Bupa Platinum Plan started July 1st. Cancer diagnosis now. Excluded or covered?

[wat]

I'm enquiring on behalf of another.

 

Here's a copy and pasted list from Bupa's website about their exclusions: 

 

Quote

Specific exclusions from the coverage are specified in the health insurance policy. Examples of exclusions, which Bupa Health Insurance shall reserve its right not to pay out benefits, are described below:

• Pre-existing conditions or any medical expenses for a sickness that happens in the course of 30 days from the initial effective date of the insurance policy
• Treatment or correction of surgery for congenital anomalies or development disorders
• Medical expenses incurred from the treatment for attempted suicide or self-inflicted injury
• Acquired Immune Deficiency Syndrome (AIDS) including a complication or sexually transmitted diseases
• Any medical treatment that is not conventional treatment, including alternative treatments
• Health check-up or a hospital confinement or a request for surgery, convalescence which is not under medical necessity or medical standard
• Pregnancy, childbirth, miscarriage (unless the insuring agreement for maternity is purchased), contraception, sterilization
• Visual acuity, laser eye treatment, LASIK, dental treatment and aesthetics treatment such as acne, blemish
• Sickness or diseases which happens within 6 months from the first day the Insurance Policy becomes effective including Tumors or Cancers, Polyps or Cysts, Hemorrhoids, Hernias, Pterygium, Pinguecula or Cataract, Tonsillectomy or Adenoidectomy, Stones, Endometriosis, Varicose Veins, Hallux Valgus, Ganglions

https://www.bupa.co.th/en/individuals/health-insurance/individual/detail.aspx?iid=1&ifid=13#tab

 

The first point makes me think it would be fine, as it's been over 30 days. But then the last point specifically mentions cancer with a 6 month window from the first day. That sounds insane to me that half of the year on a yearly insurance plan wouldn't cover all of those issues list there. Am I missing something here? Pre-existing conditions I understand, but a new diagnosis won't be covered?

[Jdietz]

If it sounds insane, then why sign up for it? It's in the rules.

So yes, excluded.

 

[Johpa]

Plan actually spells out that no disease will be covered during the first six months.  Probably not a bad tactic considering the number of people who sign up for insurance only after they either know or suspect the onset of an illness and then cancel the insurance once well again.  As for most cancers, they are usually pre-existing long before diagnosis.

[stevenl]

Agree with the previous 2 posters, it very clearly states it is not covered.

The first bullet point refers to 2 things: 1. pre-existing conditions are not covered and 2. sickness within 30 days of the start date is not covered. This refers to common sicknesses, like flue etc. The last bullet point is very clear: cancer etc. are not covered in the first 6 months.

[wat]

If it's not covered, it's not covered and that's fine. 

 

The person is question had a full range of tests done at Bangkok Hospital two months before this new plan was started and there certainly wasn't any indication there. Was only just diagnosed now after many, many, scans, tests, biopsies ect over the past weeks.

 

Out of curiosity, is this more of a case of choosing the wrong plan or wrong provider, or would this clause be considered completely standard among providers in Thailand(or the world?)?

[stevenl]

16 hours ago, wat said:

If it's not covered, it's not covered and that's fine. 

 

The person is question had a full range of tests done at Bangkok Hospital two months before this new plan was started and there certainly wasn't any indication there. Was only just diagnosed now after many, many, scans, tests, biopsies ect over the past weeks.

 

Out of curiosity, is this more of a case of choosing the wrong plan or wrong provider, or would this clause be considered completely standard among providers in Thailand(or the world?)?

In Thailand this is quite standard. Other places in the world would depend a lot on the country in question, in some countries healt care insurance is mandatory or free, so no issues there, in others there would be issues.

 

Now in this case, with apparently many tests already done 4 months before the diagnosis, it would seem the health issues were there already for some time, so it could even be considered a pre-existing condition. That would mean the tests done would have to be declared on the medical questionaire on application.

Edited September 16, 2016 by stevenl

[oxo1947]

I was in hospital 2 months after signing up with BUPA...I (thought) I knew the 6 month rule, so didn't even try to claim at Bumrungrad-- the staff run your card number through regardless---& BUPA stepped in & said we class this as an accident,  means your covered from day 1, send the account to us.

(it was a traffic accident) 

 

Pleasant surprise....................

[wat]

7 hours ago, stevenl said:

In Thailand this is quite standard. Other places in the world would depend a lot on the country in question, in some countries healt care insurance is mandatory or free, so no issues there, in others there would be issues.

 

Now in this case, with apparently many tests already done 4 months before the diagnosis, it would seem the health issues were there already for some time, so it could even be considered a pre-existing condition. That would mean the tests done would have to be declared on the medical questionaire on application.

 

The tests back then were to get a doctor's 'fit for work' letter and unrelated to anything recent. 

 

The 6 month rule sounds pretty cut and dry in this case. But as far as 'pre-existing' goes that really depends on how they define that. In this case it may have been pre-existing for some amount of time without anyone's knowledge, which could definitely fall under a definition of pre-existing. But I wonder how far they go with that since it's all just speculation and estimates. Obviously the insurance companies are going to design their own plans in their best interests and such and word them in a way that favours their own judgement. But I can't help feel like there's a lot of people out there who think they're much more protected by their insurance than they actually are.

[stevenl]

20 hours ago, wat said:

 

The tests back then were to get a doctor's 'fit for work' letter and unrelated to anything recent. 

 

The 6 month rule sounds pretty cut and dry in this case. But as far as 'pre-existing' goes that really depends on how they define that. In this case it may have been pre-existing for some amount of time without anyone's knowledge, which could definitely fall under a definition of pre-existing. But I wonder how far they go with that since it's all just speculation and estimates. Obviously the insurance companies are going to design their own plans in their best interests and such and word them in a way that favours their own judgement. But I can't help feel like there's a lot of people out there who think they're much more protected by their insurance than they actually are.

If all tests done showed no indication at all that would point very much to non existent at that point. As you said, does not matter in this case because of the 6 months rule, but these tests would help to prove 'not yet existent'.