Response to parliamentary question on complaints about unsuccessful medical insurance claims

Question:

To ask the Prime Minister a) whether the MAS monitors the annual number of complaints lodged by citizens through the appropriate channels regarding unsuccessful applications for health insurance; (b) if so, what percentage of these complaints stem from claims denied by insurers citing non-reporting of relevant health information; and (c) whether there are any data or studies that show the typical number of such reported incidents and what is the likely number of unreported cases.

Response from Mr. Tharman Shanmugaratnam, Minister of State and Minister in charge of MAS:

1 MAS expects insurers to be fair and reasonable to all policyholders, including not dismissing health insurance claims based on unstated and unrelated minor conditions. The MAS closely monitors the progress of the complaints lodged with the MAS.

2 Over the past three years, approximately 20% of health insurance claims made to MAS were due to unsuccessful insurance claims. Among these complaints relating to unsuccessful claims, the majority concerned treatments not covered by the insurance contract, claims exceeding the claim limits or made after the expiration of the policy or the failure to present the supporting documents required by the insurers to assess the claim request. . Less than 5% of health insurance complaints received by MAS during the period were for unsuccessful claims due to non-disclosure of health issues.

3 To dismiss a claim for non-disclosure of medical conditions, insurers must demonstrate that the non-disclosure is material to the outcome of the underwriting and that the claimant could reasonably be expected to have disclosed the information when underwriting the policy.

4 Policyholders who believe that their claims have been unjustly rejected and who do not reach a satisfactory resolution with the insurer may file a request for mediation or arbitration with the Financial Sector Dispute Resolution Center (FIDReC). The Department of Health also has a Clinical Complaints Resolution Process (CCRP) in place for disputes related to Integrated Protection Plan claims that are clinical in nature, such as if claims have been unjustly rejected for treatment or procedures. medically appropriate, or if there has been overloading or excessive service by physicians. practitioners.

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