Career & Money » Insurance Discrimination

I am not asking insurers to ignore risk. I am asking them to identify the risk they claim to be insuring.

This is a first-person account of my own insurance applications in Singapore, together with my views on how autistic people should be treated by insurance underwriting. Where I describe something as discrimination, I am making an argument about fairness, evidence and equal treatment. I am not claiming that a court or regulator has made a legal finding against any particular insurer.

This article is also not personalised financial, legal, medical or insurance advice. Insurance products, underwriting practices and regulatory requirements change. Applicants should answer insurers’ questions accurately and obtain advice appropriate to their own circumstances where necessary.

 

My first experience with insurance discrimination

At the time of my first application in 2010, I considered myself healthy and had not required hospitalisation since childhood. I studied in mainstream school and obtained a degree without special support or help. I served two years and four months of National Service without incident. I had worked full-time for two years in a government agency and, after this experience, spent about a decade working in the private sector without requiring special support.

My friends and colleagues sometimes found it hard to believe that I was autistic until they got to know me better.

I mention these facts not because autistic people should have to prove that they are sufficiently “normal” to deserve insurance. They are relevant because they show why I found the underwriting outcome so difficult to understand in relation to my actual circumstances.

In 2010, I proactively declared my autism diagnosis even though autism was not explicitly asked about in the application. My mother applied for the same policy around the same time. Her application was approved within about a week. My application took about three weeks before I received this rejection:

“We have considered your proposal very carefully and based the medical information we have regarding the health status of the insured person, we are sorry to inform you that we are unable to accept the cover due to medical condition.”

The letter did not identify autism by name, so I cannot claim to know everything that happened internally during underwriting. However, autism was the significant medical information I had voluntarily declared.

An autism centre in Singapore subsequently wrote a short letter explaining my individual situation and stating, among other things, that I did not have self-injurious behaviour.

After the insurer received that information, I was accepted without additional premium loading or an autism-specific exclusion.

That experience taught me something important. A diagnostic label can produce one underwriting response, while a surprisingly small amount of information about the actual human being behind that label can produce another.

 

More than a decade later, the same problem appeared again

Just over a decade later, I applied to another insurer. I declared my autism diagnosis and supplied the earlier letter from the autism centre. The insurer nevertheless issued a counteroffer containing this exclusion:

“We will not pay on any claim for hospitalization, treatment or surgery related to Asperger’s disorder, any mental health disorder, including neurobehavioural disorders, anxiety disorders, depression, stress, adjustment disorders, emotional or behavioural disorders, disorders related to fatigue including chronic fatigue syndrome, drug or alcohol misuse, psychosomatic disorders, or any treatment complications.”

This was where the issue became much more important to me. I could understand an insurer asking questions about autism. I could understand an insurer considering evidence of actual associated risks. What I could not understand was how my autism diagnosis appeared alongside a sweeping list of psychiatric and behavioural conditions that I did not have. If I had some diagnosed psychiatric disorder, assess that disorder specifically. Autism should not become a convenient proxy for illnesses that have never been diagnosed.

 

Autism is not evidence that someone has a separate mental illness

The terminology surrounding autism and mental health can become unnecessarily confusing.

The World Health Organization describes autism as a diverse group of conditions related to development of the brain. In ICD-11, autism is classified among neurodevelopmental disorders. Some medical classification systems place neurodevelopmental disorders within a broader chapter covering mental, behavioural and neurodevelopmental disorders.

That administrative classification does not make every autistic person mentally ill in the ordinary meaning of that phrase. More importantly for insurance, it does not establish that an autistic person has depression, anxiety, psychosis, substance-use disorder or another separately diagnosable psychiatric condition. WHO itself discusses depression, anxiety, epilepsy and ADHD as conditions that can co-occur with autism. The very concept of a co-occurring condition means that it should not simply be presumed from autism alone.

Call autism a neurodevelopmental disorder, a developmental disability, a condition or a neurotype according to the context. None of those words magically diagnoses depression. Autism is identified through characteristic patterns of development, communication, interaction and behaviour. Autistic people vary enormously. Some require lifelong substantial support. Others live independently and may not be diagnosed until adulthood. Some have significant psychiatric conditions. Others do not.

