Claim case sharing
Below is an example of a congenital condition/anomaly:
Chan Tai Man enrolled his son for medical insurance shortly after birth. When the child was one and a half years old, Chan Tai Man discovered that the size of his left and right testis were different. After examination by a doctor, it was confirmed that the child was suffering from Undescended Testicle.
In normal cases, testicles will descend gradually down the abdomen, through a channel (the inguinal canal) in the groin into the scrotum shortly before birth. An undescended testicle is caused by the fact that the testicle cannot descend from the abdomen to the scrotum, which is a congenital anomaly.
The child was admitted to hospital for an operation. Chan Tai Man submitted a claim to his insurance company for hospitalisation expenses. The insurance company declined his claim with the explanation that the disease is a congenital condition, which is excluded from medical insurance coverage.
Insurance intends to cover an insured for events that happen after a policy has become effective. In respect of medical insurance, congenital conditions/anomalies refer to medical abnormalities existing at the time of birth, regardless of the time of discovery. Therefore, it pre-existed the effective date of a policy and is excluded from medical insurance coverage.