While health insurance and life insurance are definitely plans everyone should have, let’s address the elephant in the room – exclusions. They can be rather discouraging and stressful. But what if we told you that there are ways to cover some of them?
With the growing cost of medical care, getting health insurance coverage is paramount. It’s a great way to avoid paying expensive hospital bills or being denied unaffordable treatment. It’s just the security blanket we all need.
However, like any business, granting insurance is still a risk for the providers. It’s no wonder that they have a list of exclusions. Exclusions may include any medical conditions, procedures, treatments, and healthcare expenses that are not included in stated coverage.
Sometimes, it can be hard to get around exclusions, making it difficult for people with conditions to get the right policy. Thus, we give you tips on how to get adequate coverage especially for conditions and other expenses that are initially excluded.
How to Extend Coverage for Certain Conditions?
#1: Add a rider
You may purchase a rider to add benefits to existing policies. While it adds to the final premium amount, it provides decent coverage for conditions that are otherwise not covered.
For instance, you may include an additional maternity cover to your health insurance benefits. This can cover any treatments or procedures due to complications during childbirth, which are usually not included in the standard health insurance policy.
Likewise, you may add long-term illness to your whole life insurance policy, which is not otherwise covered. Whole life is initially not designed to cover such benefits, but adding a rider allows you to do that.
Adding riders is one of the easiest ways to fill in the gaps of your coverage by either of the following:
- Increasing payouts
- Extending coverage to conditions that were initially not included in the policy
Each rider can only provide one additional benefit. So, if you are looking to include more than one coverage area, you need to buy multiple riders.
Here are areas that can be covered by riders::
- Long-term illnesses
- Emergency dental care
- Private nursing
- Residential doctor visits
- Post-hospitalisation care
- Maternity care
For a more detailed list of available riders, talk with your desired insurance provider.
#2: Consider alternate policies
The Ministry of Health in Singapore has introduced MediShield Life, which offers basic health insurance coverage made available to Singaporean citizens and permanent residents.
MediShield Life is a good alternative, given the cost of healthcare and the long list of exclusions. In fact, it is the best option for people with pre-existing conditions. It covers minor and major conditions that are otherwise excluded in private insurance providers’ policies.
MediShield Life’s additional premium for serious pre-existing conditions is lower than the market standard. An additional 30% premium rate will be imposed only on the first decade. The rates will then taper down to your age group’s current rate after the ten-year period.
MediShield Life only provides payouts for B2/C wards in public hospitals. You may choose an Integrated Shield Plan if you want to avail payouts for A wards or private hospitals. The Integrated Shield Plan is provided by private insurers, but you may combine it with your MediShield policy for maximum coverage benefits.
These are the insurers that offer Integrated Plans:
- NTUC Income
- Great Eastern
- Raffles Health Insurance
This is probably the best option to enhance your existing coverage. It is affordable and easy to secure an Integrated Shield Plan with any of the aforementioned insurers. MediShield Life and an Integrated Shield Plan together can make all the difference for a more extensive health insurance coverage.
Read our article on the best Integrated Shield Plans in Singapore.
#3: Revisit an exclusion
It’s possible for insurers to eventually remove exclusions under very special conditions. If you have a certain condition during your health insurance application, such as childhood asthma for example, your insurer may exclude this in your coverage.
If your condition has consistently improved over the years, your insurer may remove this exclusion. You may submit a doctor’s memo to your insurance provider, stating that your condition has not relapsed, or that you did not require medical treatment for this condition for many years. The insurer will then review your documents for consideration.
Having a good relationship with your insurance agent is necessary as they’re supposed to add this exclusion to your existing coverage on your behalf. If you’re currently not satisfied with your insurance agent, our previous article shows you how to switch to a new one.
Common Health Insurance Exclusions
Pre-existing conditions include any current or past illness, injury, or disease that impacts the quality of your overall health. A medical condition is considered ‘pre-existing’ when you are aware of it prior to the purchase of your health insurance plan.
Examples of pre-existing conditions:
- Heart conditions
- High cholesterol
- High BMI
- Liver and renal diseases
- Psychiatric conditions
- Autoimmune diseases
In essence, it’s considered a ‘pre-existing condition’ if it has long-term effects on your health. Check with your insurance provider for their full list of pre-existing conditions.
Health insurance coverage only extends to medical procedures that are deemed necessary and vital. So, cosmetic surgery conducted to solely improve a person’s physical appearance is an exclusion.
However, some cosmetic procedures such as breast reconstruction after a mastectomy, or skin graft surgery for burns are deemed medically necessary. In such cases, cosmetic surgery can be covered.
Fertility treatments such as IVF are commonly excluded in health insurance coverage. Below are other fertility treatments that are usually excluded:
- Gestational surrogacy
- Reversal of sterilisation
Maternity-related costs including expenses from childbirth complications are not included in a health insurance coverage. Most health insurance policies don’t cover any expenses leading up to the delivery date such as ultrasounds, blood tests, and such.
All insurance providers have a list of injuries or treatment plans that are not covered when caused by certain events. Insurers also look at the event or scenario that led to the need for medical treatment.
Some examples of specific events are:
- Injuries or illnesses caused by overdose of alcohol or drugs
- Self-inflicted injuries
- Injuries incurred while participating in criminal activities
- Injuries caused by war, nuclear outbursts, civil commotion, riots
Overseas medical treatment
Overseas medical treatment is a common addition to comprehensive health insurance plans usually meant for expats. However, overseas medical treatment is not included in general health insurance coverage. Alternatively, getting a separate travel insurance plan may cover the need for unplanned emergency overseas medical treatments.
Additional miscellaneous exclusions
Here’s a list of other common exclusions:
- Gender change operations
- Ambulance fees
- Private nursing
- Dental work
Read these next:
Best Integrated Shield Plans In Singapore (2022)
10 Health Insurance Terms You Need To Know
9 Things You Should Know About MediShield Life
Consequences Of Non-Disclosure Of Health Conditions In Singapore
5 Health Conditions That Will Affect Your Insurability
By Gredel Shadroch
Financial writer, closet musician, and self-proclaimed Master of the Subtle Art of Cheap Living, Gredel is all about making money work for her. Budgeting is her forte & ‘splurge’ only exists when there’s a great deal on offer.