That individual variation is precisely why underwriting should assess the individual.

 

Why I spent about S$3,000 removing exclusions I did not expect to claim against

I decided to take the next step forward. I could have accepted the exclusions; from a purely financial perspective that was the cheaper decision. I regarded myself as mentally healthy. I was not being treated for depression, anxiety, substance misuse or the other psychiatric conditions listed in the exclusion. I therefore did not expect to make claims arising from most of those conditions.

I was still studying for my degree which meant I was draining my savings. Yet I paid about S$3,000 for a psychologist to conduct an extensive reassessment and document my condition and current functioning. The report was 18 pages long. Among its findings, it stated:

“Eric’s scores suggest a current lack of emotional distress and relatively stable psychological health.”

It also stated:

“Eric’s current level of functioning demonstrates significant strengths and adaptability, with no clinically significant support needs identified at this time.”

After I submitted the report, the insurer removed the exclusions. I cannot know exactly how the insurer weighed each part of the report, and another applicant should not assume that spending money on a psychological assessment will necessarily produce the same outcome.

The S$3,000 was never only about economic value to me. It was also my symbolic way of standing up to what I regarded as discrimination. I was unwilling to quietly accept a contractual document that associated me with a long list of psychiatric conditions for which there was no corresponding diagnosis simply because I had disclosed autism. I wanted the underwriting record to describe the person who was actually applying for insurance.

Sometimes principles cost money. I decided that this particular principle mattered enough to me.

 

Why I call this discrimination

I do not use the word “discrimination” to suggest that every underwriter dislikes autistic people, or that every adverse underwriting decision involving an autistic person must be unlawful.

Insurance necessarily involves risk classification. Different medical conditions can genuinely affect mortality, morbidity, disability or hospitalisation risk, and insurers need actuarially sustainable pools. My objection begins when the classification ceases to correspond to the person’s actual risk. If an autistic applicant has a particular additional condition that creates an insurable risk, assess it. If an autistic applicant has higher support needs that are genuinely relevant to a particular insured event, assess the evidence and explain the relevance.

But if an autistic applicant is treated as though unrelated illnesses must exist merely because autism appears in the medical history, I believe the process has crossed from evidence-based risk assessment into stereotyping.

This principle is not hostile to insurance. It is consistent with good underwriting. The Life Insurance Association Singapore’s Guide to Medical Underwriting for Life Insurance says insurers should act fairly and reasonably, assess each case on its individual merits, and make objective and holistic assessments using disclosures, medical evidence and relevant data.

Similarly, the Ministry of Health has stated that insurers are expected by MOH and the Monetary Authority of Singapore to deal fairly with customers and should not indiscriminately reject an application solely because of personal information such as disability or medical condition. MOH stated that insurers should objectively assess applications using reliable information relevant to the risks being insured.

That is fundamentally what I am asking for. Assess the risk that actually exists, not the stereotype attached to the diagnosis.

 

Insurance discrimination can create a perverse incentive not to get diagnosed

There is another consequence that worries me even more than my own insurance experience.

If receiving an autism diagnosis can make someone reasonably fear rejection, exclusions, premium loading or additional scrutiny when applying for private insurance, the insurance system creates a perverse incentive: It gives some people a financial reason to remain undiagnosed. This is particularly relevant to autistic adults with low support needs.

Someone with very substantial support needs may enter the healthcare, education or disability-support system early because there is little practical possibility of the person’s differences going unnoticed. Someone with low support needs may instead reach adulthood without a diagnosis. They may work, study and live independently while spending years wondering why their experience of the world differs from that of other people.

A formal assessment may help such a person understand himself or herself, obtain appropriate support where genuinely needed, communicate needs more accurately and participate more confidently in the autistic community. But imagine telling that person:

“You may gain self-understanding from an assessment, but putting autism into your medical records might complicate future private insurance applications.”

That is a terrible incentive for any healthcare and insurance system to create. Some people may therefore decide that ignorance is financially safer. Others may avoid formal diagnosis and consequently remain uncertain about whether they should identify themselves as autistic or participate openly in autistic communities. A system intended to classify financial risk can therefore unintentionally discourage people from understanding themselves and connecting with peers.

