Scenario:
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.

Question:
Can Mr. Lee claim compensation?

Answer:
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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CriticalCare 1.0
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HospitalCare

Question:
I have already purchased life insurance with a rider for critical illness cover. Why do I need to buy a separate critical illness insurance policy?

Answer:
Medical expenses for critical illness are generally rather substantial. By taking out a separate critical illness policy and making a claim under that policy, you can preserve the various benefits purchased as riders under your life policy.

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CriticalCare 1.0
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Medical financing has become a hot topic lately. A local university recently conducted a survey of over 1,000 Hong Kong people about their medical expense burdens. The survey showed that 29.3% of interviewees had medical insurance provided by their company and personal medical insurance coverage at the same time; 13% and 17.9% of interviewees had either medical insurance provided by their company or personal medical insurance respectively. Both groups claimed that their current insurance coverage was not sufficient and the latter group expressed that the premiums of their current medical insurance were very high.

Without a doubt, comprehensive medical insurance coverage is very important so that policyholders do not have to worry about unforeseen medical expenses. A medical plan with a “top-up” feature allows customers to supplement their existing medical insurance provided by their company and personal medical insurance coverage at a discounted premium rate. Below is an example:

Ms. Chow, who is covered under medical insurance provided by her company, underwent major surgery to treat her heart disease last year. The total fees including surgery and hospitalisation costs, were HK$230,000. Initially, Ms. Chow thought that her existing medical insurance provided by her company would cover most of the medical expenses; however, she later found that the plan could only cover up to HK$120,000 of major operation and hospitalisation costs. In the end, Ms. Chow had to absorb the HK$110,000 difference, an amount that is unaffordable for most employees.

In general, many medical insurance plans provided by companies can only support medical expenses of minor to intermediate operations, and are not sufficient to cover expenses of major or complex surgery such as a coronary bypass operation etc. Hence, many people purchase additional personal medical insurance for extra protection. On the other hand, traditional medical insurance plans may not provide flexible insurance premiums and coverage; policyholders may end up with duplicate coverage and cost inefficiency.

In the case of Ms. Chow, if she wished to have more comprehensive medical coverage by purchasing MSIG Insurance’s MediSure Plus for extra protection, she could opt for a deductible of HK$120,000 – the maximum coverage offered by her existing medical insurance provided by her company – and would then enjoy a 65% discount* off the premium. In the unfortunate event of major surgery, Ms. Chow could file a claim with the medical insurance provided by her company first and any costs that exceeded the selected deductible (i.e. HK$120,000) would be covered by MediSure Plus, provided the expenses are covered under the terms of her policy. Furthermore, if Ms. Chow changes her job in the future, she may adjust the deductible according to the medical insurance plan offered by her new company upon policy renewal. When Ms. Chow reaches retirement age, she can remove the deductible and resume full core cover.

*Taking the Excel Plan of MediSure Plus as an example
Some insurance companies now provide medical insurance plans with a “top-up” feature that offers more flexibility. For example, MSIG Insurance’s MediSure Plus medical insurance plan allows customers to choose a fixed annual deductible on top of their current medical insurance coverage to enjoy an insurance premium discount.

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CriticalCare 1.0
MediSure Plus
HospitalCare

Scenario:
Ms. Tang went to see a doctor as she felt pain in her right eye. The doctor diagnosed the condition as a Right Upper Lid Chalazion (i.e. a boil in the upper eyelid). Incision and curettage of chalazion under local anaesthetic, which could be done in a clinic, was recommended by the doctor.

Question:
Ms. Tang preferred to receive the treatment as an in-patient, as she was insured with MSIG MediSure Plus. Would she be covered under this medical plan?

Answer:
In Ms. Tang’s case, she could actually receive the treatment as an outpatient in either a clinic or hospital. She would be covered under the extended Day Care Surgery benefit of the Hospital Treatment and Services section of her MediSure Plus policy. However, if Ms. Tang received the treatment as an in-patient, this would fall into the policy exclusion of her medical plan. This is because hospital in-patient treatment for conditions which can be properly treated as an outpatient, including hospitalisation primarily for diagnostic scanning, X-ray examinations or physiotherapy treatment, are excluded from the policy.

Many people have a misconception that only treatment received as in-patient can be covered by their medical plans. In fact, some medical insurance plans in the market such as MSIG MediSure Plus, also provide Day Care Surgery benefit. In this way, not only can the insured person avoid being hospitalised, they also help save medical resources for those really in need. You are advised to check the terms and conditions of your policies before being admitted to the hospital for non-emergency cases.

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CriticalCare 1.0
MediSure Plus
HospitalCare

Question:
Most marine cargo insurance includes a Classification Clause. What does this clause refer to?

Answer:
Classification Clause is a mandatory clause and is commonly found on a cargo policy. The clause lists out all the basic requirements of a qualified vessel that transports the insured cargo. The purpose of this clause is to remind the shipper to find a seaworthy vessel for transportation.

Question:
If the shipper has confirmed to have his/her goods delivered by a specified vessel that meets the requirements stated in the Classification Clause, can the marine cargo insurance policy be issued without the Classification Clause?

