Ada 3 Polisi, Tetapi Tidak Dapat Claim!

Isu ini adalah berkenaan tentang Ms Theresa Tan yang mempunyai 3 polisi insurans, dan tidak dapat membuat tuntutan untuk penyakit kansernya yang di peringkat “karsinoma in-situ”. Ini adalah peringkat awal kanser atau peringkat 0.

Ia berlaku di Singapura dan disiarkan di dalam akhbar The New Paper, 31 Aug 2010. Website akhbar tersebut ialah Walaupun kandungannya sudah tiada di website berkenaan, tatapi ia masih boleh dibaca di beberapa website lain termasuk website ini .

3 Policies, But No Coverage
WITH three critical illness policies under her belt, she assumed her insurance coverage was comprehensive enough.

Ms Theresa Tan’s policies with Prudential saw her dutifully forking out a total of $600 in insurance premiums every month.

She believed she had forked out about $77,000 for them over the years. But when it came to coverage, the mother of three, 42, thought wrong.

She was diagnosed with early stage breast cancer, or stage 0, in June.

That same month, she went through a 12-hour operation at Gleneagles Hospital to remove her right breast and to have reconstructive surgery done, using skin and fat from her stomach.

The operation and hospitalisation cost $30,000 and was covered by another insurance policy she had with Aviva.

Ms Tan then tried submitting her claim to Prudential this month for loss or potential loss of income.

She thought she could claim up to $100,000 for one policy and up to $107,000 for another policy.

But her claims were rejected by Prudential, which explained to her in a letter that her condition was non-invasive and “does not fulfil the definition of cancer”.

Ms Tan’s condition is known as ductal carcinoma in situ (DCIS) in her right breast.

This is a condition where the cancer starts in the milk ducts of the breast. It was considered non-invasive at that stage as the cancer had not spread beyond the milk ducts into the surrounding breast tissue.

In Ms Tan’s case, she had a mastectomy because the cancer cells were located in various parts of her breast.

Prudential’s decision has surprised Ms Tan, especially since her family’s medical history was known to her insurance agents.

Her mother was diagnosed with breast cancer when she was 19 years old. She subsequently died in 2003 after a long battle against cancer.

Her mother’s illness was what made Ms Tan buy her first insurance policy when she was 22.

Said Ms Tan, who is the co-partner of, an online portal set up with her friend, entrepreneur Nanz Chong-Komo: “Fortunately, my mum had a pension plan so her treatment was covered.

“But seeing what she went through and given I was not under pension, I wanted to make sure that I was provided for.

“I thought by buying three policies I was covering myself in every circumstance, but it didn’t work out that way.”

She claimed the gaps in her policy – it did not cover early stage cancer – was not explained to her by her insurance agents.

Neither was the option of a rider to supplement her existing policies offered.

“What does this term mean?”

Did she think she should have read the fine print in her policy documents?

She said: “Even if I had read the fine print, I don’t think I would have understood what DCIS meant as a layman.”

Ms Tan, who set up a blog – A Clean Breast of It – about her battle with breast cancer, said she later found out that most insurers do not pay out for non-invasive, early stage cancers.

Critical illness coverage typically covers the loss of income that comes from up to 30 critical diseases. These include major cancers, heart attack, coronary artery bypass, stroke and kidney failure.

Fortunately, Ms Tan, who is on three months’ medical leave since her operation, has not suffered loss of income as she is still being paid.

Apart from the online portal, Ms Tan also runs a writing agency, earning on average $5,500 per month.

But she said: “It does limit my options. I can’t continue to keep being paid if I’m not working. What happens if I still don’t feel well after three months? Or if I need to take a six-month break to rest?”

Currently, she suffers from stomach cramps and can barely sit up for two hours at a go, she said. Ms Tan said: “I hope telling my story will create more awareness. I tell my friends to check their coverage and to make sure they are covered in full.”

What she wishes is for the insurance industry to broaden its definition of critical illness to include non-invasive and early stage cancers.

Or to at least make it compulsory to offer to customers other options which cover the gaps in any policy, she said.

Ms Tan lives in the east with her husband, 43, a civil servant, their son, 11, two daughters, four and nine, and her parents-in-law, both retirees in their 70s.

A spokesman for Prudential Singapore said Ms Tan’s policies “unfortunately do not qualify for stage 0 cancer.”

She said coverage of early stage cancers depend on the kind of policy purchased and the definition of cancer in that particular policy.

She said: “Standard critical illness (CI) policies typically do not cover stage 0 cancer… It is important to know that each and every critical illness stated in the CI policy is precisely defined.