The concern is not imaginary. Research outside Singapore has documented clinicians reporting parental fear of rejection by insurance companies as one reason some families were reluctant about an autism label. Other research has shown that changing insurance rules can influence how many children receive an autism diagnosis through the healthcare system.

Insurance incentives can affect diagnostic behaviour. We should therefore think carefully about the incentives our own underwriting practices create.

 

Parents can face the same dilemma

Parents who notice developmental differences in a young child should be able to decide whether to seek assessment based on the child’s needs, not because they are trying to predict how an insurer might treat a diagnosis ten or twenty years later. Timely assessment can help families better understand a child’s individual strengths and needs and obtain appropriate information or support where useful.

If parents believe that obtaining a diagnosis may permanently damage their child’s future insurability, some may hesitate. I am not advising parents to delay medically appropriate assessment in order to preserve insurance options. I am arguing the opposite: insurance practices should not give parents a reason to consider delaying appropriate assessment in the first place.

Private insurance should not financially reward a family for knowing less about its child. Nor should an autistic adult be better off financially simply because nobody ever wrote the word “autism” in a medical record. That is bad alignment between healthcare and insurance.

 

This concern has historical context in Singapore

In 2010, the Ministry of Health republished a newspaper exchange concerning a parent whose autistic child had reportedly been rejected for an Enhanced IncomeShield application because of autism.

When Income launched SpecialCare (Autism) in 2013, its own announcement described autistic children and young people as a group that had commonly experienced difficulty obtaining ordinary insurance coverage.

I therefore regard the history of autism and private insurance in Singapore as a legitimate subject for public discussion and advocacy. The situation has improved in important ways. But improvement does not mean that every conceptual problem has disappeared.

One way to check mindsets is to ask your insurance representative if autism is considered a mental illness. I once mentioned this issue with an insurance representative who disagreed with me. To prove that autism was a mental illness, he performed a Google search and showed me what Google returned.

 

MediShield Life shows that autism does not automatically mean higher medical risk

MediShield Life now gives every Singapore Citizen and Permanent Resident basic lifelong health insurance protection regardless of pre-existing conditions. This is important because nobody with autism is left entirely without basic hospitalisation insurance merely because of an autism diagnosis.

There is also a historical statement from the Government that I consider especially significant. During the passage of the MediShield Life legislation, the Ministry of Health specifically addressed whether developmental conditions such as autism would attract the additional premiums imposed on certain serious pre-existing conditions.

MOH stated that developmental disorders which do not create higher risks of future complications or recurrence requiring prolonged hospitalisation or expensive outpatient treatment would not attract those additional premiums, and specifically said that the mere existence of autism on its own was not the basis for imposing them.

Private insurance operates differently from MediShield Life and insurers retain their own underwriting frameworks and risk appetites. I am not suggesting that the MediShield Life rule legally determines the underwriting of every private product.

But the underlying reasoning is worth noticing: Start with the actual insured risk. Do not assume that the label itself proves it.

 

LIA’s autism case studies are progress, but there is more work to do

In 2024, the Life Insurance Association Singapore published two autism-specific examples in its Guide to Medical Underwriting for Life Insurance.

Case Study #4 concerns a 19-year-old autistic student in a higher-level institution. The medical and school information describes minimal support needs, almost no impairment, independent living, no other medical conditions and no additional risks identified through the supplementary questionnaire. The illustrative underwriting outcomes are favourable. This resembles the principle I have argued for throughout this article: obtain information about the person and assess the person’s actual situation.

Case Study #5 concerns a six-year-old child attending a special education school. LIA describes the child’s condition as mild, with no serious behavioural problems, but regards some risks as less certain at that age and illustrates less favourable possible outcomes for total and permanent disability and hospitalisation coverage. The guide also contemplates later reassessment using fresh medical evidence.

However, there are two important gaps.

First, the guide does not clearly state the principle that I consider crucial: an autism diagnosis should not itself be treated as evidence that an applicant has an unrelated psychiatric condition. LIA actually presents anxiety disorder separately elsewhere in the same guide. That is sensible. Anxiety should be assessed when anxiety exists. I would like the industry to make that separation explicit for autistic applicants.

