Aviva - MyShield
Thursday, October 8, 2009
The most common exlusion in Health Insurance is a "Pre-existing condition" exclusion. This exclusion means that any illness or disability that you have, or have had, when you sign up for the plan will not be covered. We have to also bear in mind that the definition of "Pre-existing condition" varies among different insurer.
Let us go through the definition of "Pre-existing Illnesses" clause of our Shield Plan providers.
Aviva - MyShield
means any Injury, Illness, condition or symptom:
(a)for which treatment, or medication, or advice, or diagnosis has been sought or received or was foreseeable by You or the Insured Person prior to the Insured Person’s Effective Date or the date of Upgrade or the date of the last Reinstatement, whichever is later, for the Insured Person concerned, or
(b) which originated or was known to exist by You or the Insured Person prior to the Insured Person’s Effective Date or the date of Upgrade or the date of the last Reinstatement, whichever is later, whether or not treatment, or medication, or advice, or diagnosis was sought or received.
NTUC Income - Incomeshield
Pre-existing Illnesses, Diseases or Impairments shall mean any illness, disease or impairment:
a. for which treatment, medication, advice or diagnosis has been sought or received or which ought to have been sought or received;
b. which was known to exist, whether or not treatment, medication, advice or diagnosis was sought or received; or
c. the conditions or symptoms of which existed and would have led a reasonable and prudent person to seek medical advice and/or treatment, before the Commencement Date.
Great Eastern - SupremeHealth
Any pre−existing illnesses, diseases or impairments ("Pre−existing Conditions") from which the Life Insured is suffering prior to the Commencement Date of Insurance of the Life Insured are excluded, unless declared in the proposal for (or in the application for reinstatement of) insurance of the Life Insured and expressly accepted by the Company.
Prudential - Prushield
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 reinstatement (if any), whichever is later.
AIA - Healthshield
Pre-existing conditions which mean any physical condition or existence of any sickness or disease that was diagnosed, treated, or for which a Physician was consulted, at any time prior to the Effective Date or the last Date of Reinstatement, whicheer is later.
These are my observations about their contract wordings about "Pre-existing Conditions" as a non legal professional.
Prudential specify it as "Existence of any signs or symptoms..." and "...caused an ordinary prudent person to seek treatment". If there are clearly no signs or symptoms for an ordinary prudent person to notice it, the insurer probably may not treat it as "Pre-existing Illnesses"
AIA specify it as "Existence of any sickness or diseases...", "...that was diagnosed, treated, or for which a Physician was consulted". If the policyholder never seek a physician advise or was diagnosed with the condition, the insurer probably may not treat it as "Pre-existing".
GE don't seems to even describe the condition of Pre-existing condition properly. It only specify "Suffering prior commencement date" It do not specify clearly whether aware or not aware.
NTUC Income define quite clearly for this clause. They indicated "ought to have been sought or received", "which was known to exist" and "a reasonable and prudent person to seek medical advice". It seems to shows that if the person really are not aware of the condition or that the condition is not significaant enough for him to reasonably seek treatment, the insurer should not treat it as "Pre-existing Illnesses".
Aviva wording of "which originated or was known to exist" is not very good for the policyholder. It seems to imply as long as the condition "Originated" regardless aware or not aware, the person will not be covered.
As mentioned previously, there will be a lot of other factors to look into when an insurer decides to dispute any claims as "Pre-existing Illnesses". The wordings should not be viewed in isolation.
They have to protect their existing pool of policyholders against "Anti-Selection" whereby people with "Pre-existing Illnesses" enters the pool without declaring them properly.
at 5:56 PM