# migrations

dir: embeddings_queue
filename: 00001-embeddings.sqlite.sql
hash: d3755dfd232be8e8301f4d7fcfb3a486
sql:
CREATE TABLE embeddings_queue (
    seq_id INTEGER PRIMARY KEY,
    created_at TIMESTAMP NOT NULL DEFAULT CURRENT_TIMESTAMP,
    operation INTEGER NOT NULL,
    topic TEXT NOT NULL,
    id TEXT NOT NULL,
    vector BLOB,
    encoding TEXT,
    metadata TEXT
);


dir: sysdb
filename: 00001-collections.sqlite.sql
hash: 38352d725ad1c16074fac420b22b4633
sql:
CREATE TABLE collections (
    id TEXT PRIMARY KEY,
    name TEXT NOT NULL,
    topic TEXT NOT NULL,
    UNIQUE (name)
);

CREATE TABLE collection_metadata (
    collection_id TEXT REFERENCES collections(id) ON DELETE CASCADE,
    key TEXT NOT NULL,
    str_value TEXT,
    int_value INTEGER,
    float_value REAL,
    PRIMARY KEY (collection_id, key)
);


dir: sysdb
filename: 00002-segments.sqlite.sql
hash: 2913cb6a503055a95f625448037e8912
sql:
CREATE TABLE segments (
    id TEXT PRIMARY KEY,
    type TEXT NOT NULL,
    scope TEXT NOT NULL,
    topic TEXT,
    collection TEXT REFERENCES collection(id)
);

CREATE TABLE segment_metadata (
    segment_id TEXT  REFERENCES segments(id) ON DELETE CASCADE,
    key TEXT NOT NULL,
    str_value TEXT,
    int_value INTEGER,
    float_value REAL,
    PRIMARY KEY (segment_id, key)
);


dir: sysdb
filename: 00004-tenants-databases.sqlite.sql
hash: 048867ce8fcdefe4023c7110e4433591
sql:
CREATE TABLE IF NOT EXISTS tenants (
    id TEXT PRIMARY KEY,
    UNIQUE (id)
);

CREATE TABLE IF NOT EXISTS databases (
    id TEXT PRIMARY KEY, -- unique globally
    name TEXT NOT NULL, -- unique per tenant
    tenant_id TEXT NOT NULL REFERENCES tenants(id) ON DELETE CASCADE,
    UNIQUE (tenant_id, name) -- Ensure that a tenant has only one database with a given name
);

CREATE TABLE IF NOT EXISTS collections_tmp (
    id TEXT PRIMARY KEY, -- unique globally
    name TEXT NOT NULL, -- unique per database
    topic TEXT NOT NULL,
    dimension INTEGER,
    database_id TEXT NOT NULL REFERENCES databases(id) ON DELETE CASCADE,
    UNIQUE (name, database_id)
);

-- Create default tenant and database
INSERT OR REPLACE INTO tenants (id) VALUES ('default_tenant'); -- The default tenant id is 'default_tenant' others are UUIDs
INSERT OR REPLACE INTO databases (id, name, tenant_id) VALUES ('00000000-0000-0000-0000-000000000000', 'default_database', 'default_tenant');

INSERT OR REPLACE INTO collections_tmp (id, name, topic, dimension, database_id)
    SELECT id, name, topic, dimension, '00000000-0000-0000-0000-000000000000' FROM collections;
DROP TABLE collections;
ALTER TABLE collections_tmp RENAME TO collections;


dir: metadb
filename: 00001-embedding-metadata.sqlite.sql
hash: 2b4cf52c4bb2676e21d6860a4409f856
sql:
CREATE TABLE embeddings (
    id INTEGER PRIMARY KEY,
    segment_id TEXT NOT NULL,
    embedding_id TEXT NOT NULL,
    seq_id BLOB NOT NULL,
    created_at TIMESTAMP NOT NULL DEFAULT CURRENT_TIMESTAMP,
    UNIQUE (segment_id, embedding_id)
);

CREATE TABLE embedding_metadata (
    id INTEGER REFERENCES embeddings(id),
    key TEXT NOT NULL,
    string_value TEXT,
    int_value INTEGER,
    float_value REAL,
    PRIMARY KEY (id, key)
);

CREATE TABLE max_seq_id (
    segment_id TEXT PRIMARY KEY,
    seq_id BLOB NOT NULL
);

CREATE VIRTUAL TABLE embedding_fulltext USING fts5(id, string_value);


dir: metadb
filename: 00002-embedding-metadata.sqlite.sql
hash: 12a570f7121b3a8ce750a2a7c36da20f
sql:
-- SQLite does not support adding check with alter table, as a result, adding a check
-- involve creating a new table and copying the data over. It is over kill with adding
-- a boolean type column. The application write to the table needs to ensure the data
-- integrity.
ALTER TABLE embedding_metadata ADD COLUMN bool_value INTEGER


dir: metadb
filename: 00003-full-text-tokenize.sqlite.sql
hash: f97ad6334aeaa8f419f01110b648b97a
sql:
CREATE VIRTUAL TABLE embedding_fulltext_search USING fts5(string_value, tokenize='trigram');
INSERT INTO embedding_fulltext_search (rowid, string_value) SELECT rowid, string_value FROM embedding_metadata;
DROP TABLE embedding_fulltext;


# embeddings_queue

created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
id: 546e4981-beb2-43d5-9256-1615b4a76085
encoding: FLOAT32
metadata:
{"_node_content": "{\"id_\": \"546e4981-beb2-43d5-9256-1615b4a76085\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"36c165aa-db5e-41f2-8249-8f8fe713bec3\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"74ee3434523d21e16c0e24e62e759b7708b7649706e4a1685ea3549dd2a42f66\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 0, \"end_char_idx\": 4570, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "Health Insurance       Strictly for Internal Use Only     \n \n \nPrudential Assurance Company Singapore (Pte) Limited   1 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  \n \n \n \n \n \n \nHEALTH INSURANCE  \n(5th Edition) , Supplementary Notes -  Version 1.3  \n \nChapter Review  \nChapters 1 to 15  \n \n \n \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   2 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Chapter 1 \u2013  Overview of Healthcare Environment in \nSingapore  \n \n1. Rising healthcare cost is a concern for most gov ernments . The challenge faced by most \ngovernments is how to balance the rising expectations for quality healthcare, and yet keep cost affordable.   \n \n Healthcare  Philosophy  \nEnhancing Accessibility  \n \n\u2022 Healthcare infrastructure will \nbe ramped up, with plans to \nincrease acute- and \ncommunity hospital beds \nby 2020.  \n \n\u2022 MOH is building up its \nmanpower capability & \nbuilding a strong core  of \nhealthcare professionals to \nsupport infrastructure \nexpansions  eg:  \n\u2022 Providing flexi, part -time  \n in the community through \n its Place & Train \n Programme.  \n \n\u2022 New remuneration  \n framework for senior \n doctors to better \n recognize doctors in their \n diverse roles in clinical \n care, education, research \n & administration.  \n \n\u2022  MOH act ively drives \ninnovation & productivity in \nboth public & ITLC sectors to simplify workflow \nprocess so that healthcare \nworkers can focus on caring \nfor their patients.  \n  \n Healthcare 2020 Masterplan focuses  \non 3 strategic objectives.  \nEnhancing Quality of Care  \n \n\u2022 MOH will move away from \ndoctor -centric services & \nadopt a multi -disciplinary \nteam approach to enhance \nchronic disease \nmanagement. Eg healthcare \nclusters.  \n \n\u2022 MOH will enhance primary \ncare as Singapore's \npopulation ages so that \nresidents can be better \ncared for in a community. Egs:  \n\u2022 Strengthening primary \n   healthcare providers, \n   such as polyclinics & \n   GPs;  \n \n\u2022 Building more  \n polyclinics.  Ensuring Healthcare \nRemains affordable  \n \nThe Government has \nenhanced support for \nSingaporeans in the \nfollowing ways:    \n \n\u2022 Increasing \nGovernment share of \nnational healthcare \nexpenditure - thro \nenhanced subsidies \nfor services in SOCs & drugs in public \nhospitals and list of \nsubsidized drugs.  \n     \n\u2022 Medisave expanded \nto use for more \ntypes of outpatient \ntreatment.  \n \n\u2022 Enhancing collective \nresponsibility  for \nhealthcare through MediShield Life. The \nGovernment bears \nmost of the cost of \nthis universal \ncoverage.  \n \n \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   3 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 2. Healthcare System in Singapore consists of :  \n \n \n \n \n \n2a. Primary Healthcare Services   \n\u2022 Provided by both public and private sectors.  It involves provision of basic medical \ntreatment,  preventive healthcare and health education.  \n \n\u2022 In public sector, primary healthcare services are provided through network of \noutpatient polyclinics .  Under Community Healthcare Assist Scheme (CHAS), \nlower -to-middle income household can receive subsidized treatments at GPs and \ndental clinics, without the need to travel to Polyclinics.  \n \n\u2022 The Scheme also covers treatment for Chronic Disease Management Programme (CDMP) such as diabetes, hypertension,  root canal treatment and crowning .  \n \n\u2022 Patients under CHAS can also enjoy subsidized rates at Specialist Outpatient Clinics.  \n \n2b. Hospital Services   \n\u2022 There are 9 public hospitals and within these public hospitals, choices of different \ntypes of ward accommodation.  81% of public hospital's beds are B2 and C which are \nheavily subsidized.   19% with lower subsidy at 20% for Class B1 and no subsidy  for \nClass A wards.  \n \n\u2022 Government has restructured all its acute hospitals and specialty centres to run as \nprivate companies, wholly owned by G overnment , to allow greater autonom y and \nflexibility .  Commercial Accounting Systems have been introduced to give a accurate \npicture of operating costs , instilling greater  financial discipline and accountability."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
id: 36c165aa-db5e-41f2-8249-8f8fe713bec3
encoding: FLOAT32
metadata:
{"_node_content": "{\"id_\": \"36c165aa-db5e-41f2-8249-8f8fe713bec3\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"546e4981-beb2-43d5-9256-1615b4a76085\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"269a94b2084f040c1f8d54a71d151d23e5493b1c841142683fbfa58a1e3524b8\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"3ec10460-19b7-4af1-98e1-a273fa1b1477\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"4164d5e06d3fef3ba3854f3013561ed051d104c501cb48144875c986022d76ee\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 4410, \"end_char_idx\": 9022, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "Commercial Accounting Systems have been introduced to give a accurate \npicture of operating costs , instilling greater  financial discipline and accountability.  \n \n\u2022 Public hospitals received annual government subvention or subsidy for the pr ovision of \nsubsidised medical services of patients.  These are to be managed like not -for- profit \norganisations.  \n Healthcare  System in Singapore  \nPrimary Healthcare \nServices Hospital Services  Intermediate Long \nTerm Care (ILTC) \nServices Traditional \nChinese Medicine  3 main types of healthcare  \nWestern Medical Science  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   4 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 2c.  Intermediate & Long Term Care (ITLC)  \n ITLC services are for people who need further care after discharge from acute hospitals as \nwell a s community dwelling seniors who may need assistance with their activities of daily  \nliving .  This can be through:  \n a) Home -based services,  which are provided within their homes of frail and home - \n  bound elderly.  \n  b) Centre- based healthcare services, whi ch cater to older persons who require care \n  services during the day, usually on a regular basis, located within the community.  \n  This allows working caregivers to drop their seniors at during work.  \n \n c)  Residential ILTC services, comprises community hospitals, chronic sick hospitals, \n  nursing homes, inpatient hospices and sheltered home for the ex -mentally ill patients.  \n \n \n3. Singapore Healthcare financing framework comprises of Government subsidies, individual \n savings and insurance.  \n \n \n \n4. The Singapore Government provides universal coverage through these multiple layers of \n protection:  \n a) Government S ubsidies  \n\u2022 Government subsidies across primary, acute rehabilitative and nursing care; and  \n\u2022 Universal access, but no 100% subsidy to avoid over -consumption.  \n  \n b)  Compulsory H ealthcare Savings   \n\u2022 Individual medical savings accounts - Medisave.   \n \nc)  Risk -Pooling via Insurance Schemes  \n\u2022 National basic health insurance scheme -  MediShield Life;  \n\u2022 Private health insurance for additional coverage -  Medisave approved Integrated \nShield Plans (IPs); and  \n\u2022 Severe disability insurance for old age - ElderShi eld and ElderShield Supplements.  \n \nd) Ultimate safety net for the needy  \n\u2022 Endowment  fund set up by the Government for needy Singaporeans through Medifund.   Singapore Healthcare Framework  \nGovernment Subsidies  \n \nGovernment provides \nsignificant subsid ies across all \nhealthcare settings to help with \nhealthcare costs.  Individual Savings  \n \nThrough the Medisave Scheme, it helps individuals \ncare for their own as well as \nimmediate family's medical \nexpenses.  Insurance  \n \n\u2022 MediShield Life  \n\u2022 Medifund  \n\u2022 ElderShield  \n(cross ref - chapter 8)  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   5 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Chapter 2 \u2013  Medical Expense Insurance  \n \n1. There are broadly 3 categories of Health Insurance which can provide:  \n\u2022 A reimbursement for the cost of medical treatment or nursing care; or  \n \n\u2022 A periodic income upon disability or hospitalization; or  \n \n\u2022 A fixed cash  amount upon disability or suffering from a major illness.  \n \n \n2. What is a Medical Expense Insurance  (MEI)?  \nAlso known as Hospital  and Surgical  (H&S) Insurance, which provides inpatient and some \noutpatient benefits.  Examples of MEI include MediS hield  Life, P rivate In tegrated Shield Plans \nand managed healthcare schemes.  \n \n3.  \n Medical Expense Insurance  \nInpatient Expenses  \n \n\uf0a7 Daily  room & board;  \n\uf0a7 Intensive care unit;  \n\uf0a7 Short stay ward;  \n\uf0a7 Hospital miscellaneous;  \n\uf0a7 Surgeon\u2019s fees;  \n\uf0a7 Anaesthetist\u2019s fees;  \n\uf0a7 Surgical implant & \nprosthesis;  \n\uf0a7 Confinement in \ncommunity hospitals;  \n\uf0a7 Inpatient psychiatric treatment;  \n\uf0a7 Congenital anomalies;  \n\uf0a7 Inpatient pregnancy  \ncomplications.  Outpatient Expenses  \n\uf0a7 Pre-hospitalization \ndiagnostic and \nlaboratory tests;  \n\uf0a7 Pre-hospitalization \nspecialist consultation;  \n\uf0a7 Post hospitalization \nspecialist consultation;  \n\uf0a7 Emergency accidental treatment charges."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
id: 3ec10460-19b7-4af1-98e1-a273fa1b1477
encoding: FLOAT32
metadata:
{"_node_content": "{\"id_\": \"3ec10460-19b7-4af1-98e1-a273fa1b1477\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"36c165aa-db5e-41f2-8249-8f8fe713bec3\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"74ee3434523d21e16c0e24e62e759b7708b7649706e4a1685ea3549dd2a42f66\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"ee6cd808-265b-4a6b-b8a0-60bddba305df\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"a5e158024195d0b087de9026be82988f83039ed52ab68a8d61b65c4d80ff190d\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 9024, \"end_char_idx\": 13695, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "Catastrophic Outpatient \nExpenses  \n \n\uf0a7 Outpatient kidney \ntreatment;  \n\uf0a7 Outpatient cancer \ntreatment.  covers  \nCovers the \nfollowing charges:  \nPlease note the following covered expenses below:  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   6 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 3a. Inpatient Expenses   \na. Daily Room and Board Charges refers to the charges for standard room     \n accommodation , meals and general nursing services incurred while insured is \nhospitalized.  \n \nb.  Intensive Care Unit Charges \u2013  charges incurred during the confinement in the ICU of the \nhospital.  \n \nc.  Short \u2013stay ward \u2013  incurred during confinement in the short stay ward in an accident  and \nemergency dept of a hospital for inpatient monitoring and treat ment up to 24 hrs to allow \ndoctor to decide whether to discharge the patient or further admitted as an inpatient.  \n \nd. Hospital Miscellaneous  Expenses includes services and supplies (other than room and \nboard and general nursing care):  \n\u2022 Laboratory services;  \n\u2022 X ray examinations;  \n\u2022 Medicines and drugs;  \n\u2022 Surgical dressings;  \n\u2022 Operating room expenses;  \n\u2022 Oxygen and their administration; and  \n\u2022 Ambulance service.  \n  \ne. Surgeon\u2019s Fees \u2013  surgeon\u2019s fees for surgery, includes day surgery and gamma knife.  \n \nf.  Anaesthet ist\u2019s Fees \u2013  for the supply and administration anaesthesia.  \n g. Surgical Implant & Prosthesis  - actual costs of surgical implant of artificial devices used \nto replace missing part of a body.  \n \nh.  Confinement in Community Hospital \u2013  charges incurred for accommodation, meals  and \ngeneral nursing  services.  A referral from the attending physician from the hospital is \nrequired and the admission to the community hospital must be within a time frame \nfollowing his discharge from the hospital.  \n i. In-Hospital Psychi atric Treatment \u2013 must be received as an inpatient of the hospital.  A \nwaiting period may apply.  Treatment for self inflicted, suicide, drug addiction or abuse of \ndrug or alcohol is excluded.  \n \nj. Congenital Anomalies \u2013  inpatient treatment of any congenital anomalies, including \nhereditary conditions.  A waiting period apply.  \n \nk. Inpatient Pregnancy Complications \u2013  inpatient treatment for pregnancy complications.  \nWaiting period  apply.  This benefit may be restricted to the following pre-  defined list of  \ncomplications:  \n\u2022 Ectopic pregnancy;  \n\u2022 Pre- eclampsia or eclampsia;  \n\u2022 Disseminated intravascular coagulation;  \n\u2022 Miscarriage after 13 weeks of pregnancy(not resulting from voluntary or m alicious \nact); \n\u2022 Antepartum haemorrhage;  \n\u2022 Intrauterine death;  \n\u2022 Choriocarcinoma and hydatidiform mole;  \n\u2022 Acute fatty liver pregnancy;  \n\u2022 Breech delivery  and placenta previa and p ostpartum hemorrhage.  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   7 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 3b.  Outpatient Expenses  \na.   Pre-hospitalization Diagnostic and Laboratory Test Charges  \n Charges incurred for diagnostic and laboratory tests as prescribed by the attending \nphysician.  This benefit is payable if incurred within a specified number of days before the date of hospitaliz ation.  \n b. Pre- hospitalization Specialist Consultation Charges  \n Charges incurred for consultation of a specialist as recommended by the attending \nphysician.  This benefit is payable if insured is hospitalized  or undergoes days surgery \nwithin a specified number of days from the date of consultation of the specialist.  \n \n c.  Post \u2013 Hospitalization Specialist Consultation Charges  \nCharges incurred for follow up treatment after hospitalization, eg physiotherapy etc. This \nbenefit is payable for up to a specified number of days after his discharge from the \nhospital.  \n \n d.  Emergency Accidental Treatment Charges  \nCharges incurred for emergency outpatient treatment of accidental  bodily injuries, within \n24 hours of the accident.  \n \n \n3c.  Catastrophic Outpatient Expenses   \n a.  Outpatient Kidney  Treatment Charges  \nCharges incurred for kidney dialysis at a legally registered dialysis centre.  Includes \nexaminations and tests ordered by the physician.  Exclude purchase or rental of the \ndialysis machine."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
id: ee6cd808-265b-4a6b-b8a0-60bddba305df
encoding: FLOAT32
metadata:
{"_node_content": "{\"id_\": \"ee6cd808-265b-4a6b-b8a0-60bddba305df\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"3ec10460-19b7-4af1-98e1-a273fa1b1477\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"4164d5e06d3fef3ba3854f3013561ed051d104c501cb48144875c986022d76ee\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"34973a1e-4198-4975-b5cf-637603dbb4b7\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"4ac327104712a4c2ea714159de1efaa10d67e7fc36e704b4d16b5fa62a841112\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 13583, \"end_char_idx\": 18134, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "Includes \nexaminations and tests ordered by the physician.  Exclude purchase or rental of the \ndialysis machine.  \n \n b. Outpa tient Cancer  Treatment  Charges  \nCharges incurred for chemotherapy, radiotherapy, immunotherapy and/or stereotactic \nradiotherapy, provided by the hospital.    \n  \n \n \n4 .  Other Benefits Under MEI   \n \n1. Major Organ Transplant  \n  \n \nWhere the insured person is a recipient  \n  \nWhere the insured person is a donor  \n \nRefers to the cost  of surgeries for the \ntransplantation of kidneys, lungs, heart, \nliver or cornea , where the insured person is \nthe recipient of any of the organs. It also \nincludes the costs of immunosuppressant \ndrugs where are part of the treatment to \nreduce rejection episodes.   \n \n \n \n \n Covers charges for major organ transplant \noperations of the kidney,  or liver  where the \ninsured person is a living donor, provided:  \nI. Transplant is carried out in a hospital \nin Singapore;  \n \nII. Recipient of the organ must be insured \nperson\u2019s family member ; \n \nIII. The recipient\u2019s kidney or liver failure is \nfirst diagnosed by the attending \nphysician, or the symptoms of which \nfirst appeared, after a waiting period \nof 24 months .  \n \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   8 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 2. Specific Disease Insurance  \nProvides a lum p sum payment in the event of the diagnosis fr om the specific disease \ncovered by the policy.  \n \n \n3. Miscarriage Benefits  \nNot applicable to willful termination of a pregnancy that is not medically necessary but \nprovides reimbursement in the event of a miscarriage or ect opic pregnancy.  \n \n \n4. Private Nursing Home Care  \nPays for the cost incurred in hiring the services of a fulltime/ part time qualified nurse in \nthe insured\u2019s home for the cont inuing treat ment  of a medical condition whi ch is covered \nunder the policy for which the insured person has been hospitalized.  \n \n 5. Daily Hospital Cash  \nA daily cash benefit is payable to the insured if he is hospitalized as a result of an injury or illness.  (refer chapter 6)  \n \n 6. Emergency Overseas Medical Treatment  \nRefers to the costs incurred for an emergency inpatient treatment outside of Singapore.  \nBenefit is subject to reasonable and customary charges for equivalent medical \ntreatment in Singapore.  \n \n 7. Emergency Medical Evacuation  \nRefers to costs incurred for overseas medical evacuation if the insured person cannot  \nobtain treatment needed locally and has to be evacuated to the nearest suitable hospital \nor repatriated  to his home country to that he can be treated in familiar surroundings, near \nto his family.  \n \n 8. Final Expenses Benefit  \n  Death occurring during hospitalization  or within a specified number of days after hospital \ndischarge, and provided death is a result of the cause of the hospitalization.  In the case \nof an Integrated Shield Plan, the final expenses benefit is usually a waiver  of deductible \nand co- insurance components up to the stated amount in the policy.      \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   9 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 5. Key Features Of Medical Expense Insurance  \n \nFeatures of Medical \nExpense  Details  \n  \nWhat are the limits on the \ncovered expenses?  \n \n \n 2 ways:  \n\u2022 \u201cAs Charge\u201d Benefits  \n\u2022 Imposed Sub- Limits   \n \nNote that payment is on a reimbursement basis, hence insurer \nwill reimburse the actual amount incurred or the maximum limit stated in the policy, whichever is lower.   \n \nForms it can be purchased  \u2022 Standalone;  \n\u2022 Rider  (not common in Singapore).  \n \nFamily coverage  \u2022 5% discount given even if the spouse or only 1  \n      child is covered.  \n \n\u2022 Family members n eed not  be covered under the  \n             same plan to enjoy the discount.  \n \nExpense participation  3 methods are :  \n1. Deductibles : a flat dollar  amount paid by insured.  \n3 Types of D eductibles :  \n\u2022 Per Annum; (least restrictive) ; \n \n\u2022 Per D isability Per Year; \n \n\u2022 Per Disability Per Claim.  \n \n2."}


created_at: 2024-03-15 18:52:31
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{"_node_content": "{\"id_\": \"34973a1e-4198-4975-b5cf-637603dbb4b7\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"ee6cd808-265b-4a6b-b8a0-60bddba305df\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"a5e158024195d0b087de9026be82988f83039ed52ab68a8d61b65c4d80ff190d\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"c70b98e5-bbd7-4dc5-a3fd-18f0cccbf971\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"935356b0b0fe74c17fe3c84617d66423bf81624e15667d6716b11ff71a09f3ed\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 18003, \"end_char_idx\": 22719, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "3 Types of D eductibles :  \n\u2022 Per Annum; (least restrictive) ; \n \n\u2022 Per D isability Per Year; \n \n\u2022 Per Disability Per Claim.  \n \n2. Co insurance: a specified percentage  in excess of   \ndeductibles.  \n \n3. Pro- ration factor : when insured is admitted to a ward  \n            higher than the plan\u2019s entitlement, a p ercentage is  \n            applied on the actual charges incurred and covered  \n under the policy, hence benefit is r educed.  In this way it  \n ensures fairness such that a policy owner who pays a  \n lower premium for a lower plan should be encouraged to  \n use the services available only on the selected plan.  \n \n \nNote : Know the egs in the text for calculating deductibles \nand co-  insurance at page 28- 29.  \n \n \n \n \n \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   10 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Benefits limits  Define  :  \nLifetime limit  \nOften set at a very high amount eg. S $1m.  The maximum total \namount of all reimbursements that t he insurer is liable to the \ninsured throughout insured\u2019s l ifetime . \n \nAnnual Limit  \nThe maximum annual reimbursements by the insurer as stated \nin the Benefit Schedule of the Policy.  \n \nEvent Limit  \nMaximum amount payable in respect of any one disability  or  \nillness as defined in the policy.  \n \n \nGeographical Limit  \u2022 Most Individual Expense Insurance Policies will \nautomatically ter minate  if insured resides outside \nSingapore for more than  180 days.  \n \n\u2022 Treatment overseas are based on reasonable and \ncustomary  charges.  \n \nWaiting Period   \nDefine waiting period:  A period of time stated in the policy \nwhich must pass before the coverage can begin.  A waiting \nperiod protects members within the portfolio, by ensuring \nindividuals are not able to make claims shortly after joining and \nthen cancell ing their membership.  \n This plan is subject to a waiting period.  However waiting period \ndoes  not apply to accidental injury.   \n \n \nAge limit   \nMinimum: 15 days old.  \n \nMaximum : 75 years old.  \n \nPremium  Age band basis.  \ni.e if the person crosses to the next age band, he has to pay a \nhigher premium, based on the new age band he falls under.  \n \nGuaranteed Renewability  \n Insurer cannot terminate as long as insured pays the premium.  \nExclusions  \u2022 to avoid policy owner receivi ng reimbursement twice ; \nfor the same charges or making a profit ; \n\u2022 to make premium more affordable;  \n\u2022 to define more clearly the medical care and treatment;  \n\u2022 to avoid the policy owner selecting against the insurer . \n \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   11 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  \nCo- Ordination Of Benefit  \nClause    \nPrevents the insured from making a profit.  Total claims made \nby the policy  owner will be equal to the total medical expense \nincurred.  \n \n \n \nUnderwriting  Individual MEI   \nThe main source o f information for individual Medical Expense \nInsurance is the proposal form .  \n \nGroup MEI  \nFor group coverage, employer is required to complete the \nGroup  Fact Find form . For small group of less than 10 \nmembers, individual employees to complete health declaration   \nform . \n \nHealthcare Subsidy  \u2022 Citizens enjoy h eavy subsidy in clas s B2 and C  wards.  \n\u2022 PRs received significant subsidy.  \n      Foreigners \u2013 not subsided at all.  \n \n \nTermination of Cover   \nApply to both individual and group policies:  \n\u2022 death of the insured person;  \n\u2022 date on which insured enters full time military \nservice except  during National Service reservist \nduty;  \n\u2022 end of policy eg (80 yrs old)  \n\u2022 policy is terminated;  \n\u2022 policy is expired;  \n\u2022 total claim amount reached lifetime limit . \n \nApply to group policies:  \n\u2022 date of cessation as an employee.  \n \nClaims  Forms to be submitted to insurer are :  \n\u2022 Claims f orm;  \n\u2022 Physician statement;  \n\u2022 Original bills.  \n Must notify insurer within a specified period ( 90 days) after \nincurring medical costs.  \n \n \n  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   12 \nProduced in collaboration with Julia Sim."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
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B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Chapter 3 \u2013  Group Medical Expense  \n \n1. What are the characteristics of Group Insurance?   \n \n\uf0a7 Master Contract  - issued under a single contract kept by policy \u2013 owner.  \n \n\uf0a7 Minimum Underwr iting  \u2013 Health declaration form or waive all underwriting requirements \nand rely on pre -existing condition exclusion clauses to prevent anti -selection.  \n \n\uf0a7 Experience rating \u2013 underwritten based on past claims experience.  \n \n\uf0a7 Cost effectiveness  \u2013 low cost due to savings in administrative costs in view that only one \ngroup policy is is sued.  \n \n\uf0a7 Plan Continuation  \u2013 renewable on a y early basis.  \n \n\uf0a7 Eligibility requirements  \u2013 full time work; part time excluded.   \n Must be act ively at work.  \n \n \n2. Ministry of Manpower requires every employer to purchase a minimum medical insurance \ncoverage for t heir foreign workers and domestic workers. It is for their medical bills incurred and \ninpatient care and day surgery.  The minimum amount from 1 Jan 2020 is $15,000 for new \napplications and renewals.   \n \n \n3. Group Medical Expense Insurance policies are often purchased by employers as part of their \nemployee benefits to attract and retain their employees.  Group policies can also be extended to \ncover the employees\u2019 immediate family members. For e xample, a fter th e employees have been \nconfirmed, new dependents like spouse  can be included at any time within 30 days after \nmarriage and child at any time between 15 and 30 days after birth.   \n   \n 4. Compulsory Vs Voluntary  \n  \n Compulsory  \n Voluntary  \nCharacteristics  All employees must be covered under \nthe same plan, and premium has to be \npaid by the employer .  No need for full participation  (min \n75% participation). Employees pay \npart of the premium.  \n \n \n \nAdvantages   \n\u2022 Ease of administration since no payroll deductions to monitor;  \n \n\u2022 Lower costs \u2013  less administrative \nwork;  \n \n\u2022 Employer retains greater control.  Employer  \n\u2022 Employees pay part of the cost;  \n\u2022 Generates interest & \nappreciation;  \n  \nEmployees  \n\u2022 Employees have some form of \ncontrol over the plan;  \n\u2022 Lower premium than buying individually.  \n \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   13 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 5. Differences between Individual and Group Insurance.  \n   \n         Individual Insurance  Group Insurance  \nEligibility  Needs only be insurable to be \ngranted coverage.   \nOnly members who belong to the \ngroup and are actively at work  \nare covered.  \n \nContract   \nEach individual policy gets a policy \ncontract.  \n One master contract is issued.  \nChoice Plan  Has the right to select the coverage.   \nMay not have the choice to select the coverage in a \ncompulsory plan.  \n \nUnderwriting  Individual health and financial \nstatus are evaluated.   \nGender and age distribution of \nthe group, occupation mix and \npast claims experience.  \n \nTermination of \nCover   \nEither individual or insurer chooses to terminate it.  \n Coverage for him stops when he leaves the group.  \nPremium   \nCost of coverage is higher.  \nPremium is age related.   \n Cost of coverage is lower.  \nPremium is unit related.   \n \n \n \n6. Portable And Transferable Medical Benefits For Employees  \n \nTo incentivize employers to make the move towards enhancing the portability of inpatient/hospitalization medical benefits for their employees, Singapore Government has \nrevised the tax policy to allow employers i mplementing any of the following 3 portable medical \nbenefits to enjoy higher tax deduction for medical expenses of up to 2%\n of total employees\u2019 \nremuneration:  \n \na) Portable  Medical Benefits Scheme (PMBS);  \n \nb) Transferable Medical Insurance Scheme (TMIS);or  \n \nc) Provision of Medisave- Approved Integrated Shield Plan ( IP).  \n \n  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   14 \nProduced in collaboration with Julia Sim."}


