MyShield Frequently Asked Questions 1. PRODUCT

MyShield
Frequently Asked Questions
1. PRODUCT
1.1
What is MyShield?
MyShield is a Medisave-approved integrated Shield plan which offers additional benefits
on top of what is provided by MediShield. It is a non-participating, guaranteed renewable
annual premium plan denominated in Singapore dollars. It consists of MyShield Plan 1,
Plan 2 and Plan 3.
2. CHANGES TO MEDISHIELD
2.1
What are the changes to MediShield?
The following changes will be introduced to MediShield from 1 March 2013:
a) Increase the coverage age from 85 to 90 years to ensure that our elderly remain
insured as they live longer;
b) Extend coverage to inpatient congenital and neonatal treatment for newly diagnosed
conditions. This will allow all Singapore Citizens born on or after 1 March 2013 to be
covered under MediShield without having to be assessed for pre-existing conditions;
c) Extend coverage to inpatient psychiatric treatment at $100 per day up to 35 days per
year for newly diagnosed conditions, to encourage timely and appropriate treatment
of mental illnesses;
d) Extend coverage to short-stay wards in Emergency Departments;
e) Increase the policy year and lifetime limit from $50,000 to $70,000 and from
$200,000 to $300,000 respectively to better cover members who face exceptionally
large bills;
f) To maintain the scheme’s focus on large bills, increase the Class B2/C deductibles
moderately by $500 from $1,500/$1,000 to $2,000/$1,500 for those aged 80 and
below;
g) Remove the MediShield maximum entry age of 75 to enable healthy, uninsured
elderly to obtain coverage; and
h) Update MediShield premiums in line with the claims experience and to support the
benefit enhancements.
With effect from 1 November 2013, the Medisave withdrawal limits are:
Age Group
(age next birthday)
60 and below
61 – 65
66 – 70
71 – 73
74 – 75
76 – 78
79 – 80
81 – 83
84 – 85
85 – 90
91 and above
Withdrawal limits
$800
$1,000
$1,200
$1,400
You can get full details of the MediShield changes from www.moh.gov.sg
2.2
When will the proposed MediShield changes take effect?
The MediShield changes will take effect on 1 March 2013.
2.3
How would the proposed MediShield changes affect my MyShield plan with Aviva?
As Medisave-approved Integrated Shield Plans are integrated with MediShield,
Singaporeans who are covered under MyShield enjoy the higher of the benefits offered
by MyShield and MediShield. You will enjoy any proposed benefit enhancements where
your Integrated Shield Plan does not currently provide such coverage.
2.4
Why is there a need to increase the premium for MediShield?
As a not-for-profit self-financing insurance scheme, MediShield premiums have to be
adjusted from time to time in line with the latest claims experience. This ensures that the
scheme remains solvent and can continue to fund payouts to policyholders in future.
Since the last premium revision in 2008, the average claim per policyholder had
increased by about 12% per year from 2009 to 2011.
The increase in claims experience was due to:
•
Growing number of claims paid: Since the last revision of deductibles in 2005,
MediShield has been covering more hospital bills than projected. Together with the
rising utilisation of healthcare, the number of claims per policyholder has increased
by 9% per annum.
•
Rising cost of treatment as Singaporeans are receiving higher quality of treatment
due to medical advances, which contributes towards improving patient outcomes.
•
Overall medical inflation at about 3% per annum.
2.5
The notice from CPFB mentioned that the MediShield deductible is $2000.
However, MyShield covers me for a deductible of $3500. How will this difference in
the deductible coverage affect me?
As Medisave-approved Integrated Shield Plans (IP), for example MyShield, are
integrated with MediShield, IP policyholders are also insured under MediShield and
continue to enjoy the higher of the benefits offered under the IP and MediShield. CPF
Board will assess all claims from the IP policyholders and compute MediShield payouts
according to the MediShield benefit schedule, including the lower MediShield deductible.
The final insurance payout will be the higher of either the IP payouts or the MediShield
payouts. CPF Board will forward any MediShield payouts to the private insurer, who will
then pay the hospitals directly. As such, the IP policyholders will also benefit from the
lower MediShield deductible.
2.6
Is there a minimum number of hours of stay in the emergency ward before a
patient will be put into a short-term ward?
There is no minimum number of hours of stay in the emergency ward before a patient
can be admitted into a short-stay ward. The attending doctor decides when to admit the
patient.
2.7
For the short-stay wards for psychiatric treatment, does the hospital treat each
stay in the short-stay ward as 1 day towards the 35-day annual cap?
Yes, short-stay wards for psychiatric treatment will be covered as well and will count
towards the 35-day annual cap under the inpatient psychiatric benefit.
