The Office of the Commissioner of Insurance has clarified with an insurer the latter's stance on covering hospitalisation costs for medical procedures.
The insurance company issued letters to doctors in January stating policyholders who had undergone medical procedures not "medically necessary" but performed on them as inpatients, such as colonoscopies and cataract surgeries, might not be eligible for reimbursement for hospital confinement.
Secretary for Financial Services & the Treasury Prof KC Chan told lawmakers today the insurer has confirmed the purpose of its letter to doctors was to clarify the terms and conditions of its existing policies and there are no amendments to these terms and conditions.
He said "medically necessary" is a term commonly found in hospital indemnity insurance policies. Only claims relating to medical treatments or services that meet the "medically necessary" criterion will be indemnified.
As the matter does not involve amending the terms and conditions of existing policies, the commissioner considers the incident will not give rise to a significant increase in the number of disputes over claims or adversely affect the interests of policyholders, he said.
For any claims-related dispute, the policyholder can lodge a complaint with the Insurance Claims Complaints Bureau, Prof Chan added.
