I came across a Forum letter in The Sunday Times (10/05/2009, pg. 30), whereby Mr Lim Kim Kok was sharing his claims experience in relation to his medical insurance. Apparently Mr Lim had a Great Eastern insurance policy which covers the 30 critical illness, but he was unable to make a claim when he opted for an agioplasty instead of a bypass (upon the recommendation of his cardiologist) simply because his "illness was not serious enough to warrant a claim (no bypass and dead heart tissue)".
This brings to mind one of my client's term policy, whereby he claimed that it was 'cheap and good'. So when I asked him why does he say that it is good, he says that it covers all the necessary aspects like death, total & permanent disability and other 'illnesses'. Then I asked him what illnesses does it cover, and he thinks that is it the 'usual' 30 critical illness but isn't sure. So I requested him to show me his policy, and then we uncovered a grave misunderstanding - the policy only covers 'terminal' illness.
What is "Terminal Illness"?
According to the policy schedule, "Terminal Illness" is defined as an "illness which in the opinion of the medical specialist and subject to the acceptance of our appointed Medical Officer that the advent of death is highly within 12 months. Terminal Illness in the presence of Human Immunodeficiency Virus (HIV) is excluded". (exact wording)
In short, it means that you have to have DIE of the illness (whatever it maybe, other than AIDS) within 12 months. If you die beyond the period (i.e. you died on the 366th day), then you cannot make the claim. However, the stark difference between this and the 30 critical illness is that for the latter you have the hope of recovering, but for terminal illness is it almost akin to making the death claim - albeit that you can make the claim BEFORE you die rather than AFTER you die.
So in short, when one purchase a policy, the DEFINITIONS given in the policy schedule is of the utmost importance. Apparently Mr Lim cannot claim simply because the clause he might be able to claim under is the "Coronary Artery By-pass Surgery", which is defined as
"The actual undergoing of open-chest surgery to correct the narrowing or blockage of one or more coronary arteries with bypass grafts. This diagnosis must be supported by angiographic evidence of significant coronary artery obstruction and the procedure must be considered medically necessary by a consultant cardiologist.
ANGIOPLASTY and all other intra arterial, catheter based techniques, 'keyhole' or laser procedures are excluded".
So it is the same for my client. When he gets an 'illness' and wants to claim, he might be sorely disappointed to discover that he will not be able to claim unless he dies of it in 12 months. If he gets any of the 30 critical illness, he will not be able to claim at all. So please be aware and beware.
This brings to mind one of my client's term policy, whereby he claimed that it was 'cheap and good'. So when I asked him why does he say that it is good, he says that it covers all the necessary aspects like death, total & permanent disability and other 'illnesses'. Then I asked him what illnesses does it cover, and he thinks that is it the 'usual' 30 critical illness but isn't sure. So I requested him to show me his policy, and then we uncovered a grave misunderstanding - the policy only covers 'terminal' illness.
What is "Terminal Illness"?
According to the policy schedule, "Terminal Illness" is defined as an "illness which in the opinion of the medical specialist and subject to the acceptance of our appointed Medical Officer that the advent of death is highly within 12 months. Terminal Illness in the presence of Human Immunodeficiency Virus (HIV) is excluded". (exact wording)
In short, it means that you have to have DIE of the illness (whatever it maybe, other than AIDS) within 12 months. If you die beyond the period (i.e. you died on the 366th day), then you cannot make the claim. However, the stark difference between this and the 30 critical illness is that for the latter you have the hope of recovering, but for terminal illness is it almost akin to making the death claim - albeit that you can make the claim BEFORE you die rather than AFTER you die.
So in short, when one purchase a policy, the DEFINITIONS given in the policy schedule is of the utmost importance. Apparently Mr Lim cannot claim simply because the clause he might be able to claim under is the "Coronary Artery By-pass Surgery", which is defined as
"The actual undergoing of open-chest surgery to correct the narrowing or blockage of one or more coronary arteries with bypass grafts. This diagnosis must be supported by angiographic evidence of significant coronary artery obstruction and the procedure must be considered medically necessary by a consultant cardiologist.
ANGIOPLASTY and all other intra arterial, catheter based techniques, 'keyhole' or laser procedures are excluded".
So it is the same for my client. When he gets an 'illness' and wants to claim, he might be sorely disappointed to discover that he will not be able to claim unless he dies of it in 12 months. If he gets any of the 30 critical illness, he will not be able to claim at all. So please be aware and beware.
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