2.8
Why is the coverage only extended to psychiatric conditions diagnosed on or after
the implementation date of 1 March 2013?
This approach is aligned with the principle of insurance of helping members pool their
risks against unknown health conditions. If your condition was diagnosed prior to the
extension in cover (and hence considered pre-existing) on 1 March 2013, the condition
will not be covered under MediShield. Needy patients can continue to approach the
Medical Social Workers at public hospitals for assistance through other avenues.
2.9
I am not covered under MediShield and am older than the entry age of 75 to join
MediShield. Can I still apply to join the scheme?
In response to public feedback, the MediShield maximum entry age limit of 75 has been
removed to enable healthy, uninsured elderly persons to obtain coverage. Hence, you will
be able to apply to join the scheme. Similar to all applicants, entry into the scheme will be
subject to your good health.
However, the maximum entry age limit of 75 will still be applicable for MyShield. You will
not be able to obtain cover for MyShield if you have exceeded the maximum entry age of
75.
2.10
My MediShield cover expired in June 2012 due to the maximum entry age limit. I
am undergoing surgery for a medical condition which was previously payable
under my old MediShield cover in January 2013. Am I able to claim for this
surgery?
For members whose MediShield cover expired due to the maximum age limit, MediShield
will only cover treatment that takes place after the extension of cover from 1 March 2013.
3. BASIC PLAN FEATURES
3.1
What are the key differences between the current MyShield and the new MyShield
that takes effect from 1 March 2013?
There will be changes to the premium rates, the key differences of benefits between the
plans:
No
Current MyShield
New MyShield
1
No coverage of Accident & Emergency
Treatment under Pre-Hospital Specialist
Consultation.
We will cover Accident and Emergency
(A&E) Treatment given within 24 hours prior
to hospitalisation.
This benefit will be renamed as “PreHospital Specialist’s Consultation and
Accident and Emergency (A&E) Treatment.”
2
Cornea is not covered under Surgical
Benefits for Major Organ Transplant.
We will include Cornea into the Surgical
Benefits for Major Organ Transplant benefit.
3.
Inpatient Congenital Anomalies (after
waiting period of 24 months). Benefit is as
charged
(i) Inpatient Congenital Anomalies (after
waiting period of 24 months). Benefit is as
charged.
(ii)
Inpatient
Congenital
Anomalies
excluding Surgical Benefits (first diagnosed
within waiting period of 24 months). Surgical
fees are not payable. Refer to the table
below for benefit
Plan 1
Plan 2
Plan 3
Up to $450 per day or S$900 per day for
Intensive Care Unit
4.
Inpatient Psychiatric Treatment (after 10
months of continuous coverage) (per policy
year). Benefit is as charged for Plan 1 and
2 up to 60 days and 45 days respectively.
No
Inpatient
Psychiatric
Treatment
coverage for Plan 3.
(i) Inpatient Psychiatric Treatment (after 10
months of continuous coverage) (per policy
year). Benefit is as charged for Plan 1 and
2, up to 60 days and 45 days respectively.
$100 per day up to 35 days for Plan 3.
(ii) Inpatient Psychiatric Treatment (within
10 months of continuous coverage) (per
policy year).
Refer to the table below for benefit
Plan 1
Plan 2
Plan 3
Up to $100 per day up to 35 days
5
Pro-ration Factor
For Plan 2 and 3, we will revise the proration factors for the insured person who is
admitted to a ward/ hospital higher than his
entitlement
under
the
policy.
Here are the revised pro-ration factors:
Pro-ration
factor
Private
Hospital/
Medical
Institutions and
Hospitals
outside
Singapore
Restructured
Hospitals
–
Class A
Unsubsidised
wards
in
Community
Hospitals
MyShield
Plan
Plan
1
2
N.A.
N.A.
N.A.
65%
N.A.
N.A.
Plan
3
50%
85%
85%
Pro-ration factor
Private Hospital/
Medical
institutions
and
Hospitals outside
Singapore
Restructured
Hospitals – Class
A
Unsubsidised
wards
in
Community
Hospitals
MyShield
Plan
Plan
1
2
Plan
3
N.A.
50%
35%
N.A.
N.A.
85%
N.A.
N.A.
85%
6
Annual Deductible
The Annual Deductible will be increased
due to regulation requirements:
Annual deductible restarts once
policy year
Annual
Deductible
for Insured
Persons
80 years
and below
age next
birthday.
