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乐龄健保投保者 患视障却遭拒索偿

by user
11/06/2018
in 报道
Reading Time: 3 mins read
0

President can do more to protect our interests – regardless of whether he is an executive or non-executive president. By Jason Lee.

终身护保(CareShield Life)将在两年后取代现有乐龄健保(ElderShield),称之将能提供新加坡公民更多索赔和终身保障。然而乐龄健保投保者之一的张先生,向‘网络公民’分享自身经历,声明说即使出示视障医疗证明,向职总英康( NTUC Income)的索偿也不获批准。

乐龄健保是新加坡政府设立的严重伤残保险计划,为需要长期护理关怀的乐龄人士提供基本财务保障。在现有体制下,所有持有保健储蓄户口(MediSave)的新加坡公民和永久居民将在40岁开始自动参与乐龄健保,除非另行要求退保。

对于“严重伤残”,乐龄健保计划如此定义:在有/无辅助工具(如拐杖,轮椅等),个人在三项日常起居活动或以上无法自理,意为着该人士需要他人协助打理生活起居。

怎样才算 “重度残障”?

如果因为残疾而无法进行以下六项日常活动中的任何三项,投保人和看护者便可以向保险公司索赔:

      • 沐浴:可否自行出入淋浴间、需他者协助沐浴与否
      • 更衣:可否穿戴衣裤妥当、配置义肢、医疗辅助工具等
      • 进食:可否喂食用膳
      • 如厕:可否自行/在辅助工具协助下使用厕具
      • 在室内走动:有无能力在室内或层次表面移动
      • 下床坐上椅子或轮椅:可否从床褥上下椅子/轮椅

乐龄健保的官网这么介绍:“一旦投保,在任何年龄阶段,若不幸陷入严重残疾都可索偿。即使健保在65岁到期,您仍享有终身保障。”

张先生经诊断右眼全盲,左眼视力只能看见残影,任何有常识者都会认为他已身陷残疾,行动不便。然而职总英康却认为张先生有能力自理生活而打退了他的索偿申请。

乐龄健保计划目前由三家保险公司管理,它们是英杰华(Aviva)、大东方(Great Eastern)以及职总英康。

同样是自动参与乐龄健保,张先生在54岁时向保险公司索偿,并被指示需先进行医疗检查。

医生在2015年3月24日的诊断结果,显示张先生:

  • 在淋浴时需有人看护以防滑倒
  • 需他人协助更衣
  • 由于视力丧失,需协助他用膳
  • 如厕后需妻子检查卫生整洁
  • 在家中移动需家人监督

医生在诊断结果中,也提出张先生的身障情况从2014年12月开始。

然而,职总英康在2015年4月8日却回复,坚称张先生并不符合索偿资格,理由是他仍有能力在超过三项日常起居活动中自理。

因此张先生无法领取乐龄健保的索赔。讽刺的是,他从其他三份保险索讨永久残疾赔偿都获批准。

张先生向‘网络公民’说道,“我觉得乐龄健保如同骗局。普通的残疾是不能,那么严重残疾理应可以索偿,但残疾的定义含糊不清,很多人以为他们可以索偿,但有时即使两条腿没了,也不一定会赔。”

‘网络公民’向一名专业护士了解,其实符合乐龄健保和终身护保的索偿定义都是些晚期癌症或其他病入膏肓疾病患者,才,因此虽然把提乐龄健保升终身为支付保障,在相对提高的高保费下其实也许没有太大优惠。

乐龄健保/护保乃生财之道?

新加坡卫生部长颜金勇在2017年揭露,自2002至2015年终,共收取26亿新元的乐龄健保保费,支付了1亿的索偿,以及在2007年和2012年分批回扣了1亿3千万新元的保费于投保人。

有鉴于终身护保乃强制性且无法退保,该计划将从投保人收取多少保费,又有多少能回归给有需要的索偿者,令人感到疑虑。迄今,也没有任何报告针对该计划作精确评估,在2020年开始实施终身护保计划前,民众有知情权获得更多细节。

也许有人辩解现有索偿机制并不全是为了获利。但我们需理解,投保人付保费,就是为了将来的索偿需要。私人保险公司无法确定是否有足够的新投保者支付索偿款项,但是官营的保险计划不同,每个公民都强制交保费,政府根本无需担心无力支付索偿,根本来说,它就应该是非营利性的。

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