Group
Hospital & Surgical Insurance (GH&S)
1) If I am eligible for a lower ward in a restructured hospital, can I choose to be admitted to a higher ward in the restructured hospital or in the private hospital?
Yes. However, you will have to bear the difference in the daily rates for the room and board, as well as any other expenses exceeding the limits of benefits payable under the policy.
2) Can I claim from more than one insurance policy?
Yes. However for medical policies, you can only claim up to the amount of expenses you have incurred. Once you submit your original bills to a particular insurance company for a claim, in order to claim the balance from another insurance company, you will have to submit the certified true copies of your original bills and the assessment form or payment voucher from the first insurance company you claimed from. For protection claims you can claim from all covers you have.
3) Does the policy provide worldwide coverage?
Yes. However, it will be according to treatment costs in Singapore as per benefit schedule, or amount claimed, whichever is lower.
4) Are there any exclusions?
Yes, and they generally are
| a) |
Pre-existing conditions unless continuously insured for 12 months under any Group Hospital & Surgical Policy |
| b) |
Treatment for psychological or psychiatric condition, alcoholism or drug addiction |
| c) |
Intentional self-inflicted injury whether sane or insane |
| d) |
Congenital anomalies |
| e) |
Birth control measures, infertility, impotency or pregnancy |
| f) |
Dental except in case of accidents |
| g) |
Eye examination, correction of eye refraction except in case of accidents |
| h) |
Cosmetic or plastic surgery except in case of accidents |
| i) |
Treatment of acne, hernia, hydrocele |
| j) |
Services for the primary purpose of diagnosis, medical check-up or health screening |
| k) |
Rest cures or special nursing care |
| l) |
Treatment for weight reduction or weight improvement |
| m) |
Circumcision except where medically necessary |
| n) |
Venereal diseases, AIDS |
| o) |
Disabilities resulting from direct participation in a strike, riot or civil commotion |
| p) |
Procurement or use of wheel-chair, dialysis machines or any hospital-type equipment |
| q) |
Implants and prothesis |
| r) |
Services of a non-medical nature and administrative charges |
| s) |
Services or treatments which are paid for by any other party |
5) Is day surgery covered?
Yes. Day surgery done at the hospital or doctors' clinic is payable. There is no need for minimum number of hours of stay if there is a surgery done.
6) If I use Letter of Guarantee (LOG) for my hospital bills, do I still need to fill up the GHS claim form?
Yes. The GHS claim form, Attending Physician Report and Medical Report Authorisation form are required by the insurance company for processing of the claim.
7) Can the Letter of Guarantee (LOG) be used for day-surgery?
It depends on the hospital. Some hospitals will not accept it, and in this case, you will have to pay first and then submit the claim.
8) Do I need to sign the Medisave Form if I use LOG?
Yes. The hospital will deduct from your Medisave account if you are a CPF member, and the balance of claimed incurred will be indemnified by the LOG up to $10,000. Upon submission of claim form and other relevant documents, the insurer will then process your claim and if the claim is eligible, then insurer will reimburse your Medisave account with the amount deducted from it.
9) Can I claim for Outpatient services that are related to my hospitalisation?
You can only claim for Outpatient services if it is a pre-hospital or post-hospital expense. For pre-hospital expense, only specialists' consultation fees and diagnostic services are payable and not GP services. You need a referral letter from the GP to see the specialist and the bill must be incurred within 90 days from date of admission. For post-hospital expense, the bill must be incurred within 90 days after discharge and it must be from the same specialist who performed the operation.
10) Can I admit myself to the hospital for surgical procedures such as endoscopy?
No. You need a letter of referral from your GP or company's doctor stating signs and symptoms.
11) Is stress considered as one of the "nervous & mental conditions" under the GH&S exclusions?
Yes. It is an exclusion.
12) Am I eligible to claim from the GH&S policy if I was away for personal holiday overseas?
Yes, as your GHS policy provides 24 hours worldwide cover.
13) For payment of GH&S claims, will the insurance company pay to my Medisave account or directly to me in cash or cheque?
If your Medisave account has been utilised, the insurance company will pay to your Medisave account. Any payment made by you that can be claimed will be paid to you by cheque.
14) Will I still enjoy the insurance coverage upon my resignation?
No. The insurance cover terminates on your last day of work. However, you are covered when you are serving your notice.
15) Is GST payable?
No. The common practice amongst all Life insurance companies in Singapore is to exclude payment of GST.
16) What is the definition of "per disability"?
It means per different illness. If it is the same illness, there must be a break of a certain number of days ranging from 14 to 90 days from date of discharge to date of re-admission.
17) Are there any exclusions?
Yes. Please refer to your policy for the GH&S exclusions.
18) Will I be covered for any pre-existing conditions?
It depends on the arrangement agreed with the insurance company. Some insurance companies impose a waiting period of 12 months, while some exclude that totally. However, if the condition is underwritten and accepted by the insurance company at inception, it is covered.
