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保險與我 : 注意了!挑公立醫院 防癌險才認帳
發表者 kina168 於 2006-07-20 16:03:11 (1173 人氣)

投保防癌險的保戶要注意了,一旦不幸罹患癌症要就醫時,一定要選擇到「公立醫院、教學醫院或保險公司指定之醫院」治療,如果在其他醫院就醫,恐怕難以順利申請癌症理賠金。 ...

---■記者李淑慧/台北報導
投保防癌險的保戶要注意了,一旦不幸罹患癌症要就醫時,一定要選擇到「公立醫院、教學醫院或保險公司指定之醫院」治療,如果在其他醫院就醫,恐怕難以順利申請癌症理賠金。

最近就發生一個案例,一位女士因為罹患癌症,先前在公立醫院、教學醫院治療,保險公司都給付理賠金,但後來轉到一家小醫院的入住安寧病房,保險公司卻認為保戶所住的醫院不符合保單條款的要件,只願意給慰問金,不願給理賠金,雙方因而發生糾紛。

保險業者表示,市面上的防癌險保單條款,多半會明訂保戶必須在「公立醫院、教學醫院或本公司指定之醫院」就醫,才能申請理賠金。

保險業者指出,防癌險之所以要指定就診醫院,並不是擔心黑心醫院配合病人開假證明。而是因為市面上治療癌症的方法非常多元,例如有保戶發現罹患癌症之後,求助於中醫,或看遍大、小醫院,理賠將沒完沒了。

為了控制理賠發生率,保險公司在防癌險保單條款上約定,治療癌症之「醫院」,係指「具有診斷及治療癌症設備之…醫院」。一方面,這類醫院有具體的治療,另一方面保戶也可獲得較好的照顧,此外,保險費率也能明確計算。如果在其他醫院看病,恐因為違反保單條款的約定,無法順利申請理賠。

前一陣子壽險公會也曾經討論「安寧病房」住院是否需要理賠的問題,因為部分保險業者認為安寧病房並無做任何治療,因此不能給付癌症住院醫療保險金。

安寧病房理賠爭議不斷,最後壽險公會也做出決議,第一,保戶必須是癌症末期,第二,安寧病房必須符合衛生署所訂定「安寧醫療緩和條例」裡面定義的「安寧病房」,才可以理賠。

新聞分析》業者不說 幾個保戶知道?

記者李淑慧

壽險公司所發行的防癌險保單,條款裡面約定保戶必須到「公立醫院、教學醫院或保險公司指定之醫院」治療,才能予以理賠。可是有幾個人購買保險時,會仔細去讀密密麻麻的保單條款?有多少保戶知道有這項規定?

如果保戶沒看清楚保單條款,後來不幸罹患癌症,萬一又選了一家不符和上述規定的醫院來就診,保險公司因而拒絕理賠,對保戶相當不公平。

保險商品是一種對價關係,保險公司承擔多少風險,就收多少保費。如果一張保單的保障內容包山包海,保費肯定是非常昂貴。因此,保險公司才要對理賠內容做限制,這是合情合理的行為,也讓保戶可以買到比較便宜的商品。

但是保險公司將如此重要的規定,藏在密密麻麻的保單條款裡面,絕大多數保戶在購買時,恐怕不會想到還有這樣的條款。

【2006/07/11/經濟日報 】

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