created_at: 2024-03-15 18:52:31
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B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 6a)  Portable Medical Benefits Scheme (PMBS)  \n \n\u2022 This scheme rides on the Medisave/MediS hield framework. Employer  makes \nmonthly contribution to employees\u2019 Medisave accounts that can be used to purchase \nany one of the Medisave approved medical insurance policies to cover their \nhospitalization needs, instead of providing Group Medical Insurance coverage.  \n \n\u2022 Advantage is  that the employee can continue  to be covered even though he may be \nunemployed or is in between jobs.  Coverage continues as long as premium is paid \nregardless of employment status.  \n \n\u2022 To enjoy the 2% tax deduction, following conditions apply ;  \no Must cover at  least 20% of the local employees;  \n \no For full time employees, the additional monthly contributions to Medisave \naccounts should be at least 1% of each employees\u2019 gross monthly salary, \nsubject to a min of $16 per calendar year.  \n \no For part -time employees, the additional monthly contributions to Medisave \naccounts should be based on 1% of their gross salary for the calendar month.   \n \nHowever, for employers who choose not to implement either PMBS or TMIS, their tax  \ndeductibility in respect of medical expenses will be maintained at 1%  of total employees'  \nremuneration.  \n \n \n \n6b) Transferable Medical Insurance Scheme (TMIS)  \n \nTMIS is an enhancement of the existing employer sponsored Group Medical Expense \nInsurance outside of the CPF Medisave framework.  It is basically an employer -sponsored \nGroup Medical Insurance programme with the following 2 additional features:  \n \n\u2022 Continuation of coverage; and  \n \n\u2022 Transferability  \n \n \n1. To qualify for TMIS, the employer must :  \n\u2022 have a group size of 11 or more employees;  \n \n\u2022 take up  a group Medical Expense Insurance plan (MEI);  \n \n\u2022 insure at least 50%  of its local employees, subject to a minimum total of 11 employees;  \n \n\u2022 pay 100%  of the premiu m for the group Medical Expense Insurance coverage;  \n \n\u2022 not to  give employees the option to be insured under the group insurance plan.  \n \n  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   15 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 2. Two Features under the TMIS  \n \n \nPrevious Employer's TMIS Plan  \nContinuation Of Coverage Benefits  \n   \nNew Employer's TMIS Plan  \nTransferability of Benefits  \n \nEmployees to enjoy hospitalization coverage \nfrom their termination of employment \n(voluntary or otherwise) up to a max period \nof 12 months  (not exceeding age 62).   \nEmployees who resign from one company, \nwhich holds a TMIS policy, and joins \nanother, who als o holds a TMIS policy w ill \nenjoy these benefits:  \nI.  automatic coverage under the new \nemployer\u2019s group plan,  without the \nneed to provide evidence of good health;  \n \nII. Waiver of any exclusion on pre - existing \nmedical conditions if the employee has \nbeen continuously insured under a  \nTMIS plan for 12 months  whether with \nthe pr ior employer or new employer.   \n \nHowever, if the employee is hospitalized for \na pre existing  condit ion when he joins the \nnew employer within the first 12 months , he \nwill enjoy a lower  benefit of either the new \nemployer\u2019s TMIS plan or prior employer\u2019s \nTMIS plan. Refer to eg 3.1 in pg 52 of text.  \n \n \n  \n3. Medical Expenses that qualify under TMIS Special Bene fits:  \n\u2022 Daily room and board charges;  \n\u2022 ICU; \n\u2022 Miscellaneous hospital services;  \n\u2022 In- hospital doctor\u2019s visits;  \n\u2022 Inpatient and outpatient benefits.  \n \nAll pre/post hospitalization outpatient, emergency outpatient accident and outpatient \nkidney dialysis/cancer treatment are not eligible  for TMIS benefits, even if they can be \nreimbursed under TMIS Plan.  \n \n \n4. To be eligible for the TMIS benefits, an employee must be:  \n\u2022 Below statutory retirement age (62 years from 1 Jan 1999)."}


created_at: 2024-03-15 18:52:31
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{"_node_content": "{\"id_\": \"4dc1b6a6-0633-4398-8ea9-72988899f691\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"b873dd38-fe9f-4a30-af34-b92648ea5884\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"24ee997a9d993888a283f638b9d53488eb53cf21779f5d547d9c911e66fa7c76\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"41aa032f-83e9-4b19-b2bf-8d4ae7c5d21d\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"86987d2a59812350cf76034b6a70e8c4aad9261224fec6bb4391ce5954de617d\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 30993, \"end_char_idx\": 35545, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "4. To be eligible for the TMIS benefits, an employee must be:  \n\u2022 Below statutory retirement age (62 years from 1 Jan 1999).  However since 1 Jan \n2012, employers are now required to offer re employment to eligible employees who \nturn 62 years, up to 65 years;  \n\u2022 Singaporean or PR based in Singapore;  \n\u2022 Working full tim e with the same employer;  \n\u2022 Working on a permanent employment contract or on a temporary contract, with a \nterm of 24 months or more.  \n \n \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   16 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 5. To verify the eligibility of an employee under the TMIS, any employer has to issue a \nTransferable Medical Insurance (TMIC)  at the request of an employee upon termination of \nhis employment.  The TMIC must be submitted to the insurer when the employee submits a claim for Continuation Benefit, or to the new employer\u2019s insurer should a claim arising from \na pre existing condition be made within 12 months of joining the new employer.  \n \n \n6. PMBS Versus TMIS  \n  \nPMBS  \n  \nTMIS  \n \nWho purchase s the \nPolicy?   \nEmployees purchase policy on his \nown from the contributions made by \nhis employer to his Medisave \naccount . \n  \nEmployer purchases the \npolicy.  \n \nWhat type of medical \nplan can be \npurchase?   \nOnly a Medical Insurance policy \napproved under the Medisave \nScheme.    \nAny group Medical Expense \nPolicy, other than those approved under the Medisave \nScheme.  \n \n \nCoverage   \nLifetime for most private Integrated \nShield Plans.  \n \nCoverage continues  when the \nemployee is between jobs or out of \njob as long as premium is paid.   \nExpires at statutory \nretirement age.  \n \nCoverage continues up to a \nmax of 12 months from the \ndate of termination of a job.  \n \n \nDeductibles and Co-  \ninsurance   \nApply.  However riders can be \npurchased to offset them.   \nUnlikely to apply as Group MEI rarely have these \nfeatures.  \n \n \nPre existing Illness.   \nExcluded   \nWaive r on pre existing \nconditions where employees \nchange jobs  and where both \nemployers provided TMIS benefits.  \n \n \nWho have control \nover the policy? \n  \nEmployees   \nEmployer  \n  \n  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   17 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 6c. Provision of Integrated Shield Plan  \n\u2022 With effect from the Year of Assessment 2008, employers providing employees with a \nShield P lan (i.e MediS hied Life or Medisave- approved Private Integrated Shield Plan) \ncan claim tax deduction for medical expenses incurred, up to 2%  of their total \nemployees\u2019 remuneration, if they  meet the following:  \n \no Provide Shield plans for at least 20%  of their local employees;  \n \no Pay Shield plan premiums on behalf of their employees directly to the insurer or reimburse the premiums into their respective employees\u2019 Medisave accounts.  \n \nTax deduction excludes  premiums for Riders on Shield Plans that cover deductibles \nand co-  insurance payments.  \n  \n \n \n  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   18 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Chapter 4 \u2013  Disability Income Insurance  \n \n1. \n \n  \u2022 Often sold as Income Protection  product as it helps to replace a portion of the \ninsured\u2019s income that he loses if he becomes incapacitated and unable to work as \na result of as a result of accident or sickness.  \n \n\u2022 Known as Permanent Health  Insurance because insurer cannot cancel the polic y \nno matter how many times the insured makes a claim.  Policy will continue to pay until insured returns to work, dies or policy ends whichever happens first.  \n Also known as :  \n \n\uf0a7 Permanent  Health Insurance;  \n \n\uf0a7 Income Protection ;  \n \n\uf0a7 Income Replacement.  Disability Income \nInsurance  \nWhy?   \n4 definitions of Total Disability  \n \n1. Own Occupation  \no Insured\u2019s  inability to perform own occupation.  \n \n2."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
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{"_node_content": "{\"id_\": \"41aa032f-83e9-4b19-b2bf-8d4ae7c5d21d\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"4dc1b6a6-0633-4398-8ea9-72988899f691\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"b4bf0474ac2b3224cbbbae073552f4492b93b5459d8bf499a3468fb54f45dfe4\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"3bc43400-62f1-457b-b7b0-03115fed0842\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"28775a98ecb8e6a71f12d1577484d7594b1d7317e26466a1bddda55677c07115\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 35392, \"end_char_idx\": 39749, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "Disability Income \nInsurance  \nWhy?   \n4 definitions of Total Disability  \n \n1. Own Occupation  \no Insured\u2019s  inability to perform own occupation.  \n \n2. Modified Own Occupation  \no Insured\u2019s  inability to perform any gainful occupation or similar occupation for which \nhe is reasonable suited by reason of education, training or experience.  \n \n3. Any Occupation  \no Insured\u2019s inability to perform any occupation.   \n \n4. Severe Disability  \no Insured\u2019s inability to perform at least 3 of the 6 ADLs \u2013  washing, dressing, feeding, \ntoileting, mobility, transferring (follows the definition of Long Term Care Insurance in \nChapter 5)  \n \nQn : Which of the above definition is the most restrictive ? \n \nAnswer:   \u201cAny Occupation\u201d  Pg 62  DI will pay if insured is totally disabled and \nunable to work.  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   19 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 2.   The main difference between D isability Income  (DI) and T otal Permanent Disability  (TPD)  \n lies in the purpose:  \n \n\uf0a7 DI - provides income to the insured when he is unable t o go to work.   \n \n\uf0a7 TPD - serves to accelerate death benefit under a Life policy.   \n \n \n3.  Other differences between Disability Income and Total and Permanent Disability Benefit : \n \n \nCriteria   \nDisability Income Insurance   \nTotal and Permanent Disability \nBenefit  \n \n \nForm   \nStand-  alone policy or rider.   \nIncorporated into Life Insurance \nPolicies.  \n \n \nMaximum Sum Assured   \nUp to specified percentage of the salary.  \n  \nNot pegged to salary.  \n \nEscalation and Partial \nBenefit  \n  \nAvailable  \n  \nNot available  \n \nDeferred Period   \nAvailable (can choose)  \n  \nUsually a 6 -month waiting period.  \n \nAvailable to who   \nWorking adults with earned \nincome salary.  \n  \nNo restriction on non working people.  \n \n \n4. Compute total amount received from the DI Policy, given the  following information:  \n  \n Monthly Income: $5000     \n Escalation Benefit: 5% per year  \n Effective Benefit Period : 30 Years  \n  \n Answer  \n Monthly Benefit: $3750 ($5000 x 75%)  \n Yearly Benefit : $3750 x 12 = $45,000  \n Total Benefit Payable: $45,000 x 66.4388  (table A1 \u2013 5%;30 Yrs) = $2,989,746  \n  \n   \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   20 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 5. Definitions , Features and B enefits under Disability Income:  \n \nRecurrent Disability  \n (Linked Claims)  In the event if the insured who has been receiving disability \nbenefits under a DI Policy, returns to work, but suffers a \nrelapse within a certain period (usually 180 days), insurers \nwill waive  the deferred period and benefits payments will \nrecommence  immed iately.  It is treated as a continuation \nof earlier claim.   \n \nBenefit Period Vs Deferred \nPeriod/Elimination Period  Benefit Period           \nThe longer  the benefit period, the higher  the Premium.  \n \nDeferred Period(DP)  \n\u2022 The longer the deferred period, the cheaper  the \npremium.  \n \n\u2022 Shortest(DP) -  suitable for : Self Employed;  \n \n\u2022 Longest (DP) \u2013 suitable for : Budget Conscious.  \n \n \nTotal Disability Benefit   \n\u2022 Pays up to 75%of insured average income  \n      prior to his disability.  \n \n\u2022 Not 100% payment so that insured has inc entive to \ngo back to work.  \n \n \n \nPartial Disability Benefit   \n\u2022 Also known as \u201c Rehabilitative Benefit  \u201d.  \n \n\u2022 It provides a r educed benefit if insured is able to \nwork at a reduced income of 75% % of his pre -\ndisability income.  This reduced benefit is based on \nthis formula:  \nPre-disability Earnings \u2013  Present Earnings  X TDB  \n               Pre-disability Earnings  \n \nNote : Please know the e.g at page 67 of text  \n \n \nRehabilitation Expense Benefit   \nPays for rehabilitation costs incurred.  \n  Limited to a per disability basis.  Includes  \n\u2022 Training courses ; \n \n\u2022 Medical aids (e.g wheelchairs); and   \n \n\u2022 Workpl ace modifications."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
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{"_node_content": "{\"id_\": \"3bc43400-62f1-457b-b7b0-03115fed0842\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"41aa032f-83e9-4b19-b2bf-8d4ae7c5d21d\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"86987d2a59812350cf76034b6a70e8c4aad9261224fec6bb4391ce5954de617d\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"1ddd335f-f507-43f2-b252-7677d1664181\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"70daecfe3e8037fadf0eed421ee3444f39b91c33241b4b23cdd67cdf6b17eba2\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 39608, \"end_char_idx\": 43948, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "Limited to a per disability basis.  Includes  \n\u2022 Training courses ; \n \n\u2022 Medical aids (e.g wheelchairs); and   \n \n\u2022 Workpl ace modifications.  \n  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   21 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  \nEscalation Benefit  \n  \nUseful to hedge against inflation .  \n \nNote: Please know this e.g at page 69 of text:  \n Compute escalation benefit, and partial disability benefit \ngiven the following:  \nEddy was disabled on 30 June 2011 and he qualifies for a \nDI payment. He opted for a 3% escalation benefit per \nannum and a 6 month deferred period.  Insurer makes first \npayment  on 1.1.2012 for $6000. (75% of his monthly salary \nof $8000).  He found a job that pays him $2000 a month on 1.2.2013.  \n  \n \nQN : How much should insurer pays him on 1.1.2013?  \n Ans: $6,180 ($6000+$6000x3%) escalation benefit  \n                  kicked in on the second year.  \n \n \nQN: How much should insurer pays him on1.2.2013? \n       Ans : $4,635 \n \n       Partial disability calculated as:  \n       $8,000 - $2000 x $6,180 \n            $8000  \n \n \n  \nWaiver of premium   \n\u2022 Premium would be waived  during DI benefit  \npayment period (applies to both Total and partial \ndisability)  \n \n\u2022 For annual premium, waiver will come in at next  \nPremium Due Date even though DI payment  \n      has started. No re fund of premium.  \n   \n \nDeath Benefit   \nA lump sum amount is paid to insured dependants.  \n \n \nLimitation of Disability Clause  Disability benefit payable will be reduced by income \nreceived from Work Injury Compensation, any continuing \nsalary or other income derived by insured\u2019s occupation.  \nHowever benefits will not be reduced by payment from \nTotal Permanent Disability Benefit.  \n \n \n \nPremium  \u2022 Level premium;  \n\u2022 Premium waived during benefit period;  \n\u2022 Guaranteed renewable.  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   22 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Surrender value  No  \nAssignment  Not allowed  \n \nTax  Benefits Not Taxable  \n \nGrace Period  Policy will lapse if premium is not paid within the 30 days\u2019  \ngrace period.  \n \n \nUnderwriting Requirements  \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n Underwriting Considerations    \nIndividual  \nProposal form plus  \n\u2022 Computerized payslip or  \n\u2022 Certified letter from company, on company\u2019s  \n      letterhead, or ;  \n\u2022 Notice of A ssessment ;  \n\u2022 CPF Statement ( 6 months); and  \n\u2022 Large  Amount questionnaire ( if annual benefit \nis more than $60,000);  \n\u2022 Medical Tests based on age and amount . \n \n \nSelf Employed  \nProposal form plus \n\u2022 Notice of Assessment for the last 3  years, or  \n\u2022 Audited company\u2019s account for the last 3 yrs;  \n\u2022 Medical test based on age and am ount;  \n\u2022 Large Amount questionnaire (if annual benefit is \nmore than $60,000) . \n \n \n1.  Occupation  \n     To measure :  \n\u2022 Higher risk of disability from accident or sickness . \n \n\u2022 Degree of incapacity to return to work. Insurers \nhave a rating structure depending on the class of \noccupation.  Some insurers may issue the policy for \nwhite collar occupations  \n \n2.  Benefit Amount  \n     To assess benefits proposed are reasonable based on  \n     the type of occupation and  stated earnings.  \n  3. Benefit Period  \n    The duration that the insurer needs to pay out the  \n     benefits.  To determine the terms of acceptance.  \n \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   23 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 4.  Deferred Per iod  \n     A shorter deferred period has a higher element of  \n     moral hazard.  \n \n \n \n  6. Differences between Cessation of Benefits and Termination of Cover."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
id: 1ddd335f-f507-43f2-b252-7677d1664181
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Differences between Cessation of Benefits and Termination of Cover.  \n \n \nCessation of Benefits   \nTermination of Cover  \n \n \n\uf0a7 Insured is fit to r eturn  to work;  \n \n\uf0a7 When de ath occurs;  \n \n\uf0a7 Benefit p eriod has expired.  \n  \n\uf0a7 Policy reached expiry  date;  \n \n\uf0a7 Premium is not paid within g race period;  \n \n\uf0a7 Insured dies or reached the expiry age;  \n \n\uf0a7 Resides outside Spore for an  \n   aggregate of more  than a specified  \n   no. of days (eg 300 days) within a  \n   policy;  \n \n\uf0a7 Insured is not employed  in a full time \noccupation or profession for a continuous \nperiod of a specified number of days (except \nif he is disabled).  \n \n   \n  \n  \n7. Group DI can be issued as a Standalone or Rider.  However the group must have a  \n Group Term Life Policy  before they are eligible for DI Policy.  \n \n Group Long Term Disability Income policies are bought by employers to cover senior  \n management employees.  Benefits are payable if the disability is long term, hence there is a  \n waiting period.  \n \n  \n \n8.  Claims procedures for individual or group disability income are similar . Insured must notify \ninsurer within a specified period of time (e. g 60 days ) from the date of commencement of \ndisability. Documents insurer ask for includes:  \n\u2022 Claim form (personal particulars, details of his occupation and disability);  \n\u2022 Claimant \u2018s statement;  \n\u2022 Clinical Abstract form;  \n\u2022 Physician\u2019s statement;  \n\u2022 NRIC/ birth certificate;  \n\u2022 Evidence of earnings;  \n\u2022 Letter from company certifying that the insured\u2019s services has been terminated;  \n\u2022 Medical certificates;  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   24 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) \u2022 Laboratory tests results;  \n\u2022 Police report if disability is due to accident;  \n\u2022 Incident report  (if incident occurs at the workplace).  \n \n \n9. Foreign Residency During Claims P eriod  \nIf insured resides outside of Singapore while the benefits are payable, following conditions apply:  \n\u2022 Insurer must be notified of the change in residence within 30 days of change;  \n \n\u2022 Insurer must approve the new country of residence; \n \n\u2022 Insurer has determined that the evidence which can be submitted to make a claim under \nthe policy from  the new country of residence, is of similar (or better) standard, as \ncompared that which would be available if the insured were to  remain in Singapore.  \n \n\u2022 Insurer has determined that the expertise and facilities for the care, treatment and \nrehabilitation of the insured in the new country of residence, are similar (or better) \nstandard, as compared to those which would be available in S ingapore.   \n  \n\u2022 Insurer reserves the right to require an independent  examination of the insured by its  \n preferred doctor as and when reasonable.  \n  \nIf any of these conditions are not satisfied, insurer reserves the right to suspend the benefits \npayable, until  such time the insured returns to Singapore and the insurer receives satisfactory \nevidence to resume payment of benefits.\n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   25 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Chapter 5 \u2013  Long Term Care Insurance  \n \n1. Objective of Long Term Care Insurance (LTCI) is to meet costs of care to a person who as  a  \nresult of accident, sickness is physically impaired and unable to function independently.   They \nneed assistance to perform the most basic  activities of daily living  (ADLs).  It pays in addition \nto other insurance policies, eg MediS hield  Life. \n \n \n2. Although this product is meant for the elderly, the young should buy for 2 reasons:  \n \n\uf0a7 Cheaper  Premium;  \n \n\uf0a7 Higher  chance of being accepted.  \n \n \n \n3."}


created_at: 2024-03-15 18:52:31
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{"_node_content": "{\"id_\": \"c7cc892d-3014-440e-8efd-a065b8ec3671\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"1ddd335f-f507-43f2-b252-7677d1664181\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"70daecfe3e8037fadf0eed421ee3444f39b91c33241b4b23cdd67cdf6b17eba2\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"983ced7a-5406-4a12-979a-d28346594238\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"b7c5616a8a27b061fd00cd08bc5ddb149d37238fafbf2fe9f106898f346063c3\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 47867, \"end_char_idx\": 51617, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "2. Although this product is meant for the elderly, the young should buy for 2 reasons:  \n \n\uf0a7 Cheaper  Premium;  \n \n\uf0a7 Higher  chance of being accepted.  \n \n \n \n3. Benefits  offered under LTC  Insurance  \n \n \n  Benefits of LTCI  \nDaily Basis  Monthly Basis  \na) Service Based  \n        \n2 Types  \n1) Expense Incurred  \nInsurer will reimburse costs up to daily \nbenefit am ount in the \npolicy  (more common \nmethod);  \n  \n \n  2) Indemnity Method    \n       Pay am ount in the  \n       policy regardless  \n       of  the cost . b)  Disability Based  \n \n\u2022 Pay if meets t he  \n   benefit trigger;  \n  \n\u2022 Benefit trigger  \n  is the criteria   \n  used to   \n  determine  \n  eligibility for LTCI  \n  payments.   \n\u2022 By far the most common \ntype of LTC Plan found in \nSingapore;  \n  \n\u2022 Pay 100%  of LTCI \nmonthly benefit if unable to perform 4 out of 6 \nADLs;  \n \n\u2022 Pay 50% of LTCI  \n     monthly benefit if  \n     unable to perform 2  \n     out of 6 ADLs;  \n \n \n\u2022 Pays if the insured is \ndiagnosed to be suffering \nfrom advanced dementia \nincluding Alzheimer\u2019s  \ndisease.  \n \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   26 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 4. Insured need not be  hospitalized to be eligible for LTC benefits.  He can use the benefits he \nreceived under his LTC to pay for the costs of engaging a maid or to pay for the costs of staying \nin a nursing home.  However, he must meet the following criteria:  \n  \n \nCriteria for p ayment of LTCI Benefit  \n \n \n1a.  Meets the definition of inability to perform Activities  of  Daily Living:  \n\uf0a7 Washing  / Bathing  \nThe ability to wash in the bath or shower (including getting into and out of the bath \nor shower) or wash by other means.  \n \n\uf0a7 Dressing  \nAbility to put on, take off, secure and unfasten all garments, any braces, artificial limbs, or surgical or medical appliances.  \n \n\uf0a7 Feeding  \nAbility to feed oneself once the food has been prepared and made available.  \n \n\uf0a7 Toileting/Continence  \nAbility to use  the lavatory or otherwise manage bowel and bladder functions through \nthe use of diapers and urinary catheters, so as to maintain a satisfactory level of \npersonal hygiene.  \n \n\uf0a7 Mobility ; \nAbility to move indoors from room to room on level surfaces.  \n \n\uf0a7 Transferri ng  \nAbility to move from a bed to an upright chair or wheelchair vice versa.  \n \n \n1b.  Advanced Dementia, or dementia arising from Alzheimer\u2019s disease is covered.  The  \n       important issues are that dementia must arise from an organic reason  and that the insured  \n       requires continual supervision.  \n \n \n2.  Meets the deferred period requirement.  \n \n      Most insurers have a Deferred  Period of 90 days  commencing from the first day of any  \n      continuous period of inability to perform A DLs. This is to ensure that short term claims are  \n      avoided and therefore, reduce the premium costs.   \n \n \n3.  Do not cover pre- existing illness  that was not disclosed in the proposal form.  If disclosed,  \n     insurer may reject the application or accept the application:  \n\u2022 at standard premium rates;  \n\u2022 at substandard premium rates (higher premium);  \n\u2022 with exclusions.  \n \n \n \n \n \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   27 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 5."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
id: 983ced7a-5406-4a12-979a-d28346594238
encoding: FLOAT32
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{"_node_content": "{\"id_\": \"983ced7a-5406-4a12-979a-d28346594238\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"c7cc892d-3014-440e-8efd-a065b8ec3671\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"37f00a744a6999521b06de7d3ec1aaa15ebf302c77d28f27c2913f3591abd3f3\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"d44a4f06-927d-4ec1-98c3-f0a31ab1303f\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"4c41d3eeb03f18e44db7ef02942b4cf73af6817aab1641bee6b85abe5615b10f\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 51566, \"end_char_idx\": 55610, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 5. Other benefits payable under LTCI are:  \n  \n\uf0a7 Death Benefit  \nSmall  death cover ranging from an e.g $5000 to 6 times the LTC monthly benefit;  \n \n\uf0a7 Hospital Room and Board Benefit  \n \n\uf0a7 Surg ical Procedure Benefit  \n \n\uf0a7 Financial A ssistance with Ada ptation  Benefit ; \nA specified sum, such as 2 times the monthly benefit, is payable if the use of assistive \ndevice s is de emed necessary (eg wheelchair);  \n \n\uf0a7 Extended Care Benefit  \nAn extra specified sum, such as extra monthly benefit , is payable every 3 to 5 years;  \n  \n\uf0a7 Rehabilitation Benefit  \nA reduced benefit  (e.g 50% of the insured amount) when the insured makes partial \nrecovery (such as if he is unable to do 2 instead of 3 ADLs) . \n  \n \n6. Among the features of LTC Insurance given in the text at page 89, please know the following:  \n \n\uf0a7 Offered on a stand -alone basis or as a rider  to a plan.  \n \n\uf0a7 It is issued on a guaranteed renewable basis .  \n \n\uf0a7 There is no cash value or paid up value  (with exception of Eldershield which has a paid- up \nvalue) at any time.  \n \n\uf0a7 Policy is non- participating and does not share in the divisibl e surplus of the insurer.  \n \n\uf0a7 Premiums are level and usually not guaranteed for the policy period and can be adjusted by \nthe insurer.  \n \n\uf0a7 If insured recovers from his disability, payments will stop.   However, the insured can choose \nto continue his policy by continuing to  pay the premiums, provided he h as not reached \nmaximum limit under his policy.  \n \n \n7.  Among the exclusions given in the text at page 89, please know the following:  \n\uf0a7 All pre -existing illness;  \n \n\uf0a7 Self inflicted injury;  \n \n\uf0a7 Alcoholism or drug abuse;  \n \n\uf0a7 Acquired Immune Deficiency Syndrome (AIDS) or infection by any human immunodeficiency \nvirus (HIV), except where the infection is due to blood transfusion or resulting from \ninfection incurred by medical staff  after the issue date;  \n \n\uf0a7 Participation in a felony , riot or insurrection.  \n  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   28 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  \nChapter 6 \u2013  Other types of Health Insurance  \n \nThis chapter covers the following health insurance product:  \n \n1. Critical illness Insurance;  \n2. Hospital Cash (Income) Insurance;  \n3. Medical Expense Benefits Under Travel Insurance;  \n4. Group Dent al Care Insurance.   \n \n \n1. Critical Illness or Dread Diseases(DD)  \n1.  \n \n \n \n2. Eligibility criteria for p ayment of Critical Illness Benefit .  \n \na. Policy must be in f orce;  \n \nb. Life insured has not reached expiry age of Critical Illness Cover;  \n \nc. Critical Illness must be one that is cov ered;  2 types   \n \uf0a7 Acceleration Benefit;  \n\uf0a7 Additional Benefit;  \n \nWhich is often known as \u201cPackaged  Policy\u201d?  \nAns : Acceleration Benefit  \n \n \n \n \n \n \n Dread Disease or  \nCritical Illness   \nPurpose  \n \n\u2022 Provides a lump sum  benefit upon diagnosis of any one of the critical illness;  \n \n\u2022 It is a hybrid of life and health insurance;  \n \n\u2022 Can be sold as a stand -alone policy (individual or group) or as a rider to other policy;  \n \n\u2022 Before 1 August 2014, CI Insurance Policies cover only a maximum of 30 out of 37 \ncritical illnesses. From 1 August 2014, CI benefits offered under new individual or group \ninsurance policies may be launched under 2 changes:  \ni. revised standardised definitions of the 37 severe critical illnesses (appendix 6a).  \n \nii. flexibility for more medical conditions to be covered.  Insurers not only can offer \nCI Insurance Policies covering beyond 37 (30 previously), but also offer single \nillness CI Plans.  Definitions for addit ional CI not covered by the 37 standardised \ndefinitions will be set by individual insurers.  \n \nCI using the old definitions will no longer be sold from 15 Feb 2015."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
id: d44a4f06-927d-4ec1-98c3-f0a31ab1303f
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{"_node_content": "{\"id_\": \"d44a4f06-927d-4ec1-98c3-f0a31ab1303f\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"983ced7a-5406-4a12-979a-d28346594238\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"b7c5616a8a27b061fd00cd08bc5ddb149d37238fafbf2fe9f106898f346063c3\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"e9886d6e-508e-4805-a2e7-80388aa43594\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"eef622f572bdefff7a0a9c1fe9caaf0f1bf600a027b7b4cb2d4e2f4036e66445\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 55422, \"end_char_idx\": 59636, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "Definitions for addit ional CI not covered by the 37 standardised \ndefinitions will be set by individual insurers.  \n \nCI using the old definitions will no longer be sold from 15 Feb 2015.  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   29 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) d. Critical Illness must meet the definition  in the policy;  \nThe definition of critical illnesses a  as specified in the policy forms an important part of \nthe policy, as they will determine whether a claim is payable.  Important to explain to \nprospective client, to ensure he understands the benefits will be paid only if the disease \nqualifies and meets the definitions as specified in the policy. .  \n \ne. Critical illness must meet conditions set down by insurer.  The diagnosis of the CI must \nbe made by registered medical practitioners, which excludes physicians who are \nthemselves (life insur eds), their spouses and other lineal relatives of theirs;  \n \nf. Must meet the waiting period of  90 days  from the date of issue or reinstatement;  \n \ng. Must meet the s urvival period of usually 30 days , (although can be as short as 7 days) \nfrom date of occurrence of a critical illness.  It applies  to Additional Type only.  \n \n \n3. Among the features of Critical Illness Insurance (CI) given in the text at page 98, please know  \nthe following:  \n \n\uf0a7 Can be issued as a stand- alone basis  or as a rider to a basic policy.  It does not  pay \nupon the life insured\u2019s death or total and permanent disability;  \n \n\uf0a7 CI rider has no cash value;  \n \n\uf0a7 CI rider is automatically terminated once the basic policy is surrendered or converted \ninto an extended term policy;    \n \n\uf0a7 Stand \u2013alone term CI Policy does not  acquire cash value, and thus has no non forfeiture \noption;   \n \uf0a7 Can be packaged or attached to a Life, Endowment or Investment Linked Policy;  \n \n\uf0a7 Packaged CI Policy which accumulates cash value (e.g whole life type of CI Policy) also \nprovides non forfeiture opt ions.  However, CI cover may be terminated once  any non \nforfeiture option is exercised except Paid Up Option;  \n \n\uf0a7 Assignment may/may not be allowed;  \n \n\uf0a7 Maximum age entry (eg 55 years) and minimum age entry (eg 1 year), subject to a lien;  \n \n\uf0a7 There is a minimum ( eg $10,000) and maximum (eg $1,000,000) sum assured \nrestriction;  \n \n\uf0a7 Cover w ill expire at age 65 years, or a whole life cover may be provided.  \n \n \n4. There are 2 types of Critical Illness Covers;  \n\u2022 Acceleration Benefit; or  \n\u2022 Additional Benefit  \n \n \n \n  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   30 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) a) Acceleration Benefit Critical Illness Cover  \n \n. \n  Payment of :  \n\u2022 S$200,000 (death  in lump sum ) or \n \n\u2022 S$200,000 (TPD in instalments basis)  S$200,000  Whole Life type of CI Policy with 50% \nacceleration benefit.  \n \nPolicy owner has the flexibility of choosing the \npercentage of acceleration.  \nScenario 2  \nCritical Illness   Scenario 1  \nDeath/ TPD  \nNote :  \n\u2022 Policy owners who opt for less than 100% of acceleration, should attached a \nCritical Illness Waiver of Premium Rider so that  the future premiums on the \nbalance sum assured will be waived.  \n \n\u2022  The cover for this type of CI Policy may be up to age of 100 years, or depending \non the type of life policy to which is packaged/attached.  \n \n\u2022 Depending on what type of policy CI cover is attached to, if the basic policy has no \ncash value (eg term policy), then there is no non -forfeiture option under the policy \nto keep it in force, unlike Whole Life or Endowment Policy which has acquired cash value, the insurer can make use of automatic premium loan to keep the policy in \nforce should policy  owner default s in premium payments."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
id: e9886d6e-508e-4805-a2e7-80388aa43594
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B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) b) Additional Benefit Critical Illness Cover.  \n \n  \n \n  Payment of:  \n\u2022 S$100,000 (death  in lump sum ) or \n\u2022 S$100,000 (TPD in instalments \nbasis)  Whole Life Policy : S$100,000.  \nAdd on Critical Illness Rider: S$200,000  \n \nThis type of CI cover is usually available on a \nstand- alone basis or as a rider.  \nScenario 2  \nCritical Illness   Scenario 1  \nDeath/ TPD  \nNote :  \n\u2022 This rider pays in addition to the sum assured of the basic policy it is attached.  \n \n\u2022  The term of this rider can be shorter,  but not longer t han that of the basic policy. \nUsually expires at the age of 65 years.  The sum assured of the rider can be \nhigher than the basic policy (e.g 5 times  that of basic sum assured)  \n \n\u2022 Policy owners should at tached a Critical Illness Waiver of Premium Rider  so \nthat they need not worry about the premiu m payments for the basic policies to \nwhich CI rider is attached to.  Payment of CI Rider  \n\u2022 S$200,000  \nPayment of Whole Life \nPolicy  \n\u2022 S$100,000  Upon Death/ TPD  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   32 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 5. Differences between Severity Based Critical Illness Plan and Normal Critical Illness Plan is that  \n Severity Based CI  \n \n\u2022 pays claims during the early stages and less severe critical illness.  Benefits are \nclaimable at different stages of the illness, from early  to intermediate  to advanced and \nterminal .  It pays a percentage of the sum assured as a lump sum  payout to the poli cy \nowner.  The progressive lump sum payment, subject to a monetary  cap of each severity \nlevel, pays up to the total sum assured.   \n\u2022 Offered as a term plan or a rider; \n\u2022 Offered from age 1 to age 75;  \n\u2022 Premium is higher than normal CI plan.  \n \n \n6. Multiple Pay Critical Illness Plan  \n Allows more than one  critical illness claim on the policy.  A second or even third claim is \nallowed if the medical condition deteriorates or if a different medical condition occurs.  Waiting \nperiod of the second and subsequent claims is usually waived.  \n Eg: Total payouts of up to 200% of  sum assured.  So if the sum assured is $100,000, the plan \ncan pay up to $200,000.  \n \n \n7. CI Polices usually have a built -in death benefits payable, hence they will come under the \n Nomin ation of Beneficiaries framework.  Insured who is a policy owner can make a \n nomination at the age of 18 years and above.  2 options available are Trust Nomination or \n Revocable Nomination.  \n  \n8. Termination Of Cover   \n\u2022 valid CI claim has been made,  \n\u2022 basic l ife policy to which it is packaged matures or CI rider expires;  \n\u2022 non-payment of premiums, insured dies  \n\u2022 policy is converted into Extended Term Insurance Policy . \n \n \n9. In the event of a claim, insured must submit:  \n\u2022 Claimant  Statement  - completed by insured;  \n\u2022 Attending Physician\u2019s  Report;  \n\u2022 Proof of Critical Illness  eg histology report;  \n\u2022 Written notice of claim must be submitted within 60 days  of diagnosis of CI or performance \n of surgery;  \n\u2022 Claimant\u2019s form must be submitted 15 days  from the date the insurer sent it out ; \n\u2022 Proof of CI must be submitted within a specified period ( 60 days ) from the date of diagnosis \n of CI.  \n \n10. Group Critical Illness Policy:  \n\u2022 Will expire at age 65 regardless of whether it is issued as an Acceleration or Additional type.  \n\u2022 Can be issued a s a pac kage policy or as a r ider."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
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B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 2. Hospital Cash (Hospital Income) Insurance  \n \n1. Pays a daily benefit upon hospitalization regardless of whether it is due to injury or sickness.  \nThis amount has no direct co- relation to the actual amount of medical fees  incurred.  However \nfor sic kness, a waiting period of 30 days from issue/ reinstatement date applies. Waiting period \ndoes not apply to injury.  \n \n2. Hospital Cash :  \n\u2022 Pays daily;  \n \n\u2022 Limited by specified no. of days per h ospitalization;  \n \n\u2022 Limited by a lifetime limit.  \n \n\u2022 It pays o n top of other benefits received from medical insurances.  \n \n\u2022 Must be confined in hospital for at least  6 to 24  hours.  \n \n\u2022 Premium is on age band basis .  \n \n\u2022 There is a \u201c No Claim Discount \u201d given for policy  that is inforced for a consecutive period of \ninsurance and free of any claim.  A certain percentage (eg 25%) will be deducted from the \nnext renewal premium.  \n \n3. Standalone Policy is more attractive than as a Rider in these ways:  \n \n\u2022 Double Payment  \u2013  if stays in ICU;  \n \n\u2022 Triple Payment  \u2013  hospitalized due to accident or insured is hospitalized overseas ;  \n \n\u2022 Get Well B enefit;  \n \n\u2022 Rehabilitation Income;  \n \n\u2022 Free Accidental Death B enefit.  \n \n\u2022 Involuntary loss of employment benefit (in excess of 30 days) - waiver of premiums (up to \n6 months ). \n \n4. Hospital Cash Policy is usually not written due to its small premium, however pre-existing              \nmedical conditions are permanently excluded under the policy.   \n \n \n5. Claims  \n Require to submit the following:  \n\u2022  Claim form;  \n\u2022 Hospital discharge summary bills;  \n Additional documentary evidence:  \n\u2022 Attending Physician\u2019s Report;\n \n\u2022 Other relevant supporting documents .  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   34 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 3. Medical Expense Benefits under Travel Insurance  \n \n1.  The benefits offered by a Travel Insurance Policy include:  \n \n1. Medical Expenses and Other Related Benefits  \n2. Hospital Confinement Allowance;  \n3. Emergency Medical Evacuation; and  \n4. Repatriation.  \n \n \n1.  Medical Expenses and Other Related Benefits   \n Reimburse most of the overseas medical  and treatment  as follows:  \n\u2022 Medical expenses  such as clinical, hospital surgical nursing, ambulance and medical \nsupply charges, emergency accidental and miscarriage expenses, including any follow \u2013\nup medical expenses in Singapore i ncurred within a certain period (usually 31 days) \nafter the insur ed returns from his trip.  \n \n\u2022 Expenses incurred for treatment by Traditional Chinese Medicine physician, including \nacupuncturist, bonesetter, chiropractor, herbalist or physiotherapist, up to a limit (e.g \nS$750)  \n \nThe above is subject to a n overall limit of indemnity (e.g S$2,000,000) . \nLower limit will apply to a child (from one to 18 years) or elderly (above age of 70 years).  \n \n\u2022 Reasonable additional accommodation  and travelling expenses  incurred by insured \nperson (and a travel companion if required) to remain in the overseas country of visit for \nmedical treatment, up to a limit (e.g $25,000) and  \n \n\u2022 Hospital visit \u2013  accommodation expenses necessarily incurred by one relative or friend \nof the insured who has been hospitalized overseas for more than 5 days to visit and stay \nwith him until he is medically fit to return home up to a limit (e.g S$10,000).  \n \n \n2."}


