Insurers urged to widen coverage

Medical insurance companies should no longer exclude unknown pre-existing medical conditions from customers' plans, the Medical Association says.

In line with the government's efforts to encourage more people to obtain private medical insurance, the group is discussing with insurers a standard plan that will cover basic hospital care.

Dr David Lam Tzit-yuen, a member of the association's council, said in one case a patient with a rare intestinal disease was admitted to a private hospital for surgery but the insurance company refused his claim.

The reason given was that the disease was congenital. Lam said that was unfair because the patient had not known about the condition when he signed up for the medical plan.

'Insurance plans should cover all unknown pre-existing conditions,' Lam said. He said the association believed co-payments should be required in the basic plan, to avoid abuse.

'It means for all kinds of claims, the patients have to pay a small portion of the fees before the insurance company reimburses the expenses. This can curb abuse of medical services,' he said.

He warned patients to be careful when they add benefits to their plans.

'We have come across cases where patients did not realise that their original plan was voided when they added coverage benefits, and their pre-existing conditions were excluded in the new plan,' he said.

Insurance-sector legislator Chan Kin-por said if an insurance plan had to cover more conditions, the premium had to be increased.

Chan said the industry wanted to propose a 'progressive coverage' plan, under which coverage would increase over the years.