C
Class
Ward
B2 Class
Ward
B1 Class
Ward
A1 Class
Ward/
Private
Hospital
and
Hospital
outside
Singapore
Day
Surgery
7
9
3.2
crosses
MyShield
Plan 1
Plan 2
Plan 3
S$1,000
S$1,000
S$1,000
S$1,500
S$1,500
S$1,500
S$2,000
S$2,000
S$2,000
S$3,000
S$3,000
S$3,000
S$3,000
S$3,000
S$2,000
Policy provisions
(A) General Conditions 5 and
(B) Section II – Limits of Liability
(C) Section III- Covered Benefits
(D) General Exclusions
Premium age bands for below 30
16
If hospitalisation for the same injury or
illness period, including Pre- and PostHospitalisation
Follow-up
Treatment,
crosses over 2 policy years, we will only
apply one deductible.
Annual
Deductible
for Insured
Persons
80 years
and below
age next
birthday.
C
Class
Ward
B2 Class
Ward
B1 Class
Ward
A1 Class
Ward/
Private
Hospital
and
Hospital
outside
Singapore
Day
Surgery
MyShield
Plan 1
Plan 2
Plan 3
S$1,500
S$1,500
S$1,500
S$2,000
S$2,000
S$2,000
S$2,500
S$2,500
S$2,500
S$3,500
S$3,500
S$3,500
S$3,000
S$3,000
S$2,000
Reworded the following sections in the
policy provisions for clarity
(For details, please refer to the renewal
letter)
The premium for age 1- 20, and 21 – 30 to
be aligned with MediShield.
Why is there an increase in the premium in the new MyShield?
The recent changes to MediShield (effective 1 March 2013), also impact the benefits and
premiums of MyShield as well.
The revision to MyShield premiums is also due to the latest claims experience. It is
important to support the healthcare landscape in Singapore- such as medical inflation
and health issues which have led to an increase in number of claims and average payout
per policyholder.
3.3
When will the new MyShield take effect?
The new MyShield takes effect on 1 March 2013.
3.4
What are the changes to the pro-ration factor?
There is an adjustment to the pro-ration factor for Plan 2 and 3 in order to manage claims
experience.
Pro-ration Factor
Private Hospitals/
Medical institutions and Hospitals outside
Singapore
Restructured Hospitals - Class A
Unsubsidised wards in Community Hospitals
3.5
Plan 1
Plan 2
Plan 3
N.A.
50%
35%
N.A.
N.A.
N.A.
N.A.
85%
85%
Are there further changes to the pro-ration factor for private hospital?
From 1 March 2013, we had a pro-ration factor for other private hospitals. We will be
removing this pro-ration factor for other private hospitals with effect from 1 July 2013.
This enhancement will impact the customers whose MyShield plan are newly incepted
from 1 March 2013, and existing customers whose MyShield are renewed from 1 March
2013.
3.6
Do I need to inform Aviva if I want to change to the new MyShield?
No. For existing customers, we will inform them of the new MyShield at least 30 days
before their next renewal. They will be automatically upgraded to the new MyShield upon
the policy renewal unless they have informed us otherwise.
3.7
Can I add in riders to cover for deductible and co-insurance?
Yes, you can choose to complement MyShield by getting MyShield Plus Option A or
Option C.
3.8
Can MyShield Plus be added after commencement of MyShield policy?
Yes, Please contact us at 6827 7788 or your financial advisor for assistance.
3.9
How do I know if I am covered under the new MyShield?
For new applicants:
For applications of MyShield and MyShield Plus that are incepted on or after 1 March
2013 will enjoy the enhanced benefits immediately.
For existing policyholders:
For existing policies that are incepted before 1 March 2013, they will be automatically
enhanced to the new MyShield and/ or MyShield Plus at their next policy renewal date.
3.10
Will I still enjoy “as charged” cover under MyShield Plan 1 when I am admitted to a
private hospital?
Yes, you will continue to receive the benefits without any pro-ration if you are admitted to
any of the Private Hospitals.
3.11
Will the Free Coverage for Children Benefit be available in the new MyShield?
Yes, the Free Coverage for Children Benefit under MyShield is still available.
4. NEW APPLICATION
4.1
Am I eligible to purchase MyShield?
Any Singapore Citizen or Singapore Permanent Resident may apply as an Insured
Person, provided the Insured is a Singaporean or Singapore Permanent Resident with a
CPF Medisave account.
For dependant(s), they need not be a Singapore Citizen or Singapore Permanent
Resident but must be residing in Singapore to enjoy this coverage. Dependants are
defined to be the Insured’s legal spouse, parent(s) or grandparent(s) and/or biological or
legally adopted children.
Note: For Plan 3, only Singapore Citizens may apply.
Minimum
Age (ANB)
Insured/ Proposer (Payer)
Insured
Person/
Dependant
4.2
Entry
17
15 days old or the
date of discharge
from Hospital after
birth, whichever is
later
Maximum
Entry
Age
(ANB)
75
75
Expiry Age
NA
NA.
As
the
product
offers
lifetime cover
How do I sign up MyShield?
