Healthcare Insurance

Claim case sharing

Pre-existing conditions exclusion of healthcare insurance

Mr. Lee took out a Hospital Cash Insurance Policy with 1st September as the start date. Unfortunately, he was admitted to hospital on 5th September and diagnosed with hypertension by the doctor. He was hospitalised until 8th September and submitted his claim to the insurance company soon after he was discharged. According to his medical records before admission to hospital, he consulted a doctor on 3rd September for hypertension and had presented associated symptoms of hypertension such as dizziness and palpitation 2 to 3 weeks before 3rd September.

Can Mr. Lee claim compensation?

As Mr. Lee's medical condition of hypertension had originated before the start date of his insurance policy, it fell into the pre-existing conditions exclusion of the policy. Therefore, his claim was declined by the insurance company. According to our healthcare insurance policy in general, the definition of pre-existing conditions means: “Any injury, illness, condition or symptom for which treatment, or medication, or advice, or diagnosis has been sought or received or was foreseeable prior to the commencement of the Policy for the Insured Person concerned, or which originated or was known to exist by the Insured Person (or anyone insured under the Policy) prior to the commencement of the Policy whether or not treatment or medication or advice or diagnosis was sought or received. If benefit amount or coverage is increased after the inception date of Policy, a “Pre-existing Condition” shall mean any injury, illness, condition or symptom for which the Insured Person has had or is receiving Treatment or sought medical advice, or of which signs or symptoms were presented and the Insured Person should have reasonably been aware of (or anyone insured under the Policy) prior to the upgrade date.”

This case shows that many people have the misconception that hospitalisation within the insured period will be covered by their health insurance. To avoid any misunderstandings in the future, you should remind your customers that when they take out health insurance, pre-existing conditions are excluded from their policy.

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