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How do "Pre-Existing Conditions" affect Health Insurance?

Updated: Apr 2, 2018



We all know that health or hospitalisation insurance is one of, if not the most important type of insurance plan. It covers hospitalisation & surgery expenses as well as related outpatient expenses.


When you apply for a new insurance policy, may it be a term, whole life or hospitalisation, you will be required to answer a list of questions pertaining to your medical history. For Singapore residents, this would apply to private-integrated Shield and ElderShield as well.


The insurer will thoroughly evaluate your application, and ascertain if they could accept you as Standard Health, which means that you will be given full insurance coverage. In some cases, insurers may accept minor health conditions, or conditions that you have long recovered from.


For more severe conditions, it is common for insurers mete out “Exclusions”, which means that the pre-existing condition/s will not be covered by the insurance policy. Any medical conditions that you develop after the policy has started will be covered.


"What if I don’t declare or unintentionally miss out some health conditions?"


Most insurers won’t pull out all your medical records or send you for a health check when they receive your insurance application. However, when you file for a claim, the insurers will do their due diligence and the outcome may not be favourable to you.


Picture this scenario:

Sue bought a hospitalisation insurance plan. When she filled up the health questionnaire, she declared a clean bill of health. A few weeks later, she experienced severe pains in her abdomen and was sent to the hospital. A scope was done and doctors discovered several ulcers in her stomach. After being prescribed some medication, Sue was discharged and rested at home.

When the insurer processed her claim, they found out that one month before Sue bought the insurance policy, she visited her GP twice for stomach pains.

So what happens?


The insurer may not pay out the claims, as the GP visits proved that Sue had experienced symptoms related to her stomach ulcers prior to the insurance policy. The insurer also has the rights to cancel the policy from inception, as Sue did not disclose her health condition during the insurance application. However, most insurers are amiable enough to mete out exclusions instead of cancelling the policy.


It is not difficult for insurers to access your medical records at hospitals and GPs clinics. Hence, when you are filling up an insurance application, please pay careful attention when answering the health questionnaire.


Are there health insurance plans that cover Pre-Existing Conditions?


Yes there are!


For Singapore residents, if you are part of the MediShield Life, you should have some medical coverage for pre-existing conditions.


https://www.moh.gov.sg/content/moh_web/medishield-life/about-medishield-life/coverage-for-pre-existing-conditions.html


For non-Singapore residents and Singapore residents who are looking for more comprehensive hospitalisation insurance, there are a few hospitalisation insurance plans on the market that cover pre-existing health conditions. Many people find the premiums affordable and coverage to be worthwhile.


Hospitalisation insurance is considered by most people to be the most important insurance coverage. Hence, do spend some time to understand what you are covered for and decide if you would prefer a plan that covers you for private hospitals.


Should you need more information, drop Starlight an email and we'll point you to where you can get the best plans.

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