created_at: 2024-03-15 18:52:31
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Hospital  Confinement Allowance  \nThis entitled the insured to claim if he is hospitalized abroad for:  \n\u2022 A daily cash payment (e.g S$200 per day);  \n \n\u2022 Up to a certain period (e.g 250 days) or   \n \n\u2022 Up to a certain amount  (e.g S$50,000)  \n \n\u2022 Double benefit for overseas hospitalization in an intensive care unit resulting from an \naccident up a certain period (e.g 10 days).  \n \nFor hospitalization in Singapore when treatment is sought within a certain period ( e.g 7 days) \nupon return, the limits are lower (e.g S$100 per day payable up to 10 days).  \n \nThe benefits are payable upon his return to Singapore, when he submits a claim with all \nrelevant supporting documents.  \n \n  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   35 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 3. Emergency Medical Evacuation   \nEmergency evacuation means that, in the event of a critical  situation in which the insured \nperson suffers a serious illness or injury abroad, and has to be evacuated to another place to \nseek emergency treatment, because local medical services are inadequate or unavailable.   \n \nInsured must  contact a specialist company  contracted by the insurer to provide emergency \nmedical evacuation.  Such specialist company shall then decide whether  or not the insured \nrequires emergency evacuation.  A 24 hr multilingual hotline phone number of such specialist \ncompany is specified in the policy.  \n \nThere is usually a maximum benefit limit (e.g S$500,000) payable for the lower coverage plan.  \nHowever for the higher coverage plan, the coverage amount is usually unlimited.   \n  \n4.  Repatriation  \n\u2022 Emergency medical repatriation occurs when, as a result of an unfortunate illness or \naccident abroad, the insured has to be repatriated to his country of origin (e.g return to \nSingapore).  The decision as to whether he should be repatriated strictly rests with the \nattending medical doctor or the insurer\u2019s contracted specialist company.  \n \n\u2022 Repatriation of remains means the transportation of and return of the deceased \ninsured\u2019s mortal remains to his country of origin.  \n \n\u2022 There is usually a maximum benefit limit (e.g S$30,000) payable for the lower coverage \nplan.  However for the higher coverage plan, the coverage amount is usually unlimited  \n \n \n2.  Exclusions  \n Among the exclusions given in the text at page 115, please know the following:  \n\u2022  Driving or riding in any kind of race, engaging in any professional sport, ice or winter  \nsport, mountaineering requiring the use of guides and ropes, or underwater activity \ninvolving the use of underwater breathing apparatus;  \n \n\u2022  Aerial activity other than air travel as a fare paying passenger in a licensed passenger - \n carrying aircraft;  \n \n\u2022 Any event including strike, riot, civil commotion, health threatening situation, natural disaster  published by the mass media or through advisory of the authority, unless the \npolicy already issued or the trip already commenced before the date of publication or advisory; or  \n \n\u2022   Travel booked or undertaken against medical advice, or for the purpose of obtaining or  \n seeking any medical care or treatment abroad.  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   36 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 4. Group Dental Care  \n \n1. Group Dental Care:   \n \n\u2022 Offered on a group basis without underwriting . \n \n\u2022 It can be a rider attached to a Group Hospital & Surgical or as a Sta ndalone policy.  \n \n\u2022 Coverage is usually on a 24 hrs worldwide basis, only employees who are actively at  \nwork are covered and it is usually on a non contributory  basis.  \n \n\u2022 Pre-existing dental conditions are covered as well.  \n \n\u2022 Affected by the Limit ation Clause, hence reimbursement will be affected by workmen\u2019s \ncompensation or other dental plans.  \n \n \n2. Exclusions:  \n\u2022 Dental procedures that are not specified in the schedule of allowances;  \n\u2022 Hospital charges;  \n\u2022 Injuries arising from war (declared or undeclared), revolution, or any warlike operation;  \n\u2022 Medicine given;  \n\u2022 Treatment which is purely cosmetic in nature;  \n\u2022 Treatment resulting from self \u2013 inflicted injury, while sane or insane and  \n\u2022 Replacement of broken, lost or stolen denture s.  \n \n \n3."}


created_at: 2024-03-15 18:52:31
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Terminations:  \n\u2022 The date of termination of the insured employee\u2019s active full time employment;  \n\u2022 The date of termination of the policy;  \n\u2022 The date of expiration of the period for which the last premium payment is made in respect of the insured employee\u2019s cover\u2019  \n\u2022 The date on which the insured employee enters full time military, naval, air or police service, except during peacetime National Service reservist duty or \ntraining;  \n\u2022 The date of expiration of the period within which the insured employee reaches a \nspecified age (usually age of 65 years)  \n  \n4. Claims  \n For employee who uses his own dentist , they need to pay first and file a claim with the insurer.   \n Documents are:  \n \n\u2022 Claim f orms  \n \n\u2022 Original receipt  & itemized bills.  \n \n For insurer that has its panel of dentist , employee need only produce the m embership card  \n whenever he visits the dentist and the clinic will bill insurer directly.   \n  \n  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   37 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Chapter 7 \u2013  Managed Health Care (MHC)  \n \n1. \n \nAn overall strategy for containing medical care costs, while receiving \nappropriate medical care. It will pay for most of the medical bills when an \nindividual sees a General Practitioner, specialist or receive treatment in a \nhospital.     \n \n     \n Managed Health Care  \n(MHC)  \nPurpose  \nCost    - 4 methods  \n\u2022 Capitation;  \nCapitation means   \nMHCO prepays their  \nproviders a flat \namount  for each  \nmember\u2019s medical care \non a monthly basis.  \n \n\u2022 Discounted fee for  \nService (e.g discount \nof 10% on physician \nfees)   \n \n\u2022 Salary;  \n \n\u2022 Fee schedule .  \n Quality of care.   \n \nHealth care \nproviders must \npossess  requisit e \nskills, training and licenses as MHCO \nis concerned \nabout the quality \nof care for a good \nreputation as that \nis what attracts \nnew members and \nkeep existing \nones.  \n  \n \n \n 3 components to contain and control Healthcare \nexpenditure  \nQn:   \nWhich of the above payment methods used do \nnot discourage the provision of unnecessary \nmedical services? \n  \nAnswer: Discounted Fee For Service &  \n              Fee Schedule  A primary care physician is \nusually a general \npractitioner.  He is often \nknown as:  \n \n\uf0fc Personal Physician  \nServes the member as his \u201cpersonal physician\u201d, \nbut also acts as the first \ncontact with MHC.  \n   \n\uf0fc Gatekeeper  \nMember must obtain a \nreferral from the PCP \nbefore seeing a \nspecialist, hence called \n\u201cgatekeepers\u201d.  \n Accessibility  \n\u2022 Easily accessible;  \n \n\u2022 Requires members to  \n     select one doctor to be  \n     their Primary Care  \n     Physician (PCP) . \n \n \n \n \n \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   38 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 2. The three common types of MHC Plans are  \n Managed Healthcare Plans  \nHealth Maintenance \nOrganisation (HMO)  Point of Service \nPlan (POS)  \n1. Staff Model  \nHMO  Preferred Provider \nOrganisation (PPO)  \n2. Group \nModel HMO  3. Network \nModel HMO   5. Mixed \nModel HMO  4. IPA \nModel HMO  \n1. Staff Model HMO  \n\u2022 HMO employs PCPs who usually work together in a centre to treat members who \nare only members of the HMO.  Specialist care need is refereed to certain \ncontracted specialist.     \n\u2022 Very effective in managing costs as have control over the physicians they employ. \nCompensates physicians on a predetermined salary.  \n \n\u2022 Physicians have no financial incentive to over treat the patients.  \n  \n2.  Group Model HMO   \n\u2022 Made up of 2 entities : HMO is the organizational entity that runs the healthcare \nbusiness and it will contract a large group medical practice to provide medical care services to its members.  \n \n\u2022 Same cost \u2013management potential as Staff Model HMO as the group practice \nobtains all or a vast majority of its patients from the HMO, thus giving HMO a high \ndegree of leverage over the negotiation of payments.  \n  \n3."}


created_at: 2024-03-15 18:52:31
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Network Model HMO   \n\u2022 Similar to Group Model HMO, except that in this model, it contracts with a relatively \nlarge number of group  practices and even individual physicians.  \n \n\u2022 Physicians operate out of their own offices or facilities provided to them by their \ngroup practice. Physicians may provide services to more than one HMO.  \n \n\u2022 Does not have as tight control over utilization management as the above 2 \nmodels as physicians may t reat patients on a fee for service basis and HMO \narranges for hospital services rather than physicians.  \n \n \n  \n a b  c \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   39 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  \n \n \n \n \n2b. Preferred Provider Organisations (PPOs )  \n \n Similarities  \n \nPPOs are similar to HMOs in that they enter into contractual arrangements with healthcare \nproviders who together form a \u201c provider network\u201d.  Physicians provide care at lower rate in \nexchange for more patients directed towards them . \n \n Differences  \n \n1.  Unlike HMO, members do not have a PCP (\u201c gatekeeper \u201d) and are not restricted to use only \nthe provider network for their care, as they can choose to see a non network provider.  \n \n2. PPO member does not have to get a referral to see a specialist.  \n 3.  PPOs are less restrictive than HMO in the choice of healthca re providers.  However they \ntend to require greater \u201cout of pocket\u201d payments from members.  \n \n \n \n2c. Point -of- Service Plan (POS)  \n\u2022 Combination of a HMO and PPO . \n \n\u2022 Encourage, but does not require a member to choose a PCP.  \n \n\u2022 Allows members to use a provider who is not in the net work  for his care, however he \nhas to pay higher co -payments and/or deductibles than member who uses a PCP.  \n \n\u2022 Known as  point -of \u2013service plan because, at the point when a member needs  \nhealthcare services, he can decide to stay in the network (to allow his PCP to manage his care service)  or go outside of the network on his own, without a referral from his \nPCP. \n \n \n  4.  Independent Practitioners Association (IPA) Model HMO  \n\u2022 Also contract with other entities to provide medical care services to its members.  \n \n\u2022 IPA physicians continue to develop their own private practices and in fact, HMO members represent only a small percentage of their patient list.  \n  \n5. Mixed Model HMO  \n\u2022 Combination of 2 or more of the above 4 types of plans.  \n \n\u2022 They offer broader  consumer  choice of physicians and clinical settings.  \n \n \n \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   40 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 3.  Degree of Choice of Providers Vs Cost Control  \n Know this diagram well  for 3a and 3b   \n \n \n \n \n3a. In ascending order, list the models given below from the most cost effective  to the least cost   \n ineffective.    \n  \n POS, Network Model HMO, IPA, Staff Model HMO, PPO  \n \n Answer : Staff Model HMO/Network Model HMO/IPA/POS/PPO  \n \n \n3b. In descending order, list the given models in question 3a from most flexibility to least flexible.  \n \n Answer:  PPO/POS/IPA/Network Model HMO/Staff Model HMO  \n \n  Group Mod el HMO  \n PPO  \nIPA HMO  POS  Traditional Medical Expense Insurance (highest premium ) \nStaff Model HMO  \n(lowest premium )  Network Model HMO  \n \nDegree of choice of providers  \nCost Control  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   41 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 4. Revision of MHC Plans:  \n  \nClues  Model  \n1. This model is most effective in managing cost . \n Staff Model HMO  \n2. This model is made up of 2 entities. The organizational entity that \ndoes everything it takes to run a healthcare business except actual \npractice of medicine.   \nGroup Model \nHMO  \n \n3."}


created_at: 2024-03-15 18:52:31
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{"_node_content": "{\"id_\": \"1f5cb6b3-6977-4ac4-92fb-d8c6b1a53969\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"147e01fa-6106-41e2-b336-f650eb362f4a\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"4cec7dee794a01d50d6c4a8982aec6e9962c7d51e99c3eb899f43bc7b7b077f2\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"acac1f32-f566-4da7-9dbe-791f91a03bb7\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"01345cbaacc426336c28a6c66ca73bce4ad0ad483a3273e73a8afd646b0c7d97\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 80994, \"end_char_idx\": 85318, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "This model is made up of 2 entities. The organizational entity that \ndoes everything it takes to run a healthcare business except actual \npractice of medicine.   \nGroup Model \nHMO  \n \n3. The physicians in this model develop their own  private practices .  IPA Model HMO  \n \n4. Offer combinations of a few HMOs.  They offer broader choice \nconsumer choice of physicians.  Mixed Model \nHMO  \n \n5. This model contracts a large number of group practices, including \nindividual physicians.  Network Model \nHMO  \n \n6. Members do not have a PCP (\u201cgatekeeper\u201d) and are not restricted \nto use only the provider network for their care.  PPO  \n \n \n7. The members in this model do not need to choose how to receive \nservices until they need them. Combination of HMO and PPO.  POS  \n \n \n  \n \n5. Benefits offered include:  \n\u2022 Primary care;  \n\u2022 Specialist care;  \n\u2022 Hospital care;  \n\u2022 Emergency care;  \n\u2022 Preventive  care;  \n \n \n6. Like other types of traditional Health Insurance, elements of co -insurance and deductible may \nbe found  in MHC Insurance.  \n \n \n7. One exclusion  under MHC Insurance Policy states that payment from MHC plans will be \nexcluded by reimbursements from Workmen Compensation and other forms of i nsurance \ncoverage.  \n  \n  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   42 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 8. Claims for MHC  \n  \n \nIn- the- network providers \n  \nOut-of-network providers \nMembers who use in -the-network providers  \nneed not file claims with the insurer  Members who use out -of-network providers \nneed to file claims with the MHCO. \nSupporting documents to be submitted \ninclude:  \n\u2022 Claimant\u2019s statement; and  \n \n\u2022 Original itemized medical bill.  \n \n.  \n  \n  \n   \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   43 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Chapter 8 \u2013  Healthcare Financing  \n \n1. \n \n  \n \n2. Government Subsidies include the following:  \n  \nGovernment Subsidies   \nIn Public Hospitals  \nInpatient  Specialist Outpatient Clinics \n(SOCs)  Other services  \n\u2022 Ward classes differ only in \nthe physical amenities and \nlevel of comfort, however the standard of medical care is \nthe same regardless of the \nward's class.  \n \n\u2022 In Jan 2009, means testing \nin public hospitals was \nintroduced to better target \nthe heavy subsidies for \nclass B2 & C  wards at the \nlower -income group. The \nsubsidy received depends on \nthe monthly income of the \npatient.  B2 or C class \npatients who require follow -\nup at the specialist \nOutpatient Clinic (SOCs) will \ncontinue to receive \nsubsidies.  \n \u2022 Subsidy for lower -to-middle  \n income is 70% &  60% \nrespectively, while the rest of \nthe subsidised patient  is \n50%.  \n \n\u2022 For standard drugs :  \nLower -to middle- income  \nreceives a 75% subsidy; \nwhile the rest of the \nsubsidised patient is 50%.  \n \n\u2022 The eligibility for higher subsidy is based on the \nhousehold monthl y income \nper person, or annual \nvalue of residence (for \nhouseholds with no \nincome ) and is aligned with \nthe eligibility for the \nCommunity Health Assist \nScheme(CHAS).  \u2022 Day surgery and \nAccident & \nEmergency (A&E) \nservices are not \nmeans-  tested.  Singapore Healthcare Philosophy  \n \nAffordab ility and Accessib ility of \nBasic Healthcare  \n        \n\u2022 Heavy subsidies for basic \nservices  (primary, acute and \nstep down care) .   Individual and Collective \nResponsibility  \n \n\u2022 Individual medical savings account;  \n  \n\u2022 Co-payment by individuals; and  \n  \n\u2022 Risk-pooling for catastrophic \nillnesses and for serious long- term \ndisability.   \n      based on  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   44 \nProduced in collaboration with Julia Sim."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
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B ased on 5th Edition, Version 1.3 ( 21/3/2016 )                                                     \n                                                      Government Subsidies  \nOther Public / Community Services  \nGovernment Polyclinics  \n\u2022 Services provided is subsidised at about \n50%.  75%  if the patient is a child or \nelderly.  \n \n\u2022 Standard drugs -  subsidy  of 75% for \nlower -to-middle income patients. Means -\ntesting aligned to CHAS.  \n \n\u2022 With CHAS,  lower -to-middle \nSingaporeans will receive subsidised primary care at GPs and dental clinics in \ntheir neighbourhood.  \n Voluntary Welfare Organizations(VWOs)  \n\u2022 Provides healthcare services such as \nrenal dialysis, mental rehabilitation and nursing home care.  \n \n\u2022 MOH funds 50%  of operating expenses \nof these VWOS and 90%  of their capital \nexpenditure.  \n \n3.  CPF Healthcare Financing Schemes  \n CPF Schemes which can be used to meet members\u2019  healthcare needs are : \n \nA. Medisave;   \nB. MediS hield Life;   \nC. Integrated Shield Plans and  \nD. ElderShield and ElderShield Supplement . \n \n  \nA. Medisave  \n1. National healthcare saving scheme where the amount contributed is from the CPF members \nand their employers.  Amounts in the MA earn an annual interest rate of 4%  and can be used \nto pay for a member or their immediate family's medical expenses.  Immediate family refers to \nspous e, children, parents and grandparents .  Grandparents must be  Singaporeans o r \nSingapore Permanent Residents (SPRs) .   \n \n2. 2 Changes f rom 1 Jan 2016 :  \n \n1.  Basic Healthcare Sum (BHS)  \n\u2022 Medisave Contribution Ceiling is the maximum balance a member can save in his \nMedisave Account (MA) will be renamed as the Basic Healthcare Sum(BHS ) set at \n$49,800 (as of Jan 2016) for CPF member.  If the member is of age 65 years & \nabove in 2016, this sum  will be his BHS for life.  However if he is below age of 65 \nyears, BHS applicable to him will be adjusted yearly in January .  When a CPF \nmember reaches the age of 65, the BHS for him will be fixed at the BHS that year \nand the amount will not change for the rest of his life.   \n \n\u2022 Amount in the MA up to the BHS cannot  be withdrawn.  Medisave contributions will \ngo into the MA until it reaches the BHS, any amount above the BHS will be \nautomatic ally transferred to the members' Special or Retirement Accounts to boost \nhis monthly payouts . If the member already met his Full Retirement Sum, amount will \nflow to his OA, can be withdrawn as cash from age 55.   \n \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   45 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 2. Removal Of Medisave Minimum Sum  \n\u2022 Medisave Minimum Sum has been removed , hence CPF member will no longer be \nrequired to top up his Medisave Account  to the Medisave Minimum Sum when \nwithdrawing his CPF Savings (OA & SA) at the age of 55 years. This provides \ncertainty  on how much a CPF member can withdraw from his OA & SA after the age \nof 55 years.  \n \n3. Uses of Med isave  \n Medisave can be used to pay for hospitalisation and selected outpatient treatment   \n expenses  (up to the withdrawal limit s) such as :  \n\u2022 Colonoscopies;  \n\u2022 Mammograms ;  \n\u2022 Chemotherapy and radiotherapy.  \n \n It can also be for the following subject to withdrawal limits and other conditions:  \na. Inpatient Expenses -  daily ward charges, doctor's fees  & inpatient charges of medical \ntreatment, investigations, medicines, implants, prostheses introduced during surgery . \n \nb. Day Surgery And Surgical Operation.  - CPF members age 50 and above can use their \nMedisave to pay for their screening of colonoscopies & mammograms at approved \nmedical centres up to speci fied limit .  \n  \nc. Inpatient Psychiatric Treatment ."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
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Inpatient Psychiatric Treatment .  \n \nd. Inpatient Stay in C ommunity/Convalescent Hospital & Inpatient Hospice and Approved \nTreatment in Day Hospital & Day Rehabilitation Centre . \n \ne. Outpatient Treatment For Approved Chronic Disease Under The Chronic Disease \nManagement Programme (CDMP).  \n1.  Medisave can be used to pay for outpatient  treatment for 19 approved chronic \n diseases under CDMP such as diabetes, high blood cholesterol, hypertension \n or  asthma .  These diseases can:  \n\u2022 result in serious complications like heart disease, kidney failure and leg \namputations if not well managed; and  \n \n\u2022 have high cost of treating them over the long term if poorly controlled.  \n \n2. The aim of allowing Medisave use under CDMP is to :  \n\u2022 lower long- term healthcare costs; and  \n \n\u2022 improve care for patients with chronic diseases, resulting in better health \noutcomes.  \n \n3. Under CDMP, Medisave can be used to pay for :  \n\u2022 consultations;  \n\u2022 drugs/medications (including non standard drugs);  \n\u2022 laboratory tests;  \n\u2022 diagnostic tests, eg eye screening, foot screening; and  \n\u2022 allied health services, such as nursing and physiotherapy as referred by \nthe doctor . \n \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   46 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 4. Medisave cannot  be used for the purchase  of glucometers, glucometers strips, \nblood pressure monitoring equipment, wheelchairs, prostheses, or other home \nnursing equipment.  \n \n5. To avoid over -consumption patients must make a 15% cash co-payment for all \nCDMP claims.  The amount of Medisave that can be used for CDMP is $400 per \nimmediate family member's MA per calendar year, up to 10 MAs can be used for \neach claim.  \n  \nf. Approved Outpatient Treatments  \n\u2022 Approved vaccinations (e.g Hepatitis B, pneumococcal disease, Human \nPapillo mavirus (HPV), vaccinations on National Childhood Immunization \nSchedule).  \n\u2022 Screening mammograms;  \n\u2022 Renal dialysis;  \n\u2022 Cancer treatment (Chemotherapy, radiotherapy and related diagnostics); and  \n\u2022 Outpatient scans required for diagnosis and/or treatment of a medic al condition.  \n  \ng. Maternity Charges & Assisted Conception Procedure Treatments  \n\u2022 Medisave Maternity Package allows a f emale CPF member  or her family \nmember to use Medisave to  pay for pre delivery expenses and delivery \nexpenses  (eg consultations and Ultrasound) and delivery expenses.  \n \n\u2022 Couples can use their Medisave up to a lifetime limit of S$15,000 per patient to \npay for Assisted Conception Procedure  treatments which must be performed \nlocally.  Only Medisave accounts of the patient a nd her spouse  can be used.  \n  \nh. Buying Medical Insurance  \n  Medisave can be used to pay for approved Integrated Shield Plans , ElderShield and \n  ElderShield Supplements from approved insurers.  The use of Medisave to pay for  \n  insurance premiums is subject to withdrawal lim its. (cover later).  \n \n \n4.  Where Can Medisave Be Used?  \n In all public healthcare institutions, as well as approved private hospitals and medical \n institutions.  \n \n \n5.  Whose Medisave Can Be Used?  \n\u2022 Patient's immediate family members (i.e spouse, parents and children) can use their \nMedisave to pay for the hospitalisation bill. Eg. 2 children can specify how much each \nwill pay for their mum's hospitalisation bill.  \n \n\u2022 If immediate family members' MAs is not enough  to pay for the bill, then non immediate \nfamily members e.g brothers and sisters can appeal to help settle the bill. This option is \nonly available if the patient qualifies under certain conditions, e.g stayed in class B2 or \nC ward of a public hospital   and has exhausted the moneys in his own and \nimmediate family members' MAs.  \n \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   47 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 6. Distribution of Medisave Upon Demise \n \n \n \n \n Remaining Medisave balance :  \n\u2022 If a nomination is made -  Payable to the nominated beneficiaries."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
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Admission to hospital  just before death  \nPatient had authorised  to use his \nMedisave to pay his medical bill, all his Medisave balance will be used to pay in \nfull, without being subject to withdrawal \nlimits to pay his last medical bill.  Patient had not signed the Authorization \nForm before his demise, his immediate  family \nmember / relative could sign the form to pay \nhis last inpatient medical bill .  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   48 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) B. MediShield Life  \n1.  Unlike Medisave which is a savings scheme, MediShield Life is a basic healthcare insurance \n scheme which replaced  MediShield on 1 Nov 2015.  It is compulsory  for all Singaporeans  \n Citizens an d SPRs, regardless of where they reside.  They is no need to apply for MediShield \n Life, all are cov ered for life, in line towards universal insurance coverage from 1/11/2015.  \n \n \n2. It offers :  \n\u2022 Better protection and higher payouts , so that patients pay less Medisave/cash for \nlarge subsidised hospital bills;  \n \n\u2022 For protection for all Singapore C itizens and SPRs, including very old and those who \nhave pre- existing illness;  \n \n\u2022 Protection for life .   \n \n \n3. Benefits will be enhanced under MediShield Life, with higher claim limits and lower co-\n insurance rates, so that MediShield Life pays more and patients pay less. (Table at pg 24 of \n text).  \n \n \n4. MediShield Life premiums will be higher than MediShield premiums due to:  \na. Better benefit s than MediShield;  \n \nb. Cover Singaporeans with pre -existing conditions. Those with serious pre- existing \nconditions may have to pay additional premiums (of 30% of standard MediShield \nLife premiums) for 10 years .  The additional premiums does not reflect actual \ncosts of coverage as the Government bears most of the cost;  \n \nc. More even distribution over lifetime : Premiums are higher during working age,  \nso that premiums will rise lesser in old age.  \n \n \n5. MediShield Life Subsidies  \n \nMediShield Li fe Subsidies  \n \nType of Subsidy  \n Subsidies R eceived  \nPremium Subsidies  \n \nCriteria :  \n\u2022 For lower -to-middle income families;  \n \n\u2022 Monthly income per person of S$2,600  and \nbelow and living h omes of an Annual Value \n(AV) of S$21,000 and below.  AV covers all \nHDB flats and some  private properties.  \nThose with more than 1 property will not be \neligible for this subsidy.  \n \n \n   \n \n \n50%  of their premiums.  PRs will received \n1/2 the subsidy rate applicable to \nSingapore Citizens.  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   49 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  \n \n \n6. MediShield Life Claim Payouts   \n\u2022 It pays on a reimbursement basis , subject to the limits imposed on the covered medical \nexpenses, as well as deductibles, co- insurance and pro-ration factors.  \n \n\u2022 Deductible is the fixed amount  payable by the insured once every policy year.  However \ninsured member need not pay deductible  for outpatient treatments covered under \nMediShield Life.  \n \n\u2022 Co-insurance is the percentage of the claimable amount which insured will have to pay on \ntop of the deductible.  The larger  the bill, the lower will be the co- insurance payable.  \n \n\u2022 Pro-ration is the percentage that the CPF Board will use to pro -rate a patient's bill to the \nequivalent full subsidy bill size.  Thus bills incurred in Class A, B1 or B2 + wards  in public \nhospitals /private hospitals are pro -rated to the equivalent B2/C (MediShield Life is sized \nfor B2/C class wards in public hospitals) bills and then subject to the MediShield Life claim \nlimits."}


