QUOTE(emmahazimah @ Feb 7 2010, 11:41 AM)
Hi all, It seems that we have a few insurance expert here.
Im just want to ask a few questions. Anyone can explain in detail the answers would be a very great help for the members in this thread who may just about to purchase or already purchase a medical card.
1. Who can define the term and purposes of having a medical coverage?
2. Why a client claim was advice 'pay and claim' when they already have a valid medical card?
3. What is 120 days SI? What are the illness? What other illness that could relate to SI?
4. How 20 % co-insurance calculated?
5. Why the agent said to me that my medical bills will be covered if i purchase a medical card but in the end my claim was rejected?
6. Client came to seek agent clarification on purchasing a medical card but agent only telling the client which plan is the best? they make comparison with other insurance company plan types, co-insurance, deductible. What do agent understand about the medical illness and which illness is coverable or not by the insurer?
7. How assure that the insurance will issue a GL/ LOG to the hospital for any admission?
8. How to make sure that every time i was admitted to a hospital, the insurer will issue a LG/LOG for me without any hassle or delay?
9. Which list of illness can be coverable in within 1st year policy?
10. Why hospital staff ask me to pay for a deposit eventhough they already received a LG/LOG?
I will be glad if there is someone who is an agent explain to me all the question above.
Hi Emmahazimah,
Please find the answers to your question listed below.
This is based on my personal knowledge and is not conclusive answer from an insurer as medical plan differ in their terms from company to company & even plan to plan.
1. Who can define the term and purposes of having a medical coverage?
Medical insurance provides coverage for hospitalisation & surgical expenses incurred due to illness or accident injury.2. Why a client claim was advice 'pay and claim' when they already have a valid medical card?
This usually occurs when you're warded in non panel hospitals who don't entertain medical card from the insurer.3. What is 120 days SI? What are the illness? What other illness that could relate to SI?
Specified illness occurring within first 120 days from the effective date of the plan are excluded together with pre-existing illness. It usually would include things like diabetes, hypertension, tumours etc. This list is non-exhaustive. Please refer to your policy contract for the full list of exclusions.4. How 20 % co-insurance calculated?
20% coinsurance is usually applicable if there's upgrade of room & applies to all expenses considered eligible earlier.5. Why the agent said to me that my medical bills will be covered if i purchase a medical card but in the end my claim was rejected?
Again this is something that might have been stated as exclusion on your medical plan and your agent has not mentioned to you.6. Client came to seek agent clarification on purchasing a medical card but agent only telling the client which plan is the best? they make comparison with other insurance company plan types, co-insurance, deductible. What do agent understand about the medical illness and which illness is coverable or not by the insurer?
Some agents just don't go through the very policy they actually market. It's a sad fact. To me, the longer the agent has been in the business the more they accumulate in terms of knowledge & experience. Another advice is to go through your medical policy.7. How assure that the insurance will issue a GL/ LOG to the hospital for any admission?
This is rather difficult to answer as medical plan usually exclude some types of admissions.8. How to make sure that every time i was admitted to a hospital, the insurer will issue a LG/LOG for me without any hassle or delay?
You should contact either your agent or the insurers' customer service line even though this is usually done by the hospital staff.9. Which list of illness can be coverable in within 1st year policy?
This list is usually quite long and would be specified in your policy document as insured benefits.10. Why hospital staff ask me to pay for a deposit eventhough they already received a LG/LOG?
This is usually due to medical plan you have which calls for your co-insurance.I hope this has answered at-least some if not all your questions.
Cheers,
HH