Second, Case Study #5 is expressly described as mild. The guide therefore still does not provide a meaningful worked example showing how insurers should fairly assess an autistic person with high support needs. High support needs should not mean “do not assess”. It should mean that the insurer identifies which particular characteristics are relevant to which particular insured risks, obtains appropriate evidence and explains the resulting decision.

 

Insurance options worth knowing about

I do not maintain a list claiming that particular insurers will definitely accept autistic applicants. Underwriting changes, products change and one person’s experience cannot guarantee another person’s outcome. Nevertheless, some options are worth knowing about.

 

Singlife Multipay Critical Illness

In December 2023, a caregiver told me that her autistic child had obtained Singlife Multipay Critical Illness coverage without additional terms or exclusions. I include this as a community report, not as a representation by Singlife and not as a guarantee of present underwriting.

The product family continues today as Singlife Multipay Critical Illness II. Anyone interested should obtain current policy information and an individual underwriting decision rather than relying on someone else’s experience.

 

Income SpecialCare (Autism)

Income SpecialCare (Autism) was launched in 2013 specifically for autistic people and remains available.

As of the information published by Income in 2026, new insured persons can enter between 15 days and 30 years old, subject to its eligibility requirements, and the policy can be renewed annually up to age 75. It principally provides specified accident, infectious-disease and related benefits rather than functioning as a replacement for comprehensive hospitalisation insurance. The premium rates after factoring in coverage are not competitive compared to other mainstream insurance products. In addition, creating a separate product for autistic people is not the same thing as solving inappropriate exclusion from ordinary products.

 

MINDEF and MHA Group Insurance

Eligible National Servicemen, Operationally Ready National Servicemen, regulars and other eligible personnel should understand the MINDEF and MHA Group Insurance Scheme. From 1 November 2025, core Group Term Life and Group Personal Injury coverage increased to S$350,000 each for eligible insured personnel. Singlife is the appointed insurer, and eligible individuals may have options to purchase additional voluntary coverage.

 

How I would approach an insurance application

My experience has made me more assertive about underwriting, but it has not changed one fundamental rule:

Do not lie to an insurer.

An insurance policy that becomes vulnerable to cancellation or a rejected claim because material information was deliberately concealed defeats the purpose of buying insurance.

  • Answer the questions actually asked, fully and accurately. If you are uncertain whether something must be disclosed, seek clarification rather than inventing a convenient interpretation.
  • Do not manipulate diagnostic terminology. If your medical records say autism, do not call it Asperger’s merely because you think the older term sounds more acceptable to an underwriter. If historical records genuinely use different terminology, explain that accurately where relevant.
  • Describe the individual, not merely the diagnosis. Where relevant and true, provide information about current support needs, independent living, education, employment, medication, hospitalisation history, psychiatric diagnoses, self-harm history and other factors directly related to the insurer’s concerns.
  • Ask what risk the insurer is actually concerned about. If you receive a broad exclusion, ask why each part is considered relevant to you. “Because autism” is not a satisfactory explanation for an unrelated condition.
  • Ask what evidence could change the decision. A short letter from an appropriate professional may sometimes answer the underwriting question. In other cases a fuller report may be useful. Ask before spending thousands of dollars.
  • Keep complete records. Save applications, declarations, medical reports, emails, rejection letters, counteroffers, exclusions and revised terms.
  • Appeal where you have meaningful evidence. LIA’s own guide recognises that applicants may provide additional information and that fresh medical evidence can support reassessment in appropriate cases.
  • Compare insurers. LIA acknowledges that insurers have different underwriting guidelines and risk appetites. An adverse decision from one insurer does not automatically establish what another insurer will decide.
  • Use experienced representatives, but understand the subject yourself. An adviser who has successfully handled applications involving disability or autism may be useful, but professional status does not make every statement made by a representative correct.
  • Do not delay medically appropriate assessment or treatment merely to influence underwriting. I understand exactly why fear of insurance can create that temptation. My argument is that the insurance industry should remove that perverse incentive, not that autistic people should sacrifice appropriate healthcare to work around it.

 

Do not advocate from ignorance

Autistic people, caregivers and advocates also have responsibilities. If we want to challenge insurance underwriting, we should make the effort to understand insurance.