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{"_node_content": "{\"id_\": \"fabe35c7-dd48-4a31-a037-bebed5249939\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"20e863f2-d2ea-40f4-b152-b779ce2130ab\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"790b47d4d6c32b51cd27a39afd67d7cd3c45d632646dd624f836529ef0024b48\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"ba403561-dd80-433a-bf11-fa0a19bd842d\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"7b1df5d50e7d503c5329df7757f1d9ea935aef2f5d465a1b36080649b4a7b7be\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 97972, \"end_char_idx\": 102083, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "\u2022 Hence with limits imposed on the covered medical expenses, as well as deductibles, co -\ninsurance and pro -ration factors, the scheme will never  pay the full bill (Eg 8.1 of text) . \n    \nPioneer Generation Subsidies  \n\u2022 Pioneers refer to living Singaporeans who \nmeet 2 criteria :  \na.  Age 16 yrs and above in 1965 (born on  \n     or  before 31/12/1949, which also means  \n    that they are 65 yrs and above in 2014);  \n    and \n  \nb.  obtained citizenship on or before 31 Dec  \n    1986.  \n    ( Pg. 4 1, 7.1) \n  \n \n\u2022 Between 40% & 60%; regardless of their household monthly income per \nperson or AV of their home.  \n \n\u2022 Will also received S$200 to S$800 a year in Medisave top- ups (depend on \nyear of birth) for life, which can be used \nfor their MediShield Life  premiums.  \n(Pg 42,7.1.3)  \n \n \nTransitional Subsidies  \nTo ease the shift to MediShield Life for all  \nSingapore Citizens whose net premiums (after  \nall the above subsidies) increase in  \ncomparison to MediShield premiums,  \nregardless of their household income or AV of  \ntheir home.   \n\u2022 Available for the first 4 years of \nMediShield Life;  \n \n\u2022 1st Year - Government will pay 90% of \nthe net premium increase (after above \nsubsidies);  \n \n\u2022 2nd to 4th years  -  Government will \ncover 70%, 40% & 20% of the net \npremium increase of MediShield Life.   \n \n \nAdditional Premium Support  \nFamilies needing assistance with their \npremiums even after above subsidies and \nMedisave use.  \n  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   50 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 7. MediShield Life Scheme Act   \n Keys features of the Act are:  \n\u2022 Extension of lifelong, universal coverage and better benefits for all Singapore Citizens \nand SPRs;  \n \n\u2022 Establishment of the MediShield Life Council to review the administration of the Scheme \nin line with the policy intent;  \n \n\u2022 Providing for access to information to facilitate the extension of MediShield Life prem ium \nsubsidies to eligible households and scheme administration; and  \n \n\u2022 Powers for the recovery of premiums from willful defaulters as a last resort, to ensure  \nthat the premiums are paid in a timely manner.  \n \n \nSection 10 of the MediShield Life Scheme Act  2015 states that :  \n1. Rights and benefits of an insured person arising from the insurance cover under the \n Scheme are not assignable or transferable.  \n \n2. Policy does not  create any legal or equitable trust.  \n \n3. Section 73 of the Conveyancing and Law of Property Act (Cap.61) and Section 49L  of \n the Insurance Act (Cap 142) do not apply  to any policy under the Scheme;  \n \n4. The Insurance Act does not  apply to the Scheme or anything under this Act.  \n  \n8. MediShield Life Fund    \n\u2022 MediShield Life is a not -for-profit , long term insurance scheme.  \n \n\u2022 Renewal of MediShield Li fe policy every year is guaranteed, reg ardless of whether they \ndevelop serious illness after they join.  \n \n\u2022 Premiums co llected are put in the MediShield Life Fund, based on the actuarial principles \nand to be self -sustaining with each age group paying premiums to support its own current \nand future claims.  Premiums are adjusted every 3 to 5 years, taking into account any \nvariation in claims experiences and benefits enhancement .   \n  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   51 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) C. Integrated Shield Plan (IPs)  \n \n1. IPs are Medisave- approved hospitalisation insurance plans, made up of 2 parts:  \n \n \n\u2022 On 1 Nov 2015, those w ho have IPs are covered under MediShield Life and there is no \nduplication of coverage between IPs and MediShield Life."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
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encoding: FLOAT32
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{"_node_content": "{\"id_\": \"ba403561-dd80-433a-bf11-fa0a19bd842d\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"fabe35c7-dd48-4a31-a037-bebed5249939\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"2ec3aeff069e77f61167d5ec1a9cd3fc8f96a6f917e568c33c1147ca2c2e316c\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"5c7f434a-2dac-47cc-917c-58c3d3804f09\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"271c1d4223f407745a806c9f5f550bf3eb1cf48001851d7282f6e544ba832456\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 102088, \"end_char_idx\": 106760, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "\u2022 The following plans are IPs:  \n\u2022 AIA HealthShield Gold Max;  \n\u2022 Aviva MyShield;  \n\u2022 Great Eastern SupremeHealth;  \n\u2022 NTUC IncomeShield;  \n\u2022 Prudential's PruShield.  \n \n \n2. Insurance representative to highlight to client:  \n \na. If they wish to stay in private or subsidised ward in a public or private hospital and if \nthey wish to choose their own doctors.  From the usage of IP Policyholders, it seems \nto show t hat there is a significant degree of overconsumption in the purchase of IPs.  \n \nb. Premiums for IPs are higher than MediShield Life and increase significantly as an  \ninsured persons get older and they are not guaranteed.  \n \nc. The private component of the IPs premiums may not be fully payable by Medisave.   \nPolicyholders may have to pay part of their IP premium in cash.  \n \nd. There are different benefits provided in the IP Policy and plans can be \"as charged\" \nor \"non -as-charged\" (sub limits imposed).  \n \n \u2022 Provides higher coverage  (e.g covers costs \nof private hospitals or Class B1 or A  wards in \npublic hospitals).  \n \n\u2022 Managed by a private Insurer . \n    \n       MediShield Life  \u2022 Enough to cover your large hospital bills in \nclass B2 or C  wards in public hospitals .  \n \n\u2022 Managed by CPF Board.   \nAdditional Private \nInsurance Coverage An Integrated Shield Plan has 2 parts:  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   52 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 3.  Integrated Structure Of IPs   \n \n \n \n \n 2. A person insured under IPs will also be able to receive the applicable MediShield  \n  Life subsidies eg.  \n\u2022 Premium Subsidies for lo wer-to-middle income;  \n\u2022 Pioneer Generation Subsidies;  \n\u2022 Transitional Subsidies.  \n \nbut will not  be eligible for Additional Premium Support .  Those who cannot afford to  \npay IP should remain on MediShield Life.  \n \n \n3. Changes to MediShield Life will affect private insurers.  Increase in coverage in  MediShield \nLife is expected to reduce claims from private insurance components of  the IPs. However \nthis does not mean that the private insurer will pay less.  They will need to factor in claims \nexperience and medical inflation along the benefits offered to decide on the level of \npremiums for additional private insurance coverage.   \n \nIPs insurers have committed to leave the private insurance component of premiums unchanged for 1 year from the launch of MediShield Life.  Nonetheless overall IPs \npremium will increase when MediShield Life is launched owing to the higher premiums for \nMediShield Life component of the IPs.  \n  Structure & Premiums  \n\u2022 IP policy holders will enjoy the benefits of MediShield \nLife within his IP Policy.   \n \n\u2022 He will pay one premium to his private insurer who \nwill then arrange with CPF Board on the amount claimable under MediShield Life component.  \n \n\u2022 He need not liaise with both parties.   \n \nCoverage for IP  \nIP insurers are allowed to risk -load insured members \nwith pre -existing conditions for the private insurance \ncomponents of the IPs.  \n \nCoverage - MediShield ife  \n\u2022 He will be covered for pre- existing conditions  for \nlife under MediShield Life even though the condition \nmay excluded by the IP Insur ers.  \n     \n       MediShield Life   \nAdditional Private \nInsurance Coverage 1. An Integrated Shield Plan has 2 parts.  The premiums paid to private insurers also \n comprises 2 parts:  \n\u2022 Premium for MediShield Life component; and  \n\u2022 Premium for additional coverage by the IP insurer.  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   53 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 4. Differences between CPF MediShield Life Scheme and IP   \n \nMediShield Life \n Integrated Shield Plan  (IP) \nAdministrated by CPF Board .  Administrated and insured by only insurers  as \napproved by MOH .  \n \nDesigned for B2 and C class  ward in \npublic hospital stay . Provides for enhanced coverage beyond \nMediShield Life with various plans types \navailable for private and/or Class B1/A  public \nhospital stay s. \n \nCovers all pre -existing conditions.  May decline or imposed with exclusions and/ or \nrestrictions, arising from pre -existing conditions.  \n \nNo maximum age limit.  May have a maximum entry age limit."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
id: 5c7f434a-2dac-47cc-917c-58c3d3804f09
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{"_node_content": "{\"id_\": \"5c7f434a-2dac-47cc-917c-58c3d3804f09\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"ba403561-dd80-433a-bf11-fa0a19bd842d\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"7b1df5d50e7d503c5329df7757f1d9ea935aef2f5d465a1b36080649b4a7b7be\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"10e8595e-047f-46e8-a144-8c1d1ac1d1df\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"a9f2fcb5463738ffd4b93d4d9d98de11b2a4a4df805e5c2989d37357ac38c77a\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 106597, \"end_char_idx\": 110961, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "May decline or imposed with exclusions and/ or \nrestrictions, arising from pre -existing conditions.  \n \nNo maximum age limit.  May have a maximum entry age limit.  \nSub-limits applicable.  Typically as charged basis, though insurers still \noffer sub -limits  plans . \nMediShield Life premiums are fully \npayable under Medisave.  Private insurance component of the IP premium \nis payable by Medisave up to the Additional \nWithdrawal Limit , the rest is payable by cash.  \n \n \n \n5.  Medisave Use for IP Premiums   \n \n \n \n6. Riders  \n\u2022 IP Insurers are allowed to sell rider which pays for co -insurance and deductible portion \nof the IP payouts. These riders are not approved or regulated by MOH and cannot be \npaid using Medisave. Insurers are not allowed  to market riders as part of IPs.  \n \n\u2022 Agent should highlight distinction between IP and riders and share that riders can be \npaid using only cash.  Important to remind policyholders that rider premiums rise \nsignificantly with age. Instead of paying f or a rider, the deductible and co-\ninsurance portion incurred in the event of hospitalisation can be save for and \npaid via Medisave or cash.  Additional private insurance coverage premium can be \npaid by Medisave up to the Additional Withdrawal \nLimit  (AWL).  The AWL is set per insured person per \npolicy year, as follows:  \n \n\u2022 Age Next Birthday (ANB) 40 and below : S$300  \n\u2022 ANB 41 to 70 years : S$600 \n\u2022 ANB 71 years and above : S$900  \n    \n       MediShield  \n           Life   \n Private Insurance \nCoverage Integrated Shield Plan  \nMediShield Life Premium is fully payable by Medisave.  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   54 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 7.  a. Downgrading IP   \n\u2022 Can downgrade to a lower coverage plan within the same insurer at any point of time \n without underwriting.  \n \n\u2022 Can downgrade to basic MediShield Life, without any exclusions imposed.  \n \n  b. Switching Insurer for IP  \n\u2022  His original IP will automatically terminated  when he switches to a new IP with \nanother insurer.  \n \n\u2022  IP with the insurer will have to undergo underwriting again.  Hence he may lose coverage for his existing medical conditions covered by his original plan and may not \nbe able to re -apply for his original coverage subsequently.  \n \n8. Improvements to IP Regulatory & Accountability Framewor k \n\u2022 Insurer's disclosure documents include:  \n\u2022 Product Summary;  \n\u2022 Proposal form;  \n\u2022 Offer letter . \n \n\u2022 Insurers need to highlight:  \n\u2022 Distinction between MediShield Life and IPs;  \n \n\u2022 Limitation of upgrading, switchi ng and the option to downgrade  and \n remain  covered by MediShield Life;  \n \n\u2022 Intermediaries selling IPs to undergo a minimum of 2 hrs of training on \n MediShield Life and IPs.   \n \n9.  All insurers will be required to offer Standard IP in 2016.  Standard IP will provide adequate \n  \"no frill\" coverage at Class B1 level  and will serve as a benchmark for consumers to  \n  compare premiums offered by different IP insurers. \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   55 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 10.  Claim process for MediShield Life /IP, Medisave and Non IP Insurer . \n \nAdmission to hospital  \n1. Under IP Policy  Sign the Medical Claims Authorisat ion Form to :  \ni.   allow hospital to claim from his insurer;  \n \nii.  authorize CPF Board to pay hospital  bill from his Medisave account, while the  \n    insurer settles the claim which may take some time.  \nPay a cash deposit with hospital  \nNo Yes / No  \n2. Non IP Private Insurance  \nHospital will trigger a  \u201cLetter of \nGuarantee\"  (LOG) to waive the upfront cash required up to a cap of S$10,000. \nLOG is not applicable if hospitalised due \nto pre -excluded conditions.  \n \nFor claims from MediShield Life, IP/or Medisave :  \nHospital will submit the claim on his behalf through the \nMedi Claim online system."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
id: 10e8595e-047f-46e8-a144-8c1d1ac1d1df
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{"_node_content": "{\"id_\": \"10e8595e-047f-46e8-a144-8c1d1ac1d1df\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"5c7f434a-2dac-47cc-917c-58c3d3804f09\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"271c1d4223f407745a806c9f5f550bf3eb1cf48001851d7282f6e544ba832456\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"2681f74b-25b7-4851-95c9-a3b251cf9433\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"b983f3fe636b1db4842c566eb46bd5d5e10fedd888c1fb82a8d38abe45cde177\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 110826, \"end_char_idx\": 115132, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "For claims from MediShield Life, IP/or Medisave :  \nHospital will submit the claim on his behalf through the \nMedi Claim online system.  \n \n\u2022 Some hospital will sent the bill \ndirectly to the CPF members non IP \nInsurer or employer to work out the \namount to bear.  \n \n\u2022 In other cases, insured member will \nhave to submit the bill himself to the \ninsurer.  Need to show his insurance card \nprovided by some insurers for certain \nMedical Expense Insurance Plans.  \na.  For IP Claims   \n Hospital will submit the claims \n electronically to the Insurers directly.  \n IP will calculate how much to pay \n based on IP benefi ts, and CPF Board \n will calculate how much MediShield \n Life will pay.  The eventual payment \n will be the higher of the 2 amount.  \nb.  For MediShield Life Claims without \n IP \n CPF Board will calculate how much \n MediShield Life will pay and settle the \n amount directly with the hospital.  \nc.  Medisave to pay for his bill  \n Hospital will  submit the claims \n electronically to CPF Board based on \n prevailing Medisave withdrawal limits.  \nAny outstanding amount not covered by the above, have to be settled in cash.  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   56 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) D. Elder Shield  & ElderShield Supplements   \n \nPlan \n Elder Shield  \nPurpose   \nA new Severe Disability Insurance Scheme  to provide long term  care \nto the elderly Singaporean to help defray out of pocket expenses in the \nevent of severe disability. Any member who is a Singaporean or \nPermanent Resident who attains the age of 40 years is automatically \ncovered unless he opts out . \n \nPlans  1. Elder Shield  300 - launched in Sept 2002  \n    Payout of S$300  per month for maximum of 60 months if unable to  \n    perform at least 3 ADLs.  \n \n2. ElderS hield 400 - launched in 2007  \n    Improved coverage of S$400 per month for maximum of  72 months  \n    if unable to perform at least 3 ADLs.  \n   Note : ADLs\u2019 definition is the same as Chapter 5.  \n   \n3.  ElderShield Supplement covers :  \n\u2022 increasing monthly payout;  \n\u2022 extending payout period;  \n\u2022 a combination of both.  \n \nOnly existing ElderS hield insured can purchase ElderShield \nSupplement.  \nPremium can be paid from Medisave up to $600 (per insured per \ncalendar year ) or by cash.  \n  \nPremium  \u2022 Level premium, paid from Medisave ; \n \n\u2022 Premiums payable up to age 65 yrs, but remains insured for lif e. \n \n\u2022 Premiums are not guaranteed, review every 5 yrs.  \n \n\u2022 2  types of premium plan available  \n\u2022 Regular P remium Plan;  \n\u2022 10 year premium plan (Not available now) . \n \n\u2022 Insured members who do not have sufficient Medisave, may use their spouse, children, parents or grandchildren Medisave to pay \nfor their premiums.  \n \nRun By  \n \u2022 Aviva Ltd  \n\u2022 NTUC Income Insurance Co- Operative Ltd   \n\u2022 Great Eastern Life Assurance Co Ltd  \n \n \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   57 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Eligibility Criteria  \u2022 Waiting period of 90 days  from commencement date.  \n \n\u2022 Scheme will pay (either $300 or $400) if insured is unable to \nperform at least 3 of the 6 ADLs.  \n \n\u2022 Deferment period:  90 days from c laim date.  Does not apply if \ninsured suffers a relapse from the sa me cause within 180 days \nof recovery, prov ided he has been disabled for at least 90 days  \nduring the first disability.  \n \nClaim  \u2022 Insured complete a claim form ; \n \n\u2022 Insured has to make an appointment with one of the insurer\u2019s \nappointed assessors to have a medical assessment done.  \n \n\u2022 It will cost S$50  for assessment at the assessor's clinic and \nS$150 if insured requires  assessor to make a house call.  The \nfees for the initial or subsequent assessments are borne by the \ninsurer  if the claims is assessed to be payable.  \n \nHow are  ElderShield \nBenefits Paid?"}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
id: 2681f74b-25b7-4851-95c9-a3b251cf9433
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{"_node_content": "{\"id_\": \"2681f74b-25b7-4851-95c9-a3b251cf9433\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"10e8595e-047f-46e8-a144-8c1d1ac1d1df\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"a9f2fcb5463738ffd4b93d4d9d98de11b2a4a4df805e5c2989d37357ac38c77a\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"7d2ee423-ef82-4b3a-85e7-bc0184612fa2\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"11a342a617b9ed0b770aac2235c40a8a1d7a4d6586dc5f280931a043c8fc5f61\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 114972, \"end_char_idx\": 118777, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "The \nfees for the initial or subsequent assessments are borne by the \ninsurer  if the claims is assessed to be payable.  \n \nHow are  ElderShield \nBenefits Paid?  \u2022 Payable on a monthly basis  \n \n\u2022 Premium waived during disability;  \n \n\u2022 Payments stop  if insured recovered from his disability, premium \npayment will resume.  However he can still make a claim under \nhis policy, as long as he has not claimed more than 60 months  \nor 70 months in total.(depending on his  ElderShield Plan).  \n \n\u2022 Cash payout is not tied to insti tutional care. It can be used \nto pay for any expenses .  \n \nNon forfeiture Option   \nPremiums are prefunded.  Policy will be converted to a paid up policy \nshould he decides to stop paying his premiums after the policy is \ninforce for a number of years.  Insured will enjoy a reduced benefits .  \nKey Features   \u2022 Has a minimum  (i.e 40 y rs old) and maximum  entry age (i.e 6 4 \nyears old);   \n \n\u2022 60 days\u2019  free look period from commencement date;  \n \n\u2022 75 days\u2019  grace period for payment of overdue premium;  \n \n\u2022 Reinstatement allowed within 180  days from the expiry of grace \nperiod, subject to evidence of insurabi lity and pay ment of \noverdue premiums and interests;  \n \n\u2022 When the insured is oversea at the time of claim, insurer has \nthe right to compute the benefit payments to a single payment \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   58 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) based on the PV of future benefit payments, or withhold the \nclaim payment if it is unable to assess the claim after having \nmade reas onable attempts to do so.  \n \n\u2022 No surrender value.  \n \n \n \n4. Other Healthcare Financing Schemes for the Poor and Needy Singaporeans:  \n 1. Pioneer Generation Package  \n  1. Outpatient Care   \n\u2022 Additional 50% off :  \n\u2022 subsidised services at polyclinics and Specialist Outpatient \n Clinics (from Sept 2014).  \n \n\u2022 subsidised medications at polyclinics and Specialist  \n Outpatient Clinics (from Jan 2015).  \n \n\u2022 Special subsidies at participating GP and dental clinics under CHAS  \n  (from Sept 2014).  \n \n\u2022 Cash of S$1,200 a year for those with moderate to serve functional  \n  disabilities under the Pioneer Generati on Disability Assistance Scheme  \n  (from Sept 2014).  \n \n2. MediShield Life - Pioneer Generation Subsidies -  cover earlier.  \n \n3. Medisave Top- ups - From S$200 to S$800 annually for life (from July 2014) as  \n follows:  \n\u2022 Born 1934 and earlier -  $800  \n\u2022 Born 1935- 1939 - $600  \n\u2022 Born 1940- 1944 - $400  \n\u2022 Born 1945 - 1949 - $200  \n \n4.  Pioneer Generation Disability Assistance Scheme - Pioneers who need assistance \nin at least 3 of the  ADLS (as defined earlier under ElderShield) will receive lifelong \ncash assistance of S$100 each month to help Pioneers with their care expenses.  \n \n   \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   59 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  2. Interim Disability Assistance Programme for the Elderly (IDAPE)  \n \n  1. Those who are not eligible for Elder Shield Scheme for 2 reasons ; age or health  can \n  apply to IDAPE.  \n \n  2.  It is a social scheme to help people cope with their medical expenses in the event \n  they suffer a sev ere disability. \n  3. Premiums need not be paid.  Payments under the scheme depend on individual\u2019s per \n  capita household income."}


created_at: 2024-03-15 18:52:31
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{"_node_content": "{\"id_\": \"7d2ee423-ef82-4b3a-85e7-bc0184612fa2\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"2681f74b-25b7-4851-95c9-a3b251cf9433\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"b983f3fe636b1db4842c566eb46bd5d5e10fedd888c1fb82a8d38abe45cde177\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"c29b594b-0b0e-4246-b575-ed1d1aca490a\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"a467bc9b5a2aac7e0844e28a1ce1cb3544b0f32bb20588ed5701f00389964d74\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 118666, \"end_char_idx\": 122708, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "3. Premiums need not be paid.  Payments under the scheme depend on individual\u2019s per \n  capita household income. (see table)  \n \n      IDAPE Payout  \n \nPer Capita Household Income  IDAPE Payout (with effect from 1 July 201 3) \n \nS$0 to S$1, 800 S$250 per month up to 72 months  \nS$1,801 to S$2, 600 S$150 per month up to 72 months  \n    \n   An IDAPE applicant from a household with no income will qualify for the S$250  \n   monthly payout if the annual value of his place of residence is $13,000 or lower.  \n \n \n  4. IDAPE is administered by NTUC Income.  It is similar to ElderShield except for :  \n   \na. To making a claim under IDAPE will be subject to a means testing administered \n by Ministry Of Heath Holdings(MOHH); and  \n b. The recipient of the payout will need to pay only a nominal fee of S$10  for a clinic \n assessment (or S$40 if assessment is done at ho me) for each assessment in the \n event of a claim.  The rest of the fees are subsidised by the Government . \n \n \n 3.  Medifund  \n An endowment fund set up by the government to help the poor pay for their hospital  bills \n that despite Government subsidies in public  healthcare institutions.  \n  \n Medifund Silver and Medifund Junior were set up in 2007 and 2013 respectively to target \n the elderly and children.  \n  \n Patients unable to pay for their medical bills can apply for Medifund assistance through \n Medical Social Work ers (MSWs) at the Medifund approved institutions .  \n \n  \n \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   60 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Chapter 9 \u2013  Common Policy Provisions  \n \nHealth Insurance policy is a written evidence of a contract between Insurer and Policyholder. It  \ncontains 7 sections. They are:  \n \n1. Policy Schedule  \n2. Insurance Clause and Definitions  \n3. General Conditions  \n4. Benefit Provisions  \n5. Exclusions  \n6. Claim Conditions  \n7.  Endorsements  \n \n1. Policy Schedule  \n It contains details of the policy owner, insured person(s) as well as the insurance coverage.  \n There is a clause in the policy stating that this schedule and the policy must be read \n \u201ctogether as one contract\u201d.  It includes:  \n\u2022 Policy number,  \n\u2022 Effective date of cover and expiry date  of cover;  \n\u2022 Issue date;  \n\u2022 Currency;  \n\u2022 Name, NRIC, age gender of insured person;  \n\u2022 Name of plan, riders and premiums.  \n \nAdviser need to go through this schedule with the policy owner to ensure no typographical error .  \n  \n2. Insuring Clause and Definitions  \n \n \nInsuring Clause  \u2022 Also known as the operative clause, it rep resents insurer\u2019s  \npromises to pay.  \n \n\u2022 Often viewed as the foundation of a Health Insurance Policy.  \n \n \nDefinitions  \na) Accident  \n \n \nb) Day of Hospital  \n    Confinement  \n \nc)  Medically Necessary  \n    Service, Supply or  \n    Day  of Hospital  \n    Confinement  \n \n \n \n \n \n \n  \n \na) It means an incident caused by accidental,  violent,  external   \n     and vi sible means.  \n \nb) It refers to a full 24 hours during a period of  hospital  \n    confinement.  \n \nc) It means a service, supply or day of hospital confinement which is  \n    ordered by a physician and which is:  \n\u2022 Provided  for the diagnosis of direct treatment;  \n\u2022 Appropriate and consistent with symptoms for treatment;  \n\u2022 In accordance with accepted medical practices;  \n\u2022 Not of an experimental nature or research purposes.  \n \nThe fact that the insured\u2019s physician prescribes a service \nsupply or day of confinement does not  automatically means \nis medically necessary.  \n \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   61 \nProduced in collaboration with Julia Sim."}


created_at: 2024-03-15 18:52:31
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B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  \nd) Period of Hospital  \n    Confinement  \n \n \n \n \ne) Pre existing condition  \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nf) Usual , customary and  \n    reasonable charges  \n \n \n \ng) Per Policy Year Limit   \n \n \n \nh) Lifetime L imit  \n \n  \nd) It means a continual, medically necessary period of time  \n    during which an insured is confined to a hospital as a  \n    registered inpatient. Patients have to stay for a period of  \n    6 to 24 hours before being considered hospitalized.  \n \n \ne) Defined as a condition which have existed  and :  \n\u2022 For which insured received tr eatment  or medical advice;  \n \n\u2022 In respect of which insured showed s ymptoms;  \n \n\u2022 Of which insured was aw are;  \n \n\u2022 Of which insured should reasonably  have been aware;  \nPrior to the date policy issue or the date the cover was \nreinstated.  \n \nMoratorium Underwriting  \nInsured does not need  to make medical declarations when he \napplies for cover. Pre- existing conditions can be covered after a \ncontinuous period of e.g 5 years fr om the effective date of \ncoverage, reinstatement date whichever is later.  For the \nspecified years, insured must not have experienced any \nsymptoms, seek consultation, received treatment or medication \nfor the condition.  \n \n \nf)  It refers to the standard char ge for the provider and the  \n     amount does not exc eed the amount usually charged in  \n     the same geographical area for an equivalent service.  \n \n \ng)  Maximum amount a MEI Policy will pay for an insured within  \n     each policy year.  \n \n \nh)  Maximum amount a MEI Policy will pay under the policy .  \n \n \n \n  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   62 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 3. General Conditions  \n\u2022 Outlines the rights of both policyholder and insurer.  \n\u2022 It includes the following :  \n \n \nEntire Contract Clause  \u2022 Also known as \u201cThe Policy Contract Clause\u201d;  \n \n\u2022 In consideration of first premium  received, insurer will start \nproviding benefits;  \n \n\u2022 In a Health Insurance Contract the policy document , \nproposal form  and endorsements are the entire contract \nbetween insured and insurer.  \n \n \n \nEffective D ate Of Cover   \n\u2022 For sickness \u2013 it will commence after the waiting period.  \n \n\u2022 For injury \u2013 it will commence as at the effective date of \ninsurance.  \n \n \nPremium Warranty Clause  \n  \nPolicy shall not be in force, unless premium  is paid on or before \nthe inception date of the policy.  \n \n \nFree Look Period   \nPolicy  owner may review within 14 days  from the receipt of the \npolicy and return for a refund of premium  (less medical fees \nincurred) . The policy document is deemed to have received by \nthe policy owner within 3 days after Insurer dispatched it.  \n \n \nActively At Work  \n  \nNot eligible for cover if he is absent from work because of \nsickness, injury, on the otherwise effective date of coverage.  \n  \n \n \nRenewal   \nRenewal Provision describes the c ircumstances which the \ninsurer has the right :  \n\u2022 not to renew ; \n\u2022 to cancel ; \n\u2022 to increase the amount of premium payable.   \n \nHI polices can be issued on these basis:   \n\u2022 Cancelable  -  Terminates the policy at any time for any  \n reason.  \n \n\u2022 Optionally Renewable -  Refuse to renew the policy on  \n certain dates, usually the policy anniversary or premium   \n due date.  \n \n\u2022 Conditionally Renewable -  Refusal to renew cannot be  \n related to insured\u2019s health, but rather age and  \n employment status.  \n \n \n \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   63 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  \n\u2022 Guaranteed Renewable - Insurer relinquishes the rights to  \n cancel the policy.  Renewal is guaranteed as long as  \n insured pays the premium.  \n \n\u2022 Non renewable \u2013  examples are: Term Insurance,  \nTravel Insurance, Student Personal Accident.   \n \n \nMis-statement of age or sex    \nInsurer will adjust premium based on correct  age or sex ."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
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Coverage remains in \nforce during grace period.  \n \n \nReinstatement   \nThis provision states that if certain conditions are met, the \ninsurer will reinstate a lapsed policy for non premium payment, \nprovided insured person pays any overdue premium and \ncomplete a health warranty.  \n \n \nIncontestability   \nThis provision stops  the insurer from repudiating liability under a \npolicy purely on grounds of breach of utmost food faith, except \nfraud has been proven.  \n \n \nCo- Ordination O f Benefit   \nAlso known as  \n\u2022 Over -insurance provision;  \n  \n\u2022 Cont ribution provision.  \n To prevent the insured from  making a profit from sickness/illness.  \nWill cause the insurer to reduce the benefits payable under the \npolicy.  \n \n \nCancellation   \nAllows the insured to cancel the policy by giving written notice to \nthe insurer.  \n \n \nChange Of Plan   \nA MEI Policy has a provision to allow the insured to upgrade or downgrade the coverage plan, at the insured\u2019s expense.  Any \napplication of change should be submitted to insurer at least 30 days before the policy renewal date or Premium due date.   \n \n \nCurrency   \nPayments of all claims and benefits will be made in Singapore \nCurrency.  \n  \n \n \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   64 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  \nLast Payer Status   \nThis clause appears in MediShield and Private Integrated \nShield Plans where it states the insurer shall  be the last payer  \nreimbursing the claims if the insured has any other Medical \nInsurance, such as workman compensation. The insured person \nshall provide insurer with the full details of such other insurance \npolicies or employee\u2019s benefit.   \n \n \nPolicy Owner\u2019s Protection \nSche me (PPF)   \n\u2022 Effected since 1 Jan 2012, to protect policy owners in \nthe event of failure of a life or general insurer which is a \nPPF Scheme member .   \n \n\u2022 The scope of this scheme includes individual and group short -term or long- term accident and health policies (e.g \nHospital Cash, Medical Expense, Personal Accident, Disability Income, Long term Care Insurance.)  \n \n\u2022 Is administered by the Singapore Deposit Insurance \nCorporation.   Coverage for PPF is automatic and no \nfurther action is required from the policy owner.  \n \n \n \n \n4. Benefit Provisions  \n This provision is the essence of insurance policy.  It set forth insurer\u2019s promises and each \n benefit is  usually drafted in utmost care.    \n \n \n5. Exclusions   \n  Exclusions refer to the circumstances under which the insurer will not pay.   No benefits will be \npaid for charges which are in excess of the usual, cust omary and reasonable charges.  \nSickness contracted wit hin the waiting period, pre- existing conditions are not covered.  \n   \n6. Claims Conditions  \n\u2022 Includes provisions that define insured\u2019s obligation to provide timely  notification of loss  \n to the insurer.   \n \n\u2022 Physical Examination Provisions \u2013  usually included in most individual and group  \n  Disability Income Policies.  After the insured submits a claim, the insurer has the right  \n to have the insured person examined by a doctor of the insurer\u2019s choice, the insurer\u2019s  \n expense t o validate claim.  \n \n\u2022 Mediation/Arbitration and Legal Actions Provisions  \n\u2022 Health Insurance Policy will include a Dispute Resolut ion Clause.  All dispute under \n  the policy should be referred to Financial Industry Disputes Resolution Centre \n  Ltd  (FIDReC).  If the dispute cannot be dealt with by FIDReC, it will be referred to \n  and decided using arbitration , according to the Arbitration Rules of the Singapore \n  International Arbitration Centre. Insurer will not be legally liable unless insured  \n  first received an award under arbitration.  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   65 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) \u2022 Where both mediation and arbitration fail to settle the dispute, the insured may \n  seek legal actions against the insurer.  Legal provision limits the time during   \n  which the insured who disagree with the insurer\u2019s claim decision has the right to \n  sue for the rightful amount."}