19) If I retire or leave the Company, can I continue to enjoy the Group GHS cover?
No. it will cease on the last day of working for your Company. Group policies usually cannot be converted to individual policies as they are not portable.
20) When will the cover cease?
For employees and their spouses, the cover is valid till the age of 65. However, some insurance companies allow renewals up to the age of 70. For children, the cover is usually up to age 19, if they are unmarried and unemployed. The cover can be extended up to the age of 24, if the children are studying in an institution of higher learning.
21) How do I define "pre-existing" conditions?
Conditions that exist before the date that your cover is effected and have been treated for, or conditions that existed before cover is effected, pathologically known or unknown to you.
22) When can a newborn child be enrolled?
Usually after 15 days old.
23) How do I make a claim?
You need to fill in the claim form, which includes a section that your attending physician has to complete (if hospitalised in a Private Hospital). Attach the original final bills with the claim form and submit these to us directly or through your HR department.
24) If my company has a group medical plan for me, do I still need to apply for Incomeshield or Medishield Plus?
Yes. Your company's cover will terminate when you leave the company. Incomeshield provide guaranteed renewal for lifetime whilst Medishield Plus provide renewal up to ages 80 and lifetime for different plans.
25) Will I be covered under GH&S if I broke my toe accidentally and was treated at Accidental & Emergency (A & E) or any other clinics?
Yes. You can claim up to a maximum of amount (depending on the Plan you are eligible for) for "Emergency Outpatient Treatment for Accidents" if you consult A&E within 24 hours of your injury. Subsequent follow up will be covered up to 31 days after the accident.
26) Which medical policy should I first claim from?
If your company covers you under a Group Policy, then you should claim from this policy. Only if your bill exceeds the benefit amount, then you claim from your own personal medical plan.
Scenario 1 - without Shield policy
- Claim from Group Hospital & Surgical (GHS) policy first.
- Claim the excess (e.g. if surgery in Private Hospital, surgical schedule
applies) from your own private medical plan. Any amount beyond that or
not claimable, employee has to bear.
Scenario 2 - with Shield policy
- The claims will be submitted to your shield insurer by the hospital via the
Central Claim Processing System (administered by CPF Board); hence
your shield insurer becomes the 1st payor of the hospital bills.
- Submit your claim to your GHS policy for recovery of claims paid out
from your shield policy
- Group insurer will reimburse the eligible amounts paid out from your
shield policy (up to the GHS policy limits)
1) Can I visit more than one GP a day?
No. Insurer will only cover 1 GP visit a day, including polyclinic.
2) What happens if I did not bring my MHC card along when I visit the panel general practitioner and specialist along for identification?
You will have to pay first and seek reimbursement. Please inform the panel doctor that you are covered under the respective Insurer's Managed Healthcare programme (MHC).
3) Is a second opinion specialist consultation payable under the plan?
No. Once a diagnosis has been reached the insurer will not cover second opinion.
4) Do I need to get a new referral letter each time I visit the same specialist / physiotherapist / for each diagnostic tests consultation?
If you had obtained a referral letter for a particular medical condition, you can continue to seek treatment from the same specialist until he discharges you. After that, if you need to consult him again, you will have to get a new referral letter from a panel GP. If you are visiting a non-panel specialist, please submit a photocopy of the referral letter when you submit each and every claim.
5) Can I claim my medical expenses from two insurance companies?
Yes, up to the amount incurred for eligible claims. Please provide (i) payment advice from the first insurer (ii) certified true copies of receipts by the first insurer.
6) What should I do if lose my MHC card?
Issue a $10 cheque made payable to Insurance Company. Provide your name, NRIC number & the cardholder's name (if the lost card is your dependant's), and send to Pan Group via Claim box provided at your Company's premises.
7) What should I do if my wallet / bag containing my MHC card was stolen?
Submit a copy of the police report to Pan Resources via the Claim box provided at your Company's premises. Insurer will reprint the card at no charge.
8) What is the deadline for submission of claims?
You have 30 days from the date of visit or date of discharge, whichever is later.
9) Can the panel doctor ask me to pay cash other than the $5 op-payment (Group Medical Outpatient Insurance Option 1)
Yes, for the following: -
(a) Conditions not covered E.g. Prevention - if you are travelling and you ask for flu or diarrhoea medication although you are not suffering from these medical conditions
(b) Medication not related to the medical condition you are seeking treatment for. E.g. You have the flu but you ask for cream for your skin
(c) Supplements and vitamins (cover is only for medicine)E.g. Glucosamine
(d) Collection of medicine with no consultation E.g. Calling the doctor to ask for panadol tablets
(e) Obtaining Referral Letter / Medical Certificate (MC) only. Some doctors will charge even if there is no medication given as the doctor's time is taken to issue these documents
10) If I have a Referral Letter from the General Practitioner, does that mean my specialist consultation is covered?
