Insurers
Hospital claim covered by Incomeshield and group insurance
Many people have a personal medical coverage (Medishield or integrated plan) and also a group medical coverage provided by the employer.
It can be quite confusing when they make a claim for a hospital stay. How do the two insurers treat the claim?
This problem is illustrated by the following example.
Hi Mr Tan
My wife was hospitalized and as she is covered under my company policy as a dependent, I claimed against my company policy. Out of the S$25,000 hospital bill, S$23,000 was paid leaving S$2,000 out off pocket by myself.
My wife has a Incomeshield Standard Plan which essentially covers Class B1 ward stays and has a deductible of S$2,500 and co-payment 10%. She also stayed at Class A ward so I believe an additional 80% pro-rate will be applied as well.
I am not sure how the deductible etc applies but am I right is concluding that since the out of pocket amount (S$2,000) is below the S$2,500 deductible, amount claimable from NTUC Income would be NIL?
MY REPLY
I do not know what is the practice adopted in splitting the bill between the two insurers.
I believe that the correct approach that should be taken by Income is to calculate the amount of the claim they have to pay if there was no other insurance. Let us say that this sum is $14,000. As your wife's out of pocket amount is only $2,000, it should be paid in full by Income. Income would still have save more than $12,000.
However, I am not familiar with how they actually treat such a case. You can certainly argue this case based on the approach that I have suggested.
Tan Kin Lian
Add Comment