Frequently Asked Questions

Co Pay Assist Plan

  • Q:Can I claim for child delivery?

    A:

    Yes, any claims arising out of or relating to pregnancy or childbirth is claimable except for accouchement charges. This is provided that you have been insured under the Co-Pay Assist Plan for more than 12 months.

  • Q:Can I claim from another medical policy after I have submitted a claim under Co-pay Assist Plan?

    A:

    If there is a balance amount not payable by Co-pay Assist Plan, you can submit a claim request for the remaining portion under another medical policy.

  • Q:How much can I claim under my Co-Pay Assist Plan?

    A:

    You can claim according to the following co-payment rates:

    Ward Adjusted Co-Payments Rates
    Entitlement Admitted to Policyholder Dependant
    C B2 4.4% 11.7%
    C B2+ 3.1% 8.3%
    C B1 1.8% 5.0%
    C A 1.3% 3.3%
    B2 B2+ 5.3% 13.3%
    B2 B1 3.1% 8.3%
    B2 A 2.6% 6.7%
    B1 A 5.7% 15.0%
    As per plan eligibility / Downgrade of ward 7.5% 20.0%

  • Q:How will I receive my claim payout?

    A:

    You will receive your claim payout depending on the method of payment as indicated in your bills.


    For example:


    Your total bill amount:$1,250
    Your total eligible amount (assuming $250 is not payable):$1,000
    Employer’s co-payment (85% on your total eligible amount):$ 850
    Amount paid by you in cash:$ 400
    Our co-payment (7.5% on your total eligible amount):$ 75


    Since you have paid $400 by cash, we will pay you $75 via direct crediting to your bank account. If the balance $400 is paid using Medisave, we will arrange with CPF Board to credit $75 to the Medisave account as indicated in the bill. If the balance of $400 is paid by CPF MediShield or Medisave-approved Private Integrated Plan 1, we will reimburse $75 to your plan.


    1. Refers to IncomeShield or AIA’s HealthShield or Singlife Shield or Great Eastern’s SupremeHealth or Prudential’s PruShield.

Hospital Benefit rider

  • Q:Are there any exclusions under the HB rider?

    A:

    Yes. Common exclusions are found in such riders that pay for each day of hospital stay. For example, it is common to have claims excluded if they were to arise out of deliberate acts such as self-inflicted injuries, suicide or attempted suicide; unlawful acts, provoked assault, or wilful exposure to danger; effects of alcohol, drug or any dependence; psychological conditions, or eating disorders; pregnancy, childbirth; or dental conditions. Do refer to your policy document for the full set of the exclusions.

  • Q:Can I claim for medical leave following my discharge from hospital?

    A:

    Yes. We will pay 50% of the HB rate for such medical leave. The medical leave must immediately follow a discharge from the hospital. If there is a break, the leave will not qualify for the claim. The hospital stay must be of at least one day in duration. This can be evidenced by a hospital bill.

  • Q:Do you cover overseas hospitalisation under the HB rider?

    A:

    The claim is only valid for hospitals registered in Singapore. The policy document has specified exclusion of overseas hospitalisation.

  • Q:If I have other medical benefit coverage, can I still claim under the Hospital Benefit (HB) rider?

    A:

    Yes. The HB rider pays for each day of stay in a hospital. It does not matter if you have already been fully reimbursed under other medical plans.

  • Q:Is day surgery covered under the HB rider?

    A:

    Yes.

  • Q:Is there any limit on the number of days I can claim for?

    A:

    Yes. We will pay the per day benefit for each period of confinement up to 365 days. If the insured person is given medical leave following discharge from hospital, we will pay 50% of the per day benefit up to 30 days. If the policyholder has taken up this rider many years back, there may be some differences. Do refer to your original policy contract for the specific terms.

  • Q:Is there a waiting period?

    A:

    Yes. You will not be allowed to claim under Hospital Benefit for confinement to hospital for an illness or injury which occurs prior to or during the first 30 days of issuance of this rider or revival of the main policy.

  • Q:Why is medical leave not payable if there is no hospitalisation?

    A:

    This is primarily a hospitalisation benefit. There must be a hospital stay of at least one day before any claims can be considered. In fact, most similar hospital benefit plans offered by other insurers do not pay for any hospitalisation leave. They only pay for each day's stay in the hospital. If you wish to have an insurance plan to cover your medical leave (due to accidental injuries) without any prior hospitalisation, you should consider taking up an Accident Benefit rider.

Hospital Cash Benefit

  • Q:Does Hospital Cash Benefit cover overseas hospitalisation?

    A:

    No, Hospital Cash Benefit does not cover overseas hospitalisation. It only covers hospitalisation in Singapore.

  • Q:Does Hospital Cash Benefit cover reimbursement of medical expenses?

    A:

    No, Hospital Cash Benefit does not cover reimbursement of medical expenses.

  • Q:How will the Hospital Cash Benefit be paid?

    A:

    The Hospital Cash Benefit will be paid to the policyholder if there is no nomination of beneficiary under Section 49(L) of the Insurance Act.

    More information on the Insurance Act

  • Q:If I consulted the A&E Department in a hospital due to an illness (acute or otherwise) but was not hospitalised, can I claim for Hospital Cash Benefit?

    A:

    No, Hospital Cash Benefit claim is only payable when you are hospitalised or have undergone a surgery in a specialist clinic or hospital due to an illness / accident.

