Response to parliamentary question on complaints about unsuccessful health insurance claims

Question:

To ask the Prime Minister a) if the MAS monitors the annual number of complaints made by citizens through the appropriate channels regarding unsuccessful health insurance claims; (b) if so, what percentage of these claims arise from claims rejected by insurers alleging failure to report relevant medical information; and (c) whether there are data or studies which show the typical number of such reported incidents and what is the probable number of unreported cases.

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

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

2 In the past three years, approximately 20% of health insurance complaints to MAS were due to unsuccessful insurance claims. Of these complaints relating to unsuccessful claims, the majority concerned treatments not covered by the insurance contract, claims that exceeded the claim limits or had been made after the expiration of the policy, or the failure to submit documents. supporting documents required by 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 health conditions, insurers must demonstrate that the non-disclosure is material to the underwriting outcome and that the claimant could reasonably be expected to have disclosed the information. when taking out the policy.

4 Insureds who believe their claims have been unfairly dismissed and are unable to reach a satisfactory resolution with the insurer may file a claim for mediation or arbitration with the Financial Industry Disputes Resolution Center (FIDReC). The Department of Health has also established a Clinical Complaints Resolution Process (CCRP) for disputes of a clinical nature related to the Integrated Protection Plan, for example if claims have been unfairly rejected for medically appropriate treatment or procedures, or if there has been overcharging or over-service by the practicing physician.

***