“They are based on standard definitions given by the Life Insurance Association (LIA). Unless the person’s disease or surgery has fully satisfied the definition in the policy, no claim is payable.”

But the spokesman pointed out that Prudential has policies like PruSmart Lady, which provide coverage for female-related illnesses that are non-critical in nature such as DCIS.

Policy booklet

She added that all information pertaining to a specific policy is provided in the policy booklet given to customers.

Dr Wong Seng Weng, 40, consultant oncologist at The Cancer Centre, drew a distinction between cancers where the person’s longevity is compromised versus conditions which are treatable.

He said: “DCIS, if diagnosed and treated early, usually the survival rate is 100 per cent.

“Usually life insurers pay out when a person’s longevity is compromised.”

But this doesn’t mean that the cancer has to be very advanced, before a claim can be made, he clarified.

Even if the cancer is at stage 1, the insurer can pay out if it is an invasive form that spreads, he said.

Ms Tan is grateful she caught her cancer early. She said: “I’m thankful I caught it earlier so I didn’t need to go through chemotherapy and radiation.

“But I believe cancer is cancer, whether in the early or late stages.”

Why most standard policies don’t include non-invasive cancer

WHY do the bulk of standard critical illness policies not include non-invasive cancer?

MsPauline Lim, executive director of Life Insurance Association (LIA), explained: “Carcinoma in situ is specifically excluded from cover as these cancers can be treated and is not viewed as a ‘critical’ condition.”

She said: “Insurers base their premiums on the extent of coverage.

“There is a much higher incidence of the less serious cancers, so if they are also covered, it means premiums will cost much more and become less affordable for most ordinary people.

“This is not beneficial from a public policy perspective. LIA reviews its standard CI definitions from time to time.”

The LIA standardises the definitions of critical illnesses.

Ms Lim said consumers should look out for the following:

The scope of coverage and the circumstances under which policy will pay out.
Whether the amount of critical illness (CI) payout is sufficient.
If the CI premiums are fixed or if they increase as the policy holder gets older.
If there are exclusions for any of the CI conditions

Recent policies

Recent policies in the market do offer early stage coverage or multiple critical illness coverage.

These typically cost more than policies based on LIA’s standard definitions, said the spokesman.

One such policy is Great Eastern’s Early-Payout Critical Care (EPCC), which provides payouts at earlier stages of critical illness.

Its Great Eastern PinkLife plan pays out 25 per cent of the sum assured for carcinoma in situ, for cancers in the female organs.

Apa yang berlaku adalah sebenarnya sebagai pengajaran untuk para ejen dan juga para pengguna.

Pengajaran Untuk Ejen

Kepada para ejen-ejen takaful mahupun insurans, pastikan para pelanggan diberikan maklumat secukupnya tentang polisi. Ambil sedikit masa untuk luangkan bersama-sama pelanggan untuk membaca satu-per-satu kandungan polisi ketika membuat penghantaran polisi. Ya, walaupun aktiviti tersebut tidaklah memberi sebarang keuntungan pendapatan kepada kita, tetapi ia amat bermakna buat pelanggan. Ini adalah tugas kita, bukan hanya tertumpu kepada aspek jualan dan komisen sahaja. Inilah servis kita kepada pelanggan.

Juga pastikan pelanggan ambil polisi secukupnya yang bersesuaian dengan keperluan. Sekiranya pelanggan menolak, terangkan kepada mereka implikasi. Gunakan borang carian fakta untuk pengesahan perkara tersebut yang menunjukkan kita telah menjalankan tanggung jawab untuk memberi penerangan tetapi ditolak oleh pelanggan.

Pastikan kita terangkan kesemua keperluan sebenar pelanggan dan bukan hanya menerangkan produk yang memberi komisen yang tinggi.

Pengajaran Untuk Pelanggan

Kepada para pelanggan pula, jangan terus percaya bulat-bulat apa yang diperkatakan oleh ejen. Yang perlu dipercayai ialah kandungan polisi tuan-tuan. Ambil masa untuk menyemak dan membaca polisi takaful yang kita ambil. Komitmen kewangan yang kita ambil untuk melanggan satu-satu polisi takaful selalunya mengambil masa yang panjang 10 sehingga 20 malah mungkin hingga 30 tahun. Justeru, ambillah masa 15 hingga 30 minit untuk menyemak polisi tersebut, ia sesuatu yang amat berbaloi.

