Health coverage criteria differ among IP insurers

PEOPLE looking for private health coverage who have pre-existing medical conditions are being advised to shop around.

When MediShield Life launches at the end of next year, insurers offering Integrated Shield plans (IPs) will be allowed to impose a surcharge to provide full coverage to such customers.

Currently, they can only reject them or offer partial coverage.

IPs are private medical insurance plans that can be paid for fully or partially with Medisave premiums and are offered by five insurers here.

However, the Life Insurance Association of Singapore (LIA) has told The Straits Times that a condition excluded by one insurance company might not be considered so important by another.

"The underwriting philosophy and practices vary across the five IP insurers, each with its own internal underwriting guidelines," the LIA said.

There are about 65,000 people on the basic MediShield or an Integrated Shield plan (IP) who are excluded from full coverage because of a pre-existing condition. Many of these have said they would like to be fully covered and are willing to pay extra for it.

With MediShield Life, they need to pay premiums that are 30 per cent higher, for 10 years. For IPs, it is entirely up to the insurer.

The LIA said it could not provide a standard list of conditions that all five companies do or do not cover. Allowing each to decide for itself "ensures that insurance companies remain financially sound to provide payouts for policyholders".

Insurance companies look at the following when deciding whether to offer full or partial coverage, or not to cover the person:

-The risk of future complications or recurrence;

-The likelihood of surgery in the foreseeable future;

-The additional risks of such surgery; and

-Ongoing medical treatment or monitoring the person would usually require.

IP insurer Aviva said it would generally not cover people who have diabetes with complications, HIV/Aids, or who have recently been diagnosed with cancer and are having treatment for it. It would cover, with exclusions, an asthmatic who suffers frequent attacks.

But someone with deficiency of the G6PD enzyme, which could lead to the sudden destruction of red blood cells, is given normal full coverage.

The LIA said that charging people with medical conditions higher premiums, or refusing to cover them for certain conditions is being fair to healthy people covered by the insurance. Doing otherwise would mean healthy policyholders were "burdened by the financial risks of those with pre-existing conditions."

Dr Chia Shi Lu, head of the Government Parliamentary Committee for Health, said IPs are run commercially, so "criteria will differ amongst providers depending on their marketing strategy and business considerations".

He suggested that people with pre-existing conditions "should shop around" for the best deal.

Twitter: @STHealth

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