Don’t wait till the last minute (or for a health issue to emerge) to scramble and read through your policy papers. You should be aware and familiar with your health insurance policy – particularly its exclusions – even before securing your plan! With benefits varying greatly across plans and insurers, it’s important to find out what your insurance plans consist of. Here, Head of Sales & Renewals at Pacific Prime Singapore, Alejandra Perez Coria, tells us more about six common exclusions.
#1 Pre-existing conditions
A pre-existing condition is an injury or illness (e.g., a heart condition) that you currently have or previously had before purchasing your health insurance. As they tend to be very expensive, coverage commonly excludes the treatments of these conditions. This is because insurance is meant to cover risks and pre-existing conditions are no longer risks. Rather, they are certainties. However, there are some insurers that offer the option of covering these conditions by placing an additional premium.
#2 Ancillary hospital charges
In most cases, a general in-patient plan will usually address most aspects of hospital charges such as surgery, ambulance, room and board fees, lab tests and anaesthetist charges. But charges related to a hospital stay often include more than just boarding and medical procedure fees. Excluded miscellaneous charges that can apply include guest meals, telephone calls, extra pillows and use of the TV.
#3 Specific scenarios
Most health insurance plans have a list of scenarios that the policy will not provide coverage for.
Commonly excluded scenarios include:
- Injuries or illness caused by hazardous use of alcohol or drugs
- Injuries or illness caused by participation in criminal activities
- Self-inflicted injuries
- Treatment arising from war or terrorist acts
- Injuries sustained from engaging in professional sport
By and large, health insurance policies offer benefits for a wide selection of inpatient and outpatient treatment. Specific conditions and treatment covered vary from insurer to insurer, and policies often do not have a specific ailment or treatment that they cater to.
#4 Cosmetic surgery
Cosmetic surgery is an obvious health insurance exclusion as almost all health plans only cover procedures that are medically necessary. If you want to undergo surgeries or procedures (e.g., a nose job or a tummy tuck) to improve your looks, you will need to pay out of your own pocket. Insurance will never cover procedures such as breast augmentation, Botox injections for wrinkles or similar non-essential procedures.
However, there is an exception if the cosmetic surgery is medically essential to live a more normal life. This includes breast reconstruction surgery after a mastectomy or a skin graft to replace an excision for skin cancer.
#5 Pregnancy and childbirth
If your plan does not include maternity benefits, it would usually not cover pregnancy (e.g. diagnostic tests) and childbirth costs. If you’re planning to have a baby, it’s best to add such a benefit to your plan. Prenatal and delivery costs can be very expensive in Singapore. It is even more costly for expats who do not benefit from local healthcare subsidies. For instance, a normal delivery at a private hospital can cost up to S$12,000 and a C-section delivery can cost up to S$19,000.
Be aware that maternity benefits typically have a waiting period of 10 to 12 months, meaning that you’ll need to secure it well ahead of conception if you wish to benefit from the coverage.
#6 Outside of Singapore
Local health insurance usually does not cover benefits outside of Singapore. If you (and your family) travel frequently, an international health insurance plan would be the best option. Look for a plan that will offer coverage at almost any hospital, anywhere in the world.
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Read on to find out more about health insurance for you and your family.