Please contact us at 6827 7788 to arrange for a financial advisor to get in touch with you.
4.3
Can I purchase MyShield if I do not have MediShield?
Yes, you will be automatically covered for MediShield upon insuring for MyShield. The
exception is for non-Singaporeans or non-Singapore Permanent Residents who are not
eligible for MediShield.
4.4
Can I purchase more than one Integrated Shield Plan with Medisave?
Medisave can be used to pay the premiums of only one Medisave-approved schemeMediShield (standalone) or Integrated Private Medical Insurance Scheme (IPMIS).
4.5
What happens to my Integrated Shield Plan from another private insurer if I sign up
MyShield?
Your existing Integrated Shield Plan will be automatically cancelled upon acceptance by
Aviva and the pro-rated premiums for the terminated plan will be refunded to the
customer’s Medisave account. Upon commencement of MyShield, the premiums will also
be deducted from your Medisave account.
4.6
If my spouse and I have existing MyShield policies, do we have to wait until our
policy’s anniversary date before applying for coverage for our newborn child?
Parents can enjoy the free child coverage at anytime without the need to wait for the
policy anniversary date.
To sign up MyShield for your child, please contact us at 6827 7788 or your financial
advisor for assistance.
4.7
What are the advantages of signing up for child(ren) coverage?
If your child(ren) is/are 20 years old age next birthday and below, up to a maximum of 4
children will be covered for free under MyShield Plan 2 provided both the you and your
spouse have signed up and are accepted for MyShield Plan 1 or 2.
4.8
Can I opt not to be covered under MyShield but only purchase for my
dependant(s)?
Yes, you may purchase MyShield for dependant(s) without coverage under MyShield for
oneself.
Please contact us at 6827 7788 or contact your financial advisor for assistance.
4.9
Can I choose to commence the coverage on any dates?
It is MOH requirement that all the Medisave-approved Integrated Shield Plans (IPs)
st
commence on 1 day of every month.
4.10
What are the underwriting options available for MyShield?
The applicant can choose to have Full Medical Underwriting or Moratorium Underwriting
subjected to the terms stipulated in the application form
Please contact us at 6827 7788 or contact your financial advisor for more details.
4.11
What is Moratorium Underwriting?
With Moratorium Underwriting, applicants are not required to make any medical history
declaration. This underwriting method has been available since 1 Sep 2007.
Under Moratorium Underwriting, no underwriting is required. Any new, unexpected
medical conditions arising after the start of insured person’s coverage will be covered,
subject to the terms and conditions of the Policy.
Other than the list of permanently excluded Pre-Existing Conditions, Pre-existing
Conditions can be covered after a continuous period of 5 years from the coverage start
date or reinstatement date or date of upgrade, whichever is later, provided the Insured
Person has NOT in respect of that particular pre-existing condition:
•
•
•
•
experienced symptoms or;
sought advice or tests from a Physician or Specialist or Alternative Medicine Provider
(including checkups for that medical condition) or;
required treatment or medication or;
received treatment or medication
If at any time, during the 5-year Moratorium, the Insured Person undergoes any of the
above, then that particular Pre-Existing Condition shall be permanently excluded under
MyShield policy.
4.12
What is the list of pre-existing conditions that are permanently excluded under the
Policy if I have chosen the Moratorium Underwriting option?
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
4.13
Heart attack, heart bypass, angioplasty
Chronic obstructive lung disease, chronic corpulmonale, pulmonary hypertension
Stroke
Liver cirrhosis
Paralysis
Osteoporosis
AIDS or HIV infection
Thalassaemia Intermediate/ major
Diabetes with complications such as protein in urine or eye problem
Kidney failure
Organ transplantation
Systemic lupus erythematosus (SLE)
Muscular dystrophy
Multiple sclerosis
Alzheimer’s disease
Dementia
Any form of Cancer (other than skin cancer)
Autism
What is Full Medical Underwriting?
Full Medical Underwriting is the common underwriting practice for health insurance plans.
With Full Medical Underwriting, the applicant is required to declare his / her medical
history by fully disclosing the medical history before the date of application for the policy.
The cover offered will be based on his / her medical history.
This underwriting option is available for new applicants of MyShield as an alternative to
Moratorium Underwriting.
4.14
Is a medical checkup required for Full Medical Underwriting?
Depending on the information required to assess the risk, the underwriter may request
the insured person to provide past and/or recent medical reports. The cost of medical
report will be borne by the insured person.
4.15
I have applied for MyShield and was recently hospitalised. Do I need to inform
Aviva?
You will need to inform us about any change in health conditions (including accidents or
illnesses), before your application is approved and/or commences.
5. PREMIUMS & PROCEDURES
5.1
Will I be informed when MyShield is due for renewal?
