FAQ on insurance coverage on Influenza A (H1N1)

The World Health Organisation (WHO) declared the worldwide spread of Influenza A (H1N1) had reached pandemic level 6 on 11th June 2009. The Ministry of Health Malaysia has since declared that the country has entered a mitigation phase where there is sustained community spread and new cases have no defined epidemiological links with existing cases.

In view of the serious implications, the Ministry of Health has also advised the public to take extra precautions. Those patients who exhibit influenza-like illnesses or those who are in the high-risk groups are advised to seek immediate treatment. The general public is also advised to maintain good hygiene habits and practise reasonable “social distancing” to reduce the spread of H1N1.

In the midst of addressing the H1N1 threat on the medical and public health front, some concerned members of the public have posed questions on general insurance protection in relation to exposures to H1N1. In this regard, PIAM wishes to advise the public on some insurance coverages on the following types of insurance policies:

a) Hospital and Surgical Insurance

Q: What is a Hospital and Surgical Insurance (HSI) Policy and what does it cover?

Ans:
A HSI policy is generally designed to cover the cost of private medical treatment, such as the cost of hospitalisation and healthcare services, if you are diagnosed with covered illnesses or have had an accident.

A HSI policy will help you to pay for the various hospitalisation and medical expenses that you will incur, if you become ill or injured. These expenses will include hospital room and board, professional and surgery fees and medical supplies and services. A HSI policy will also help you if you are not able to work because of a covered illness or injury.
The payment of HSI benefits will depend on the type of policy that you buy. You must check the policy contract for details of the benefits, such as what is and what is not covered, when benefits will be payable and how they will be paid. The insurance company will reimburse only the actual costs incurred subject to the limits of the policies.

Q: Does a Hospital and Surgical Insurance (HSI) policy include cover for Influenza A (H1N1)?

Ans:
Generally, HSI policies do not carry an exclusion against hospitalisation treatment arising from infectious or communicable diseases like Influenza A (H1N1).
However, some policies do expressly exclude cover for communicable diseases requiring quarantine by law. This means that if H1N1 is classified as a communicable disease requiring quarantine by law in Malaysia, then the policy will not cover such medical expenses.

b) Travel Insurance

Q: What is travel insurance?

Ans:
You purchase a travel insurance to cover yourself and/or your family against travel-related accidents, losses or interruption. The coverage is usually limited to the period of your travel. However, some insurance companies may offer various combinations of protection to cater to the specific needs of customers, including long-term annual policies if you are a frequent traveler.
The scope of cover and scale of benefits differ between insurance companies and the coverage commonly provided under a travel insurance policy include:

• Personal accident,
• Medical and its related expenses
• Loss of baggage, personal effect and money
• Loss of passport
• Personal liability
• Delayed baggage
• Travel delay
• Hijacking
• Repatriation

Q: Will my travel insurance policy insure me against influenza A (H1N1) for medical and its related expenses?

Ans:
While most travel insurance offer similar benefits, the scope of coverage and scale of benefits varies between insurance companies.

In general, expenses for medical and its related expenses for treatment for Influenza A (H1N1) is covered under the travel insurance policy, subject to the terms, conditions and exclusions of the policy.

Payment for emergency evacuation and repatriation expenses arising from H1N1 must be medically necessary in the opinion of the insurer or the emergency assistance company appointed by the insurer.

The coverage for travel delay, cancellation or curtailment of travel under the policy may vary amongst insurers. Please refer to the policy contract or refer to your insurance company for the details.

PERSATUAN INSURANS AM MALAYSIA
August 2009