Not Disclosing Health Conditions Can Void Your Private Health Insurance Claim. Here’s What You Need to Know.

No good will come from keeping your health insurance provider in the dark. Here’s everything you need to know about the consequences of non-disclosures of pre-existing medical or health conditions.  

We Singaporeans may enjoy among the highest standards of healthcare in the world, but the last thing anybody needs is getting slapped with a hospital bill without insurance cover.

That’s why it is crucial to have proper health insurance coverage to help defray the high costs of healthcare while  maintaining good physical and financial health.

However, one thing to note when applying for a policy is that being careless or dishonest can cause your medical claims to be rejected, saddling you with medical debt that you’ll be struggling to pay off. 

What could lead to this sorry outcome? Well, failing to disclose pre-existing medical or health conditions, and having your insurer find out, will just about do it.

Here’s everything you need to know about the potentially serious consequences of what you may believe to be an innocuous oversight.

Medishield Life covers all pre-existing health conditions

Now, first things first, it is important to know that Medishield Life will cover any and all pre-existing conditions you may have - up to the limits specified in your plan. There is no need for you to make any prior disclosures. 

What we will be discussing only applies to private health insurance plans, such as Integrated Shield Plans (IPs), which you may know are optional health insurance plans that provide additional benefits and claims limits on top of your Medishield Life plan. 

Other examples of private health insurance plans include critical illness plans, cancer care plans, disability income plans, hospital care plans, etc. 

How do insurers define ‘pre-existing health conditions’?

Simply put, a pre-existing health condition is any medical or health issue that you have or had been diagnosed with, or advised by a certified professional to seek medical treatment for. This can apply to past, recent or current health conditions. 

The common understanding of a pre-existing health condition is that it is serious and/or chronic, such as heart disease, diabetes, hypertension, cancer, etc. 

However, insurers may also count less serious or inconsequential events like childhood asthma, allergies, vertigo and other such common conditions most people consider to be a nuisance rather than an actual health issue. 

On a related note, insurers may also take into account lifestyle habits and factors, such as Body-Mass Index (BMI), history of tobacco use, family medical history, even bone fractures suffered in the past.

All these pieces of information are collected and used in the underwriting process, which determines your eligibility for the insurance plan applied for, and the level of your premiums.

What are the consequences of not disclosing my health conditions? 

If your insurer discovers that you failed to declare a pre-existing health condition, they can reject your health insurance claim and even void your entire plan. 

When this happens, you will not receive your insurance payout, and you will have to bear the full costs of your medical fees. And don’t think this is just some toothless threat. 

Section 25(5) of the Insurance Act states, “No Singapore insurer shall use, in the course of carrying on insurance business in Singapore, a form of proposal which does not have prominently displayed therein a warning that if a proposer does not fully and faithfully give the facts as he knows them or ought to know them, he may receive nothing from the policy.”

Still, this doesn't mean you’re completely at the mercy of your insurance provider. 

Before rejecting your health claim, your insurer must “demonstrate that the non-disclosure is material to the underwriting outcome, and that the applicant could be reasonably expected to have disclosed the information during the application for the policy,” according to the Monetary Authority of Singapore (MAS).

Does having a pre-existing health condition mean I can’t get insured? 

No, not at all. 

As stated at  the beginning of the article, all Singaporeans and Permanent Residents will be covered by Medishield Life, including pre-existing conditions. This means you’ll have some form of health insurance at the very least. 

Now, when applying for a private health insurance plan, declaring your pre-existing conditions can result in the following outcomes.

Accept as standard

Your insurer accepts your proposal for the health insurance plan you are applying for, and agrees to cover you the same way as someone in your cohort with no medical conditions. 

This usually happens when your insurer deems the disclosed condition to be inconsequential to the terms of your cover, or is willing to accept the risk of extending cover to you. 

Exclude from cover

Your insurer may decide to exclude the declared condition from your health plan, which means you will not receive any benefits or payouts arising from the condition. Related conditions may also be excluded from your plan.

Conditions deemed more serious or having a higher likelihood of occurring have a higher chance of being excluded from cover.

However, claims for unrelated conditions covered under the policy may go through.   

Impose a moratorium 

Certain pre-existing conditions may cause a moratorium or waiting period to be added to your policy. 

This means that you cannot receive any payouts or benefits within the specified waiting period. Instead, you’ll have to wait till the moratorium period has been cleared before your claims can be honoured. 

Add premium load

Your insurer may still offer you full coverage of your pre-existing condition, but in return you’ll have to pay a higher premium. This is to make up for the increased risk on account of your medical condition. 

Premium loading means you’ll have to pay more for insurance cover, but you’ll still be able to make relevant claims as needed.

Loading is a common practice, and can apply to many situations besides having a pre-existing condition. Some of these include being a smoker or ex-smoker, or having a family history of certain illnesses. 

Reject

In this worst-case outcome, your health insurance application is completely rejected. This means you have no private health insurance coverage at all, even for conditions other than the pre-existing ones.

This outcome usually only applies to applicants whose health profile is deemed too risky, such as having or have had serious medical conditions, or partake in risky activities and behaviours.  

I believe my claim has been unfairly rejected. How can I seek redress? 

We must stress that incidences of insurers rejecting insurance claims due to non-disclosures of pre-existing conditions are relatively rare in Singapore

Over the past three years, complaints about unsuccessful claims due to non-disclosure of health conditions made up less than 5% of all health insurance-related complaints made to the Monetary Authority of Singapore (MAS).

MAS further disclosed that the majority of complaints concerning unsuccessful health insurance claims involved “treatments not being covered under the insurance contract, claims that exceeded claim limits or were made after the policy had lapsed, or failure to submit supporting documents required by insurers”. 

Still, if you happen to find yourself facing down this gnarly situation here are some steps you can take. 

• Make an appeal to your insurance provider and attempt to come to a mutually satisfying agreement.
• File a claim for mediation or adjudication at the Financial Industry Disputes Resolution Centre (FIDReC). 
• For IP claim disputes, consider tapping on the Clinical Claims Resolution Process (CCRP), which is an initiative by the Ministry of Health. 

Looking for critical illness coverage? Before signing up for a plan, make sure you compare the best critical illness insurance plans available.

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