MyShield is a guaranteed renewal plan subject to premium payment. A renewal notice will
be sent to inform the customer of the revised renewal premium. There will be an
arrangement to deduct the annual premium from the designated Medisave account.
If the Medisave account has insufficient funds for the renewal premium, a notification
letter will be sent to arrange for the necessary premium top-up.
5.2
How do I know if my policy has been renewed?
As long as you did not initiate any termination request, the policy is deemed to be
automatically renewed upon expiry (subject to the full payment of premium).
The annual premium deduction will be reflected in your Yearly CPF Statement.
5.3
What are the available frequencies of payment?
MOH allows only annual payment for all Medisave-approved Integrated Shield Plans
(IPs)
5.4
What premium payment methods are available?
Premiums will be deducted in full from the designated Medisave Account. In the event the
annual premium exceeds the maximum Medisave withdrawal amount allowed for a
Medisave approved Integrated Shield Plan, or the balance in the designated Medisave
Account is insufficient to pay the full annual premium, you can pay the top-up premium in
excess of the maximum withdrawal limit via cash/ cheque/ credit card/ GIRO.
For initial premium payment method, you can pay the top-up premium in excess of the
maximum withdrawal limit via cash/ cheque/ credit card.
For renewal premium payment method, you can pay the top up premium in excess of the
maximum withdrawal limit via GIRO/ credit card. To apply for GIRO, you are required to
complete our Application for Interbank GIRO form
5.5
When is the Medisave deduction date?
The deduction takes place on 22
CPFB.
5.6
nd
of the policy renewal month which is a preset date by
When is the GIRO deduction date?
th
The first deduction takes place on 7 of the renewal month. If the first deduction fails,
th
there will be a second deduction on the 20 of the same month
5.7
Are the premium rates guaranteed?
Rates are not guaranteed and are subject to regular review. However, individuals will not
be penalised for individual poor claims experience or ill health.
5.8
How long is the grace period for renewal of MyShield?
The grace period for payment is 60 days from the due date. If no premium is paid, the
policy will be lapsed
5.9
How do I update my personal particulars?
You are required to submit the Request for Changes to Individual Health Policies form.
The form is available on Aviva’s corporate website
5.10
How do I change to a higher or lower plan?
Please contact us at 6827 7788 or your financial advisor for assistance.
5.11
Can do I change the plan during the course of insurance?
Please contact us at 6827 7788 or your financial advisor for assistance.
5.12
How long is the free look period?
For MyShield, the free-look period is within two months from the policy commencement
date or 14 days from the date of receipt of the policy, whichever is later.
5.13
Will there be a pro-rated refund of premium if I choose to terminate the policy
early?
There will be a pro-rated refund of the annual premium for the unexpired period of
coverage.
5.14
How soon is the pro-rated refund transferred back to Medisave upon cancellation
of policy?
The refund takes up to 3 months
5.15
What happens if I am no longer a Singaporean?
Regardless of the status of your citizenship, your MyShield cover is automatically
renewed by payment of the renewed premium before the Renewal Date.
We will request for deduction of the premium from the designated CPF Medisave Account
subject to the withdrawal limit set by CPF. Any shortfall in premium due to insufficient
funds in the designated CPF Medisave Account must be paid before the Policy can be
renewed.
We may continue to provide coverage under MyShield as long as premium can be
deducted from the payer’s Medisave Account
MediShield will be terminated once CPF Board has received your application to renounce
your citizenship and withdraw all your CPF monies due to the renunciation of your
citizenship. This will lead to an automatic termination of MyShield when we are unable to
deduct premium from your then closed CPF Medisave Account.
6. CLAIMS
6.1
How do I make a claim?
This guide below shows how a claim can be made when you are hospitalised or need a
day surgery.
•
•
•
On the day of hospital admission / surgery, inform the hospital/clinic of your intention
to file a claim under MyShield.
You will be asked to fill up the Claim Form For Medisave-Approved Integrated Plan at
the hospital/clinic. The hospital/clinic will send your claim to Aviva within 2 weeks
hospital discharge. We will administer all payouts and inform you on the outcome of
the claim. This will include the MediShield claim if the customer is also covered under
MediShield. We will be your single point of contact and service.
Once Aviva receives your claim, we will do our assessment to decide if it is payable,
not payable or require further information
•
•
From the assessment, you may be informed by Aviva to furnish additional
requirement. Upon advice by Aviva, please furnish us with required document /
information soonest possible so as we can process the claim.
After we have completed assessment of the claim, we will pay the claimable amount
to the hospital / clinic. If you have made any payment to the hospital / clinic, relevant
refund will be made by the hospital / clinic to you or your Medisave account (if
applicable).
