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View Full Version : Employer Health insurance won't cover congenital problem!



kmlim
19-07-2010, 01:30 AM
My daughter has been clinically identified as having thryroglossal cyst and both my wife and mine company insurance (Gre*Ea* and M*Car*) is washing hand off this by saying that it falls under exclusion ie. congenital problem.
Even if you buy into pru* *kid, which claim to be the only company offering health protection for foetus and congenital condition, you must buy when you child is still in the <strike>stomach</strike> womb and the congenital coverage is only up till 2 years whereas my daugther already 2+ before having obvious sympton, what is the consumer right we have here :mad:
http://www2.prudential.com.my/prumychild/index.html

USJ27Resident
19-07-2010, 01:40 AM
... what is the consumer right we have here :mad:



NONE!!

In Bolehland.... if you're born with a congenital defect - you either leave it to fate or pray that you were born into a rich family !!

failing which - you pray harder... that the newspapers/readers/good samaritans would help...

rakyat
19-07-2010, 08:41 AM
My daughter has been clinically identified as having thryroglossal cyst and both my wife and mine company insurance (Gre*Ea* and M*Car*) is washing hand off this by saying that it falls under exclusion ie. congenital problem.
Even if you buy into pru* *kid, which claim to be the only company offering health protection for foetus and congenital condition, you must buy when you child is still in the stomach and the congenital coverage is only up till 2 years whereas my daugther already 2+ before having obvious sympton, what is the consumer right we have here :mad:
http://www2.prudential.com.my/prumychild/index.html

Insurance companies like most businesses are profit making companies as oppose to charitable organization. Congental problems are birth defects inherent in babies at time of birth. .If the policy is bought after birth, isn't it considered pre-existing? You know why insurance company do not cover pre-existing conditions right?

You might not be aware of the condition but the basis that the doctors term it as 'congenital' negate your claim.

We like to bash big businesses but sometimes we must also be fair.

kmlim
19-07-2010, 12:56 PM
You might not be aware of the condition but the basis that the doctors term it as 'congenital' negate your claim.

We like to bash big businesses but sometimes we must also be fair.
Sorry you are only partially right, see back the pru* link that I've posted previously, even you buy but it will only cover up to 2 years old!
Congenital is also a disease and they are discriminating on people that suffer from these.

kwchang
19-07-2010, 01:48 PM
..Congenital is also a disease and they are discriminating on people that suffer from these.
Sorry, "congenital" simply means a condition that someone is born with. It need not be a "disease". The insurance companies (as rightly mentioned by rakyat) will not for example insure someone who has a known risk of being hospitalised for a disease. Take for example hole-in-the-heart where some people are unfortunately born with. Why would a business agree to pay for treatment of a sure risk? Insurance is based on the statistical risk of an unfortunate event. The lesser the risk, the lesser the cost of buying the insurance. If the risk is 100%, no insurance company will cover that eventuality

Let us understand the idea of "insurance" - it is to help pay for the unfortunate event of a loss. Insurance started in the past because of piracy on the high seas. The ships of course do not hope to be robbed in the high seas and the chance of meeting pirates, although a known risk, is not very high. So all the shipping companies contributed to a fund to help their unfortunate members recover their losses in the event some of them get to meet pirates.

StonTemplePilot
20-07-2010, 08:58 PM
Sorry, "congenital" simply means a condition that someone is born with. It need not be a "disease". The insurance companies (as rightly mentioned by rakyat) will not for example insure someone who has a known risk of being hospitalised for a disease. Take for example hole-in-the-heart where some people are unfortunately born with. Why would a business agree to pay for treatment of a sure risk? Insurance is based on the statistical risk of an unfortunate event. The lesser the risk, the lesser the cost of buying the insurance. If the risk is 100%, no insurance company will cover that eventuality

Let us understand the idea of "insurance" - it is to help pay for the unfortunate event of a loss. Insurance started in the past because of piracy on the high seas. The ships of course do not hope to be robbed in the high seas and the chance of meeting pirates, although a known risk, is not very high. So all the shipping companies contributed to a fund to help their unfortunate members recover their losses in the event some of them get to meet pirates.

If the event is 100% to happen it is no longer a risk. It is an EVENT which has happened...so no need to insure la :D