Page 39 - MEDICAL AND HEALTH INSURANCE

MEDICAL AND HEALTH INSURANCE

reasonable charges. In certain cases, the co-insurance would be high

during the 1st year of coverage and decrease during the 2nd year and

subsequent years of renewal. It can be as high as 80% during the 1st year

and decrease subsequently to 50% for the insured portion.

The coverage is generally also extended to cover emergency dental
treatment due to accident, with a fixed amount.

The dental insurance policies' exclusions can be quite standard, such as:

a) cosmetic exclusion, which is not necessary for sound natural tooth

b) missing tooth provision, of which, the tooth was missing during the

policy inception

c) purchase of drugs for oral disease, unless specifically provided in the

policy

d) replacement of prosthetic appliances during the 5 years period after
benefit is paid

e) self-inflicted injury resulting in dental treatment, whether sane or

insane

Dental expense insurance is very different from medical expense insurance

and can be subject to abuse, as dental treatment can be postponed until

the plan is effective and the insurer will be liable for the expenses. Hence

prudent underwriting and a properly designed plan must be in place to
minimise adverse selection.

Currently, this benefit is not popular as most employers would deem it as a

'good to have' benefit. Moreover, it is expensive and not many insurers

offer this type of coverage.

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