If you are covered under MyShield Plus, Aviva will automatically assess this benefit
together with MyShield and pay the relevant claimable amount to you or hospital/ clinic,
where applicable. However if there are outstanding requirements for your MyShield Plus
policy, Aviva will assess only your MyShield claim first and update you accordingly on
your MyShield Plus claim.
6.2
If I am not a Singaporean or Permanent Resident, how do I make a claim?
You will not be required to submit via the online claims system (E-file). You will have to
settle the bill with the hospital first, then seek reimbursement from Aviva with the original
final hospitalisation bill, discharge summary/available medical reports and complete the
Retail
and
Individual
Medical
Form
obtained
from
our
website
http://www.aviva.com.sg/customer-care/life-and-health/make-a-claim/
6.3
How will claims be computed since CPF Board and Aviva are jointly insuring me?
The final payout of the PMIS is based on the higher of benefits under MyShield or
MediShield. If MediShield payout is more than that of the MyShield, claim is fully paid by
MediShield.
There will only be a single point of contact with Aviva, and thus there is no need to file
two separate claims.
6.4
If I failed to make the claim during the hospital stay, can I still do so after
discharge?
You can do so by returning to the hospital to activate a MyShield claim. You will be asked
to complete the Claim Form For Medisave-Approved Integrated Plan which allows the
hospital to send the hospital claim to Aviva for assessment. There is an administrative fee
for late submission. You should always file your MyShield claim upon admission to the
hospital even if medical benefits are provided by your employers or other medical
insurance. This ensures easier claims processing and help you avoid paying any
administrative fee charged by the hospital.
6.5
I am admitted into a hospital overseas - how do I submit the claim?
MyShield covers for any Inpatient treatment due to a Medical Complaint outside
Singapore. A Medical Complaint outside Singapore refers to a medical condition that
requires immediate attention by Physician to identify or treat an injury or illness.
You have to settle the bill with the hospital first, then submit the original bill together with
a medical report and Aviva’s Claim Form (Medical Insurance Claim Form obtained from
our website) to seek reimbursement from Aviva.
However, any Pre & Post-Hospitalisation bills incurred are not covered, regardless of
where the Pre and Post-hospitalisation treatment is received
6.6
Is medical report required for all claims?
No. If medical report / additional document is required, Aviva will apply on your behalf and
we will pay for the cost of medical report obtained.
6.7
Are annual deductible and co-insurance applied to all claims?
Annual deductible is not applied to claims under outpatient catastrophic treatment. Coinsurance is applied to both inpatient and outpatient claims.
6.8
How does the pro-ration factor work?
It is the percentage as expressed in the Benefit Schedule which will be applied on the
hospital bills (including pre- and post- hospital treatment) incurred. It will be used in the
event that the insured person is admitted to a ward/hospital higher than what he/she is
entitled to under his / her policy. The pro-ration factor is not applicable to Plan 1.
Example 1 (MyShield Plan 2 without MyShield Option A or C)
Madam Tan was hospitalized for 10 days for surgery. She was admitted to Thomson
Medical Centre. A 50% pro-ration is applied to the bill before deductible and coinsurance.
Private hospital
Thomson Medical Centre
Pro-ration
Deductible
Co-insurance
MyShield pays
Policyholder pays
Amount
$20,000
$20,000 X 50% = $10,000
$10,000 - $3,500 = $6,500
$6,500 X 10% = $650
$5,850
$14,150
Example 2 (MyShield Plan 1 with MyShield Option C)
Madam Fatimah was hospitalized for 10 days for surgery. She was admitted to Thomson
Medical Centre. No pro-ration is applied as Madam Fatimah stay within her entitled ward.
Private hospital
Thomson Medical Centre
Pro-ration
Deductible
Co-insurance
MyShield pays
MyShield Plus Option C pays
Policyholder pays
Amount
$20,000
NIL
$20,000 - $3,500 = $16,500
$16,500 X 10% = $1,650
$ 14,850
$1,650 (co-insurance) + $3,500 (Deductible)
$0
If the Insured Person is admitted to a ward/hospital that is the same or lower than what
the Insured Person is entitled to under the Policy but their Pre-Hospital Specialist’s
Consultation and Accident and Emergency (A&E) Treatment, Pre-Hospital Diagnostic and
Laboratory Services or Post-Hospital Follow-up Treatment is in a hospital or clinic higher
than what the Insured Person is entitled to, we will apply the Pro-ration Factor to the PreHospital Specialist’s Consultation and Accident and Emergency (A&E) Treatment, PreHospital Diagnostic and Laboratory Services or Post-Hospital Follow-up Treatment as
specified in the Benefits Schedule.
If, during hospitalisation, there is a change of ward, we will base on the ward immediately
before the discharge to determine whether the Pro-ration Factor should be applied to the
hospital bills.