  • Q:If I had a day surgery, can I claim under Hospital Cash Benefit?

    A:

    Yes, you can make a claim for Hospital Cash Benefit for day surgery performed in a specialist clinic or a hospital but not any surgery performed by a General Practitioner. Please note that the payment of claim is subject to claim assessment.

Hospital Surgical (Under Family Insurance Policy)

  • Q:Are pre- and post- hospitalisation expenses covered under H&S Benefit?

    A:

    Only pre-hospitalisation medical expenses will be reimbursed, subject to the limits under "Hospital Expenses". Post-hospitalisation expenses are not covered.

  • Q:Are there any exclusions under the H&S Benefit?

    A:

    Yes. Common exclusions are found in such hospitalisation benefits. For example, it is common to have claims excluded if they were to arise out of deliberate acts such as self-inflicted injuries, suicide or attempted suicide; unlawful acts, provoked assault, or deliberate exposure to danger; effects of alcohol, drug or any dependence; psychological conditions, or eating disorders; pregnancy, childbirth; or dental conditions. Do refer to your policy document for the full set of the exclusions.

  • Q:Do you cover hospitalisations in private medical institutions under the H&S Benefit?

    A:

    Yes. But we will first apply 75% to the medical expenses incurred, before we start to compute your claim.

  • Q:Do you cover overseas hospitalisation under the H&S Benefit?

    A:

    The claim is only valid for hospitals registered in Singapore. The policy document has specified exclusion of overseas hospitalisations.

  • Q:If I have other hospital and surgical coverage, can I still claim under the H&S Benefit?

    A:

    Yes.

    If the medical expenses incurred have been fully reimbursed by another party, we will pay the Alternative Cash Benefit 1 (not exceeding the medical expenses incurred).

    If the medical expenses incurred have been partially reimbursed by another party, we will pay the higher of the Alternative Cash Benefit (not exceeding the medical expenses incurred), or the net medical expenses borne by the insured, subject to the limits in the H&S Benefit contract.

    1 Alternative Cash Benefit is computed this way - 80% of the Sum Assured (Room & Board) for each day of hospitalisation, up to 30 days.

  • Q:If I utilise a third party's Medisave to pay for the medical expenses, can I be reimbursed in cash under my Hospital & Surgical (H&S) Benefit?

    A:

    No. An insurer will reimburse the Medisave Account holders whose accounts have been charged with the medical expenses under the bill. If both cash and Medisave have been utilised, then we will reimburse the cash portion first before we reimburse any balance to the Medisave Account, subject to the limits specified in your policy contract.

  • Q:Is day surgery covered under the H&S Benefit?

    A:

    Yes.

  • Q:Is there a waiting period?

    A:

    Yes. You will not be allowed to claim if the hospitalisation occurs prior to or during the first 30 days of issuance of this benefit or revival of the main policy.

Managed Healthcare System (MHS)

  • Q:Can I go to a private hospital?

    A:

    Yes, you can. However, we would like to highlight to you that your policy will pay up to its limits only. The amount to be borne by you may be higher if the cost of medical expenses is higher.

  • Q:How much can I claim for eligible medical expenses (excluding surgeon fee and surgical implant) for my day surgery or hospitalisation?

    A:

    It will depend on your length of stay in the hospital. For day surgery or hospitalisation for one day, the plan limit is equal to the 'Room & Board per day limit'. For hospitalisation for more than one day, the plan limit is equal to 'Room & Board per day limit' multiply by 'length of stay'.

  • Q:How much can I claim for my surgeon fee?

    A:

    It will depend on the table of surgical operation applicable for your surgery. The surgical table number will then be used to determine the surgical limit under your plan type. Surgical table numbers range from 1 – 7, depending on the complexity of the operation.

  • Q:How much can I claim for my surgical implant?

    A:

    It is subject to the surgical implant limit per year under your plan.

  • Q:Is there any benefit for pre- and post- hospitalisation expenses?

    A:

    No, there is no pre- and post- hospitalisation benefit under this policy. Any outpatient specialist follow up treatments before and after hospitalisation or surgery are to be filed under Specialist Care Benefit, subject to its limits.

  • Q:Is there any other amount that I have to pay besides the 10% co-payment of my total eligible bill?

    A:

    You will need to bear ineligible expenses and 10% co-payment on your total eligible bill or amount in excess of your plan limits, whichever is higher.

    For more information on the plan limits, please refer to your policy document.

  • Q:How will I receive my claim payout?

    A:

    We will pay according to the priority listed below.

    1. Payment to the hospital if there is any outstanding amount billed to us
    2. Payment via direct crediting to your bank account if you have settled the eligible medical bills by cash.
    3. Payment to Medisave account indicated in the bill
    4. Payment to MediShield/your Medisave-approved Private Integrated Plan 1 (if applicable)

    1 Refers to IncomeShield or AIA’s HealthShield or  Singlife Shield or Great Eastern’s SupremeHealth or Prudential’s PruShield.

  • Q:If I am claiming from another medical policy, can I still claim from my MHS Policy?

    A:

    In the event that your bill has been fully settled under another medical policy, you will not be able to claim under your MHS Policy. However, if your bill is only partially settled, you can claim for the remaining amount or up to the policy limit as specified under your policy, whichever is lower.