Martin Lee @ Sg
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Dangers of Switching Shield Plans

Picked up this story from Tan Kin Lian’s website.

A consumer was insured under company A for a integrated Shield policy for more than 10 years.

An agent persuaded the consumer to change the Shield insurance to company B saying it was better. The consumer was worried that the change in policy would lead to claim issues in the future. The agent assured that if the policy is accepted after 3 months by company B, there will not be any problems in the future.

In addition, the agent also told the consumer that his record with company A would be retrieved by company B. The consumer finally agreed to make the change. A year later, the consumer went for day surgery for a heart condition and submitted a claim. Company B investigated the claim and found that the consumer had taken medication for hypertension five years ago. No declaration was made on this during the application. Company B refused to pay the claim and offered a revised cover under special terms, excluding medical claims due to hypertension.

The consumer said that he had taken hypertension medication for two weeks but had stopped it after completing the prescribed medication. There was no indication from the doctor that he was diagnosed with hypertension and needed to be on any long term medication. He had told the agent of company B about this medication, but the agent said there was no need to declare it as he was not on long term medication.

My comments:

In this case, the consumer has been badly advised by the agent.

Switching shield plans can actually be quite dangerous as this example has shown. This is especially so if you have been with one company for a long time.

I usually advise people to stick to the same company once they have taken up an integrated shield plan. The shield plans market is quite competitive and the plans undergo changes quite often. Often, after one insurer adds in some benefits that the rest does not have, the other insurers will follow suit after a while.

Any upgrading of plans (if desired) should be attempted within the same company.

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6 comments
Roger says 13 years ago

Yes, Nuts understood my meaning perfectly. I used to have over ten policies, some of which matured but got back less than the projected value, one I surrender in protest of the lack of transparency and poor service from the insurer. My experience in dealing with the insurance company is one of great frustration and agony, so much so that I wondered if it is so difficult for me to find answers and clarifications then how much worse it must be for my family when I am no longer around.
I bought insurance so that my family can have the peace of mind and some comfort when I pass on, but from the recent experiences with the insurance company I do not think there will be much peace of mind and comfort. Worse, it may be damaging to physical and mental health when one has to challenge them in court in a time of distress, thus multiplying the ill effects of the traumatic experience.
If I buy a business class air ticket, I expect to take business class. But because of the uncertainty in claiming nowadays, it is better that I buy an economy class and sit peacefully in the economy class cabin and have peace of mind, rather than go to sit at the business class section and then pay the penalty because I am overweight and did not declare that I am overweight when I bought the ticket, or like in my case, I do not look overweight but because my bones are heavy so I am overweight.

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Nuts says 13 years ago

I believe the point that Roger is bringing across, which is valid, is that once you’re on a higher Shield plan, you will naturally admit to higher class wards or go to private hospitals, fully expecting your medical claims to be honoured. Just like you don’t pay for 1st class ticket but go and sit in economy class.

The danger comes when you’ve not been advised properly, have not read thru the terms & conditions legalese, have not pondered carefully your whole life medical history, or do not realise the implication of a prior minor medical problem. All of which can lead to the insurer outright rejecting your medical claims.

As you already stayed in high-class ward, even if the insurer gives you the basic medishield portion, it will only cover a small fraction of the bills. You will have additional stress finding the money to pay for the rest of the bills.

Furthermore, many insurers don’t even bother to offer the basic medishield portion — they simply totally 100% reject your entire medical claims. You need to fight for your basic medishield portion. All these while you are sick and trying to recover from your sickness or injury.

Reply
    Wilfred Ling says 13 years ago

    Furthermore, many insurers don’t even bother to offer the basic medishield portion — they simply totally 100% reject your entire medical claims. You need to fight for your basic medishield portion. All these while you are sick and trying to recover from your sickness or injury.

    This is a serious allegation. I am interested to meet you to find out more that the private-integrated shield plan isn’t integrated with Medishield Basic.

    Reply
      Nuts says 13 years ago

      Rejecting your private shield claims doesn’t mean there is no integration with the basic medishield. There is still integration, but there are many instances where private insurers claims officers can’t even be bothered to automatically extend this basic coverage even when the private shield portion is denied. They just send you a template letter denying your claims with 1 or 2 of the 1001 various SOP reasons. Then you need to chase them for the basic medishield portion, in addition to really nailing them down for greater clarity on the claims rejection. Some of these private insurers then act blur or MIA or take their own sweet time 2 months before giving you a standard reply email. Just take a look at TKL’s blog for so many examples of this.

      Reply
Wilfred Ling says 13 years ago

Roger,

When you upgrade your basic medishield to the private-intergated shield plan, you will not lose your basic medishield. Premiums payable to the private insurer is inclusive of basic medishield premium.

Reply
Roger says 13 years ago

Actually I have been approached quite a few times by insurance agents to upgrade my basic medishield. My answer to them has always been that I have been on medishield for more than two decades so I am confident that should there be a claim it will be honored versus the lack of peace of mind should I switch with all those doubts about denied claims. Why pay more, have no peace of mind and run the risks of not being able to claim?
As we aged, we must turn to simpler solutions instead of more complicated ones as our memory, intellect as well as physical conditions deteriorate.
When we are admitted to hospital, the last thing we should be thinking about is whether we can claim or not. We should be thinking of how to get better instead of fretting over whether we can afford to pay the hospital bills. Imagine the effect on our health when we learn that we are saddled with a huge hospital bill because we thought the insurance company is going to pay for our stay in A class ward? So it is simpler to just go for B2 and rest with the peace of mind to focus on getting well, knowing full well that medishield will pay for our B2 ward stay.

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