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{"_node_content": "{\"id_\": \"764ba759-9ed9-4d3d-9ca2-92b4a6f6ff59\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"e0e09eb8-d1c7-4c6c-ae1a-a0469c78bcd7\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"06e43f906d0789c3b2b9820684b32b3bf57afcfa1695b5e712127fdecfc887e4\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"ae7bd4bf-5034-41b3-8ae6-6fa1115265d0\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"2bdab126f12ffb81d0218b127c294d48e40586168fe9ce96b9c7fa74f5910a77\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 131607, \"end_char_idx\": 136212, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "Legal provision limits the time during   \n  which the insured who disagree with the insurer\u2019s claim decision has the right to \n  sue for the rightful amount.  The Policy state s that no action in law or equity will be \n  brought under the policy until after the expiration of 60 days from the date a  \n  satisfactory proof of claim has been furnished to the insurance company.  \n \n \n7. Endorsements  \n  An endorsement is a separate document that modifies the policy to which it is attached.  \nModifications can be:  \n \n\u2022 Supplementary agreements (e.g maternity benefits for attachment to Hospital and \nSurgical Policy).  \n \n\u2022 Exclusions  (e.g exclude pre -existing conditions)  \n  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   66 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Chapter 10 \u2013  Health Insurance Pricing  \n \n1.  7 keys factors used to calculate Health Insurance P remium s are: \n \n \n1.  Morbidity Experience   \nThe primary  consideration for Health Insurance Pricing. It \nmeasures rate of sickness or failure of health.  \n \n2.  Investment income  Increase in investment income will lead to a  decrease  in \npremium.  \n \n \n3.  Operating expenses  Increase in operating expenses will lead to a n increase  in \npremium.  \n \n \n4.  Medical Inflation   \nMedical inflation will lead to a n increase  in premium.  \n \n5.  Scope of benefits  Increase in scope of benefits will lead to a n increase  in \npremium.  \n \n \n6.  Insurer\u2019s Profit  Loading is added to n et premium to provide a profit margin.  \nHence depending on company\u2019s p rofit strategy, it will affect \nthis loading.  (increase premium ) \n \n7.  Modes of premium  \n     Payment  \n  \n\u2022 Annually  \u2013 once a year;  \n\u2022 Bi- annually \u2013 twice a year;  \n\u2022 Quarterly \u2013 once every 3 months;  \n\u2022 Monthly \u2013 once a month (most expensive).       \n \n \n2. Parameters For Premium Rating :  \n1. Age \n \n2. Gender  - Women\u2019 s premium is higher than male for health insurance products.  \n \n3. Physical Condition \u2013  refers to proposed health status of the proposed insured. (eg pre- \nexisting conditions ).  \n \n4. Occupation \u2013 the higher the risk of injury or illness resulting from an occupation, the higher \nthe insurance premium.  \n \n5. Persistency \u2013 Refers to the percentage of policies renewed each year.  If the persistency \nrate of a type of coverage is expected to be high , then the insurer will reduce the amount of \npremium charge.  \n \n6. Claims Experience \u2013  Claims experience demonstrates the general health condition of the \ngroup and the propensity of the group members to file claim. Key factor for affecting \npremium rate charged for group plans .  \n \n7. Participation Level \u2013  Low participation means there will be greater chance that a higher  than \nnormal proportion of unhealthy  lives will seek coverage.  This is called anti selection.  \n \n8. Life Style  -  Can influence premium charge.  Eg hazardous sport will call for extra premium. \nThe most important lifestyle factor is smoking, which will attra ct a higher premium  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   67 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Chapter 11 \u2013  Health Insurance Underwriting  \n \n1.  \n \n \n \n \n \n \n \n \n \n \n \n \n \n2. Factors affecting Risk  \n \n \nMedical Factors  \n  \nNon Medical Factors  \n \n1.   Medical History    \n     Insurers review history of previous  \nconditions to determine :  \n \n\u2022 Possibility of recurrence;  \n \n\u2022 Effect of a medical history on proposer\u2019s general health;  \n \n\u2022 Complications that may arise;  \n \n\u2022 Normal progression of any \nimpairment.  \n       \n \n2.   Curr ent Physical Condition  \n \nThe proposer\u2019s statement on a \nproposal and medical examinations \nresults are the first indicators of \npresent physical conditions, before \nunderwriters  request for other test s. \n  \n1.  Financial Factors  \n     Important consideration in underwriting \n     individual Disability Income Insurance.  \n  \n2.  Occupational Factors \n     Accident hazards \u2013  eg painter  \n     Health Hazards \u2013 e.g handling asbestos will lead \n     to respiratory failure.  \n \n \n3.  Age \n     Older \u2013 more thorough because of possibility of  \n     health problems.  \n \n \n4."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
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Age \n     Older \u2013 more thorough because of possibility of  \n     health problems.  \n \n \n4.  Avocations / L ife Style Risk  \n      a. Examples of Life Style risks -  Drug abuse,  \n          hazardous occupations, multiple sexual  \n          partners . \n \na. Habits  \n           Eg drinking and drug use .  \n \n \n \n  Underwriting  \nThe main purpose of underwriting is a process  to ensure premium charged \ncorrespond closely  with the r isk that each proposer  represents.  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   68 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 3.  Factors that are specifically important for each type of Health Insurance \n Products .   \n \n \nHealth Insurance Plans  \n  \nFactors  \n \nMedical Expense Insurance  \n \u2022 Medical history ;  \n\u2022 Current physical condition.  \n \n \nDisability Income Insurance  \u2022 Size and stability of earnings;  \n\u2022 Overall financial situation;  \n\u2022 Occupation risks \u2013  only white collar workers are \npermitted.  \n \n \nLong Term Care Insurance  \u2022 Detection of cognitive impairments;  \n\u2022 Morbidity risk.  \n \n \nCritical Illness  \u2022 Medical history  \n\u2022 Current physical condition \n\u2022 Smoking habit;  \n\u2022 Family history.  \n \n \nManaged Healthcare  \u2022 For Individual \u2013 Medical history and current \nphysical condition;  \n\u2022 For Group \u2013 age and gender.  \n \n \n \n4. Types of Underwriting Methods for Medical Expense Insurance   \n \nFull Medical Underwriting \n  \nMoratorium Underwriting \n\u2022 Proposed insured completes  a health \ndeclaration when he applies for cover.  \n \n\u2022 Pre-existing conditions are excluded.  \n \n \n \n \n \n \n \n \n \nAdvantage  \n\u2022 Insured has certainty  as to what is \ncovered at the point of joining rather \nthan when he needs to make a claim.  \u2022 No need  to fill in a health declaration . \n \n\u2022 Insurer will automatically exclude  any pre-\nexisting conditions  (for which insured has \nbeen treated)  during the 5 years \nimmediately preceding the commencement \ndate of cover.  However, if insured does \nnot have any symptoms, treatment etc for \nthose pre- existing conditions for a \ncontinuous period ( usually 2 to 5 years), \nthen he is covered when the conditions \nrecur, subject to the terms and conditions.  \n \n Advantage  \n\u2022 Provides only basic information about \nhimself, but must understand that any pre-\nexisting condition are excluded from cover, \nunless he can satisfy moratorium criteria \nfor pre -existing condition (as per  point \nabove).  \n \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   69 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 5. Group Underwriting Factors  \n \n1. Reason For Existence  \nThe reason for the existence of a group applying for group coverage must be for some \npurpose other than  for purchasing insurance.  This is to prevent anti - selection.   The \ngroup members must be actively at work on a full time regular basis and have a fairly \npredictable income.  \n \n2. Group Stability  \nAn ideal group for insurers is one in which there is a steady  flow of new members to \nreplace those who leave, but not  massive influx or outflow of members.  \n \n3. Group Size  \nGroup size is important, as it provides a better spread and diversification of risk.  \n \n4. Insured company\u2019s nature of business  \nCertain lines of business are more risky than others.  \n \n5. Employee Classes  \nOver -representation by a highly paid class can result in higher than average medical \nclaims.  Over -representation by a class which the employees earn low income  can result \nin a higher -than \u2013desired rate of turnover.  \n \n6. Level of Participation  \nEspecially in a contributory plan as members\u2019 participation is on a voluntary basis.  Insurers \nnormally specify a minimum participation level requirement of e.g 70% to 90%  to prevent \nanti- selection.  \n \n7. Age and Gender  \nAge is important in underwriting, as it increases the mortality of the group.  Gender in the \nform of ratio of males to females is important as females  have lower mortality rates, but \nhigher morbidity rates than males.  \n  \n \n  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   70 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 6."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
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Sources of Underwriting Information \n  \n1. The proposal (application) form is the primary source of underwriting information for the  \ninsurer.  It will form the contract and used as a basis when a claim is filed.  \n  \nSections of a Proposal Form  \ni. Heading and identification of the parties  \n\u2022 States the names of the insurer  and contact details.   \n\u2022 \u201cParticulars of the life to be insured\u201d and \u201cParticulars of the Proposer\u201d serves \n   2 reasons.  First ly is to distinguished the proposer from others having a  \n similar name, secondly, to provide relevant information to the underwriter to  \n assess the risk.  \n \nii. Particulars of policy applied for   \nDetails of the policy and sum assured.  \n \niii. Information regarding pas t applications and existing policies  \nProposer needs to indicate whether he is purchasing this policy to replace an \nexisting policy.   \niv. Personal health details and habits of the proposed insured  \nThis section is critical as it provides a detailed description of the propos ed \ninsured\u2019s medical history, physical conditions, habit etc.  \n \nv. Declaration  \nServes the following purposes that the proposed insured:  \n\u2022 has disclosed all material facts truthfully;  \n\u2022 has not withheld any material facts;  \n\u2022 is aware that the benefits may be lost if material facts are not disclosed;  \n\u2022 agrees and authorizes insurer to release to any medical source or insurance \noffice, any information concerning him, regardless of whether the proposal is eventually taken up.  \n \n2. The Agent\u2019s Statement \u2013  to indicate :  \n\u2022 Knowledge of any information on the proposer that is not in  the proposal form;  \n\u2022 Proposer\u2019s net worth , earned income, income from other sources.  \n \n3. Medical Examinations /Tests  \nNamely for these plans:  \n\u2022 Disability Income Insurance  \n\u2022 Critical Illness Insurance  \n\u2022 Long Term Care Insurance  \n \n4. Attending Physician Statement  \nTo enable the underwriter to have a better insight into the applicant\u2019s medical history  that \nis not available from the medical examination.  \n \n5. Supplemental Questionnaires  e.g financial questionnaires are to gather information about net worth and unearned \nincome.  \n \n  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   71 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 7. Final Underwriting Decision \n \n 1.   Standard Risk   \n\u2022 Policy issued is based on premium rates stated in the rate book.  \n \n2. Sub Standard Risk  \nThe following can occurs:  \n \n1. Modifications of cover  \n\uf0a7 Specific Exclusions  \nE.g. excl uding disease of the intestines, commonly usually used in Medical \nExpense Insurance.   \n \n\uf0a7 Extra Premium  \nUsually used for these plans:  \nDisability Income Insurance, Critical Illness Insurance.  \n \n\uf0a7 Modifications of Benefits offered. E.g reduction in monthly benefits . \n \n2. Postponement  \nEg: going for an operation.  \n \n3. Declined  \nUsually for serious medical reasons . \n \n \n8.  Commencement of Risk  \nRisk commences when the applicant agrees to the terms stated in the letter of acceptance  \nand pays premium.  \n \n  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   72 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Chapter 12 \u2013 Notice No: MAS 120 \u2013 Disclosure and \nAdvisory Process Requirements For Accident And \nHealth Insurance Products \n \n1. This Notice covers the following products:  \n \n\u2022  A & H Policies; and  \n \n\u2022  Life Policies with A & H Benefits.  \n \n \n2.  This Notice applies when a financial adviser provides advice or arranges contracts of  \n insurance or both, in respect of accident and health insurance policies and life policies that  \n provides accident and health benefits but does not apply  where:  \n \n\u2022 Such policies are in respect of reinsurance o f liabilities under insurance policies; and  \n \n\u2022 Such policies provide that the accident and health benefits are paid out only if  the \ninsured becomes totally and permanently disabled, as defined under that policy.  \n \n \n3.  This Notice comprises the following 2 parts:   \n \n (a).  Part 1 \u2013  Mandatory Requirements;  \n \ni. Division 1: Disclosure requirements for accident and health policies;  \n \nii."}


created_at: 2024-03-15 18:52:31
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This Notice comprises the following 2 parts:   \n \n (a).  Part 1 \u2013  Mandatory Requirements;  \n \ni. Division 1: Disclosure requirements for accident and health policies;  \n \nii. Division 2 : Disclosure requirements for life policies that contains accident and \nhealth benefits;  \n \niii. Division 3 : Additional requirements for direct insurers;  \n \niv. Division 4  : Requirements on provision of advice relating to accident and health \npolicies;  \n \nv. Division 5 : Requirements on provision of advice relating to the life policies that \ncontains accident and health benefits;  \n \nvi. Division 6 : Offences relating to this Part;  \n \n (b). Part 2  - Non- Mandatory Best Practice Standards on Information Disclosure and  \n   Provision of Advice.  \n  \n4. This Notice shall come into effect on 1 April 2004.  \n  \n  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   73 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Part 1 \u2013 Mandatory Requirements  \n \nDivision 1: Disclosure Requirements for Accident and Health Policies  \n \nPlease note : (Division 6)  -  Failure to comply with the following  (Pt 1 to 4)  are considered \noffences liable on conviction to a fine not exceeding S$25,000 or to imprisonment for a term \nnot exceeding 12 months  or both:  \n \n1. General Information about the A&H intermediary and the status of an A& H insurance  \n    Representative.  \n An A&H insurance intermediary shall disclose to the insured in writing  its business name under \n which it conducts its insurance business, its business address and its telephone number and \n when there is a change in such information, to inform insured in writing.  \n \n \n2.  Remuneration of the A& H Insurance Intermediary  \n An A&H insurance intermediary shall, upon the request of the insured, disclose in writing  to the \n insured all remuneration, including any commission, fee, and other benefit, that it has received or \n will be receiving for providing advice on any accident and health policy.  \n  \n3. Conflict of Interest  \n   An A&H insurance intermediary shall disclose to the insured in writing  any actual  or potential \n conflict of interest arising from any connection to or association with any insurer, including any \n material information that may compromise its objectivity in advice provided.  \n \n \n4.  Disclosure when Providing Advice   \n 1.  An A&H insurance intermediary shall disclose to the insured the following information . \n  The insured can refers to an individual or policy owner of a group policy .  \n  For voluntary group to disclose to each person as if it is dealing with the individually:  \n \na)  Nature and objective of the policy;  \n \nb)  Details of the insurer;  \n \nc) Contractual rights and obligations;  \n An intermediary to explain to the insured:  \n\u2022 The party against which the insured may take action to enforce his rights with \nrespect to the policy he has purchased;  \n \n\u2022 An intermediary to explain to the insured that he ( insured) is responsible  for the \naccuracy and completeness of the information when applying for the policy and making a claim.  Any misstatement or non disclosure of material facts may affect \nvalidity of the policy.  \n \n\u2022 Amount and frequency over which the payment is to be made, and whether the premium rate is guaranteed or non- guaranteed  \n  \nd) Benefits of the Policy  \n\u2022 Conditions under which the payment of policy moneys (guaranteed/non \nguaranteed) is to be made or not made to the insured;  \n\u2022 Any lien on the policy.  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   74 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) e) Risks of the Policy  \n\u2022 Whether insurer may alter the terms of contract, and if so, what may be altered \nand under what conditions would the alterations be all owed;  \n \n\u2022 Whether insurer may decline to renew the policy or unilaterally terminate the \npolicy.  \n  \n2. Where a benefit illustration or a product summary in respect of accident and health policy \nprepared by the insurer or the A& H insurance intermediary is available, it shall be \nfurnished and explain to the insured.  \n  \n3."}


created_at: 2024-03-15 18:52:31
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Where a benefit illustration or a product summary in respect of accident and health policy \nprepared by the insurer or the A& H insurance intermediary is available, it shall be \nfurnished and explain to the insured.  \n  \n3. In the case of a personal accident  policy,  shall ensure that insured is aware that the policy \nmoneys shall be payable in the event:  \n\u2022 of an injury to, or disability as a result of accident;  \n \n\u2022 of death by accident;  \n \n\u2022 combination of above.   \n  \n \nPlease note: (Division 6): Failure to comply with the followi ng (Pt 4(4) to 6) are \nconsidered offences liable on conviction to a fine not exceeding S$12,500 : \n \n4. When a n A&H insurance intermediary prepares a benefit illustration or a product summary, \nit shall be prepared in accordance to the industry standards, if any set for the insurers.  \n \n \n5.  Marketing Materials  \n Representatives shall only use marketing materials approved by the A&H Insurance  \n Intermediary  for which the representative acts.  \n \n \n6. Telemarketing and Direct Marketing  \n1.  In the case of using telemarketing over the phone to solicit and close a sale, A& H \n intermediary shall, where no advice is provided,  communicate to the insured a warning \n that: \n\u2022  insured may wish to seek advice from an A&H insurance intermediary before \n purchasing the policy;  \n \n\u2022  in the event the insured choose not to seek  advice, he should consider suitability  of \n the policy; and  \n \nIntermediary shall maintain a record of all conversations made over the phone sufficient \nfor the purpose of conducting audit checks where necessary.  \n  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   75 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  \n  2.  In the case of marketing A&H policies using direct response  advertising communications \n  through any medium including mail, print, TV, radio and electronic media to solicit and  \n  close a sale, A& H intermediary shall include, in all its marketing materials a prominent  \n  warning that:  \n \n\u2022  insured may wish to seek advice from an A& H insurance intermediary before \n purchasing the policy;  \n \n\u2022  in the event the insured choose not to seek advice, he should consider suitability of \n the policy.  \n \n \n    \nDivision 2 : Disclosure requirements for L ife Policies that C ontains Accident and  \nHealth Benefits  \n  \nThis Division is somewhat similar to Division 1  \n \n    \nDivision 3 : Additional Requirements for Direct Insurers  \n \n1.  When a direct insurer prepares a benefit illustration or a product summary for policies it \n underwrites, it shall be prepared according to industry standards, if any.  This shall not apply \n to policies underwritten by insurers other than a registered insurer.  \n \n 2.  Any alterations made in the terms of the contract, the direct insurer shall discl ose and \nexplain  the new terms and the manner in which insured may accept these new terms or the \ncircumstances under which the insured will be deemed to have accepted the new terms.  \nSuch information should be furnished to the insured in writing at least 30  days  before the \nvariation or amendments take effect.    \n \n \n \n  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   76 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Division 4 : Requirements on Provision of Advice Relating to Accident and Health  \nPolicies  \n \n1. This Division shall not apply  to: \n \n\u2022  Circumstances where no recommendation is made or where only factual information \nis provided  with respect to any health policy; or  \n  \n\u2022  Any advice provided in respect of ElderShield Policy.  \n  \n \n \nPlease note: (Division 6): Failure to comply with the following in this Division are \nconsidered offences liable on conviction to a fine not exceeding S$12,500:  \n \n2.  An A&H Intermediary shall have a reasonable basis for providing advice to the insured.  For \n the purpose of ascertaining that the advice is reasonable, the representative shall give regard \n to the information such as the insured\u2019s objective, financial situation, particular needs, etc.  \n \n3.  In providing advice on health policies to the insureds, A&H intermediary shall comply with  \na.  Know - Your Client  \n \nb. Needs analysis; and  \n \nc. Documentation and r ecord keeping.  \n \n \n   \n3a."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
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Know Your Client  \n \nIndividual  \n Group  \n \n\u2022 Objectives of insured;  \n\u2022 Employment status;  \n\u2022 Income;  \n\u2022 Existing health insurance, including \npolicy from CPF;  \n\u2022 Any medical conditions;  \n\u2022 Whether policy is to include \ndependants.  \n  \n\u2022 Objectives of the insured;  \n\u2022 Size and composition of the group \nincluding age, gender, income, \noccupation;  \n\u2022 Claims history of the group;  \n\u2022 Any medical conditions of members of \nthe group.  \n \nA& H intermediary shall highlight in writing the following:  \n \na.  information provided will be the basis  on which advice will be made;  \n \nb.  any inaccurate or incomplete information provided may affect suitability .  \n \n \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   77 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  3b. Needs Analysis   \n\u2022 A&H intermediary shall analyze the information provided;  \n \n\u2022 Where the A& H Intermediary is unable to identify a suitable policy, it shall inform  \nthe insured accordingly.   \n  \n  Where an insured does not want to provide any information requested in (a), or accept \n  the advice of the A&H insurance intermediary and chooses to purchase another policy \n  which is not advised by the intermediary, then the intermediary:  \n\u2022 may proceed to the insured\u2019s request but it shall properly document  the decision \nof the insured; and  \n \n\u2022 inform the insured that it is the insured\u2019s responsibility  to ensur e suitability of the \npolicy selected.  \n \n \n3c.  Documentation and Record Keeping   \n  Before the insured signs on the application form for the purchase of a Health Policy or \n  gives consent for withdrawal or surrender of a Health Policy, A&H Intermediary shal l  \n  furnish to its insured a document containing a summary  of the information gathered and \n  the basis of the advice given and where applicable a statement that the insured does \n  not want to provide information or received advice of the A&H insurance intermediary . \n  \n \n \n4.  Switching of Accident and Health Insurance Policies   \n An A&H insurance intermediary shall not cause the insured to switch products that would be \n detrimental to the insured.  The following are examples of detrimental switch:  \n  \na. whether the insured suffers any penalty for terminating the original policy;  \n \nb. whether the insured will incur any transaction cost without gaining  any real benefit;  \n \nc. whether the replacement policy confers a lower level of benefit at a higher cost  or \n same c ost; or the same level of benefit at a higher cost ; \n \nd. whether the replacement policy is less suitable.  \n      \n     An  A&H insurance intermediary shall disclose to an insured , any fee or charges  the insured \n would have to bear for switches, in order to ensu re the insured is able to make an informed  \n decision on whether to switch.  \n \n \n  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   78 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Division 5 : Requirements on Provision of A dvice Relating to the Life Policies that  \nContains Accident and H ealth Benefits  \n \nThis Division is somewhat similar to Division 4 . \n \n \nDivision 6: Offences Relating to This Part  \nCovered in the respective parts above.  \n \n \n \nPart Two \u2013  Non Mandatory Best Practice Standards on Information Disclosure and \nProvision of Advice   \n \n1. Encourage to observe but not a crim inal offence. They are : \n \n\u2022 Information disclosed in any advertisement should be in pl ain language , jargons \nexplained ; \n \n\u2022 Information provided should be sufficient ( not limited to this Act) to help insured make an  \ninformed decision ; \n \n\u2022 Information should not be ambiguous.  It should be disclosed in an objective and \nunbiased manner.  There should be a reasonable basis  for expressing an opinion, and \nit should be unambiguously stated that it is an opinion;  \n \n\u2022 Documents should be kept up to date .  \n  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   79 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Chapter 13 \u2013  LIA & GIA Guidelines  \n \n1."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
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{"_node_content": "{\"id_\": \"db0c94b4-ef04-41d3-8085-774d36b3a514\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"4b93314e-770f-4d07-94f1-863d1c8d62e9\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"9e446e3d1229d9e4db1a9d68bd5fa316d90668ecfa0496732184d03b6351e35d\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"a148ddaf-4228-4c75-b066-408b5abb5118\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"c7eb4c75764c764a55e9eac10c3f8aa1d2833379f0861aba1efd125db1dbb73e\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 159012, \"end_char_idx\": 163322, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Chapter 13 \u2013  LIA & GIA Guidelines  \n \n1.   This Chapter consists of:  \n  \n\u2022  LIA & GIA Guidelines on disclosure requirements for Accident and Health (A&H) products \n as specified in Appendix 13A;  \n \n\u2022   LIA Guidelines on Needs -based Sales Process for Individual Health Insurance Products \n as specified in Appendix  13B; \n \n\u2022  GIA Guidelines on Needs -based Sales Process for Individual and Group Health \n Insurance Products as specified in Appendix 13C  \n \n \nLIA & GIA Guidelines on Disclosure Requirements for A&H Products \u2013  Appendix 13A  \n \n1.  Compulsory Documents to be presented to client at Pre -Sales Stage  \n \n \nDocuments at Pre -Sales Stage \n \nIndividual  (pg 241)  \n Corporate  (pg 246)  \n\u2022 Your Guide to Health Insurance  \n \nInsurer to reproduce in verbatim this document.  \n \u2022 Same (under voluntary plan)  \n Insurer to reproduce in verbatim this document  \n\u2022 Product Summary  \n \u2022 Same (under voluntary plan)  \n\u2022 *To ensure p roposers to sign the \nproposal form t o confirm that they \nare given a copy of the documents and \nthat the contents of these have been \nexplained to them.  \n \u2022 **Same except that members applying \nfor insurance under voluntary plans  \nshall be required to sign on the Policy \nHealth Declaration Form  and to confirm \nthat they have read and understood \nthese 2 documents.  \n \n \n \n2.  Specific Guidelines to Product Summary   \n 1.  Product Summary aims to provide prospective buyers with details on key product  \n  information and features, contract provisions, or terms and conditions that may  \n  affect their  decisions to purchase the policy.  \n  \n \n 2.  *For Individual Business   \n\u2022 To ensure proper disclosure and acknowledgment of information presented, the original signature of the prospective client and the intermediary  must be \nobtained and both these endorsements must be made on the front page of \nProduct Summary .   \n \n\u2022 A copy of the duly signed Product Summary must be filed with the insurer for \nrecord purposes.  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   80 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) \u2022 Disclosures of distribution costs, charges & expenses in the \u201cProduct Summary\u201d is \nnot mandatory , however it should be clear in the document that such information \nwill be made available at the client\u2019s request.  \n   \n  **For Corporate  \n  The final proposed terms are to be signed by the client or a legally appointed   \n  representative of the client and members applying for insurance under voluntary plans \n  shall be required to sign on the Policy Health Declaration Form .  \n \n 3.  Product Summary comprises 2 sections  for both Individual and corporate business:  \na. Product Information  \n \nb. Key Product Provisions  \n  \n \nProduct Summary (pg 242,247)  \n \nProduct Information  \n Key Product Provisions  \n\u2022 Summary of benefits or covered events;  \n\u2022 Benefits schedule table;  \n\u2022 Premium rates;  \n\u2022 Premium payment duration;  \n\u2022 Duration of policy cover;  \n\u2022 Definition of ADLs.  \n \n \u2022 Cancellation / Termination clause;  \n\u2022 Renewability of Policy;  \n\u2022 Premium guarantee;  \n\u2022 Waiting period;  \n\u2022 Benefits limitation;  \n\u2022 Pre-existing conditions;  \n\u2022 Deferment period;  \n\u2022 Survival period.  \n  \n For Individual Business  \n3. Application of the guidelines to direct marketing and telemarketing channels   \n \n 1.  Most of which is s imilar to Chapter 12 (Division 1, Pt 6 of this Review ). \n \n 2. In the case of direct marketing, the insurer must have control over  the entire process, \n  from publication and distribution of promotional materials to delivery of the policy  \n  document.  For telemarketing, the insu rer must have sufficient control  over its  \n  telemarketing staff, or the telemarketing firm if the function is outsourced, such that the \n  information conveyed on product features is accurate.  \n \n 3.   The insurers must make adequate arrangements to provide appropriate post -sales  \n  disclosures to policyholders who have purchased health insurance products through  \n  direct marketing or telemarketing channels."}


created_at: 2024-03-15 18:52:31
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The insurers must make adequate arrangements to provide appropriate post -sales  \n  disclosures to policyholders who have purchased health insurance products through  \n  direct marketing or telemarketing channels.  Such post -sales disclosures include a  \n  \u201cfollow -up letter\u201d  which:  \n\u2022 advises the proposer to read the 2 compulsory  disclosure documents enclosed;  \n \n\u2022 highlights to the proposer that he is entitled to a \u201c 14-day Free Look \u201d period and \ncan cancel his coverage without penalty within this period if he deems the product \nunsuitable;  \n \n\u2022 requests the proposer to return the enclosed pre -pay reply card to the insurer to \nconfirm his receipt  of the disclosure documents.  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   81 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  4. With such procedures in place, the following standard disclosure requirements will not \n  apply to direct marketing and t elemarketing:  \n   \n\u2022 Having the proposer sign on the proposal form stating that he has been given the \n   2 compulsory disclosure documents, and that the contents of these have been \n   explained to his satisfaction; and  \n \n\u2022 Having the proposer sign on the first page of the Product Summary.  \n \n \n4.  Individual Business -  Disclosure requirements for personal accident products  -  \n Similar to Chapter 12, Division 1(Pt 4 (3) of this review)  \n \n \n \n5. Individual Business  \n Post -Sales Disclosure  \n \n 1.  Continual disclosures  to be made to policyholders whenever there are modifications to \n  the Product Information or Key Policy Provisions specified in the Product Summary.  \n  Circumstances that would require continual disclosure include:   \n\u2022 Premium rates or premium rates table;  \n \n\u2022 Policy benefits or coverage;  \n \n\u2022 Exclusion clauses;  \n \n\u2022 Change in definition of contract provision.  \n    \n Both  the existing and modified benefits/terms need to be shown .  In cases where \n some original benefits are withdrawn or new exclusions are added with no change in \n premium rates, this must be highlighted to the policyholders.  \n \n \n 2. Insurers are required to give policyholders advance written notice of at least 30 days   \n  before the modifications take effect.  \n \n \n 3. To modify any original terms of the original policy contract, insurer may:  \n\u2022 obtain written acceptances of the modified terms from policyholders; OR  \n \n\u2022 where no written acceptances of the modified terms is sought, the insurer  must \nensure that all of the following conditions are fulfilled:  \nI. policyholders are given the option to reject the modified terms and cease \ncover;  \n \nII. in the notification letter to policyholders:  \na. the modified terms must be conspicuously indicated on the front \npage of the notification letter,  \nb. the modified terms must be highlighted in bold print  on the \nnotification letter and  \nc. the print size of the modified terms should not be smaller  than the \nrest of the text on the notification letter.  \n \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   82 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) III. the following standard st atement must be highlighted on the ratification \nletter:  \n\u201c Please be advised that unless otherwise advised by the Owner of the \npolicy, receipt of the renewal premium by the Company shall be construed \nas an acceptance of the modified terms and the modified terms shall take \neffect from the date of policy renewal\u201d.  OR  \n \n\u201c Please be advised that unless otherwise advised by the Owner of the \npolicy  by DD/MM/YY (expiry date of the advance notice), the modified \nterms shall take effect from DD/MM/YY(effective date of the modified terms)\u201d.  \n \n \n6. Corporate Business   \n \n 1.  Information to be disclosed to clients at the Pre Sales Stage:  \n\u2022 Name of Insurer underwriting the product;  \n\u2022 Duration of cover, premiums rates , benefit schedules, period of validity;  \n\u2022 Key product terms and conditions  \n\u2022 Whether premium rates and renewals are guaran teed;  \n\u2022 Whether the product qualifies under TMIS;  \n\u2022 Whether free look is applicable;  \n\u2022 Upon request by the client, commission amounts must be disclosed  \n \n \n 2. The rest covered above.  \n \n  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   83 \nProduced in collaboration with Julia Sim."}


