The Financial Supervisory Commission decided in April that mild cases who underwent home isolation would be able to claim settlement without requiring hospitalization, as long as there is "medical behavior." The definition of medical behavior, however, has also aroused confusion and controversy. The Ministry of Health and Welfare said it will announce new guidelines.
The local epidemic situation is severe, and adjustments to epidemic insurance policies have also caused controversy in the settlement of epidemic insurance claims. The Financial Supervisory Commission decided in April that mild cases who underwent home isolation would be able to claim settlement without requiring hospitalization, but only if there is "medical behavior." What kind of behaviors are required for home care to be considered medical behaviors has aroused public scrutiny.
Huang Tien-mu, Chairperson, Financial Supervisory Commission: “It depends on the final adjustment of the epidemic prevention policy by the Ministry of Health and Welfare. I think our Life Insurance Association will make some more judgments.”
Huang said that the definition of medical behavior is defined by the Ministry of Health and Welfare. FSC said it won't cross the jurisdiction lines. According to the terms of the policy, if there is no hospitalization, then it is not included in the scope of claims. However, after April 8, a large number of patients with mild symptoms were supposed to flood into hospitals. To reduce medical capacity, the FSC coordinated with the insurance industry to relax home isolation and quarantine claims. As for the behavior of home care, it is a medical behavior, which is determined by the property insurance association. In addition, a positive quick screening test will be deemed as a confirmed diagnosis going forward. Thus, the public is also concerned about whether epidemic insurance will still pay claims.
Huang Tien-mu, Chairperson, Financial Supervisory Commission: “As long as the insurance company agrees to cover this policy. In the past, if a person bought several insurance policies, the insurance companies all had this responsibility. As long as the person has a claimed accident in line with the policy's terms, the insurance companies will have to pay the claims.”
Huang emphasized that underwriting is not equal to claim settlement. As long as the insurance policy has been approved, no matter how many policies a consumer has bought, insurance companies are responsible for claim settlement. A policy's underwritten success will depend on whether the insurance company agrees to the risk. In the future, the insurance association will publish claim settlement guidelines.