Answer:
The Clause is a mandatory clause of a cargo policy to protect the insurer. It serves to bind the shipper to ensure to his best effort the quality of the vessel in the insured voyage. As such, the marine cargo insurance still holds to be valid should the vessel be changed without the acknowledgement of the shipper.

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Cargo
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When transporting large-scaled machinery, such as knitting machines or generators for power stations from one country to another; flat rack containers (FR) or open top containers (OT) would be used because these machines are too large to be placed inside a wooden case. After placing the machine in a flat rack container (FR) or open top container (OT), tarpaulin would be used to cover it so as to prevent the machine from being damaged by bad weather.

However, as these containers are not sealed, when the weather is extremely bad with tumbling waves, there is a risk that the tarpaulin will be damaged by the waves or heavy rain, leading to the damage of the machine by seawater or rainwater. Besides, when the container is unloaded by cranes at the discharge port, the cranes could also easily damage the machine as the container is not sealed.

• When transporting large and delicate machinery, you are advised to place the machine in the ship's underdeck for better protection against damage by water or shock

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Cargo
Pleasure Craft

Question: What is meant by the 'Period of Insurance' in a cargo policy?

Answer: A cargo policy, also often known as a 'voyage' policy, does not have a fixed period of insurance specifying a start date and an end date that is usually found in other types of insurance policies. The 'period of insurance' starts at the point when the goods are delivered from a shipper's warehouse and ends at the point when the goods are delivered to a consignee's discharging port.

It is also important for either party to contact the insurer at once should any delay occur during the voyage, in order to ensure faster claims settlement and avoid unnecessary disputes.

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Cargo
Pleasure Craft

According to the Insurance Claims Complaints Bureau, the number of medical claims complaint cases doubled to 120 in 2007. The majority of these disputes were related to non-disclosure of the insured’s medical history.

What follows is an example quoted from The Insurance Claims Complaints Bureau:

Ms. Lam declared that her health condition was good, so the insurance company accepted Ms. Lam's application of medical insurance at the standard premium rate. Fifteen months later, Ms. Lam was hospitalised with cancer in the oesophagus. However, her hospitalisation claim was rejected by the insurance company on the grounds that she had not disclosed her Hepatitis B carrier status. Ms. Lam admitted that she was aware of being a Hepatitis B carrier when applying for the insurance plan, but she was dissatisfied with the decision of the insurance company as there was no medical evidence associating cancer in the oesophagus with Hepatitis B, and that being a Hepatitis B carrier was common in Hong Kong.

The Complaints Panel reviewed Ms. Lam’s application form and noticed one of the questions was “Have you ever had, suffered from or been treated for or been told you had …Hepatitis B …?”. Ms. Lam's answer was “No”. Although there was no direct relation between the medical history of a Hepatitis B carrier and the hospitalisation claim for cancer in the oesophagus, the Complaints Panel took the view that the fact which Ms. Lam did not disclose was material, as it would have affected the insurance company's underwriting decision in charging a standard premium rate. Therefore, it upheld the insurance company's decision in rejecting the hospitalisation claim.

The fact is that all insurance contracts are based on trust. The insurance company trusts the insured to give precise and true details of the subject matter to be insured. This is called the principle of Utmost Good Faith. Non-disclosure of details violates this principle.

In order to avoid disputes, you should remind your customers of the following:

1. Disclose fully and accurately all information in the application form
2. If in doubt as to whether a fact is material, it is better to disclose it
3. Even though a medical check-up report is provided, the insured still needs to disclose his/her medical history
4. If the insured answers “Yes” to any of the questions, he/she has to give full details, including:
   • Name of insured (if more than 1)
   • Date of onset
   • Diagnosis
   • Existing condition
   • Treatment/medication/investigation/operation
   • Date of last consultation or treatment, together with name, address and telephone number of attending doctor

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CriticalCare 1.0
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HospitalCare

According to the statistics of the Hong Kong Cancer Registry of the Hospital Authority in 2005, the 5 most common cancers in Hong Kong are: lung cancer, colorectal cancer, breast cancer, liver cancer and stomach cancer, which account for 56.9% of the most common cancers.

Ms. Lee suffered from breast cancer which was excised 2 years ago. There has so far been no recurrence and she would like to take out medical insurance. Can Ms. Lee take out health insurance successfully?

The criteria for an insurance company to assess the risk of a cancer-recovered customer depend on whether he/she is considered free from recurrence of his/her cancer. Generally speaking, if the cancer was treated within the last 2 years, most customers cannot take out health insurance successfully as the risk of recurrence within 5 years is high. For those who have received treatment within the last 2 years, some insurance companies may use a medical report to consider his/her application on condition that cancer and cancer-related diseases are excluded. For those who have received treatment more than 5 years ago, if the medical report clearly shows that he/she has totally recovered and the risk of suffering from cancer again is the same as other ordinary healthy people, insurance companies may accept his/her application as normal.

Below is some general information which a cancer-recovered customer has to provide when applying for medical insurance:

1. Date of onset
2. Treatment received and period of treatment
3. Did the cancer recur or spread to other areas?
4. Name of attending hospital and doctor
5. Current condition

Learn more about our insurance plans:
CriticalCare 1.0
MediSure Plus
HospitalCare