Malah, sekiranya tuan-tuan dapati kandungan di dalam polisi tersebut bersalahan dengan apa yang diterangkan oleh ejen takaful atau insurans tuan-puan, ada masa 15 hari tempoh bertenang untuk membatalkan polisi takaful berkenaan dan akan mendapat kembali kesemua 100% sumbangan yang telah dibayar!

Dan akhir sekali pastikan kita mengambil perlindungan yang secukupnya. Cukup tidak semestinya banyak. Itulah pentingnya untuk tuan-puan mendapatkan perunding takaful yang benar-benar menjalankan tugas sebagai perunding, dan bukan sekadar jurujual!

Ya, mungkin tuan-puan tidak didedahkan dengan perkara ini sebelum ini!

Rosazaman Sarifdin



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7 Responses to Ada 3 Polisi, Tetapi Tidak Dapat Claim!

  1. ramli says:

    betul tu.. terang biar jelas…jangan nak kaut untung jer…bila clain nak claim agent pun cabut…hahahha

  2. eton says:

    saya nak tanya ape kelebihan takaful GE ni? ada jgk yg dtg untuk cruman rm100 xdisertakan dgn medical card. kalau carum rm150 bru disertakan Medical card. blh jelaskan mcm mana nk claim

    • Razman says:

      Terima kasih di atas soalan anda.
      1- kelebihan takaful GE daripada segi Rider nya (manfaat yang ada). Satu2 nya syarikat yang takaful yang menawarkan pelindungan manfaat penyakit peringkat awal. Yang mana anda tidak perlu menunggu sehingga penyakit kritikal anda berada di tahap ke 4 untuk mendapatkan manfaat ini, manfaat penyakit peringkat awal ini anda boleh perolehi pada tahap serendah 10%.
      Selain daripada itu manfaat protection Income juga di sediakan, manfaat ini dapat melindungi pendapatan anda yang sedia ada. Manfaat ini anda akan perolehi sehingga anda berusia 70 tahun.
      2- sebenarnya plan yang biasa saya buat adalah berdasarkan client needs. mengikut keperluan anda..
      3. untuk urusan claim jika saya servis agent anda saya akan lakukan untk anda.

      • eton says:

        1.saya nk tanya, niat dihati nak ambil yang medical card punya tpi suami dah kerja gov. tapi ada kelebihan yang lain x jika saya ambil medical card?
        2. jika saya tidak claim langsung dengan medical card, adakah akan ada bonus untuk saya yang dimasukkan ke tabung simpanan saya?
        3. jika saya berhenti dalam tempoh 20 tahun caruman, adakah medical card akan cover lg sehingga 99 thun or ditamatkan setelah kita berhenti mencarum?

        tq atas penjelasan encik

      • Razman says:

        Saya cuba menjawab prsolan anda.
        1-Bagi saya tidak kisah kerja apa sekalipun medical card ini merupakan satu keperluan. Antara kelibihan yang ada pada medical card GE Takaful,
        Had tahunan yang tinggi RM 60K-200K,
        Rawatan pesakit luar akibat kemalangan RM2k-4k perclaim,
        PA ( personal accident percuma) RM 10k-20k,
        Co-Takaful (perkongsian bill) minimum 10% dan maximum RM500
        Car Assistn Program (towing percuma)
        Elaun hospital kerajaan RM5o sehari
        Kemasukan ke hospital pakar (sakit dan ICU) 180 hari setahun

        2-Jika tiada claim dalam masa 3 tahun had tahunan akan meningkat sehingga 10%.
        Contoh 1, had tahunan anda RM60k, Pada tahun ke 4 had tahunan anda RM66K. Kelebihan peningkatan had tahunan ini,nilai sumbangan anda tetap sama. tetapi anda dapat menampung kos perubatan yang semakin meningkat.
        Contoh 2, Katakan saya berusia 34tahun bekerja kerajaan, mengambil medical card dari GE Takaful dengan had RM60K setahun. Tidak pernah claim langsung sehingga saya pencen 55tahun.(55-34=21tahun/3tahun=7 kali kenaikan 7x6K=RM42K. selepas saya pencen saya tak perlu risau kerana pada waktu itu had tahunan saya RM102k setahun.amat relevent dengan kos rawatan pada waktu itu.

        3- Jika selepas 20 tahun anda berhenti membuat sumbangan, anda masih dapat menikmati manfaat medical card ini selagi nilai pelaburan anda masih ada. Yang mana pada waktu ini dipanggil “sumbangan Holiday”.


  3. shafarin says:

    kalau umur saya 31 tahun.berapa bayaran bulanan saya untuk medical kad sahaja.

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