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{"_node_content": "{\"id_\": \"f5feeb67-b394-4776-830d-927d5ef1314b\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"a148ddaf-4228-4c75-b066-408b5abb5118\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"c7eb4c75764c764a55e9eac10c3f8aa1d2833379f0861aba1efd125db1dbb73e\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"18872c9e-2a92-4fc5-81c2-769f12e0c099\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"a20e95f92114a23a557c84f50cefac41bce49730ba94089a5c6fb0ed841d0ce9\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 167724, \"end_char_idx\": 172314, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "The rest covered above.  \n \n  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   83 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) LIA Guidelines on Needs -Based Sales Process for Individual Health Insurance \nProducts  \u2013  Appendix 13B  \n \n1.  The objective of the Guidelines is to set a minimum standard for the needs -based sales  \n process for insurance representatives.  It is important for a representative to obtain relevant \n information on a client, analyze the information before making appropriate recommendations \n on product suitability.  \n \n2.  The Guidelines apply to:  \n\u2022 Health Polic ies (including health insurance bundled with or riders to life policies) sold to \nindividuals by insurance representatives  i.e life insurance agents, general insurance \nagents, brokers, and representatives of financial representatives, banks and financial \ninstitutions.  \n \n3. The following requirements:  \na. Disclosure of representative\u2019s status  \nb. Use of fact find form  \nc. Use of needs analysis/recommendation form  \n \ndo not apply to :  \n \n\u2022 Direct  marketing (provided no advice has been given)  \n- includes internet as a tool of DM, but not as an e -intermediary  \n \n\u2022 Personal Accident Policy with or without Medical Reimbursement du e to Accident only  \n \n\u2022 Hospital cash due to Accident only  \n \n\u2022 Elder Shield, where advice is for a person who has previously opted out to re-opt into \nElder Shield. \n \n \n  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   84 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Minimum Fact Find Form and Needs Analysis & Recommendation Form  \n \n1.  The following forms appended below are adopted as the minimum industry standard : \n\u2022 \u201cKnow Your Client\u201d Form  (Individual Health Policies) \u2013  Appendix 1A of text.  \n \n\u2022 \u201cOur Advice and Reasons Why\u201d Form  \u2013 Appendix 1B  \n  \nNote:  Insurer may incorporate the Fact Find Form and Needs Analysis & Recommendation \nfor Life and Health Products into one form but the \u201c Application type\u201d is to be distinguished \nfor life and health insurance.  Fact Find and Need Analysis  & Recommendation pertaining to \nHealth Insurance is also required when a health product that is bundled with or riders to life \npolicies.  \n \n \n2. Application T ype for individua l accident and health policies.   \n \u201cApplication Type\u201d in the fact find form is to be ticked by the client and signed off as follows:  \n  \n1. Type 1  \n \u201cI/We have disclosed relevant information for comprehensive planning\u201d .  \nMeant for those who wish to complete the  fact find form in full , so as to receive \nrecommendations on product suitability.  \n \n \n2. Type 2 \u201cI/We have disclosed relevant information for specific need(s) planning\u201d  \n Meant for those with partial completion  of fact find form. Suitable for those who wish to \n receive recommendation on product suitability.  \n \n \n3. Type 3 \n  \u201cI/We did not undergo any needs analysis in this review and it is my/our   \n responsibility to ensure product suitability\u201d               \nMeant it is mandatory to explain  product features, fees and charges to the client.  \n  \n4. Minimum Requirements for each Application Type selected by the client.  \n \nMinimum requirements  \n Application Type  \n 1 \n 2 3 \nPersonal Information  Compulsory  Compulsory  Compulsory  \nDependent  Compulsory  Good to have  Not applicable  \nExisting health policies  Compulsory  Good to have  Not applicable  \nPersonal priorities  Compulsory  Compulsory  Not applicable  \nHealth conditions  Compulsory  Compulsory  Not applicable  \nReplacement of policy  Compulsory  Compulsory  Not applicable  \nNeeds analysis  Compulsory  Compulsory  Not applicable  \nRecommendation  Compulsory  Compulsory  Not applicable  \nClient\u2019s choice of App. Type  Compulsory  Compulsory  Compulsory  \nAcknowledgement by client  Compulsory  Compulsory  Compulsory  \n \n  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   85 \nProduced in collaboration with Julia Sim."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
id: 18872c9e-2a92-4fc5-81c2-769f12e0c099
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{"_node_content": "{\"id_\": \"18872c9e-2a92-4fc5-81c2-769f12e0c099\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"f5feeb67-b394-4776-830d-927d5ef1314b\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"d2bd3f0de46ad1c025d62f009bb4e3e3e516f3ecd708f5272015d9184b55aab5\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"55b54253-9469-4adc-96bb-e13f776d45b7\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"4eac0abf2d1da463d00015277c3892cc201104bf873383add6d7939396dcb7aa\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 172315, \"end_char_idx\": 176862, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Responsibilities of Life Insurer/Principal of Life Insurance Representative  \n \n\u2022 Insurer and principal of representative shall keep  a copy of the Fact Find Form, Needs \nAnalysis and Recommendation Forms for a length for necessary audit trail.  \n \n\u2022 Principal must ensure that a register  is set up and maintained by itself or its distribution entity \nfor audit by MAS.  The register should refle ct the \u201cApplication Type\u201d chosen by the client.  \n \n\u2022 Insurer to ensure that it underwrites proposals submitted only if accompanied by the required  \nform duly completed and signed .  \n \n\u2022 Intervention to rectify any erroneous recommendation is to be taken before the  expiry of the \nfree- look provision.  \n \n \nResponsibilities of  Supervisors of Representative  \n \n\u2022 Supervisor of representative must sign off on the register as soon as practicable.  Supervisor \nto ensure if applicable to his organizational structure , to set up and maintain a Register  for \nthe submissions of the said Forms by his representatives  to be recorded.  \n  \nResponsibilities of Life Insurance Representative  \n \n\u2022 To ensure that at each separate occasion of purchase, his client and him sign off  afresh  \ntogether on the Fact Find Form, \u201cOur Advice and Reasons Why\u201d Form.  A copy of the Fact \nFind Form which was completed on an earlier occasion may be used, provided the information \nis still current.   \n \n\u2022 Ensure to provide a copy of the Fact Find, Needs Analysis and Recommendation Forms to the  \nclient and to his supervisor  as soon as practicable.  \n \n\u2022 Treat information with confidentiality.  \n \n \nRemedies for Non- Compliance by Life Insurance Representatives  \nRepresentatives found not  to have submitted duly completed and signed Fact Find Form, and \nNeeds Analysis/Recommendation Form to the insurer for underwriting, or to the client, or to the supervisor will be penalized as follows:  \n \n\u2022 1\nSt offence \u2013 counseling \n  \n\u2022 2nd offence \u2013re-training on HI  \n \n\u2022 3rd offence \u2013 letter of warning   \n \n\u2022 4th offence - 3 months suspension  \n \n\u2022 5th offence \u2013 termination of contract  \n \nInsurer to ensure that supervisors validated the Recommendation Form submitted by their reps as \nsoon as practicable and take appropriate and timely actions to rectify an erroneous \nrecommendation made by their representatives.  \n  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   86 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) GIA Guidelines on Needs -Based Sales Process for Individual Health Insurance \nProducts  For Individual Health Products -   Appendix 13 C  \n \n1.  This Guideline for individual health product is similar to LIA Guidelines covered above except \n these areas:  \n  \nLIA Guidelines  \n GIA Guidelines  \n \nApplication  \n \n1. The following requirements:  \na. Disclosure of representative\u2019s status  \nb. Use of fact find form  \nc. Use of needs analysis/recommendation  \nform \n \ndo not apply to:  \n \n\u2022 Direct  marketing (provided no advice has  \nbeen given)  \n- includes internet as a tool of DM, but \nnot as an e -intermediary  \n \n  \n \nOffence  \nOffence for not submitting duly completed F act Find Form and Needs \nAnalysis/Recommendation Form  \n \n \n\u2022 1St offence \u2013 counseling \n  \n\u2022 2nd offence \u2013re-training on HI  \n \n\u2022 3rd offence \u2013 letter of warning   \n \n\u2022 4th offence - 3 months suspension \n \n\u2022 5th offence \u2013 termination of contract  \n \n \n  \n\u2022 1St offence \u2013 counseling \n  \n\u2022 2nd offence \u2013re-training on HI  \n \n\u2022 3rd offence \u2013 letter of warning   \n \n\u2022 4th offence - 3 months suspension \n \n\u2022 5th offence \u2013 Report to GIA -ARB  \nBe permanently barred from selling \nhealth insurance .   \n \n  Similar to LIA \nGuidelines  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   87 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) GIA Guidelines on Needs -Based Sales Process  \nFor Group Health Insurance Products Appendix 13C \u2013 Pg 276   \n \n1.  The Group Insurance Fact -Find Form (GIFF) serves as a means for the collection of certain \n basic information; needs analysis and documentation of any recommendation made.  \n \n \n2."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
id: 55b54253-9469-4adc-96bb-e13f776d45b7
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{"_node_content": "{\"id_\": \"55b54253-9469-4adc-96bb-e13f776d45b7\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"18872c9e-2a92-4fc5-81c2-769f12e0c099\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"a20e95f92114a23a557c84f50cefac41bce49730ba94089a5c6fb0ed841d0ce9\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"2f1a2a85-6840-49d6-92f7-e5592643a558\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"b7b83071c0a26fade3476e51c18f930776d605d62d8c4aad7c6778982e9fc66d\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 176681, \"end_char_idx\": 181261, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "The Group Insurance Fact -Find Form (GIFF) serves as a means for the collection of certain \n basic information; needs analysis and documentation of any recommendation made.  \n \n \n2.  Scope of Application  \n The GIFF is applicable to all distribution channels for : \n  \n\u2022 Compulsory and voluntary or participatory programmes  \n \n\u2022 Group health only  \n \n  The GIFF do not apply to:  \n\u2022 Standard off the shelf packaged products where the benefits and premium rates are fixed and are intended for the clients to buy off the rack.  \n \n\u2022 Standalone Group Personal Accident Products \n \n \n3.  Signatory Requirements  \n For direct sale s, the client\u2019s signature plus the insurance executive\u2019s signature as witness are \n to be appended.  For sales made via intermediaries, the client\u2019s signature plus the \n intermediary \u2019s signature to be appended.  \n  \n4. Code of Conduct /Practice for Insurers  \n\u2022 The contents in the GIFF serve as minimum  industry standards.  \n \n\u2022 Insurer must ensure that it will not issue any quotation and/or accept any application \nproposal form (except for off -the-rack pa ckage product), that is not accompanied by \nthe GIFF duly completed and signed.    Incomplete form or forms without required \nsignatures are NOT to be accepted.  \n \n\u2022 Holding ins urer must provide all the information requested in the GIFF, particularly the \nclaims experience  of the  policy for the period insured is with the holding insurer.  \n \n \n5. Documentation and Record Keeping  \n Insurer shall keep the GIFF for a length of time for necessary audit trail.   \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   88 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  \nChapter 14 \u2013  Financial Need Analysis  \n \n1. Advantages of needs selling compared to product selling are:  \n \n\u2022 Service  Oriented;  \n\u2022 Not Pre ssure Selling;  \n\u2022 Relationship Based.  \n  \n2. Stage 1 \u2013 Fact-Finding  \n \n Fact-finding is the process of obtaining answers to a series of questions about a prospective \n client\u2019s personal circumstances, finance  ambitions etc to enable you to have a better \n understanding of the client\u2019s objectives, needs for a proper basis to rec ommend suitable \n Accident and Health (A&H) Insurance Products.  \n  \nBasic Sections of a Fact Find Form  \nSections  Purposes  \n \na. Important Notice to Clients  Enables the prospective client to know:  \n \n1. Which inter mediary\u2019s product the reps is selling;  \n \n2. Highlight to client the importance of completing Fact \nFind Form for appropriateness of product \nrecommendation to his needs.  \n \n \n \n \n \n \n \nb. Application Type  \n       \nType 1 :  \n\u201cI/We have disclosed relevant information for            comprehensive planning\u201d  \n \nMeant for those who wish to  complete the fact find in full, \nso as to receive r ecommendations on product suitability.  \n Type 2 :  \n\u201cI/We have disclosed relevant information for  specific \nneed(s) planning\u201d  \n Meant for those who do not wish to or unable to provide \nall information requested.  Suitable for those who wish to \nreceive recommendation on product suitability.  \n \nType 3:   \n\u201cI/We did not undergo any needs analysis in this \nreview and it is my/our responsibility to ensure \nproduct suitability\u201d               \n \nMeant for those who already know w hich medical \ninsurance product and the amount of coverage they want.  \n \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   89 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  \n \nc. Personal In formation  \n\u2022 Essential for admin purposes on the part of the \ncompany;  \n \n\u2022 Provides reps with a preliminary assessment on \ntype of products that will like likely be needed;  \n \n\u2022 Age \u2013 needed or underwriting and premium                    \ndetermination.  \n \n \nd. Employment Details  \n \n\u2022 Employed/ Unemployed \n \n\u2022 Monthly Income  \n \n\u2022 Occupational Hazard \n \u2022 Determines whether eligible for DI , as Di is not \nissued to any unemployed person ; \n \n\u2022 Determines the def erred period  for DI , (self \nemployed \u2013shortest deferred period compared to \none who is employed)  \n \n\u2022 Determines affordability ; \n \n\u2022 May need to ask for more details to assist in  \nunderwriting."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
id: 2f1a2a85-6840-49d6-92f7-e5592643a558
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Details of Spouse &  \n    Dependant   \n\u2022 Identification in event of claim ; \n\u2022 Premium  determination (to cover dependant);  \n\u2022 Occupational hazard of spouse;  \n\u2022 Determines eligibility & whether a need to  \n               provide A& H cover for dependants.  \n \n \n \nf.  Existing HI Polices   \nServes as a refer ence point for further A & H insurance \nrecommendations.  Avoid replacement or caused insured \nto be over insured for those policies which is subject to \nCo- Ordination of Benefit Clause.  \n \n \n \ng.  Personal Priorities   \n\u2022 Enables reps to know client\u2019s priorities with  \nregard to A& H polices;  \n \n\u2022 Help client to re \u2013 prioritize  his needs based on  \noverall profile of the client.  \n \n \nh.  Health Condition   \n\u2022 Determines insurability and on what terms;  \n\u2022 Obtain relevant reports for underwriting.  \n \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   90 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  \ni.  Replacement of Policy  \n  \nExplain consequences  of replacement.  \nE.g: higher premiums, terms and conditions may be less \nbeneficial.  \n \n \nj. Representative\u2019s Declaration   \nInformation in Fact Find Form will be treated as confidential, use strictly for determining product suitability.  \n \n  \n3. Stage 2 \u2013 Identifying and Quantifying Needs  \n \n Analyze information gathered during Fact -Find Stage. Examples:  \n \n\uf0a7 Emer gency Fund  \n\uf0a7 Useful to guard against breadwinner\u2019s loss of a job or short term disability.  \n \n\uf0a7 If a client has no emergency fund, it may aff ect ability to service policies that he \nmay purchase from you.  \n \n \n\uf0a7 7 Life Stages  \n\uf0a7 It has an eff ect on product recommendations ; \n \n\uf0a7 Disability Income Insurance Pol icy is needed to protect income for all stages  \n except childhood.  H owever , it is not available to the unemployed.  \n \n \n\uf0a7 Dependants  \n Provision should be made for medical expenses  should dependant becomes disabled,\n it will be a financial burden to the family\u2019s finances.  \n \n \n\uf0a7 Clients\u2019 Existing Polices.   \nIf the prospective client has the given policies, you need to compare the benefits under \nhis existing insurance with his current needs to see of the prospective client is sufficiently \ncovered.     \n\uf0a7 Disability I ncome;  \n\uf0a7 Medical Expense Insurance;  \n\uf0a7 Managed Healthc are ; \n\uf0a7 Critical Illness ;  \n\uf0a7 Long Term Care Insurance;  \n\uf0a7 Hospital Cash Insurance   \n\uf0a7 Work  Injury Compensation Insurance  \n Pays in the event of any accident resulting in hospitalization, permanent incapacity  \n and/or death arising in the course of employment.  \n \n \n \n \n Covered in the respective \nchapters already  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   91 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  Quantifying Needs  \n  \n1. Quantify Maintenance cost  using the Total and Permanent Disability Benefit Method,  \n given:  \n \n Salary per month:  $3000 \n Expenses per month: $1,500 \n Rate of return 5%; Inflation rate 2%  \n Number of year  income needed: 21  \n  \n Covered under the following :  \n Group Term Life : $100,000 \n His own e xisting life Insurance $50,000  \n   \n Answer: $135,795  \n  \n Workings:  \n $1,500 X 12 = $18,000  \n $18,000 X 15.8775  (table A2: 3%;  21 years)  = $285,795  \n $285,795 \u2013 ($100,000 + $50,000)  \n = $135,795  \n \n \n \n2. Quantify Medical Cost  given:  \n \n Mr. Lim would like to based his average annual medical expenses to be $50,000  \n He has the following policies to cover him:  \n a)  Group Policy (max pay able) = $18,000  \n b)  Income Shield (total amount payable) = $7,000  \n \n \n Answer : $25,000  \n \n Workings:  \n Average Medical Expenses = $50,000  \n Less amount payable under Group P olicy = $18,000 \n Less amount payable under his MediShield  = $7,000 \n Hence shortfall =  $25,000 \n \n \n3."}


created_at: 2024-03-15 18:52:31
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{"_node_content": "{\"id_\": \"33ef0430-ecc0-4f24-9b42-055df3049bf1\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"2f1a2a85-6840-49d6-92f7-e5592643a558\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"b7b83071c0a26fade3476e51c18f930776d605d62d8c4aad7c6778982e9fc66d\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"92f5df94-c2b7-456a-a63b-70d958213ee8\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"802cf14b7a2b1f44d3e21d8f429f8be47ce3fd1b62341115ba20eb0e0be580f8\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 185472, \"end_char_idx\": 190087, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "Quantify the following Hospital Cash Insurance  (per day) policy given:  \n \n Monthly expenses: $5, 000 \n Existing Cash Benefit per month: $500  \n \n Answers :$150 per day  \n \n Workings:  \n ($5,000 - $500)/ 30  \n = $150 per day  \n  \n \n \n \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   92 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 4. Stage 3-  Product Recommendations and Presentation  \n  \n1. Product Recommendations  \n \n 2 basic principles:  \n  \n\u2022 recommend products  only if client needs  them;  \n \n\u2022 recommend products which are most suitable for him, given the circumstances.  \n Product suitability calls for good product know ledge.  \n \n \n \n2. Product Presentation   \n \nIt is advisable to follow a Systematic Process for presenting your recommendations:  \n \n\u2022 Purpose of product;  \n \n\u2022 Description  and nature  of product;  \n \n\u2022 Benefits and limit ations of product ; \n \n\u2022 Explanations on options  within the product;  \n \n\u2022 Give reasons for recommendations;  \n \n\u2022 Explain Benefit Illustration  and highlight guaranteed and non guaranteed;  \n \n\u2022 Disclose distribution costs, charges and expenses under the policy   \n \n \n \n \n5. Stage 4 \u2013 Client Review \u2013 Necessary because of :  \n \n\u2022 Change in client\u2019s circum stances ; \n \n\u2022 Exter nal development  such as changes in CPF ruling etc which can have an impact \non the client\u2019s financial position;  \n \n\u2022 Original product purchased is not sufficient  to cover all his needs;  \n \n\u2022 New product launch.  \n  \n\nHealth Insurance                                                                                                  Strictly for Internal Use Only                                           \n \nPrudential Assurance Company Singapore (Pte) Limited   93 \nProduced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Chapter 15 \u2013 Case Studies   \n \nThis chapter brings out 2 case studies; one on individual and the other on group.  \n  \nIndividual  \n \n \n1.   Source of Information:  \n      Fact Find Form   \n  \n2.  After calculating maintenance cost,  \n     the most suitable product are :  \n \n\u2022 Disability Income Insurance   \n  \u2013 must be employed \n \n\u2022 TPD /Personal Accident Policy            \n\u2013 if unemployed \n  \n3.  Products to meet Medical cost are:  \n \n\u2022 Medical Expense Insurance ;  \n \n\u2022 Managed Healthcare Insurance ; \n \n\u2022 Long Term Care Insurance;  \n \n\u2022 Cri tical Illness Insurance ;  \n \n\u2022 Hospital Cash Insurance ;  \n \n\u2022 Personal Accident Policy  \n (with medical expense benefit)  \n  Case Study  \nGroup  \n \n \n1.  Source of Information:  \n     Group Fact Find Form  \n  \n2.  Determine Sum assured for Group  \n        Term Life Insurance in 2 ways:  \n \n\u2022 By R ank    \n   Advantage: Easy to manage \n \n Disadvantage: Does not take into  \n consideration the length of service \n of the staff.  \n \n\u2022 Number Of Times Of Employee  \n Basic Salary.  \n Advantage: More equitable  \n \n \n3.  Obtain the company\u2019s past 3 years of  \n claim history  for premium  \n determination.  \n  \n 4.  Client and representative must  \n sign on the Group Fact Find Form to  \n enable Insurer to give a quotation.    \n \n \n5.  Rep to go through quotation, and once  \n client accepts the quotation, reps to  \nassists on the completion of necessary  \nforms and to submit to insurer with  \n payment.  \n\nHealth Insurance                                                                                                                                                  Quick comparison at a glance   \n      Managed HealthCare  Medical Expense  Disability  Income  Long Term Care  Critical Illness(CI)  Hospital Cash  \nDefinition  & Purpose  \nOverall strategy for \nappropriate medical care \nyet containing medical \ncost.  \n3 components:  \n1. Accessibility  \n   PCP-   are called     \n   \u201cPersonal Physician\u201d ,  \n   \u201cGatekeeper\u201d  \n2.  Quality of care  \n3. Cost  \n    4 methods \u2013    \n\u2022 Capitation  \n\u2022 Salary  \n\u2022 discounted fee  \n\u2022 fee schedule  Reimbursement \nbenefits for specific medical expenses that \nresult from accidental \n& sickness.  \n \n- Inpatient Expenses  \n( 11 points)  \n - Outpatient \nExpenses  \n(4 points)  \n \n-    Catastrophic  \n       Outpatient  \n- Kidney and  \n- cancer treatment  \n Income replacement to \nsafeguard one\u2019s earning capacity if one \nis totally disabled and \nunable to work.  \n \nAlso known as -\nPermanent Health \nInsurance, Income \nProtection, Income \nReplacement.  Pays daily or monthly \nbenefits."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
id: 92f5df94-c2b7-456a-a63b-70d958213ee8
encoding: FLOAT32
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{"_node_content": "{\"id_\": \"92f5df94-c2b7-456a-a63b-70d958213ee8\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"33ef0430-ecc0-4f24-9b42-055df3049bf1\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"338b3e9f6a1b8e27aea607cb89a20855a159ff527f8102855c8405c3cf5e6365\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"4036d204-c682-491c-967e-cdc511d7c255\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"acc2dbd4e407dfb88804ff997fc8dd92f2f603cd880cdd36cb1fd9fb3ff742eb\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 189968, \"end_char_idx\": 193999, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "Also known as -\nPermanent Health \nInsurance, Income \nProtection, Income \nReplacement.  Pays daily or monthly \nbenefits. Cover cost of care of person who is \nphysicall y impaired and \nthat no longer able to \nfunction independently \nand have to depend on \nothers to help perform \nADLs.  Lump sum upon \ndiagnosis of one of 37  \nor more dread \ndiseases or undergoing \nsurgical procedure covered under the \npolicy.  \n \nNew: Severity based \nCI Plans pay claim \nduring early stages and \nseverity of CI (% of \nSA). Premium is higher \nthan normal CI.  \n \nNew: Multiple Pay CI  Daily cash benefit if \none is hospitalized due \nof accident or illness  \nPremium   \nFixed Annual Premium  Age Band  Level  Level  Usually level and non \nguaranteed. For \npolicies on yearly \nbasis \u2013 age band  Age band  \nWaiting Period  \n \n Apply, but not to \naccidental injury  Can choose deferred \nperiod  90 days from inability to \nperform ADLs  \n \u2022 90 days waiting \nperiod from date of \nissue \n/reinstatement  \n\u2022 30 days survival \nperiod from \noccurrence of CI  \n \n \n Apply, but not to  \naccidental injury  \n\nHealth Insurance                                                                                                                                                  Quick comparison at a glance   \n      Managed HealthCare  Medical Expense  Disability  Income  Long Term Care  Critical Illness(CI)  Hospital Cash  \nMin /Max Age of Coverage  \n \n \n 15 days -75 years old  \n \n Must be working  \n \n Min age \u2013 determine by \ninsurer.  \nMax : 70 to 75 yrs next \nbirthday  Min age: 1  \nMax age : 55  \ncover may expire at 65 \nor whole life  \n Up to age 65 or 70 \nyears old \n \n \nTypes  \n\u2022 Staff HMOs  \n\u2022 Group HMOs  \n\u2022 Network HMOs  \n\u2022 Independent \nPractitioners \nAssociation (IPA)  \n\u2022 Mixed Model  \n\u2022 Preferred Provider organizations (PPOs)  \n\u2022 Point of Service Plans (POS)  \n \n \n \u2022 Other benefits \nunder Med \nExpense ( 8 points. \nImpt to know:  \nmajor organ \ntransplant,  \nmiscarriage \nbenefit, private \nnursing home, final expense).  \n\u2022 Diff b/w indiv and \nGroup Policy.  \n\u2022 Diff b/w compulsory & \nvoluntary plans  \n\u2022 PMBS VS TMIS  \u2022 Total disability \nbenefits. 3 Types  \n- own occupation  \n- similar occupation  \n- any occupation  \n \n\u2022 Partial disability \nbenefit or \nRehabilitation \nexpense benefit  \n\u2022 Escalation benefit  \n\u2022 WP benefit  \n\u2022 Death benefit  \u2022 Pays daily or \nmonthly.  \n \nDaily (2 methods )  \n 1. Service Based  \n 2. Disability Based     \n    (Benefit  Trigger)  \n \nMonthly  \n(most common)  \n100% - unable to  \nperform 4 out of 6 ADLs  \n \n50% - unable to \nperform 2 out of 6 \nADLs\n. \n \nAlzheimer\u2019s disease covered  \n \n\u2022 Hosp R&B  \n\u2022 Surgical procedure  \n\u2022 Financial. \nAssistance with \nadaptation  \n\u2022 Extended care \n  \n \u2022 Acceleration i.e. \nadvances sum \nassured plus \nbonuses  \n \n\u2022 Additional i.e. pays \nout dread disease \nsum assured \nwithout touching \ndeath benefit.  \n \n\u2022 Severity based CI Plan - pays out \nfrom early to \nintermediate to \nadvanced  and \nterminal.  \n \n\u2022 Multiple pay CI -  \nallows more than 1 CI claim.  \u2022 Daily benefit \nchosen at \ninception subject to \nspecified no. Of \ndays and lifetime \nlimit. \n \n\u2022 Fixed cash amount \nis not related to \nactual cost \nincurred.  \n\nHealth Insurance                                                                                                                                                  Quick comparison at a glance   \n      Managed HealthCare  Medical Expense  Disability  Income  Long Term Care  Critical Illness(CI)  Hospital Cash  \nFeatures  \n1. Standalone only  \n2. Expense participation  \n  - Deductibles  \n  - Co insurance  \n3. Can be extended to  \n   dependents.  \n \n 1. Standalone or rider  \n \n2. 2 types  -  \u201cas \ncharged\u201d benefits \nor sublimits \nimposed subject to per policy yr & per \nlifetime limits  \n3. Family coverage  \n4. Reimbursement  \n5. Expense \nparticipation ie. \nDeductible & co-\ninsurance, pro-  \nration factor.  Note \ninsurers do not \nimposed \ndeductibles on \noutpatient \ntreatments.  \n6. Benefit Limits i.e. \nLifetime, annual, \nevent  \n7. Covered charges  \n \n8."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
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created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
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War & civil \ncommotion  \n7. Flying other than a fare paying \npassenger.  1. As in MEI  \nUnderwriting  \nImportant Factors in \nUnderwriting.  \n\u2022 Medical history  \n\u2022 Current physical \ncondition  \n \n \n \n \n \n Important Factors in Underwriting:  \n Individual  \n\u2022 Medical history  \n\u2022 Current physical \ncondition  \n \n \n Important Factors in \nUnderwriting  \n\u2022 Size & stability of earning  \n\u2022 Overall financial \nsituation  \n \n \n \n \n Important Factors in Underwriting  \n\u2022 Detection of early cog impairment  \n\u2022 Morbidity risk  \n  \n \n \n \n Important Factors in Underwriting  \n\u2022 Family history  \n\u2022 Smoking habit  \n\u2022 Medical history  \n\u2022 Current physical \ncondition  \n \n \n \n  Not underwritten due \nto its small premium.  \nPre existing conditions \nare permanently excluded.  \n\nHealth Insurance                                                                                                                                                  Quick comparison at a glance   \n      Managed HealthCare  Medical Expense  Disability  Income  Long Term Care  Critical Illness(CI)  Hospital Cash  \nSources of Underwriting  \n\u2022 Individual  \n   -   Proposal form  \n \n\u2022 Group  \n- Group fact find form  \n- Individual health  \n     declaration form  \n     (for small group)  Source of Underwriting  \n\u2022 Proposal form  \n \nGroup  \n\u2022 Group fact find  \n\u2022 Below 10 \nemployees - \nIndividual \nemployee fil ls up \nhealth declaration form.  \n  Source of Underwriting  \n \n\u2022 Individual  \nProposal form  \n-  Computerised \npayslip/ letter from Company.  \n- Notice of \nAssesssement  \n- CPF Statement \n(6months)  \n- Large amt questionnaire if \nbenefit is more \nthan $60,000  \n- Medical test  \n \n\u2022 Self Employed  \nProposal form     \n - Notice of \nAssessment or audited co a/c for past 3 years.  \n -  Large amt \nquestionnaire  \n- Medical tests  \n \n  \n \n \n \n Source of Underwriting  \n\u2022 Proposal form  \n\u2022 Some may ask for \ndetailed medical \ninfo or undergo \nclinical assessment  Source of Underwriting  \n\u2022 Lower non medical limit \ncompared to \napplication for a \nlife policy  \n\u2022 Medical & family history  \n\u2022 Occupational risk  \n\nHealth Insurance                                                                                                                                                  Quick comparison at a glance   \n      Managed HealthCare  Medical Expense  Disability  Income  Long Term Care  Critical Illness(CI)  Hospital Cash  \nTermination of Cover  \n \u2022 Death of insured  \n\u2022 Life time limit \nreached  \n\u2022 Policy terminated  \n\u2022 Non- payment of \npremium  \n\u2022 Insured dies \n\u2022 End of yr expiry \nage reached  \n\u2022 Date on which \ninsured enters full -\ntime military ser \nexcept NS reservist duty.  \n\u2022 Leave employer/ \npolicyowner \n(group)  \u2022 Policy expires  \n\u2022 Non- payment of \npremium  \n\u2022 Insured dies  \n\u2022 Expiry age \nreached  \n\u2022 Unemployed for \nmore than \nspecified \ntime(except if he is \ndisabled)  \n\u2022 Resides outside Spore for an \naggregate of more \nthan 300 days \nwithin 1 policy yr.  \u2022 Policy expires  \n\u2022 Nonpayment of premium  \n\u2022 Reached max limit  \n\u2022 Insured dies  \u2022 Valid DD claim \nmade  \n\u2022 Basic plan matures \nor expires  \n\u2022 Policy lapse due to non-payment of \npremium  \n\u2022 Surrender or \nconvert to \nextended term under NFO.  \n\u2022 Insured dies  \n\u2022 Expiry age \nreached  \u2022 Per lifetime limit \nreached  \n\u2022 Basic matures  \n\u2022 Policy lapses due \nto non- payment of \npremium  \n\u2022 NFO  \n\u2022 Insured dies  \n\u2022 Expiry age reached  \nClaims  \nIn-network care, no claims \nrequired.  \n \n \n \n \nOut-of-network:  \n\u2022 Claimant\u2019s statement  \n\u2022 Original med bills  \u2022 Claim form  \n\u2022 Physician \nStatement  \n\u2022 Original med bills  \u2022 Claim form  \n\u2022 Physician Statement  \n\u2022 NRIC/BC  \n \n\u2022 Evidence of \npresent or pre-\ndisability earnings  \n\u2022 Letter from \ncompany  \n\u2022 Copies of med \ncerts &  test results  \u2022 Proof of inability to perform ADLs on \nco. furnished forms  \n\u2022 NRIC/BC  \n \n\u2022 Proof of med \nexamination  \n\u2022 Death cert  \u2022 Claimant statement  \n\u2022 Attending \nPhysician Stt \n\u2022 Original bills  \n\u2022 Proof of DD  \n\u2022 Original policy doc  \n\u2022 Written notice of claim submitted \nwithin 60 days  of \ndiagnosis.  \n\u2022 Submission of claimant\u2019s form \nwithin 15 days \nafter insurer sent \nout. \u2022 Claim form  \n\u2022 Original bills  \n\nHealth Insurance                                                                                                                                                  Quick comparison at a glance   \n      Managed HealthCare  Medical Expense  Disability  Income  Long Term Care  Critical Illness(CI)  Hospital Cash  \n\u2022 Proof of CI \nsubmitted within 60 \ndays from date of \ndiagnosis."}