It is easy to be angry about a rejection, exclusion or premium loading. It is harder – and much more useful – to understand underwriting, adverse selection, risk pooling, material disclosure, morbidity, mortality, policy definitions, exclusions, claims, disability definitions and the differences among hospitalisation, critical illness, life and personal accident insurance.

Without that knowledge, legitimate underwriting and questionable underwriting can become mixed together. I want advocates to be able to say: “I understand why underwriting exists. I understand the risk you are trying to price. Now show me the evidence connecting this applicant to this risk.” That is a much stronger argument.

 

You can study the same subject matter as insurance representatives

The Singapore College of Insurance administers regulatory examinations covering the knowledge required for different insurance and financial-advisory activities.

For example, CM-LIP: Life Insurance and Investment-linked Policies, together with RES5: Rules, Ethics and Skills for Financial Advisory Services, forms part of the competency requirements for representatives intending to advise on or arrange relevant life insurance policies. CM-LIP covers subjects including insurance concepts, products, premiums, applications and underwriting. SCI explicitly permits candidates to prepare for the closed-book examination through self-study.

Those particularly interested in medical insurance can also examine the Health Insurance examination. Its syllabus includes healthcare financing, health-insurance pricing, policy provisions, underwriting, disclosure requirements and case studies, and it too allows self-study.

Examination structures, competency rules and fees can change, so check SCI’s current information before registering. Passing an examination does not by itself make someone an authorised financial adviser, but you do not need to sell insurance to educate yourself about it. For someone who intends to spend years advocating about insurance, learning the same technical subject matter studied by industry representatives can be a relatively accessible way to improve the quality of that advocacy.

 

I applied that principle to myself

I do not tell other advocates to educate themselves while exempting myself. I studied insurance and financial planning and eventually obtained a Diploma in Financial Planning from the Singapore College of Insurance. I do not mention the diploma to claim that everything I say about insurance must therefore be correct.

I mention it because I believe advocacy should be informed advocacy. If I tell an insurer that its reasoning is wrong, I want to understand the insurer’s reasoning first. If I criticise an exclusion, I want to understand what an exclusion does. If I challenge underwriting, I want to understand why underwriting exists. We should know the system well enough to challenge the system on its own terms.

 

If you disagree with an underwriting decision

Ask questions. Request the decision and its basis in writing where possible. Identify exactly which condition, evidence or risk factor is causing the problem. Ask whether additional medical evidence could result in reconsideration. If you believe information has been misunderstood, correct it with documentation rather than simply arguing that the outcome is unfair.

If the matter remains unresolved, use the insurer’s formal complaint procedure. LIA’s underwriting guide describes a complaints process and states that complaints should be handled independently and fairly. Where an eligible dispute cannot be resolved with the financial institution, the Financial Industry Disputes Resolution Centre (FIDReC) provides an independent dispute-resolution process involving mediation and, where applicable, adjudication.

Not every underwriting decision will fall within FIDReC’s jurisdiction: for example, its jurisdiction contains limitations concerning commercial decisions. Check its current rules for the particular dispute. Where the concern involves possible regulatory misconduct rather than merely disagreement with a commercial decision, the appropriate regulatory avenue may also differ.

For a dispute involving substantial money or a serious legal issue, obtain advice from an appropriately qualified Singapore lawyer rather than relying on this article.

 

Insurance is only one form of protection

I still believe in the principle behind the old saying that prevention is better than cure. Insurance transfers certain financial risks. It does not prevent the event from happening. Regardless of how much insurance a person can obtain, sensible risk management includes looking after physical and emotional health, avoiding unnecessary hazards, maintaining emergency savings and understanding the protection one already has.

For me, useful precautions include not smoking, avoiding recreational drugs, obtaining appropriate preventive healthcare and dental care, using safer transportation, taking sensible precautions during higher-risk activities, practising safer sex, maintaining supportive relationships and keeping sufficient liquid savings for emergencies.

 

Sources and further reading

Verification reminder: Insurance products, underwriting rules and regulatory requirements can change. Historical experiences and community reports on this page should not be treated as promises of present coverage. Always check current policy documents and provide accurate information when applying.