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香港很多市民都有購買保險，其中一種較多人購買的，就是醫療保險。這一節「長者法網智多聲」，就為大家說一下醫療保險。
簡單來說，醫療保險的保單，是投保人和保險公司訂立的書面合約，投保人因為患病或意外而要付醫療費的話，醫療保險就可以分擔這些開支。不過，並非所有醫療服務和開支，醫療保險都會承包的，保單一般都會列明受保範圍和不保事項，亦設有賠償上限，每項受保的事，只會賠償至某一個限額，通常保單都有列明，所以投保人最重要是在購買保險之前，小心看清楚保單的細則。
保險合約是建基於信任，保險公司相信保單持有人，投單時會如實提供準確的資料，讓保險公司可以合理和全面地評估風險，這叫「至誠原則」。如果投保人沒有披露重要事實，影響了保險公司的評估，將來保險公司可以撤銷保單或拒絕賠償。值得留意的是，大部分涉及沒有披露事實的糾紛，都和投保人的病歷有關。而其他資料，例如投保人以往的索償紀錄、平均離港時間、吸煙和飲酒習慣、甚至是交通違規紀錄和職業，即使跟投保人當時所患的病症一點關係也沒有，但有可能影響保險公司釐訂保費和評估風險、而又沒有交代的話，保險公司也有權拒絕賠償。如果您不肯定哪些資料重要，就最好全部都交代清楚了。
買了保險之後，萬一索償被拒絕，可以怎樣做呢？首先，您要了解保險公司為甚麼拒絕賠償。看清楚所有文件，如果發現是醫療帳單出錯，就要請醫生更正，如果保險公司不肯賠償某些療程的開支，就要請醫生寫一封信，證明您接受的療程是必須的。您可以寫信給保險公司，反對它不肯賠償的決定，信內要寫清楚您的姓名、個人資料、為何被拒絕賠償、您認為為甚麼應該獲得賠償等。很多保險公司在拒絕賠償之後，都容許客人在特定時間之內提出反對，所以您要把握時間，保險公司的人找您，最好就立刻回覆了。如果解決不了，您亦可以考慮向獨立的保險索償投訴委員會投訴，甚至是訴諸仲裁或訴訟。如果有任何疑問，可以問問律師。
我們在長者社區法網文字版，列出了一些購買醫療保險要注意的事，大家可以慢慢看，另外，我們也有為大家說一下人壽保險，歡迎各位到長者社區法網了解。拜拜。
PrintNon-disclosure
As mentioned in the previous section, insurance contracts are based on trust. The nature of the subject matter of insurance and the circumstances pertaining to it are facts within the knowledge of the policyholders. Insurers, on the other hand, are not aware of these facts unless the policyholders tell them. The policyholders must tell the whole truth.
Non-disclosure arises when an applicant for an insurance policy fails to disclose on the application form material facts within his/her actual or presumed knowledge. It should be noted that the information given by an applicant in the application form has great impact on the insurer’s underwriting assessment. From the information given in the application form, the insurer can identify high-risk features and decide whether or not to take on the risk, and if it decides to do so, at what premium and on what terms.
It is important to note that the majority of non-disclosure disputes are related to the medical history of the policyholders. Non-disclosure can result in policy repudiation and claim rejection.
Although the majority of non-disclosure disputes arise from the policyholders’ failure to disclose fully their previous medical history, material information is not only restricted to their medical records. Other information, such as their history of past claims, average length of stay outside Hong Kong, smoking and drinking habits, previous traffic offences, and occupation, may also affect an insurer’s decision in setting the premium or determining whether or not to underwrite the risk.
If the non-disclosed information is material enough to affect the underwriting decision of an insurer, it may be legitimate for the insurer to decline a claim even though the non-disclosed information is not related to the current illness. This is because the non-disclosure prejudices the insurer from making a fair and accurate underwriting assessment, and thus it may justify the insurer’s repudiation of the contract from inception.
You should not rely solely on your insurance agent to determine whether or not a piece of information is material. In order to avoid unnecessary claims disputes, you should disclose all information and all material facts fully and accurately when filling in the application form. If in doubt as to whether a fact is material, it is better to disclose it.