Make medical cover clear

PUBLISHED : Tuesday, 22 July, 2014, 5:25am
UPDATED : Tuesday, 22 July, 2014, 12:05pm

Medical insurance is something you pay for but hope never to use. That explains why people usually take out a policy as a fallback without studying carefully what is and isn't covered. Sometimes the policies are peppered with opaque and hidden terms, putting the insured at a disadvantage.

The problem was highlighted by the Consumer Council in its recent monthly media session. The watchdog has received 195 insurance complaints in the first half of this year. The number appears to be small, but it represents a 30 per cent jump from the same period last year. With more than 30 cases each month, the trend calls for concern.

Some cases were apparently due to conditions not made clear to consumers. For instance, a person who underwent balloon angioplasty - a common operation to widen an obstructed artery - was denied indemnity even though coronary artery disease was covered in the policy. The insurer said the operation was considered a non-surgical technique and was therefore excluded. In another case, a claim for two days of inpatient expenses was reduced to one by the insurer, on the grounds that the patient did not stay overnight on the second day and did not meet the 24-hour stay requirement.

Policyholders should be told clearly about the scope of protection, especially when there are a wide range of exceptions. It amounts to misleading sales practice if unreasonable rules are deliberately buried in fine print or written in a way that is too difficult to understand. The provision of information in a clear and transparent manner is a basic consumer right. Consumers should also read carefully the terms and conditions before signing any agreement.

The mounting complaints do not augur well for the government's plan to encourage more people to take out medical insurance. Given the potential growth in the insurance business, it is in the industry's interest to enhance its professionalism and public trust.

Confidence can also be raised through reforming private health care, such as by mandating higher transparency in hospital charges. The government has rightly proposed that private hospitals should release statistics and standard pricing for common operations. The requirement can help patients choose what fits their budget and insurance coverage. Hopefully, this will offer better protection for consumers.