Do due diligence before agreeing to exclusion clauses

A patient consulted me about her abdominal pain some time back.

She had bought an Integrated Shield Plan many years ago, but her policy excluded diseases in the hepatobiliary tract, which consists of the liver, gall bladder, bile ducts and the pancreas.

She was worried that if the cause of her pain was due to a gall bladder problem, she might not be able to make a claim.

She was a known hepatitis B carrier and had declared her hepatitis B status when she applied for the plan.

The insurer came back with a clause which excluded any disease in the hepatobiliary tract. She agreed and signed the contract.

While hepatitis B may affect the liver, it does not affect the gall bladder, bile duct or pancreas directly or indirectly.

Many Singaporeans have bought Integrated Shield Plans with exclusion clauses. Some exclusions are justifiable. However, some exclusions are illogical...
Check with other insurers, family doctors or specialists to ensure that the exclusion clauses are reasonable.

However, she did not seek proper medical opinion when she signed the contract. Now, she regrets it.

Many Singaporeans have bought Integrated Shield Plans with exclusion clauses.

Some exclusions are justifiable. For instance, someone with a history of heart problem would have heart diseases excluded if he signs up for a new health insurance plan.

However, some exclusions are illogical.

Excluding diseases in the gall bladder and pancreas in someone with hepatitis B is just unscientific and unreasonable.

I strongly advise all to do their due diligence before agreeing to any exclusion clause when they buy a medical insurance plan.

Check with other insurers, family doctors or specialists to ensure that the exclusion clauses are reasonable.

Desmond Wai (Dr)

A version of this article appeared in the print edition of The Straits Times on August 29, 2016, with the headline 'Do due diligence before agreeing to exclusion clauses'. Print Edition | Subscribe