created_at: 2024-03-15 18:52:31
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Legal action will be taken to protect our copyright.  \n \nAny website references are correct as of the time of publication.  \n \n \nWARNING TO ALL EXAMINATION CANDIDATES  \n \nYou WILL NOT BE ADMITTED  into the examination room (whether virtual or on -site) if you:  \n \n1. Produce unacceptable identification documents (IDs).  \n2. Your name/ID Number on the acceptable ID DOES NOT MATCH EXACTLY THE NAME (including \nHanyu Pinyin name) and ID NUMBER provided to us by either you/whoever has assisted you to register at the time of examination registration on our examination site.  \nPlease bring along the ID that you used during your examination registration for your admission. If the \nname/ID number on the ID that you bring to the examination room differs from the name/ID number \nthat you had keyed in at the point of registration, notwithstanding that it may be a valid acceptable ID that you had brought, you WILL BE TURNED AWAY from the examination room. No appeals for refund s \nor reschedule of examinations will be entertained.  You will need to re -register for the examination and \npay all fees again.  \n(If you are unsure of which ID you had used during your examination registration, you can email SCI at \ntalk2us@scidomain.org.sg  during office hours to check at least ONE WORKING DAY before the \nexamination day.)  \n3. Are late for the examination.  No reasons are entertained.  \n \nCandidates must  produce the same Registration ID  as the one that they had registered with, before they can \nbe allowed to sit for the examination:  \n \n\uf0a7 For Singapore Citizens or Singapore Permanent Residents , the acceptable IDs are valid \nNRIC/Passport/Singapore Driving License.  \n \n\uf0a7 For Foreigners , the acceptabl e IDs are valid Passport, Employment Pass, Work Permit OR S Pass*  (*S Pass \ndoes not refer to Student Pass)  \n \nFor Regulars or Full- time National Servicemen (NSFs) belonging to (Singapore Armed Forces/Singapore \nPolice Force/Singapore Civil Defence), the acce ptable IDs are valid and original SAF/SPF/SCDF Card, \nrespectively.  \n \nNote: WE DO NOT ACCEPT 11B Card for those who are NO LONGER REGULARS OR FULL- TIME NATIONAL \nSERVICEMEN (NSFs).  \n \nNo soft copies are allowed. No other forms of identification are allowed.  \nSCI does not accept police reports of lost IDs as a document for admission.  \nNo appeals for refunds or reschedule of examinations will be entertained.  You will need to re -register for \nthe examination and pay all fees again.  \n \nCandidates who arrive more than 30 minutes after  the commencement of the examination will NOT  be \nallowed to sit for the examination and will be recorded as being \u201cAbsent\u201d. If candidates are refused admission, \ntheir examination fees are non-refundable, non-deferrable, and non- transferable.   \n\n \nHEALTH INSURANCE  \n \n7th Edition, Version 1.0 \u2013  1 July 2020  \n7th Edition, Version 1.1 \u2013  25 August 2020  \n7th Edition, Version 1.2 \u2013  26 March 2021  \n7th Edition, Version 1.3 \u2013  15 February 2022  \n7th Edition, Version 1.3a \u2013  15 April 2022  \n7th Edition, Version 1.4 \u2013  1 October 2022 \n \n \n \n \n \n \n \n \n \n   \n \n  \n \n \n \n \n\u00a9 202 0 by Singapore College of Insurance Limited. All rights reserved.  \n \nAny reproduction or redistribution of this Study Text in part or in its entirety, without granted permission, other \nthan for the purpose of your examination preparation, is strictly prohibited and will be tantamount to a copyright \ninfringement. Legal action will be taken to protect our copyright. Any website references are cor rect as of the time \nof publication.  \n This Study Guide is designed as a learning programme. The SCI is not engaged in rendering legal, tax, investment or other professional advice and the reader should consult professional counsel as appropriate. We have tr ied to \nprovide you with the most accurate and useful information possible. However, the information in this publication may be affected by changes in law or industry practice, and, as a result, information contained in this publication may become outdated."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
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This material should in no way be used as an original source of authority on legal matters. \nAny names used in this Study Guide are fictitious and have no relationship to any persons living or dead.  \n \nFirst Edition published in 2001.  \nSecond Edition publishe d in 2004.  \nThird Edition published in 2007.  \nFourth Edition published in June 2010.  \nFifth Edition published in June 2013.  \nSixth Edition published in October 2016.  \n\nHealth Insurance   \n \nCopyright reserved by the Singapore College of Insurance Limited [Version  1.4] Table of Act Changes  \n \nExcept for the Notices which were extracted in full from  the MAS website, \namendments were only made to the title of the Acts in the relevant  paragraphs  of the \nstudy text.   \n \nAs the respective notices are still pending release from MAS, they will be updated \nonce MAS has published them.   \n \nVersion 1.2 : Version 1.3  \nAmended to:  \nEnlistment Act (Cap. 93)  Enlistment Act 1970  \nSections 35TA and 64(2) of the \nInsurance Act (Cap. 142)  Sections 71 and 154(4) of the \nInsurance Act 1966  \nPart IIIC of the Insurance Act (Cap. \n142) Part 3C of the Insurance Act 1966  \nTrust or Irrevocable Nomination \n(Section 49L of the Act)  Trust or Irrevocable Nomination \n(Section 132 of the Act)  \nRevocable Nomination  \n(Section 49M of the Act)  Revocable Nomination  \n(Section 133 of the Act)  \nInsurance Act (Cap. 142)  Insurance Act 1966  \nSection 25(5) of the Insurance Act \n(Cap. 142)  Section 23(5) of the Insurance Act \n1966  \nSections 35P, 35TA and 64(2) of the \nInsurance Act (Cap. 142)  Sections 67, 71 and 154(4) of the \nInsurance Act 1966  \nFinancial Advisers Act (Cap. 110)  Financial Advisers A ct 2001  \nSection 55(2) of the Insurance Act \n(Cap. 142)  Section 142(3) of the Insurance Act \n1966  \n \n \nPlease note that there are no changes in the Table of Acts in V1.4  \n\nTable of Contents  \nCopyright reserved by the Singapore College of Insurance Limited  [Version 1. 4] i \nContents  Chapter 1  Overview Of Healthcare Environment In Singapore 1 \n Chapter Outline  \n Learning Outcomes  \n1. Introduction  \n2. Singapore\u2019s Healthcare Philosophy  \n3. Healthcare 2020 Masterplan  \n4. Healthcare System In Singapore  \n   \nChapter 2  Medical Expense Insurance 11 \n  Chapter Outline  \n Learning Outcomes  \n1. Introduction  \n2. Health Insurance   \n3. Key Features Of Medical Expense Insurance  \n4. Underwriting  \n5. Healthcare Subsidy Level  \n6. Termination Of Cover  \n7. Claims  \n8. Notice No: MAS 117 -  Training and Competency \nRequirements \u2013 Health Insurance  \nAppendix 2A \u2013  Sample Medical Expense Insurance Benefit \nSchedule  \nAppendix 2B \u2013  Sample Schedule Of Surgical Benefits  \nAppendix 2C \u2013  Table Of Healthcare Subsidy Level  \nAppendix 2D \u2013  Notice No: MAS 117 -  Training and \nCompetency R equirement: Health Insurance  \n \nChapter 3  Group Medical Expense Insurance  50 \n  Chapter Outline  \n Learning Outcomes  \n1. Introduction  \n2. Group Insurance  \n3. Individual & Group Medical Expense Insurance \n4. Portable, Transferable Medical Benefits & Shield Plans \nFor Employees  \nAppendix 3A - Transferable Medical Insurance Certification  \n \nChapter 4  Disability Income Insurance 64 \n Chapter Outline  \n Learning Outcomes  \n1. Introduction  \n2. What Is Disability Income Insurance?  \n3. Disability Income Insurance & Total And Permanent \nDisability  \n4. Computation Of Disability Income Insurance Benefit  \n5. Definitions  \n6. Benefits Offered Under Disability Income Insurance \n7. Features Of A Disability Income Insurance Policy \n8. Underwriting  \n\nHealth Insurance  \nii Copyright reserved by the Singapore College of Insurance Limited  [Version 1. 4] Contents  9. Cessation Of Benefits  \n10. Exclusions  \n11. Termination Of Cover  \n12."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
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Cessation Of Benefits  \n10. Exclusions  \n11. Termination Of Cover  \n12. Group Disability Income Insurance  \n13. General Underwriting Principles For Group Disability \nIncome Insurance  \n14. Disability Income Claims  \n15. Conclusion  \nAppendix 4A - Clinical Abstract Form   \n \nChapter 5  Long- Term Care Insurance 88 \n Chapter Outline  \n Learning Outcomes  \n1. Introduction  \n2. What Is Long- Term Care (LTC) Insurance?  \n3. Benefits Offered Under LTC Insurance  \n4. Other Benefits Provided Under LTC Insurance  \n5. Maximum Benefit  \n6. Benefit Payment Term  \n7. ElderShield  \n8. CareShield Life  \n Chapter 6  Critical Illness Insurance  101 \n Chapter Outline  \n Learning Outcomes   \n1. Introduction  \n2. Critical Illness  (CI) Insurance \n3. LIA Critical Illness Framework  \n4. Benefits Offered Under Critical Illness Insurance \n5. Variation Of Illness Insurance  \n6. Underwriting  \n7. Factors To Consider In Determining Adequacy of Critical \nIllness Coverage  \n8. Exclusions  \n9. Termination Of Cover  \n10. Claims  \n11. Group Critical Illness Insurance Policy  \n Appendix 6A \u2013  Standard Definitions for Severe Stage of 37 \nCritical Illnesses: Version 2019  \nAnnex 1 -  List of changes to the standard list of 37 critical \nillness under the Critical Illness Framework 2019 \n \nChapter 7  Other Types Of Health Insurance  140 \n Chapter Outline  \n Learning Outcomes  \n1. Introduction  \n2. Hospital Cash (Income) Insurance  \n3. Medical Expense Benefits Under Travel Insurance \n4. Group Dental Care Insurance  \n\nTable of Contents  \nCopyright reserved by the Singapore College of Insurance Limited  [Version 1. 4] iii \nContents  Appendix 7A \u2013  Sample Schedule Of Allowances Under Group \nDental Insurance  \n \nChapter 8  Managed Healthcare  155 \n Chapter Outline  \n Learning Outcomes  \n1. Introduction  \n2. What Is Managed Healthcare (MHC)  \n3. How Does MHC Work?  \n4. What Are The Common Types Of MHC Plans?  \n5. Choice Of Providers Versus Cost Control  \n6. Managed Healthcare (MHC) Insurance  \n7. MHC Model In Singapore \n \nChapter 9  Part I Healthcare Financing  167 \nChapter Outline  \n Learning Outcomes   \n1. Introduction  \n2. Healthcare  Subsidies  \n3. Medi Save \n4. MediShield Life  \n5. Integrated Shield Plans (IPs)  \nAppendix 9A \u2013  Withdrawal Limits for Inpatient, Outpatient, Long -\nTerm Care and Insurance Premiums  \nAppendix 9B \u2013 MediShield Life Ben efits \nAppendix 9C \u2013 LIA Standardise Pre -Authorisation Form  \n \nChapter 9  Part II Healthcare Financing          203 \nChapter Outline  \n Learning Outcomes  \n6. ElderShield & ElderShield Supplements  \n7. CareShield Life & CareShield Life Supplements  \n8. Other Healthcare Financing Schemes Set Up By The \nSingapore Government  \n \nChapter 10  Common Policy Provisions  221 \n Chapter Outline  \n Learning Outcomes   \n1. Introduction  \n2. Sections Of A Policy Contract  \n3. Policy Schedule  \n4. Insuring Clause & Definitions  \n5. General Conditions  \n6. Benefit Provisions  \n7. Exclusions  \n8. Claim Conditions  \n9. Endorsements  \n10. Conclusion  \nAppendix 10A - Policy Schedule  \n\nHealth Insurance  \niv Copyright reserved by the Singapore College of Insurance Limited  [Version 1. 4] Contents  Chapter 11  Health Insurance Pricing  246 \n Chapter Outline  \n Learning Outcomes  \n1. Introduction  \n2. Key Factors Used In Premium Computation  \n3. Parameters For Premium Rating  \n \nChapter 12  Health Insurance Underwriting  254 \n Chapter Outline  \nLearning Outcomes  \n1. Introduction  \n2. What Is Underwriting?  \n3. Underwriting Factors That Affect The Risk  \n4. Sources Of Underwriting Information  \n5. How An Insurance Representative  Can Help In The \nUnderwriting Process  \n6. Final Underwriting Decision  \n7. Commencement Of Risk  \n8."}


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{"_node_content": "{\"id_\": \"29f0c172-eef4-464f-85fb-88ca764cb637\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"ec1f76cb-ab53-4329-8f61-4df8a58d3137\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"e670c65c139a78012b8d817dc82dbc2939a1d59792455a7f5f71a39e3f553bc2\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"192eb32b-776a-452c-af2b-1ef5e37db1c4\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"632c9817fd1e3a0cf5eb5ac1ea3ab5265f3202b4f302ccbca316a24751088838\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 213198, \"end_char_idx\": 217819, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "Sources Of Underwriting Information  \n5. How An Insurance Representative  Can Help In The \nUnderwriting Process  \n6. Final Underwriting Decision  \n7. Commencement Of Risk  \n8. Conclusion  \nAppendix 12A \u2013  Sample Supplementary Lifestyle \nQuestionnaire  \nAppendix 12B \u2013  Sample Individual Hospital & Surgical \nInsurance Proposal Form  \nAppendix 12C \u2013  Sample Group Hospital & Surgical Insurance \nProposal And Health Declaration Form  \n \nChapter 13  Notice No: MAS 120 \u2013  Disclosure And Advisory Process   280 \n  Requirements For Accident And Health Insurance Products  \n Chapter Outline  \nLearning Outcomes  \n1. Introduction  \n2. Scope Of Notice No: MAS 120  \n3. Structure Of Notice No: MAS 120  \nAppendix 1 3A \u2013 Notice No: MAS 120  \n \nChapter 14  Financial Needs Analysis  313 \n Chapter Outline  \nLearning Outcomes  \n1. Introduction  \n2. Needs Selling Versus Product Selling  \n3. What Is Fact Finding?  \n4. Identifying & Quantifying Needs  \n5. Product Recommendations  \n6. Presenting Your Recommendations  \n7. Periodic Client Review  \n Appendix 14A \u2013  Top 10 Conditions Of Hospitalisation  \n  Appendix 14B \u2013  Hospital Bill Size By Conditions/Procedures  \n \n\nTable of Contents  \nCopyright reserved by the Singapore College of Insurance Limited  [Version 1. 4] v \nContents  Chapter 15  Case Studies  337 \n Chapter Outline  \n Learning Outcomes  \n1. Introduction   \n2. Case Study 1 \u2013  Individual Health Insurance  \n3. Case Study 2 \u2013  Group Health Insurance  \nAppendices 15A & 15B \u2013 Mr Tang\u2019s Existing Health Insurance \nPolicies  \n \nTables  356 \n \nLIST OF CHANGES  \n \n \n   \n\n1. Overview of Healthcare Environment in Singapore  \nCopyright reserved by the Singapore College of Insurance Limited [Version  1.4]                        1  \n \n      CHAPTER 1  \nOVERVIEW OF HEALTHCARE ENVIRONMENT IN SINGAPORE  \n \n \n \nCHAPTER OUTLINE  \n \n1. Introduction  \n2. Singapore\u2019s Healthcare Philosophy  \n3. Healthcare 2020 Masterplan  \n4. The Healthcare System In Singapore  \n \n \nLEARNING OUTCOMES  \n \nAfter studying this chapter, you should  be able to : \n\u25aa understand  the Singapore G overnment\u2019s healthcare philosophy  \n\u25aa know the key goals of the Healthcare 2020 Masterplan  \n\u25aa understand  the difference s between  primary  healthcare  services , hospital services , \nand Intermediate and Long -Term Care  servic es \n\u25aa know the other healthcare services provided \u2013 dental, traditional chinese medicine \nand support services  \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\nHealth Insurance   \n2 Copyright reserved by the Singapore College of Insurance Limited [Version  1.4] Contents  \nCHAPTER OUTLINE  ................................ ................................ ................................ .............  1 \nLEARNING OUTCOMES  ................................ ................................ ................................ ...... 1 \n1. INTRODUCTION  ................................ ................................ ................................ .........  3 \n2. SINGAPORE\u2019S HEALTHCARE PHILOSOPHY  ................................ ............................  3 \nA. Enhancing Accessibility  ................................ ................................ ........................  3 \nB. Enhancing Quality Of Care  ................................ ................................ ...................  4 \nC. Ensuring Healthcare Remains Affordable ................................ ............................  4 \n3. HEALTHCARE 2020 MASTERPLAN  ................................ ................................ ...........  5 \nA. Better Access  ................................ ................................ ................................ .........  5 \nB. Higher Quality  ................................ ................................ ................................ ....... 5 \nC. More Affordable  ................................ ................................ ................................ .... 6 \nD. Living Well  ................................ ................................ ................................ .............  6 \n4. HEALTHCARE SYSTEM IN SINGAPORE  ................................ ................................ ... 7 \nA. Primary Healthcare Services and Facilities  ................................ ..........................  7 \nB. Hospital Services ................................ ................................ ................................ ... 8 \nC. Intermediate & Long -Term Care (ILTC) Services  ................................ .................  9 \nD. Other Healthcare Services  ................................ ................................ ..................  10"}


created_at: 2024-03-15 18:52:31
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created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
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created_at: 2024-03-15 18:52:31
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Overview of Healthcare Environment in Singapore  \nCopyright reserved by the Singapore College of Insurance Limited [Version  1.4]                        5  \nCareShield Life also receive additional participation incentives for doing \nso. \n  \n2.9 For more details of the above mentioned su pport and schemes, please refer to \nChapter 9  of this study guide . \n \n \n3. HEALTHCARE 2020 MASTERPLAN  \n \n3.1 The Ministry of Health (MOH) had put together a \u201cHealthcare 2020\u201d Masterplan \nin 2012 to improve the provision of healthcare for Singaporeans. It aims to \nshape the future of healthcare in Singapore by identifying, developing and \nexperimenting with game -chan ging systems -level concepts and innovations in \nthe key areas of health promotion, illness prevention and the delivery of care.  \n \n3.2 Its goals were to improve access, affordability and quality of healthcare services \nfor Singaporeans. Many improvements have si nce been made.  \n \nA. Better Access  \n \n3.3 MOH is expanding its services and building new facilities to make it easier for \nSingaporeans to seek healthcare. These include developing new polyclinics and \nclinics nearer our homes.  \n \nB. Higher Quality  \n \n3.4 Singapore\u2019s healthcare p rofessional workforce had expanded by 9,000 between \n2011 and 2014. It was on track to expand by another 11,000 by 2020. The \ngovernment enhanced salaries across all professions, with additional funding \nfrom government, and improved career progression to imp rove retention.  \n \n3.5 In 2015, local medical and nursing intakes were up by 29% and 17% compared \nto 2012. Other initiatives included the establishment of Singapore\u2019s third \nmedical school, the Lee Kong Chian School of Medicine and new allied health \ndegree progra mmes at the Singapore Institute of Technology from 2016.  \n \n3.6 There have been also initiatives related to better career development. For \nexample, the National Nursing Taskforce came up with recommendations to \nboost nursing profession. The role of Assistant Nurse Clinician was introduced \nand greater support was render ed to encourage doctors to undergo post -\ngraduate training in family medicine.  \n \n3.7 In terms of enhancement of recognition, there has been salary increases for \npublic healthcare and MOH funded intermediate and long -term care sector staff.  \n \n3.8 Initiatives relating to building further skills and knowledge have also been \nintroduced such as increased funding, training and a dedicated AIC Learning \nInstitute for staff working in long -term care.  \n \n \n \n\n\nHealth Insurance   \n6 Copyright reserved by the Singapore College of Insurance Limited [Version  1.4] C. More Affordable  \n \n3.9 More subsidies have been rolled out for lower to middle income patients.  \n \n3.10 Higher subsidies have been granted for long -term care services, with more \npatients able to enjoy subsidies. For subsidised specialist care in the public \nhospitals \u2014patient pays up to 40% less. For standard outpatient drugs in the \npublic hospitals and polyclinics \u2014patient pays up to 50% less.  \n \n3.11 The government has introduced universal healthcare insurance for lifelong \nprotection. MediShield Life gives better protection, for all Singaporeans, for life. \nThis is part of a more inclusive so ciety, where Singapore residents look after \none another.  \n \n3.12 Other initiatives to make healthcare costs more affordable are expanded \nMedisave use to reduce out -of-pocket payment. For example, Flexi -Medisave \naffords seniors to use additional $200/ year for out patient medical treatment. It \ngives $300/ year for outpatient scans and 19 chronic conditions (up from 10 \nconditions in 2011) are covered at $400/ year.  \n \n3.13 To help Singaporeans build up more Medisave for their healthcare needs, an \nadditional 1%  point Medisav e contribution from employers have been \nimplemented since Jan 2015. There has been Government top -ups for lower -\nincome, elderly under the GST -Voucher scheme not to mention an increase \nfrom $3,000 to $4,0001 in Medisave Grant for newborns born on or after 1 Jan \n2015.  \n \nD. Living Well  \n \n3.14 MOH has been expanding home care services and eldercare centres so that it \ncan help seniors to be cared for at home.  Nursing home care will also be \nexpanded for seniors who cannot be cared for at home.  \n \n3.15 Enhanced standards for nursing homes and guidelines for eldercare centres, \nhome care and end -of life care ensure that Singapore seniors receive better, \nmore holistic and safer care."}


created_at: 2024-03-15 18:52:31
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Overview of Healthcare Environment in Singapore  \nCopyright reserved by the Singapore College of Insurance Limited [Version  1.4]                        7  \n3.18 There is also the Foreign Domestic Worker grant of $120 for families with an \nelderly with m oderate disability, to help with the cost of employing a foreign \ndomestic worker.  \n \n3.19 Launched in 2014, the Healthy Living Master Plan promotes healthy living as \naccessible, natural, and effortless for all Singaporeans. It encourages \nSingaporeans to adopt healthy behaviours by bringing healthy living options to \nthe \"doorstep\" of every home, workplace, and school by 2020.  \n \n \n4. HEALTHCARE SYSTEM IN SINGAPORE   \n \n4.1 There are three main  types  of healthcare services  : \n(a) primary healthcare  services  and facilities  \n(b) hospital services  \n(c) Intermediate and Long Term Care (ILTC) services.   \n \nA. Primary Healthcare Services  and Facilities  \n \n4.2 Primary healthcare services are provided by professionals \u2014usually general \npractitioners \u2014 in polyclinics and private medical clinics within the community. \nThese healthcare professionals are often the first point of contact with patients.   \n \n4.3 Primary  healthc are involves the provision of basic medical treatment, \npreventive healthcare and health education. In Singapore, primary healthcare \nservices are provided by the public sector, as well as the private sector.  They \nprovide holistic and personalised care for patients of different age groups. They \ntreat acute conditions such as upper respiratory tract infections, manage \nchronic illnesses such as diabetes, and keep the population healthy through \npreventive measures such as targeted health screening. They also he lp to \ncoordinate patients' care with other providers and help patients who require \nmore specialised medical attention to navigate the healthcare system.  \n \n4.4 In the public sector, primary healthcare services are provided through a network \nof outpatient polycli nics.  \n \n4.5 Under the Community Health Assist Scheme (CHAS), eligible Singapore \nCitizens can also receive subsidised treatments at participating GPs and dental \nclinics, without the need to travel to the polyclinics.  CHAS enables all Singapore \nCitizens, includi ng and Merdeka Generation (MG) and Pioneer Generation (PG) \ncardholders, to receive subsidies for medical and/or dental care at participating \nGeneral Practitioner (GP) and dental clinics.  \n \n4.6 Besides subsidies for care at CHAS clinics, CHAS, MG and PG cardhol ders enjoy \nsubsidised referrals to public Specialist Outpatient Clinics (SOCs), as well as \nsubsidised referrals to the National Dental Centre Singapore and National \nUniversity Centre for Oral Health Singapore*, if required.  The colour of the \nCHAS card indi cates the subsidy tier that cardholders are entitled to, namely \nthe CHAS Blue, Orange or Green tier.  \n \n*Only for CHAS Blue, CHAS Orange, MG and PG cardholders"}


created_at: 2024-03-15 18:52:31
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created_at: 2024-03-15 18:52:31
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Overview of Healthcare Environment in Singapore  \nCopyright reserved by the Singapore College of Insurance Limited [Version  1.4]                        9  \ndiscipline and accountability. The public hospit als are different from the other \nprivate hospitals in that they receive an annual Government subvention or \nsubsidy for the provision of subsidised medical services to the patients. They \nare  managed like not -for-profit organisations. The public hospitals a re subject \nto broad policy guidance by the Government through MOH . \n \n4.14 The public hospitals are structured by regions split into  three clusters: National \nUniversity Health System (NUHS), National Healthcare Group (NHG) and \nSingHealth. The last reorganisation of these clusters was announced in January \n2017, with  six clusters merged into three , based on location.    \n \n4.15 For more information on the regions and the healthcare institutions under each, \nplease visit the MOH website at:  https://www.healthhub.s g/directory/hospitals  \n \nC. Intermediate & Long -Term Care  (ILTC)  Services   \n \n4.16 These continuing care facilities are for patients who no longer require the level \nof care dispensed by a hospital, but nevertheless require continued care. ILTC \ncomprise:  \n\u25aa Residential IL TC services care, for patients who stay in these facilities both \nin the day and at night.   \n\u25aa Community -based ILTC services, both centre -based and home -based, \nprovided to patients during the day.  \n \n4.17 ILTC services are typically required for persons who need further care and \ntreatment after being discharged from an acute hospital , as well as community -\ndwelling seniors who may be frail and need supervision or assistance with their \nactivities of daily living.  The types of ILTC services are : \n(a) Home -based services,  which are provided within the homes of frail and \nhome -bound elderly. The se services address the health and social needs of \nthese elderly and support families in the care of their seniors  with the aim \nto help seniors age in p eace ; \n(b) Centre -based healthcare se rvices,  which cater to elderly  who require care \nservices during the day, usually on a regular basis.  These centres are \nmostly located within the community, enabling those in need to receive \nservices in a familiar environment close to their homes, and allow  working \ncaregivers to conveniently drop off their seniors during work ; and  \n(c) Residential ILTC services , which  comprise community hospitals, chronic \nsick hospitals , nursing homes , inpatient hospices , rehabilitation homes  and \nsheltered home s for persons in mental health recovery.  \n \n  \n\n\nHealth Insurance   \n10 Copyright reserved by the Singapore College of Insurance Limited [Version  1.4] D. Other Healthcare Services  \n \n(a) Dental Services  \nPublic dental services are available through the National Dental Centre and \nin some polyclinics and hospitals. The Health Promotion Board primarily \nfocuses on preventive dentistry, targeted mainly at school pupils .  \n \n(b) Traditional Chinese Medicine  \nMOH bases its healthcare services on Western medical science. However, \nthe ethnic groups in Singapore occasionally consult traditional medicine \npractitioners for general ailments. Interest in Traditional Chinese Medicine \n(TCM) and other traditional or alternative me dical treatments is increasing \nboth here and around the world. MOH is therefore reviewing standards of \ntraining and practice of TCM in Singapore. Its aim is to ensure a higher \nquality of TCM practice, for the benefit of patients who consult TCM \npractitione rs. \n \n(c) Support Services  \nSupport services to hospitals and primary healthcare programmes include \nforensic pathology, pharmaceutical services and blood transfusion service."}


created_at: 2024-03-15 18:52:31
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{"_node_content": "{\"id_\": \"a7a2675e-5ab0-4cec-bc27-80a96302ecfa\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"a43043d1-c5d5-49ba-820f-86d586a9888e\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"fb46bb657dab60ee2116194b41111458a2788d9b06c7366c940e0f099f83ac5b\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"f021c939-01df-4c67-8c65-0ce47d8a5c8e\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"a8e23136dc814cfaca2d3fa15a808d4aa8d4d5d2e2ba595405be648c1a9897c1\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 238792, \"end_char_idx\": 243944, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "2\nOVERVIEW OF HEALTHCARE \nENVIRONMENT IN SINGAPORE\nIMPORTANT CONCEPTS DEFINITIONS/EXPLANATIONS\nSingapore Government\u2019s \nhealthcare philosophySingapore\u2019s healthcare philosophy is anchored on individual responsibility and \naffordable healthcare for all.\nThe philosophy consists of three pillars:\n1.Building up a healthy population with preventive health care and encouraging\nhealthy lifestyles.\n2.Emphasising personal responsibility towards healthy living through the \u201c3M\u201d(Medisave, Medishield and Medifund) system.\n3.\nKeeping healthcare costs down by controlling the supply of healthcare servicesand providing heavy subsidies in respect of fees charged by public healthcareinstitutions.\nThree key strategies for the Healthcare 2020 Masterplan\u2022\nEnhancing Accessibility.\n\u2022Enhancing Quality of Care.\n\u2022Ensuing Healthcare Remains Affordable.\nPrimary healthcare servicesPrimary healthcare services are provided by professionals\u2014usually general practitioners \u2014 in polyclinics and private medical clinics within the community. These healthcare professionals are often the first point of contact with patients.\nHospital services\nThere are ten public hospitals comprising eight general hospitals, a women's and \nchildren's hospital, and a psychiatry hospital. General hospitals provide \nmultidisciplinary inpatient and specialist outpatient services, and 24-hour \nemergency departments. Six national specialty centres provide cancer, cardiac, eye, \nskin, neuroscience and dental care.\nIntermediate and Long-\nTerm Care servicesThese continuing care facilities are for patients who no longer require the level of care dispensed by a hospital, but nevertheless require continued care. ILTC comprises:\u2022\nResidential ILTC services care, for patients who stay in these facilities both in theday and at night.\n\u2022\nCommunity-based ILTC services, both centre-based and home-based, providedto patients during the day.CHAPTER01\n\n\n2. Medical Expense Insurance  \nCopyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] 11  \n      CHAPTER 2  \nMEDICAL EXPENSE INSURANCE  \n \n \n \nCHAPTER OUTLINE  \n \n1. Introduction  \n2. Health Insurance   \n3. Key Features Of Medical Expense Insurance  \n4. Underwriting  \n5. Healthcare Subsidy Level  \n6. Termination Of Cover  \n7. Claims  \n8. Notice No: MAS 117 - Training and Competency Requirements \u2013 Health Insurance  \nAppendix 2A \u2013 Sample Medical Expense Insurance Benefit Schedule  \nAppendix 2B \u2013 Sample Schedule Of Surgical Benefits  \nAppendix 2C \u2013 Table Of Healthcare Subsidy Level  \nAppendix 2D  \u2013 Notice No: MAS 117 - Training and Competency Requirements \u2013 Health \nInsurance  \n \n \nLEARNING OUTCOMES  \n \nAfter studying this chapter, you should be able to:  \n\u25aa describe the three categories of Health Insurance  \n\u25aa know the types of coverage provided under a Medical Exp ense \nInsurance policy  \n\u25aa understand the various benefits offered by insurers under a Medical Expense \nInsurance policy  \n\u25aa describe the key features of Medical Expense Insurance:  \n- stand -alone or a rider  \n- choice of plans  \n- family coverage  \n- reimbursement of expenses  \n- expense participation (deductible, co -insurance and pro -ration factor)  \n- benefit limits  \n- covered charges  \n- geographical limit  \n- waiting period  \n- age limits  \n- premiums  \n- renewability  \n\u25aa know the common exclusions and limitations (co -ordination of benefits) under \nMedical Expense Insurance  \n\u25aa know the  sources of  underwriting information  for both individual and group cover s \n\nHealth Insurance   \n12 Copyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] \u25aa know the rationale for the subsidy distinction between citizens and non -citizens  \n\u25aa know when the coverage of an insured person under a Medical Expense Insurance \npolicy will terminate  \n\u25aa know the documents to be furnished in the event of a claim  \n\u25aa know the training and competency requirement s for health insurance as stated in \nNotice No.:  MAS 117  - Training and Competency Requirements  - Health Insurance.  \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n2. Medical Expense Insurance  \nCopyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] 13  \nContents  \nCHAPTER OUTLINE  ................................ ................................ ................................ ...........  11 \nLEARNING OUTCOMES  ................................ ................................ ................................ .... 11 \n1. INTRODUCTION  ................................ ................................ ................................ ....... 15 \n2. HEALTH INSURANC E................................ ................................ ...............................  15 \nA. What Is Medical Expense Insurance?  ................................ ...............................  15 \nA1. What Is Covered Under Medical Expense Insurance?  ..............................  16 \nA2. Inpatient Expenses  ................................ ................................ .....................  17 \nA3. Outpatient Expenses  ................................ ................................ ..................  20 \nA4."}


created_at: 2024-03-15 18:52:31
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Inpatient Expenses  ................................ ................................ .....................  17 \nA3. Outpatient Expenses  ................................ ................................ ..................  20 \nA4. Catastrophic Outpatient Expenses  ................................ ............................  20 \nB. Other Benefits Under Medical Expense Insurance  ................................ ..........  21 \nB1. Specific Disease Insurance  ................................ ................................ ........  21 \nB2. Miscarriage Benefit  ................................ ................................ ....................  22 \nB3. Private Nursing Home Care  ................................ ................................ ....... 22 \nB4. Daily Hospital Cash  ................................ ................................ ....................  22 \nB5. Emergency Medical Evacuation  ................................ ................................  22 \nB6. Final Expenses Benefit  ................................ ................................ ...............  22 \nC. What Are The Limits On The Covered Expenses?  ................................ ...........  23 \n3. KEY FEATURES OF MEDICAL EXPENSE INSURANCE  ................................ ..........  23 \nA. Stand -alone Or Rider  ................................ ................................ ........................  23 \nB. Choice Of Plans  ................................ ................................ ................................ . 23 \nC. Family Coverage ................................ ................................ ................................  24 \nD. Reimbursement Of Expenses  ................................ ................................ ...........  24 \nE. Expense Participation ................................ ................................ ........................  25 \nE1. Deductible  ................................ ................................ ................................ ... 25 \nE2. Co-insurance  ................................ ................................ ...............................  27 \nE3. Pro-ration Factor  ................................ ................................ .........................  27 \nF. Benefit Limits  ................................ ................................ ................................ ..... 28 \nG. Covered Charges  ................................ ................................ ...............................  29 \nH. Geographical Limit  ................................ ................................ ............................  29 \nI. Waiting Period  ................................ ................................ ................................ ... 30 \nJ. Age Limits  ................................ ................................ ................................ ..........  30 \nK. Premiums ................................ ................................ ................................ ...........  30 \nL. Renewability  ................................ ................................ ................................ ...... 31 \nM. Exclusions & Limitations  ................................ ................................ ..................  31 \nM1. Exclusions  ................................ ................................ ................................ ... 31 \nM2. Limitations (Co -ordination Of Benefits) ................................ .....................  32 \n\n\nHealth Insurance   \n14 Copyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] 4. UNDERWRITING  ................................ ................................ ................................ ...... 32 \n5. HEALTHCARE SUBSIDY LEVEL  ................................ ................................ ...............  32 \n6. TERMINATION OF COVER  ................................ ................................ .......................  33 \n7. CLAIMS  ................................ ................................ ................................ .....................  33 \n8. NOTICE No.: MAS 117 - TRAINING AND COMPETENCY REQUIREMENTS \u2013 \nHEALTH INSURANCE ................................ ................................ ...............................  34 \nAPPENDIX  2A ................................ ................................ ................................ ....................  35 \nAPPENDIX  2B ................................ ................................ ................................ ....................  36 \nAPPENDIX  2C ................................ ................................ ................................ ....................  40 \nAPPENDIX  2D ................................ ................................ ................................ ....................  41"}