For avoidance of doubt, the Pro-ration Factor is only not applicable to expenses incurred
in:
a) a Singapore Restructured Hospital for Outpatient Catastrophic Treatments, day
surgery, Pre-Hospital Specialist’s Consultation and Accident and Emergency (A&E)
Treatment, Pre-Hospital Diagnostic and Laboratory Services and Post-Hospital
Follow-up Treatment; or
b) a subsidised dialysis or cancer centre in Singapore for Outpatient Catastrophic
Treatments.
If the Insured Person stays in a room that is more expensive than the standard room
covered under the covered plan, we will pay the minimum of the Reasonable and
Customary charges or the prorated amount of the total bill, whichever is lower. The
prorated amount of the total bill is calculated by using the following formula:
Standard room charge
------------------------------- X
Incurred room charge
total bill
For Plan 1, the standard room charge shall be based on the standard single-bedded (A1)
ward in Mount Elizabeth Hospital.
For Plan 2, the standard room charge shall be based on the standard A1 ward in
Singapore General Hospital.
For Plan 3, the standard room charge shall be based on the standard B1 ward in
Singapore General Hospital.
6.9
My company provides me with a private medical insurance cover. Can I still claim
under MyShield or MediShield? What is the process?
Yes, you can. You are required to file the claim under MyShield policy upon admission to
hospital. You will need to complete the Claim Form For Medisave-Approved Integrated
Plan (provided by the hospital) and note that submission is via the online claim system, in
which Aviva will receive the claim. Therefore you do not have to manually submit any
documents to Aviva. After the settlement of the MyShield policy, you will receive the
original tax invoice from the hospital. Thereafter, you can submit the original final tax
invoice to your group insurer/ other medical insurance company where they will work out
the relevant amount and reimburse Aviva for their share. Aviva will reinstate the benefit
that was utilized based on the payment we received.
Should you not make the claim in this order and the Group medical insurer has paid
directly to the hospital, we will pay the balance of the claim under MyShield or the
expense incurred, whichever is lower. You need to be aware that if you choose not to
submit E-file the claim and only wish to claim the balance from MyShield, we will still
request for the claim to be submitted through the online claim system because Aviva
and/or Medishield will be the payers of the balance benefits where applicable.
This means that you must return to the hospital to E-file the claim and be charged an
administrative fee. We urge you to E-file through the online claim system. Even if the
Group Insurance guarantees full or partial payment, he or she can still submit via the
online claim system. Another advantage is that MyShield will pay for the GST that’s not
payable under Group Insurance. If you have your own private medical insurance (not
company/employer), the process on reimbursement is similar.
6.10
Can I seek reimbursement on the GST portion on my bill?
Any GST paid in Singapore on medically necessary service or supply is covered under
the policy provided the claim is admissible.
6.11
Are complications arising from premature births considered as congenital
anomalies, and covered under MyShield and/or MyShield Plus?
Complications arising from premature births may not necessarily be congenital
conditions, and may be covered under other benefits.
MyShield and MyShield Plus currently also do not cover newborns from Day 1.
Coverage for newborn babies can only be applied 15 days after birth. Hence, any
conditions that are diagnosed prior to that policy inception will be subject to underwriting.
6.12
Is stem cell transplant covered?
Yes. It is covered under Surgical Benefits for Major Organ Transplant, subject to the
general exclusions.
6.13
Is hospice care covered?
No. The general exclusions include exclusion for ‘private nursing charges and nursing
home services’ (General Exclusion 5) as well as ‘rest cures and services or treatment in
any home, spa, hydro-clinic, sanatorium or long-term care facility that is not a hospital’
(General Exclusion 7).
6.14
Is Stereotactic Radiotherapy covered?
Yes. It is covered under benefits for Outpatient Cancer Treatment, subject to the general
exclusions.
6.15
How is day surgery defined?
Day surgery is defined as surgical procedures done as an outpatient, i.e. with no hospital
confinement required.
6.16
If the customer claims for inpatient treatments for congenital anomalies during the
waiting period of 24 months, the claimable limit is $450/day (or $900/day for ICU).
Will Aviva work out the balance of the bill with MediShield?
Yes. For all benefits, Aviva will be the single point of contact for administration of claims,
and will pay the higher benefit of MyShield or MediShield.
6.17
How do I file claims for Pre- or Post-Hospital treatment bills?
Simply mail the original Pre or Post-Hospital treatment bills to Aviva for claims
assessment. Upon receipt of the bills, Aviva will assess and pay any claimable amount to
the client by cheque.
6.18
Do I need to make any payment or deposit at the hospital when filing the claim
under MyShield?
