MyShield Frequently Asked Questions

Transcription

1 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 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 Withdrawal limits (age next birthday) 60 and below $ $1, $1, $1, and above You can get full details of the MediShield changes from

2 2.2 When will the proposed MediShield changes take effect? The MediShield changes will take effect on 1 March 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 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.

3 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 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 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 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 Pre- Hospital 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.

4 (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 Plan 3 N.A. 65% 50% N.A. N.A. 85% N.A. N.A. 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%

5 6 Annual Deductible Annual deductible restarts once crosses policy year The Annual Deductible will be increased due to regulation requirements: If hospitalisation for the same injury or illness period, including Pre- and Post- Hospitalisation 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$1,000 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 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 7 Policy provisions (A) General Conditions 5 and 16 (B) Section II Limits of Liability (C) Section III- Covered Benefits (D) General Exclusions Reworded the following sections in the policy provisions for clarity (For details, please refer to the renewal letter) 9 Premium age bands for below 30 The premium for age 1-20, and to be aligned with MediShield. 3.2 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.

6 3.3 When will the new MyShield take effect? The new MyShield takes effect on 1 March 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 Plan 1 Plan 2 Plan 3 Private Hospitals/ Medical institutions and Hospitals outside N.A. 50% 35% Singapore Restructured Hospitals - Class A N.A. N.A. 85% Unsubsidised wards in Community Hospitals N.A. N.A. 85% 3.5 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 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 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 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 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.

7 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 Entry Maximum Expiry Age Age (ANB) Entry Age (ANB) Insured/ Proposer (Payer) NA Insured Person/ 15 days old or the 75 NA. As the Dependant date of discharge product offers from Hospital after lifetime cover birth, whichever is later 4.2 How do I sign up MyShield? Please contact us at 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 scheme- MediShield (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?

8 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 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 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 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) commence on 1 st day of every month 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 or contact your financial advisor for more details 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 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.

9 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? 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 4.13 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 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 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.

10 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 nd of the policy renewal month which is a preset date by CPFB. 5.6 When is the GIRO deduction date? The first deduction takes place on 7 th of the renewal month. If the first deduction fails, there will be a second deduction on the 20 th 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 or your financial advisor for assistance.

11 5.11 Can do I change the plan during the course of insurance? Please contact us at or your financial advisor for assistance 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 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 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? 6. CLAIMS 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. 6.1 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

12 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 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?

13 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 Amount Thomson Medical Centre $20,000 Pro-ration $20,000 X 50% = $10,000 Deductible $10,000 - $3,500 = $6,500 Co-insurance $6,500 X 10% = $650 MyShield pays $5,850 Policyholder pays $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 Amount Thomson Medical Centre $20,000 Pro-ration NIL Deductible $20,000 - $3,500 = $16,500 Co-insurance $16,500 X 10% = $1,650 MyShield pays $ 14,850 MyShield Plus Option C pays $1,650 (co-insurance) + $3,500 (Deductible) Policyholder pays $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 Pre- Hospital Specialist s Consultation and Accident and Emergency (A&E) Treatment, Pre- Hospital 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.

14 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 total bill Incurred room charge 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.

15 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 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 Is stem cell transplant covered? Yes. It is covered under Surgical Benefits for Major Organ Transplant, subject to the general exclusions 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) Is Stereotactic Radiotherapy covered? Yes. It is covered under benefits for Outpatient Cancer Treatment, subject to the general exclusions How is day surgery defined? Day surgery is defined as surgical procedures done as an outpatient, i.e. with no hospital confinement required 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 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 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

16 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 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 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.

17 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 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 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 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: and Resource Centre in AOL. Alternatively, you can obtain from our Customer Service at