MyShield Plus Frequently Asked Questions 1. PRODUCT DESCRIPTION 1.1 What is MyShield Plus? MyShield Plus provides complementary protection to MyShield by specifically reducing the gap in coverage due to compulsory deductibles and co-insurance. It meets the needs of customers who wish to reduce the uncertainty of out-of-pocket expenses in their MyShield coverage. Only customers who have MyShield coverage are eligible to purchase MyShield Plus. 2. PLAN FEATURES 2.1 Why do I need to purchase MyShield Plus Option A and C cover? You may complement MyShield by adding MyShield Plus Option A or C. 2.2 Why is there a need to increase the premium for MyShield Plus? The recent changes to MediShield effective 1 March 2013, also impact the benefits and premiums of MyShield Plus as well. As in the case of MyShield, the revision to MyShield Plus premiums is also due to the latest claims experience. It is important to support the healthcare landscape in Singapore- which has been changing and developing due to reasons such as medical inflation and health issues which have led to an increase in number of claims and average payout per policyholder. For renewal premiums, it may also change depending on 2 factors: (i) the Insured Person s age next birthday at renewal whether it crosses over to the next age band; and (ii) the plan option the Insured Person purchased. 2.3 When will the new MyShield Plus take effect? The new MyShield Plus takes effect on 1 March 2013. 2.4 What are the key differences between the current MyShield Plus and the new MyShield Plus? There will be changes to the premium rates to MyShield Plus. Here are the key differences of benefits between the plans: No Current MyShield Plus New MyShield Plus 1 Customers are required to inform us of any material changes relating to the occupation, business or sporting activity, in line with the General Conditions section, 6. Material Changes clause in the policy contract. This clause has been removed and customers no longer need to inform Aviva of any material changes once the policy is in force.
2 For children under Free Child Cover, they are covered under 5 Critical Illnesses. The Free Child Cover ends upon the demise of any one of the parents. 3 (a) Hospital-related Benefits are not payable if MyShield is not payable. For children under Free Child Cover, they are covered for 30 Critical Illnesses. Please refer to Covered Benefits, Option A Benefits, 2. Critical Illness Benefit for details. In addition, upon the demise of any one of the parents before the cessation of the Free Child Cover, this benefit will also continue up to 20 age next birthday. (a) Hospital-related Benefits are payable if MyShield or Deductible Benefit of MyShield Plus is payable. Please refer to Covered Benefits, Option A Benefits, 3. Hospital-related Benefits for details. (b) Post-Hospital Follow-up TCM Treatment is currently worded as: (i) Referrals must be made by the same attending Physician from Restructured Hospital. (ii) TCM treatment must be carried out at the TCM clinic of a Restructured Hospital and administered by a TCM Practitioners registered under the TCM Practitioners Board. (iii) The hospitalisation is a result of an Accident and the TCM treatment must be for the same injury or illness for which the Insured Person received Inpatient treatment due to the Accident, provided that such injury or illness is covered by the Policy. We will not pay the Post-Hospital Follow-up TCM Treatment Benefit following a day surgery, confinement in Community Hospital or if there is no hospital stay involved. 4 No Accidental Coverage for Child Benefit (b) The benefit is revised and the new clause is reworded to: (i) Referrals must be made by the same attending Physician from the Hospital where an Insured Person was received as an Inpatient. (ii) TCM treatment must be administered by a TCM Practitioner registered under the TCM Practitioners Board. (iii) The hospitalisation is a result of an Accident and the TCM treatment must be for the same injury or illness for which the Insured Person received Inpatient treatment due to the Accident, provided that such injury or illness is covered by the Policy. We will not pay the Post-Hospital Follow-up TCM Treatment Benefit following a confinement in Community Hospital. TCM treatment shall include the cost of consultation, acupuncture, scrapping, cupping and tui na, but not the cost of medication. TCM Practitioner shall mean a person who is legally qualified to provide the prescribed practice of TCM and is registered and issued with a license to practice TCM by the TCM Practitioners Board of Singapore. New Accidental Coverage for Child Benefit under MyShield Plus Option A Please refer to Covered Benefits, Option A
Benefits, 4. Accidental Coverage for Child Benefit for details. 5 No Advanced Benefit New Advanced Benefit for MyShield under MyShield Plus Option A Accidental Inpatient Dental Coverage Post Hospitalisation Follow-up Treatment Confinement in Community Hospital Inpatient Congenital Anomalies As charged within 31 days following accident As charged within 180 days after discharge As charged up to 60 days per policy year As charged within 12 months Waiting Period Please refer to Covered Benefits, Option A Benefits, 6. Advanced Benefits under MyShield for details. 6 Premium age bands for below 30 The premium age band below 30 will be split into two age bands, 1-20, and 21 30 to be in line with MediShield. 7 The grace period for payment of renewal premium is 30 days. The grace period for payment of renewal premium is 60 days. 8. It is yearly renewable. It is guaranteed yearly renewable. 9 Option A and Option B Option A and Option C 2.5 What is the difference between Option A and Option C? Here are the benefits offered under Option A and Option C. Option A Option C Co-Insurance Benefit Yes Yes Critical Illness Benefit Yes Yes Hospital-Related Benefits Yes Yes Free Coverage for Child Benefit Yes No Accidental Coverage for Child Benefit Yes Yes Advanced Benefits for MyShield Yes Yes Preferred Rate for Children No Yes Deductible Benefit No Yes 2.6 What is Advanced Benefit?