No, if your consultation is for e.g. acne, hair loss, fertility, pregnancy and all other excluded items, then Insurer will reject your specialist claim even with a referral letter from a GP.
11) Can I visit a specialist without a Referral Letter?
No. You must obtain a Referral Letter from a panel General Practitioner. However, if you are visiting a Specialist in a Restructured Hospital, you can attach the photocopy of the appointment card and the need for a referral letter can be waived. Always attach a photocopy of the appointment card or referral for subsequent visits as well in order to facilitate faster processing of your claim.
1) When does it pay?
It pays upon death and total and permanent disability caused by illness or accident.
2) Does this plan cover beyond working hours and/or when I am not in Singapore?
Yes. The cover is 24 hours worldwide.
3) Does this plan pay in addition to Group Personal Accident and my own personal plans?
Yes.
4) Are there any exclusions?
There are no exclusions for most insurance companies.
5) When does the cover cease to be valid?
Usually up to age 65, but some insurance companies allow renewals up to age 70.
6) Will I be automatically covered when I join a company?
It depends on the amount insured and the non-medical evidence limit enjoyed by your employer. Medical Underwriting may be required in certain cases.
7) What are the differences between GTL and GPA?
GTL pays due to any causes.
GTL provides the following cover:
" Death or total & permanent disability
" Extended death and total & permanent disability
" Family income benefit
" Terminal Illness
GPA pays only for accidental causes.
GPA provides the following cover:
" Against bodily injury caused solely and directly by accidents resulting in:
" Death -100% of sum insured per person
" Total & permanent disability -150% sum insured per person
" Permanent & partial disability - according to percentage in the schedule depending on severity.
" 3rd degree / 2nd degree burns
8) What is terminal illness?
Terminal Illness is any illness where death is highly probable within the next 12 months.
9) How is Total and Permanent Disability defined in GTL policy? The definitions are:
(a) total and irrecoverable loss of sight of both eyes, or
(b) loss by severance of two or more limbs at or above wrist or ankles, or
(c) total and irrecoverable loss of sight of one eye and loss by severance of one limb at or above wrist or ankles
(d) unable to do any work at all
10) Can I make a claim from GTL if I suffered the loss of one limb?
No. GTL policy pays only upon Total and Permanent Disability. If the loss is due to accident, GPA insurance will cover you for the loss according to the schedule of Benefits.
11) Is death or total & permanent disability payable if it arises from a natural disaster?
Yes. Both GTL and GPA will pay.
12) Is terrorism an exclusion of Life and Personal Accident benefits?
No. Terrorism is not excluded under the Life and Personal Accident policies.
13) What is non-medical evidence limit?
Non-Medical Evidence Limit shall mean the maximum sum insured which the insurance company is able to accept without evidence of insurability. Sum insured in excess of non-medical evidence may be accepted subject to evidence of insurability satisfactory to the insurance company.
1) When does it pay?
It pays upon death, total and permanent disablement and permanent partial disablement (according to severity) caused by accidents.
2) Does this plan cover beyond working hours and/or when I am not in Singapore?
Yes. The cover is 24 hours worldwide, unless it falls under the exclusions.
3) Does the plan pay in addition to Group Term Life or my own personal plans?
Yes.
4) Are there any exclusions?
Yes, and they generally are:
| a) |
Suicide or any attempted suicide whether sane or insane |
| b) |
War (declared or undeclared) |
| c) |
Participation in racing on wheels |
| d) |
Engaging in naval, military or airforce service except peacetime reservist training |
5) When does the cover cease to be valid?
Generally, when one reaches 70 or 75 years of age.
6) Will I be covered immediately upon joining a company?
Yes, as there is no need for medical underwriting. However, your employer-company has to submit your name and particulars to the insurance company if the arrangement with the insurance company is not on a headcount basis.
7) What is the definition of "accidental"?
You have to refer to your policy. Different insurance companies may have different definitions.
8) Can I claim against GPA if I suffer an injury during reservist?
Yes, if it is peacetime reservist training.
9) Will GPA be payable if death or permanent disability occurs arising from riots or civil unrest during duty travel or my own personal holiday abroad?
Yes, only if you do not take part in the riots or civil unrest.
10) How would I know the extent/degree of my injury to file for a claim under GPA?
It will be assessed and stated in the doctor's report.
11) Is death or total & permanent disability payable if it arises from an accident due to drunken driving?
No, the policy will not pay if it is proven that amount of alcohol in the deceased was above the legal limit allowed by law.
12) If I'm injured in a country with an on-going war, can I file a claim under GPA?
No. The policy excludes war (declared or undeclared).
13) Am I covered if I'm injured due to sports activities overseas?
Yes. As long as you are not engaged in "racing on wheels", both GTL and GPA will pay for total and permanent disability. For partial disability, it will be covered by GPA. GH&S will cover your hospital and surgical claims up to the schedule of benefit you are entitled to.
Terms
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