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{"_node_content": "{\"id_\": \"d5042368-1504-4aba-8d81-67a6d330b105\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"21f95357-e21e-4add-a0c7-ad5e31054608\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"ff017ec5b9b67e9bc3656b4052ec54a233237bdc375e2bb540cb01fdfbe86533\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"e5c5e4fb-08bd-41cf-a783-682ff2b70a47\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"572e2c86eda5e0f06ba80270606410104fdb316b3d6c4632e1bdfb2d9f3179ed\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 251546, \"end_char_idx\": 255224, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "Health Insurance   \n16 Copyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] Shield Plans (IPs) offered by private insurers, MediShield Life S cheme and \nManaged Healthcare Schemes. Appendix 2A gives an example of the Medical \nExpense Insurance benefit schedule.  \n \nA1. What Is Covered Under  Medical Expense Insurance?  \n \n2.6 Most  of the Medical Expense Insurance plans in Singapore generally cover the \nbasic benefits as described below:  \n \n(i) Inpatient Expenses  \n\u25aa daily room and board charges;  \n\u25aa intensive care unit charges;  \n\u25aa short stay ward;  \n\u25aa hospital miscellaneous expenses;  \n\u25aa surgeon\u2019s fees;  \n\u25aa anaesthetist\u2019s fees;  \n\u25aa surgical implant and prosthesis charges;  \n\u25aa stay in community hospitals;  \n\u25aa inpatient psychiatric treatment;  \n\u25aa congenital anomalies;  \n\u25aa inpatient pregnancy complications;  \n\u25aa radiosurgery;  \n\u25aa stem cell transplant;  \n\u25aa emergency overseas inpatient treatment;  \n\u25aa accident inpatient dental treatment;  \n\u25aa major organ transplant ; \n\u25aa living donor organ transplant . \n \n(ii) Outpatient Expenses  \n\u25aa pre-hospitalisation diagnostic and laboratory tests charges;  \n\u25aa pre-hospitalisation specialist consultation charges;  \n\u25aa post-hospitalisation special ist consultation charges;  \n\u25aa accident and emergency (A&E) treatment;  \n\u25aa emergency accidental treatment charges.  \n \n(iii) Catastrophic Outpatient Expenses  \n\u25aa outpatient kidney treatment charges;  \n\u25aa outpatient cancer treatment charges;  \n\u25aa major organ transplant approved immunosuppressant  drugs . \n \n \n \n \n\n2. Medical Expense Insurance  \nCopyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] 17  \n2.7 Some  policies also extend cover to include:  \n\u25aa emergency medical evacuation; and  \n\u25aa private nursing home care.  \n \n2.8 Let us now look at each of the covered expenses in turn.  \n \nA2. Inpatient Expenses    \n \n2.9 If inpatient treatment is received in a luxury or deluxe suite or any other special \nroom of a hospital, the inpatient bill will be pro -rated based on the actual \ncharges that the insured person would have paid under his plan type. The lower \nof either the reasonable expenses or the pro -rated amount of the total bill, will \nbe paid.  \n \n(a) Daily Room & Board Charges  \nThis refers to the charges for  a standard room  accommodation, meals and \ngeneral nursing services incurred by the insured person , while he is \nhospitalised. The reimbursement is on a per day basis up to a specified \nmaximum number of days per hospitalisation. This also includes charges \nfor a high depende ncy ward accommodation.  \n \n(b) Intensive Care Unit (ICU) Charges  \nThis refers to charges incurred during confinement in the ICU of the \nhospital.  \nLike Daily Room & Board, the reimbursement for ICU charges is also on a \nper day basis up to a specified maximum number of days per \nhospitalisation.  \n \n(c) Short -stay Ward  \nThis refers to charges incurred during confinement in the short -stay ward \nin an accident and emergency department of a hospital, where the patient \nneeds a short period of inpatient observation, monitori ng and treatment, \nusually up to 24 hours. This will allow the attending doctor to decide \nwhether the patient is fit for discharge, or he should be further admitted \nas an inpatient.  \n \n(d) Hospital Miscellaneous Expenses   \nThis refers to the services and supplies  (other than room and board and \ngeneral nursing care) furnished during a hospital stay , and will usually \ninclude the following:  \n\u25aa laboratory services;  \n\u25aa X-ray examinations;  \n\u25aa medicines and drugs;  \n\u25aa surgical dressings;  \n\u25aa operating room expenses;  \n\u25aa oxygen and its administration; and  \n\u25aa ambulance service s."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
id: e5c5e4fb-08bd-41cf-a783-682ff2b70a47
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{"_node_content": "{\"id_\": \"e5c5e4fb-08bd-41cf-a783-682ff2b70a47\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"d5042368-1504-4aba-8d81-67a6d330b105\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"1e3d010d7c5004a6234f6e25a3d925d4c3ec4605c444017c29ef2251c257fc79\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"5a57af5f-e604-4628-9779-7cc6e7b1e6dd\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"3ddcd85127aa46078811e0dfa9898c2d6bc7c87dd1c98bfed2f4e2dcfe754e85\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 255232, \"end_char_idx\": 259664, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "Health Insurance   \n18 Copyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] (e) Surgeon\u2019s Fees  \nThis refers to the surgeon\u2019s fees for surgery. Charges for day surgery and \ngamma knife are also payable. The level of reimbursement in the surgical \nschedule varies , or depends on the type and complexity of the specific \nsurgery. To find out how much MediShi eld Life reimburses this benefit, \njust refer to the website of the Ministry of Health (MOH) at \nwww.moh.gov.sg , to view a full list of the types of Surgical Operations \nand the Medisave withdrawal limits for each category. In some insurance \npolicies, there is also a limit on the maximum number of days from the \ndate of surgery that the insurer will pay for the surgeon\u2019s visits and post -\noperative care. For Group Hospital and Surgical (H&S) Insurance, \nreimbursement fo r surgical fees is usually set out in a Schedule  of Surgical \nBenefits attached to such a Group H&S Insurance policy. A sample in \nAppendix 2B  shows a Schedule of Surgical Benefits with limits.  \n \nWhile there are Medical Expense Insurance policies in the marke t that still \nimpose sub -limits on different surgical procedures, the majority of \ninsurers have started to offer plans with \u201cas charged\u201d benefits.  \n \n(f) Anaesthetist\u2019s Fees  \nThis refers to the fees for the supply and administration of anaesthesia by \nan anaesthet ist for a surgery.  \n \n(g) Surgical Implant & Prosthesis Charges  \nThis refers to the actual costs of surgical implant or prosthesis1. \n \n(h) Stay In Community Hospital  \nThis refers to charges incurred in a community hospital for \naccommodation, meals and general nursing services. A referral from the \nattending physician from the hospital, where the insured person has \nreceived inpatient treatment is usually required, and admission to the \ncommunity hospital must be within a time frame following his discharge \nfrom the hospita l. \n \n(i) In-hospital Psychiatric Treatment  \nThis refers to charges for psychiatric treatment received as an inpatient of \nthe hospital. All treatment s must be administered under the direct control \nof a registered psychiatrist. A waiting period may apply before this benefit \nis payable. Treatment for self -inflicted injury, suicide, drug addiction, or \nabuse of drug or alcohol is excluded.  \n \n(j) Congenital Anoma lies \nThis refers to charges for inpatient treatment of any congenital anomalies, \nincluding hereditary conditions. A waiting period may apply before this \nbenefit is payable.  \n \n(k) Inpatient Pregnancy Complications  \nThis refers to charges for inpatient treatment for pregnancy \ncomplications. A waiting period may apply before this benefit is payable. \n \n1  Prosthesis is an artificial device used to replace a missing part of the body.  \n\n\n2. Medical Expense Insurance  \nCopyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] 19  \nNote that not every pregnancy complication is covered. This benefit may \nbe restricted to a pre -defined list of pregnancy complications, including \nbut not limited to:  \n\u25aa ectopic pregnancy;  \n\u25aa pre-eclampsia or eclampsia;  \n\u25aa disseminated intravascular coagulation;  \n\u25aa miscarriage after 13 weeks of pregnancy (not resulting from voluntary \nor malicious act);  \n\u25aa antepartum haemorrhage;  \n\u25aa intrauterine death;  \n\u25aa choriocarcinoma and hydatidiform mol e, which is the occurrence of a \nhistologically confirmed choriocarcinoma and/or molar pregnancy;  \n\u25aa acute fatty liver pregnancy;  \n\u25aa breech delivery;  \n\u25aa placenta previa; and  \n\u25aa postpartum haemorrhage.  \n \n(l) Radiosurgery  \nThis refers to charges for Gamma Knife and Novalis radiosurgery \n(including day surgery) by a surgeon in a hospital.  \n \n(m) Stem Cell Transplant  \nThis refers to charges for stem cell transplant surgery. All other costs \nincidental to the stem cell transplant , such as costs of harvesting, \nlaboratory tests, i nvestigations, storage, transport and cell culture , as well \nas outpatient therapies , where there is no surgery or admission , are not \ncovered.  \n \n(n) Emergency Overseas Inpatient Treatment  \nThis refers to charges for inpatient treatment resulting from an emergency  \nwhile overseas. It pays the lower of either the actual charges or reasonable \nexpenses for equivalent medical treatment in Singapore. Pre - and post -\nhospital treatments which are given before and after emergency overseas \ntreatment are not covered."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
id: 5a57af5f-e604-4628-9779-7cc6e7b1e6dd
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metadata:
{"_node_content": "{\"id_\": \"5a57af5f-e604-4628-9779-7cc6e7b1e6dd\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"e5c5e4fb-08bd-41cf-a783-682ff2b70a47\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"572e2c86eda5e0f06ba80270606410104fdb316b3d6c4632e1bdfb2d9f3179ed\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"a88603f0-d24f-4ec6-a604-273bf207648b\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"571b02ba2605f3cefea4fca1c89eddfe21f64db0ed1708f169cda89a808bd5a6\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 259430, \"end_char_idx\": 264148, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "It pays the lower of either the actual charges or reasonable \nexpenses for equivalent medical treatment in Singapore. Pre - and post -\nhospital treatments which are given before and after emergency overseas \ntreatment are not covered.  \n(o) Accident Inpatient Dental Treatment  \nThis refers to charges to remove, restore or replace sound natural teeth \nwhich have been lost or damaged in an accident. Treatment must be \nreceived within 14 days following the accident.  \n \n(p) Major organ transplant  \nThis refers to the costs of surgeries for the transplantation of kidneys, \nlungs, heart, liver or cornea, where the insured person is the recipient of \nany of the organs.  \n \n \n \n \n\nHealth Insurance   \n20 Copyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] (q) Living donor organ transplant  \nThis refers t o charges for major organ transplants of the kidney or liver , \nwhere the life insured is a living donor , provided that:  \n(i) the transplantation is carried out at a hospital in Singapore;  \n(ii) the recipient of the kidney or liver must be the insured person\u2019s \nfamily member (i.e. parent, sibling, spouse or child); and  \n(iii) the recipient\u2019s kidney or liver failure is first diagnosed by the \nattending physician, or the symptoms of which first appeared, after \na waiting period of 24 months as specified in the policy.  \n \nThis benefit is not payable if the transplantation is illegal or arises from \nany illegal transaction or practice involved.  \n \nA3. Outpatient Expenses  \n \n2.10 (a) Pre-hospitalisation Diagnostic & Laboratory Test Charges  \nThis refers to the charges incurred by the insured person for diagnostic \nand laboratory tests as prescribed by the attending physician or specialist. \nThis benefit is payable if incurred within a specified number of days before \nthe date of hospitalisation.  \n \n(b) Pre-hospitalisation Specialist Consultati on Charges  \nThis refers to the charges incurred by the insured person for consultation \nof a specialist as recommended by the attending physician. This benefit is \npayable only if the insured person is hospitalised , or undergoes day \nsurgery within a specified  number of days from the date of consultation \nof the specialist.  \n \n(c) Post -hospitalisation Specialist Consultation Charges  \nThis refers to the expenses incurred by the insured person for follow -up \ntreatment s after hospitalisation, e.g. physiotherapy after an a rthroscopy \nsurgery. This benefit is payable for up to a specified number of days after \nhis discharge from the hospital.  \n \n(d) Accident & Emergency (A&E) Treatment  \nThis refers to treatment in the accident & emergency department of a \nhospital up to 24 hours , before an inpatient treatment for the same injury \nor illness.  \n \n(e) Emergency Accidental Treatment Charges  \nThis refers to the charges incurred for emergency outpatient treatment of \naccidental  bodily injuries of the insured person, within 24 hours of the \naccident.  \n \nA4. Catastrophic Outpatient Expenses  \n \n2.11 (a) Outpatient Kidney Treatment Charges  \nThis refers to the charges incurred for kidney dialysis at a legally \nregistered dialysis centre. Cover may also include examination and tests \nordered by the attending physician for the course of treatment, as well as \n \n\n\n2. Medical Expense Insurance  \nCopyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] 21  \nerythropoietin , as part of the treatmen t for chronic renal failure and \nambulatory peritoneal dialysis ordered by the attending physician.  \n \nAny additional formulated solution not prescribed by the attending \nphysician or other prescribed medications (apart from erythropoietin) will \nnot be covered . In addition, the cost of purchase or rental of the dialysis \nmachine will not be covered.  \n \n(b) Outpatient Cancer Treatment Charges  \nThis refers to the charges incurred for chemotherapy, radiotherapy, \nimmunotherapy and/or stereotactic radiotherapy treatment (or any other \ncancer treatment approved by the insurer) provided by the hospital or at \na legally registered cancer treatment centre, including examinations and \ntests ordered by the attending physician for the course of treatment.  \n \n(c) Major Organ Tra nsplant Approved Immunosuppressant Drugs  \nThis refers to costs of immunosuppressant drugs approved by the Health \nScience Authority as part of necessary medical treatment , as an outpatient \nafter a major organ transplant to reduce the rate of rejection episod es.  \n \nThe list of covered drugs includes, but is not limited to:  \n(i) Cyclosporin;  \n(ii) Tacrolimus;  \n(iii) Azathioprine;  \n(iv) Prednisolone; and/or  \n(v) other approved immunosuppressant drugs for Major Organ \nTransplant."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
id: a88603f0-d24f-4ec6-a604-273bf207648b
encoding: FLOAT32
metadata:
{"_node_content": "{\"id_\": \"a88603f0-d24f-4ec6-a604-273bf207648b\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"5a57af5f-e604-4628-9779-7cc6e7b1e6dd\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"3ddcd85127aa46078811e0dfa9898c2d6bc7c87dd1c98bfed2f4e2dcfe754e85\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"87e1cc70-6858-4620-ba09-e3cf5a830f6a\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"ff5e3dcb9aa2c02f5dac33b2991381b9dcbda95a6298e6fb30d2cceff5f0b40e\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 264153, \"end_char_idx\": 268745, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "The major organ transplant must first be approved under the policy.  \n \nB. Other Benefits Under Medical Expense Insurance  \n \n2.12 Insurers  may also provide additional benefits, such as the following:  \n\u25aa specific disease insurance;  \n\u25aa miscarriage benefit;  \n\u25aa private nursing home care;  \n\u25aa daily hospital cash;  \n\u25aa emergency medical evacuation benefit; and  \n\u25aa final expenses benefit.  \n \n2.13 Let us look at the benefits provided by the above additional covers in detail.  \n \nB1. Specific Disease Insurance  \n \n2.14 Specific  Disease Insurance provides for a lump sum payment (e.g. S$50,000) in \nthe event that the insured person is diagnosed to be suffering from the specific \ndisease (e.g. cancer) covered by the policy.  \n \n\nHealth Insurance   \n22 Copyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] B2. Miscarriage Benefit  \n \n2.15 This refers to the costs incurred in a miscarriage or ectopic pregnancy. \nHowever, the coverage is not applicable to wilful termination of a pregnancy \nrequested by the insured person that is not medically necessary.  \n \nB3. Private Nursing Home Care  \n \n2.16 This ref ers to the costs incurred in hiring the services of a full -time or part -time \nregistered and qualified nurse in the insured person\u2019s home. It is for the \ncontinuing treatment of a medical condition that is covered under the policy for \nwhich the insured perso n has been hospitalised.  \n \nB4. Daily Hospital Cash   \n \n2.17 This refers to a daily cash benefit payable directly to the insured person if he is \nhospitalised as a result of an injury or illness.  \n \n2.18 In Singapore , in order for  insurers to keep medical claims costs low, especially \nin private hospitals, daily hospital cash is often packaged in Medical Expense \nInsurance and payable only upon hospital or ward downgrade. This is to \nencourage the insured person to stay in a public ho spital, or a ward that is lower \nthan his covered plan.  \n \nB5. Emergency Medical Evacuation  \n \n2.19 Normally  provided for in global medical plans, this refers to the costs of getting \nthe insured person to a place for accessibility to medical treatment because of \na serious injury or serious sickness whil e overseas. It must be medically \nappropriate and safe to move him to another location or to return him to \nSingapore for treatment. The evacuation method may include air ambulance, \nsurface ambulance, regul ar air transportation, railroad or any other appropriate \nmeans . The final destination will be made by the treating doctor and the \nemergency medical assistance company , and this will be based solely on \nmedical necessity.  \n \nB6. Final Expenses Benefit  \n \n2.20 In the event of death occurring during hospitalisation or within a specified \nnumber of days after hospital discharge, and provided that death is a result of \nthe cause of the hospitalisation, a final expenses benefit is payable. In the case \nof an Integrated Shield  Plan (IP), the final expenses benefit is usually a waiver \nof deductible and co -insurance components up to the stated amount in the \npolicy schedule.  \n \n2.21 Note: Different insurers may have varying definitions of each of the above \ndescribed benefits. Hence, ins urance representatives should check their own \ninsurers\u2019 definitions.  \n \n \n\n\n2. Medical Expense Insurance  \nCopyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] 23  \nC. What Are The Limits On The Covered Expenses?  \n \n2.22 Medical Expense  Insurance policies provide separate benefits for the different \nexpenses covered. While most insurers now offer plans that have \u201cas charged\u201d \nbenefits, there are still many plans that impose sub -limits, e.g. based on a table \nof surgical operations and a max imum limit on Room & Board benefit, etc. \nMediShield Life is just one of the Medical Expense Insurance schemes with \nlimits imposed. Besides the limits, deductibles and co -insurance are also \ncommon features of these policies. Also, all policies are subject t o per policy \nyear/period and lifetime claimable limits.  \n \n2.23 Note that the payment of this Medical Expense Insurance policy is on a  \nreimbursement basis. Hence, the insurer will reimburse the actual amount \nincurred (for \u201cas charged\u201d plans) or the maximum limit as stated in the \nSchedule of Benefits, whichever is lower. The policy owner may not get a full \nreimbursement for the medical ex penses incurred by the insured person in \nsome cases . It is important to highlight this clearly to the prospective client and \nexplain what is precisely covered in the Schedule of Benefits."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
id: 87e1cc70-6858-4620-ba09-e3cf5a830f6a
encoding: FLOAT32
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{"_node_content": "{\"id_\": \"87e1cc70-6858-4620-ba09-e3cf5a830f6a\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"a88603f0-d24f-4ec6-a604-273bf207648b\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"571b02ba2605f3cefea4fca1c89eddfe21f64db0ed1708f169cda89a808bd5a6\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"f685329c-3efc-4e09-9510-6beb57c42bdc\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"e4790380ea549a227271933654b498954b870157701f5738b77435c83883a224\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 268610, \"end_char_idx\": 272830, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "It is important to highlight this clearly to the prospective client and \nexplain what is precisely covered in the Schedule of Benefits.  \n \n \n3. KEY FEATURES OF MEDICAL EXPENSE INSURANCE  \n \n3.1 Although the Medical Expense Insurance policies offered in the market vary in \ncoverage and limits, they generally share the common features  as described \nbelow : \nA. Stand -alone Or Rider  \n \n3.2 Medical Expense Insurance can be offered as a rider or a stand -alone  policy . If \nissued as a rider, it is often attached to a permanent Life Insurance policy . Note \nthat it is not common in Singapore for Medical Expense Insurance to be offered \nas a rider.  \nB. Choice Of Plans  \n \n3.3 Insurers normally offer Medical Expense Insurance with a var iety of plans , \ngiving the policy owner  the option to choose a plan that best meets his needs \nand budget in terms of the  following : \n\u25aa amount of general medical  expenses provided by the policy, such as hospital \ntype and/or room and board charges;  \n\u25aa per policy year, per disability and per lifetime limits; and/or  \n\u25aa amount of deductible and/or co -insurance which he needs to bear.  \n \n3.4 These plans are designed to cover the different amounts that the hospital \ncharges for its various wards. Plans with higher benefit s will cost more \npremiums.  Lower plans are meant for people who prefer to stay in the four to \nsix bedded wards  in a public hospital , while the higher plans are for those who \nwish to stay in double or single -bedded wards. Usually , the insured person is \nfree to choose the hospital or ward type when he is hospitalised.  \n \nMedical \nExpense \nInsurance \nRiders  \n \nBasic  \nLife Policy  \n\nHealth Insurance   \n24 Copyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] 3.5 However, the insurer will reimburse the policy owner based only on the plan \nunder which the insured  person is insured . Should the insured person wish to \nstay in a higher ward (i.e. from Ward B to Ward A), the insurer will apply the  \npro-ration factor  accord ingly.  \n \nC. Family Coverage  \n \n3.6 Unlike other types of Health Insurance, most Medical Expense Insurance \npolicies allow the policy owner  to include immediate family members (i.e.  \nspouse and children) in the policy. Most insurers also give the policy owner  the \nflexibility of selecting different plans for his family members. In addition, some \ninsurers give a family discount (e.g. 5%) if the application is submitted at the \nsame time.  \n \n3.7 Example 2.1  illustrates how the premium for a family coverage plan is arrived \nat. \n \nExample 2.1: Illustration Of The Calculation Of The Premium For A Family \nCoverage Plan \n \nAssuming Mr Andy Ang is buying a policy for himself and his wife and two \nchildren. The premium is calculated as follows:  \n \nMr Ang  S$800.00  \nMrs Ang  S$800.00  \nTwo Children  S$620.00  \nTotal Gross Premium  S$2220.00  \nLess: 5% Family Discount  (S$111.00 ) \nPremium Payable  S$2,109.00  \n \n \nD. Reimbursement Of Expenses  \n \n3.8 Expenses eligible for reimbursement under the Medical Expense Insurance are \nthose incurred during the period of insurance for medically  and reasonably \nnecessary  treatments resulting from  accident, illness or disease.   \n \n3.9 Benefits under the Medical Expense Insurance are provided on a \nreimbursement basis, i.e. the insurer will reimburse the policy owner  up to a \nmaximum dollar amount , or limit for each medical expense item covered under \nthe policy which the  insured person incurs.  \n \n3.10 For plans which do not specify the limits for each treatment, the insurer will \nreimburse the actual amount of covered medical expenses incurred by the \ninsured  person .  \n \n3.11 In other words, the policy owner  is not allowed to claim more than  the actual \nmedical treat ment expenses incurred , nor can he claim more than the limits as \nstated in his policy.  \n \n \n \n \n\n2. Medical Expense Insurance  \nCopyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] 25  \n3.12 When the insured  person receives medical treatment, he normally has to pay \nthe charges first , and thereafter seek  reimbursement from the insurer for the \nexpenses covered under the plan by filing a claim."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
id: f685329c-3efc-4e09-9510-6beb57c42bdc
encoding: FLOAT32
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{"_node_content": "{\"id_\": \"f685329c-3efc-4e09-9510-6beb57c42bdc\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"87e1cc70-6858-4620-ba09-e3cf5a830f6a\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"ff5e3dcb9aa2c02f5dac33b2991381b9dcbda95a6298e6fb30d2cceff5f0b40e\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"e4548c23-e9fc-4956-89bc-9e45991d5b69\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"944fb3b9c6aa70deb9e5806e1567e02bc96cdd10f5cb7b747cd6f01fa1edfe03\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 272609, \"end_char_idx\": 276887, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "4] 25  \n3.12 When the insured  person receives medical treatment, he normally has to pay \nthe charges first , and thereafter seek  reimbursement from the insurer for the \nexpenses covered under the plan by filing a claim. For any patient claiming \nunder an Integrated Shield Plan  approved under Medisave, all he need s to do \nis to inform the hospital of the name of his insurer , fill in a s tandard claim form , \nand the hospital will file the claim on his behalf for inpatient expenses  through \nan online  network called MediC laim System . This applies to public hospitals \nand major private hospitals . \n   \nE. Expense Participation  \n \n3.13 Some  Medical Expense Insurance policies require the policy owner  to share in \nthe payment of the medical expenses incurred. This requirement encourages \nthe insured  person to keep medical expenses to a minimum, as well as helps to \nsieve out small claims. In turn , this helps to reduce the premiums  payable . \n  \n3.14 The three  expense participation methods used by insurers are deductibles , co-\ninsurance and pro -ration factor , and all Integrated Shield Plans , includ ing \nMediShield Life Scheme, come with  these  features. Some  insurers offer plans \nwith no expense participation , and these plans are  payable by cash (i.e. not \nMedisave approved) . Obviously, these types of plans will cost a lot more. They \nare more suitable for self -employed people who most likely will not have any \nform of Medical Expense Insurance , except maybe for their MediShield Life \nScheme and Medisave savings . Such plans will enable them to enjoy maximum \nreimbursement of their hospitalisation expenses from the first dollar onwards.   \n \n3.15 Although the Integrated Shield Plans offered in Singapore come with \ndeductible , co-insurance and pro -ration factor , there are some  insurers  that will \noffer a rider  (at an extra  premium ) to cover the deductible and co -insurance \ncomponents.  \n \nE1. Deductible  \n \nClaim from Insurer S$3,500  \n \n \nPolicy owner pays \nDeductible S$1,500  \n \n \n3.16 A deductible is a flat dollar amount of medical expenses that the policy owner \nmust pay out of his own pocket, before the insurer will begin making any benefit \npayment under the policy. It is usually on a per year basis, i.e. it is applicable \nagain on the yearly renewal of the policy.  \n \n3.17 As mentioned, d eductibles are found  in all  Integrated Shield Plans . It is common \nto find that the deductible  is tiered to the Class of Ward that the patient stays in. \nThe higher the Class of Ward, the higher the deductible  (e.g. Class C - S$1,500 , \nClass B2 /B2+ - S$2,000 , Class B1 - S$2,500 , and Class A and private hospital - \nS$3,500 ). The higher deductibles for hi gher Ward Classes are to ensure that \npremiums remain affordable and that such insurance focuses on larger bills.  \n\nHealth Insurance   \n26 Copyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] 3.18 There are basically three types of deductibles as follows:  \n\u25aa per annum deductible;  \n\u25aa per disability/per year deductible;  and \n\u25aa per disability (or per claim) deductible.  \n \n3.19 Under a per annum deductible, all the e ligible expenses incurred by the insured  \nperson for a variety of covered illnesses or injuries within a policy year will be \nused to satisfy the deductible amount. This type of de ductible is the most \ncommon one used by insurers  in Singapore.  \n \n3.20 As for the per disability/per year deductible, the deductible amount must be \nsatisfied by eligible medical expenses that are attributable to the same illness \nor injury within the same policy y ear.  \n \n3.21 The per disability deductible is the most restrictive , as the policy owner  has to \nbear the deductible each time that he makes a claim , regardless of whether the \nclaim is made within the same policy year.  \n \n3.22 Example 2.2 illustrates  how the three types of deductibles work . \n \nExample 2.2: Illustration Of The Working Of Per Annum Deductible, Per \nDisability/Per Year Deductible & Per Claim Deductible  \n \nBilly had a Medical Expense Insurance policy with a S$2,000  deductible for the \nperiod 1 January 2019  to 31 December  2019 . He suffered a high fever on 1  \nJune 2019 and was admitted to  the hospital for two days."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
id: e4548c23-e9fc-4956-89bc-9e45991d5b69
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{"_node_content": "{\"id_\": \"e4548c23-e9fc-4956-89bc-9e45991d5b69\", \"embedding\": null, \"metadata\": {}, \"excluded_embed_metadata_keys\": [], \"excluded_llm_metadata_keys\": [], \"relationships\": {\"1\": {\"node_id\": \"fa2d9045-7b86-42b8-be24-f1750f5bd4a1\", \"node_type\": \"4\", \"metadata\": {}, \"hash\": \"59c4fda642f7a90fe0cffa1f7ef298e0f041e802b8044620af0ef6b6309b0c9d\", \"class_name\": \"RelatedNodeInfo\"}, \"2\": {\"node_id\": \"f685329c-3efc-4e09-9510-6beb57c42bdc\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"e4790380ea549a227271933654b498954b870157701f5738b77435c83883a224\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"91b7da61-f4d6-4617-8aa8-f4060c63f8e6\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"2b80fd84685b22a52017934b4f4d5889c602085f530964f6d08599be004666e6\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 276798, \"end_char_idx\": 280922, \"text_template\": \"{metadata_str}\\n\\n{content}\", \"metadata_template\": \"{key}: {value}\", \"metadata_seperator\": \"\\n\", \"class_name\": \"TextNode\"}", "_node_type": "TextNode", "document_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "ref_doc_id": "fa2d9045-7b86-42b8-be24-f1750f5bd4a1", "chroma:document": "He suffered a high fever on 1  \nJune 2019 and was admitted to  the hospital for two days. The hospital bill was \nS$800 which was within the deductible amount. On 16 July 2019 , he \ndeveloped some skin problems and was hospitalised for observation and \ntreatment. The hospital bill was S$1,800 .  \n \nFor per annum deductible, Billy would  have met the deductible  on the second \nhospitalisation and able to claim some expenses , as the total  eligible \nexpense s from the two causes exceeded the required S$2,000  within the \npolicy year.  \n \nFor per disability/per year deductible , no amount w ould be paid from the \ninsurance because for each disability, the bill would be within the S$2,000 \ndeductible .  \n \nSimilarly, for per disability deductible , Billy would  not be able to claim from \nthe insurance.   \n \n3.23 The higher the deductible, the cheaper will be the premium. Most insurers do \nnot impose deductibles on outpatient treatments.  \n \n3.24 Deductible is applicable separately on each of the family members insured \nunder the policy. For example, a husband cannot combine his medical expenses \nwith his wife\u2019s medical expenses , to satisfy the deductible under the policy for \nthe same policy year.  \n\n2. Medical Expense Insurance  \nCopyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] 27  \nE2. Co-insurance  \n \n3.25 Once the policy owner has satisfied the deductible, he is then eligible for \nreimbursement under the policy. However, if there is co-insurance, he is \nrequired to pay a specified percentage (e.g. 1 0%) of the total covered medical \nexpenses wh ich are in excess of the deductible.  This helps to  reduce over -\nconsumption . \n \n3.26 Example 2 .3 illustrates  how the deductible and co -insurance principles are \napplied to a Medical Expense Insurance policy.  \n \nExample 2.3: Illustration Of The Application Of Deductible & Co-insurance \nUnder A Medical Expense Insurance Policy  \n \nCharlie  held a Medical Expense Insurance policy with a per annum deductible \nof S$2,000 and a 20% co -insurance. He met with a car accident in June 2019 \nand was admitted to the hospital for one day  of observation. The hospital \ncharges were  S$1,000 . As this amount was below the deductible, he had to \npay the full cost of S$1,000  from his own pocket.  Even though this amount \nwas not claimable, he was advised to file the claim for the insurer , to consider \nit as fulfilling par t of the deductible amount for that policy year.  \n \nIn August 2019 , Charlie was admitted to the hospital for remov al of a kidney \nstone. The total hospital bill was S$5,000 . Assuming that the entire S$ 5,000  \nfell within the limit allowed under his policy, the amount payable to him by \nthe insurer would be S$3,200, calculated as follows:  \n \n \nHospital charges     S$5,000  \nLess: Deductible *   (S$1,000 ) \nClaimable Amount     S$4,000  \nLess: Co -insurance  (20%)   (S$  800)  \nBenefits Paid by Insurer    S$3,200  \n                                                    \nIn the 2nd hospitalisation , Charlie would need only to pay S$1,800 out of the \nS$5,000  that he ha d incurred , and this could be settled using Medisave and/or \ncash.  \n \n* Having  fulfilled a S$ 1000 deductible during the June 2019 hospital stay , the \ndeductible that Charlie must pay is the difference.  (i.e. S$2,000 - $1000)  \n \nE3. Pro-ration Factor  \n \n3.27 When the insured person is admitted to a hospital better than and/or ward \nhigher than what he is entitled to under his existing insured plan, a percentage \n(expressed as pro-ration factor in the benefit schedule) is applied on the actual \ncharges incurred and covered under the policy. Therefore, t he benefit payable \nis reduced , to take into account the differences in the G overnment subsidi es \napplicable to the ward type of the insured plan . \n \n\nHealth Insurance   \n28 Copyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] 3.28 This ensures fairness within the portfolio , such that those  who pay  lower \npremium s for lower plan s should be encouraged to use the services available \nonly on the selected plan s."}