For customers with MyShield Plus Option A, the following benefits under MyShield will be improved as follows: a) Inpatient Congenital Anomalies will be subject to Waiting Period of 12 months; and b) Charges incurred for Post-Hospitalisation Follow-Up Treatment within 180 days after discharge will be payable; and c) Charges incurred for Confinement in a Community Hospital will be payable up to 60 days per Policy Year; and d) Charges for Accidental Inpatient Dental Treatment within 31 days following Accident will be payable. We shall pay the Insured the claims under Advanced Benefit as shown in the Benefits Schedule of the Policy provided that it is payable under MyShield or Deductible Benefit of MyShield Plus. 2.7 What is Accidental Coverage for insured child? If the child is under 19 years of age at the time of the Accident and requires hospitalisation and results in fracture to the skull, spine, pelvis, femur or hip, we will pay out a cash benefit that is S$1,000, provided that there is no prior claim made under this benefit. This benefit is only payable once during the lifetime of the child, regardless of the number of fractures sustained. 2.8 Will the Accidental Coverage for Child Benefit cover for a second fracture if it happens within the same year? No, this benefit is only payable once per lifetime of the child. 2.8 Will the Free Coverage for Children Benefit be available in the enhanced MyShield Plus? Yes, the Free Coverage for Children Benefit under MyShield Plus Option A is still available. In addition, we enhanced this benefit such that upon the demise of any one of the parents before the cessation of the Free Coverage for Children Benefit, this benefit will continue up to 20 age next birthday. For the children on Option C, they will pay a lower premium under Preferred Rate for Child(ren) instead. 2.9 What are the benefits of MyShield Plus Option C? MyShield Plus Option C shall cover the following benefits: a) All benefits under Option A according to the chosen plan excluding Free Coverage for Child(ren); b) Preferred Rate for Child(ren); and c) Deductible as incurred under MyShield 2.10 Who is eligible for Preferred Rate for Child(ren) under MyShield Plus Option C? The Preferred Rate for Child(ren) under MyShield Plus Option C Plan 2 will be extended to the customer s child: a) who is entitled to free coverage under MyShield; and
b) whose both parents are insured under MyShield and MyShield Plus Plan 1 or 2 of Option A or Option C; and c) who is less than 20 years old at next birthday 2.11 What will happen to MyShield Plus Option B from 15 May 2013? MyShield Plus Option B will continue to be available for renewal for the existing Option B customers. It will not be available for new business from 15 May 2013. 2.12 For existing MyShield Plus customers, can they add the new Option A or Option C? i. For existing Option A customers who wants Option A and deductible benefits, they can do so by upgrading their existing Option A to Option C. ii. For existing Option B customers who wants both Option A and deductible benefits, they can do so by upgrading their existing Option B to Option C. iii. For existing Option B customers who want to be covered only for Option A benefits, they can do so by cancelling the existing Option B and take up Option A. For customers who upgrade their existing Option A or Option B to Option C, any claim arising from a Pre-Existing Condition after the upgrade will be assessed under the terms and conditions of the plan prior to the upgrade. Please contact us at 6827 7788 or your financial advisor for assistance. 3. NEW APPLICATION 3.1 Am I eligible to purchase MyShield Plus? All MyShield Insured Persons age between 15 days old and 75 years old at age next birthday. Insured/Proposer (Payer) Insured Person/ Dependant Minimum Entry Maximum Entry Expiry Age Age (ANB) Age (ANB) 17 75 Lifetime cover. However, Critical 15 days old or the 75 Illness Benefit date of discharge expires on the from Hospital after Policy Anniversary birth, whichever is date following which later the Insured Person reaches the age of 65 years old. All other benefits have no expiry age. 3.2 Can I purchase MyShield Plus if I do not have MyShield? MyShield Plus can only be added if you are buying MyShield or are already covered under MyShield. 3.3 How can my child qualify for Free Coverage for Children? Your child can qualify if he meets the following requirements: a) Who is entitled to free coverage under MyShield b) Both parents insured under MyShield and MyShield Plus Plan 1 or 2 of Option A or Option C
c) Child is less than 20 years old next birthday d) Up to 4 children 3.4 If my spouse and I have existing MyShield Plus policies, do we have to wait until our policies anniversary date before applying for coverage for our newborn child? Parents can apply for child coverage at any time without the need to wait for the policy anniversary date. To sign up for MyShield Plus for your child, please contact us at 6827 7788 or your financial advisor for assistance. 3.5 What are the advantages of signing up 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 Plus Option A Plan 2 provided both you and your spouse have signed up and are accepted for MyShield Plus Plan 1 or 2 of Option A or Option C. Alternatively, they can also choose to pay the Preferred Rate for Child(ren) under MyShield Plus Option C Plan 2 for eligible children, provided both the customer and spouse also signed up and are accepted from MyShield Plus Plan 1 or 2 of Option A or Option C. 3.6 Can I opt not to be covered under MyShield Plus but only purchase for dependant(s)? Yes, you may purchase MyShield Plus for dependant(s) without having coverage under MyShield Plus for yourself. Please contact us at 6827 7788 or your financial advisor for assistance. 3.7 Why must the policy period of MyShield Plus coincide with MyShield policy? One of the policy benefits of MyShield Plus is the co-insurance and/or deductibles which issubject to the same annual limits of MyShield. Hence both policies must have the same policy period. 3.8 Why must I choose the same plan for MyShield and MyShield Plus? Both policies must be the same plan so that coverage for co-insurance is subject to the same annual limits of MyShield. 3.9 Can I apply for Options A or B separately or must they be applied for as Options A and C together? The Insured Person may choose to be covered under either Option A or Option C only, and not both. To apply for Option A or C, please contact us at 6827 7788 or your financial advisor for assistance. 3.10 Can I choose to commence the coverage on any dates? MyShield Plus commences on 1 st day of every month as it must coincide with MyShield coverage period. Also the coverage start date cannot be earlier than MyShield.
