Translate Insurance Terms To Layman Terms

[Yeobt]

Hi,

 

My wife got a day surgery with KK hospital recently. KK hospital deducted the amount $700+ from her medisave while we were waiting

for reply of her medical claims from the insurance company. Now, We just got a letter from her insurance company saying that her

bill is covered by the policy.

 

We don't understand how the payment could be made by the insurance company to KK hospital and how could my wife medisave

could be reinstated, so we wrote a first email to the insurance company to clarify.

 

first reply from the insurance company.

 

 

Dear Ms Tan

Thank you for your email. 

Our claims letter has already been sent to you on 10/12/15. 

In the claims letter for PruShield policy number XXXXXXX, we have informed that the claim amount is approved within deductible under the

PruShield plan. Hence, there is no payment to KKH. 

There will also be no payment made to CPF.

 

Ok, i don't understand what is no payment to KKH and CPF. So, we wrote again for an explanation in layman terms. 

 

Second reply from the insurance company.

 

Dear Ms Tan 

Thank you for your reply. 

The deductible portion is the part of the claimable amount that the policyowner is liable for before any benefits are payable under this policy.

The Deductible amounts for the various benefits under this policy are stated in the Benefits Schedule.

 

 

Sorry, i tried to figure out their term myself but after more than a month, i still cannot understand what are they trying to say. 

my question here is very simple,

 

1. Insurance says my wife can claim her medical bill?

2. How could her deducted amount be credited back into her medisave?

 

Thanks from a layman. 

 

 

  

[Ender]

I think deductible are the amount you have to pay either via medisave or cash. Whatever balance after your deductibles will be cover by insurance co-payment scheme.

[Maxus-MIFA9]

Pay And Pay ...

 

Whether by cash, medisave or insurance, Hospital gets the money.......

[Kangadrool]

2. your insurer pays CPF, CPF reinstates back the amount received from your insurer.

 

 

[Galantspeedz]

layman terms... same as car insurance excess

[Iisterry]

Your total bill is $700+? If so, it is below the claims threshold so no monies will be paid out by policy.

 

Deductible, co-insurance, excess, etc etc essentially the same meaning. Anything over this threshold is borne by the insurer, anything below is self-insure.

 

This "deductible, co-insurance, excess" is to deter frivolent claims.

 

There will also be riders/add-ons/extensions available to cover this "Deductible, co-insurance, excess" should you wish to. However it will usually be more expensive. Insurance is meant to cover catastrophic losses which might beyond the capability of layman to absorb themselves.

 

 

 

 

[Nzy]

Basically the deductible is the amount you have to pay first. For eg, if go C ward, its $1500, so the first $1500 you got to pay, anything more than that can claim, but got co-insurance. Deductible reset every year.