

Congential conditions

Hi Mr. Tan,
My student was found to have a hole in the heart in an ECG program initiated by his secondary school. He subsequently underwent heart surgery. He has been active in sports all along so the condition was never detected before.
He has been insured medically since birth. However, the insurance company has refused to pay a single cent towards the medical costs citing congenital cause.
Even the medishield claims [with the same company] were also rejected. Have all the premiums paid by his parents been just money down the drain?
I would like to know if there is any recourse for his parents to relieve them at least a little of the medical expenses.

Generally, health insurance policies exclude congenital conditions. The rationale is that people who knows that they have congenital condition are more likely to buy insurance, so the exclusion is to prevent what is called adverse selection.
In some countries, the government insists that congenital conditions must be covered. I think that this is one provision in the new health plan that has recently been passed in US Congress. Unfortunately, we do not have such a requirement by the regulators in Singapore. In my view, the Ministry of health should have insisted that all convenital conditions are covered under Medishiled and private Shield plans - but this was unfortunately not the case.
Although the health plan does not cover congenital conditions, it does cover all of the other illness that are not connected with the congenital conditions, such as infection, injury and others. The premium is used to cover these other conditions.

Hi Mr. Tan
Thank you for your kind reply to my query. However, it seems that I can't really do anything to help my student.

I do agree with you that the MOH should look into making congenital cases covered by shield plans. I am sure my student isn't the only case which was not detected at birth and only surfaced much later in life.
However, I'm still upset that the insurance company didn't even bother to give a token sum to help the parents defray costs.

Please ask the student to write to the insurance company to request for an ex-gratia payment to cover part of the bill, considering the premiums that have been paid over the years, for which there was (presumably) no claim. If the insurance company reject the request, ask the student to write to the Minister for Health, as the Medishield scheme comes under his Ministry.


Wilfred Ling said...

There are certain private-integrated shield plans that cover congential illnesses subjected to a waiting period. But like most insurance, once the congential illness is discovered, it is almost too late to buy any insurance.

Still, it is might be possible to cover even those congenital illnesses and pre-existing illnesses by looking at international health insurance plans but the premiums will be high.

Also it is important to review one's policies to check that it is not outdated. I believe the student's policy was one of those outdated plan.

Wilfred Ling said...

Even the medishield claims [with the same company] were also rejected.

Medishield is underwritten by CPF Board, not by the insurance company.

Anonymous said...

Yes, do try seeking for ex-gratia payment as it is an honest claim and your student's condition was not known when the insurance was bought, since no medical examination was required at the point of purchase.

Anonymous said...

I got this under "Endorsement E0901.." in my renewal certificate for Incomeshield.

It says:
22B. Congenital Abnomalities Benefit

We shall reimburse you for reasonable expenses incurred for the Necessary Medical Treatment .....birth defects, including hereditary conditions and congenital sickness or abnormalities provided ....24 months from...
a) 1 Sep 2008
b) Commencement date of policy
c) date of last reinstatement of this policy.


Blog Archive