If you are eligible for Aviva’s Electronic Letter of Guarantee (eLOG) at participating
hospitals, no upfront hospital payment or deposit is required up to $10,000. Otherwise,
the hospitals may still request client to pay a deposit or full payment upon admission or
discharge. Any amount payable under MyShield will be refunded by the hospital to you
after Aviva has fully completed the claims assessment process. Further LOG exceeding
$10,000 is subject to further approval by requesting through the hospital.
6.19
What are the eligibility criteria for Aviva’s eLOG?
To be eligible, the estimated bill size has to be above Deductible and reason for the
hospitalisation or surgery does not fall within the following list of pre-excluded conditions:
•
•
•
•
•
•
Pregnancy or childbirth
Self inflicted injury or suicidal attempt
Congenital or birth defect
Cosmetic surgery or treatment
Infertility, sterilisation, impotence, sexual dysfunction, sex change operations
Treatment for weight reduction or weight improvement
Do note that if your admission is for a condition that was specifically excluded
(substandard terms) by Aviva after underwriting, the eLOG can still be issued. After we do
our assessment, we will reject the claim as it is excluded. If the admission was for a
different condition, the claim will be admitted (assuming it is not a pre-existing condition).
If the Insured Person is a foreigner, he/she will not be eligible for Aviva’s eLOG.
6.20
How does the eLOG benefit work? Does it mean with eLOG the hospitalisation is
cashless?
In the event that the insured is unable to pay the upfront cash deposit or the Medisave
account of the insured or family member is insufficient to cover the deposit required by
the hospital, the eLOG will be used to request the hospital to waive the admission
deposit, up to $10,000
Upon admission or on the day of surgery, the hospital staff will check whether you are
eligible for eLOG by verifying through the eLOG system. eLOG allows the waiver of
hospital deposit required by the hospital in the event of a hospitalisation or surgery at
participating hospitals if the claimant’s estimated medical bill is above the plan deductible.
If the insured is covered under MyShield only (without MyShield Plus), the annual
deductible and coinsurance will not be included in the eLOG. Upon issuance of the
eLOG, the insured is still required is still required to bear the deductible and coinsurance.
Do note that the eLOG is subject to acceptance by the hospital and does not guarantee a
waiver of deposit. At the time of discharge, the hospital may require the insured to fully
settle the hospitalization bill despite eLOG being issued.
While we provide this facility to our customers to ease the admission process (so no
upfront cash is required up to the eligible amount approved by the eLOG system), Aviva
has the right to review each claim submitted after discharge. If the claim is payable, Aviva
will be responsible for the eligible claim amount. If the claim is not payable, Aviva or the
hospital will request any amount not covered under the policy.
6.21
Which are the participating Hospitals providing LOG?
Restructured Hospital
Alexandra Hospital
Changi General Hospital
Khoo Teck Puat Hospital
KK Women’s and Children’s Hospital
National University Hospital
Singapore General Hospital
Tan Tock Seng Hospital
Private Hospital
Fortis Colorectal Hospital
Gleneagles Hospital
Mount Alvernia Hospital
Mount Elizabeth Hospital
Parkway East Hospital
Novena Surgery Pte Ltd
Mount Elizabeth Novena Hospital
Thomson Medical Centre
Raffles Hospital
This e LOG service is subject to these key terms and conditions:
a) The hospital may require you to fully settle the bill despite eLOG being issued
b) eLOG will not be issued if the patient’s estimated medical bill is below the plan’s annual
deductible amount or the medical condition to be treated is an exclusion defined in the
policy document.
c) Annual Deductible and / or Co-Insurance would not be included in the eLOG, unless the
patient is also covered under MyShield Plus Option A and / or B or C
d) eLOG is not a policy benefit and is not part of your MyShield policy document.
e) The issuance of an eLOG is subject to Aviva’s review and discretion. It does not mean
that Aviva approves or admits any claim made under your MyShield and / or MyShield
Plus policy contract or any claim amount payable (if at all) in respect of any such claim.
Aviva will assess the claim upon receipt of the bill from the hospital.
f) No employer or third party insurer has provided any Letter of Guarantee.
6.22
How long does it take for Aviva to process the eLOG request?
The hospital staff can generate Aviva eLOG instantly by logging into eLOG system.
6.23
Does Aviva provide LOG for non-participating hospitals?
No, we do not provide LOG for non-participating hospitals. Claims will be solely on
reimbursement basis. However, the hospital can still help to e-file the claim for the
customer.
6.24
How do I file an Interim Cover claim?
You have to submit the original hospital bills together with the duly complete Medical
Claim Form for us to assess the Interim Cover claim. A copy of the Claim Form may be
downloaded from Aviva’s web-site: http://www.aviva-singapore.com.sg and Resource
Centre in AOL. Alternatively, you can obtain from our Customer Service at 6827 7788.