My friend have a strong trust in the integrated health plan. He likes to buy the top plan to cover private hospital and is willing to pay the high premium. He also read the coverage and policy conditions carefully and talk to the insurance agent to clarify any doubts.

Recently, he came across an unexpected problem. 

He had some problems with irregular heartbeat recently. He carried out a thorough medical checkup. The doctor discovered that he had a congenital hole in the heart and a faulty valve. 

He thought - how fortunate that he had a complete integrated plan coverage.  That would take care of his financial problem. 

He got a shock. Congenital defects are excluded from the coverage. 

My friend has been insured under this plan more than ten years. He is now approaching 60 years. All along, he was not aware of this medical defect. 

He recalled that the medishield plan (on which the integrated plan was built on) was extended to cover congenital defects many years ago.

The insurance company said that this coverage applied to integrated plans taken after the change of government policy. It does not apply to insurances taken earlier.

I find this reason to be ridiculous. My common sense indicates that the inclusion of congenital defects should be applied to all coverages, and not those taken after the change of government policy.

I was not sure if he had since resolved this issue with the insurance company. 

Over the years, many people have consulted me on claims settlement matters. The problem arises with the interpretation of the policy conditions, and the obvious effort by the claims officers to reduce the claim payment as much as possible, to the detriment of the customers. 

This is a big disadvantage of an insurance system that is run by private insurers to make the most profit.

Tan Kin Lian