4. PREMIUMS & PROCEDURES 4.1 What are the available frequencies of payment? Annual and monthly. 4.2 What are the modes of premium payment? For initial premium payment - Cash, Cheque and Credit Card. For subsequent premium payment Credit Card and GIRO. 4.3 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. 4.4 When is the credit card deduction date? The deduction will take place one day before the policy renewal. There will be no second deduction. 4.5 What is the procedure to change the payment method to GIRO or credit card? For change of GIRO, and credit card details, you are required to complete our Application for Interbank GIRO form and Credit Card Authorisation form respectively. The forms are available on our Aviva s corporate website. 4.6 Will I be informed when MyShield Plus is due for renewal? MyShield Plus is a guaranteed yearly renewal plan subject to premium payment. The renewal notice will be sent to inform you on the renewal premium. There will be an arrangement to deduct the monthly /annual premium from the designated mode of payment. In the event there is insufficient fund for the renewal premium, notification letter will be sent to arrange for the necessary premium top-up 4.7 How I know if 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). 4.8 Are the premium rates guaranteed? Rates are not guaranteed and are subject to regular review. However, we will not cancel any individual policy. 4.9 How do I update my personal particulars? The Request for Changes to Individual Health Policies form is to be submitted. The form is available on our Aviva s corporate website. 4.10 What is the procedure to upgrade / downgrade the plan to 1, 2 or 3? Please contact us at 6827 7788 or your financial advisor for assistance.
4.11 How do I add in MyShield Plus Option A or C? Please contact us at 6827 7788 or your financial advisor for assistance. 4.12 How do I cancel the policy? You are required to complete our Request for Changes to Individual Health Policies form under Section G Others. The form is available in Aviva s corporate website. 4.13 How long is the free-look period? 5. CLAIMS For MyShield Plus, the free-look period is 14 days from the date of receipt of the policy. 5.1 How do I make a claim? a) For Hospital & Related and Advanced Benefits Claims Please submit claim under MyShield. b) For co-insurance, deductible and hospital cash benefit Claim(s) will be automatically processed when the claim for MyShield is filed. c) For Critical Illness and Accidental Coverage for Insured Child Claims Please notify Aviva Ltd of the Critical Illness or Accident of any Insured Person within 30 days of diagnosis or occurrence. The insured person has to submit original documentation together with a fully completed Claim Form signed by the treating Physician. 5.2 How is Hospital Cash Benefit payable? We shall pay the Insured Person the Hospital Cash Benefit as shown in the Benefit Schedule of this Policy in the event of hospitalisation provided that: a) the hospital admission is recommended by a Physician as Medically Necessary and b) the Insured Person stays in a hospital ward lower than what he is entitled to under his chosen plan and c) there is a claim payable under MyShield (other than MediShield) and/or MyShield Plus Option B. (other than MediShield) Please note that we will not pay the Hospital Cash Benefit in the event of a day surgery, confinement in Community Hospital, confinement in private Hospital or if there is no hospital stay involved. 5.3 How will the payments under MyShield Plus claim be made? For benefits that are filed together with MyShield, we will pay the relevant amount to the hospital / clinic or the insured. For Hospital Cash Benefit, Critical Illness and Accidental Coverage for Insured Child, we will make payments to the policyowner by cheque.
5.4 How do I make a claim for one or more of the 30 Critical Illnesses? Please notify Aviva Ltd of the Critical Illness of any Insured Person within 30 days of diagnosis or occurrence. You can obtain from Aviva s corporate website for Claimant s Statement and Physician Statement (for Stroke, Coronary Artery Bypass Surgery, Major Cancers and Kidney Failure). 5.5 How do I claim for the Accidental Coverage for Insured Child? Please notify Aviva Ltd of the Accident of any Insured Person within 30 days of occurrence. You can obtain the Personal Accident Claim Form from Aviva s corporate website. The insured person has to submit original documentation together with a fully completed Claim Form and Medical Report signed by the treating Physician.