# embeddings_queue

created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
id: 8f83d0ef-a731-49e7-9ed9-fe35cf61a96b
encoding: FLOAT32
metadata:
{"_node_content": "{\"id_\": \"8f83d0ef-a731-49e7-9ed9-fe35cf61a96b\", \"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\": \"16b82b23-6c8e-4c69-b7c5-e63865437c96\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"c0cd089a530484dbf1c94bdcdcad01be6edaf1af3be6667ac07c301e0e445cda\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"1f081176-ee5c-4267-a187-891313340c0f\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"bbc453c4d26d2d1ca498d508e6303aba7ffc6e1932d319e9875a47646f43e099\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 1398112, \"end_char_idx\": 1402829, \"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": "Question: Which of these offences under MAS Notice 120 is not considered a criminal offence and does not attract any penalties?\nAnswer: The answer is \"Documents given to the insured are kept up to date\".\n\nQuestion: For policies sold through direct marketing and telemarketing, insurer must ensure: \nAnswer: The answer is \"A follow up letter to advise clients to read the Guide to Health Insurance and product summary which is enclosed\".\n\nQuestion: Under LIA Guidelines which documents, should insurer under Corporate Business make available to insured members\u2019 of a voluntary plans?\nAnswer: The answer is \"Your Guide to Health Insurance\".\n\nQuestion: When recommending a Group A&H Policy, what must be given to the client before the client applies for the product?\nAnswer: The answer is \"Group Insurance Fact Find Form\".\n\nQuestion: Most group insurance is issued without medical examination as the risk for the insurer diminishes as the size of the group increases. This is known as _________________.\nAnswer: The answer is \"The law of large numbers\".\n\nQuestion: Mr Tan has a monthly income and expenditure of $7,000 and $5,000 respectively. His son is currently 2 years old and he would like to provide for his son till age 25. Assuming that the interest rate is 5% and inflation is 2%, please calculate his maintenance cost.\nAnswer: The answer is \"$1,016,214\".\nRationale is that,\n$5000 x 12 = $60,000 x 16.9369 (table A2 \u2013 3%\u2019 23 yrs) = $1,016,214\n\nQuestion: Mr. Lim the prospective client does not have an emergency fund, you should:\nAnswer: The answer is \"not recommend any policies as it may affect his ability to service the policies\".\n\nQuestion: Which of the following policy is MOST suitable for meeting the maintenance costs of a client?\nAnswer: The answer is \"Disability Income Insurance\".\n\nQuestion: Primary Care Partnership Scheme does not cover treatment for:\nAnswer: The answer is \"Cancer Treatment\".\n\nQuestion: Which of the following is a Costing Mechanism to determine amount of subsidies to be given?\nAnswer: The answer is \"Casemix\".\n\nQuestion: Which of the following regarding Medical Expense Insurance is true?\nAnswer: The answer is \"Miscarriage due to ectopic pregnancy is covered.\"\n\nQuestion: Final Expenses Benefit in a Medical Expense Insurance covers:\nAnswer: The answer is \"Death that occurs within a specified no. of days after leaving the hospital and is a result of the cause of the hospitalization\".\n\nQuestion: When one is required to pay a deductible regardless of the no. of claims made in a year, this type of deductible is known as:\nAnswer: The answer is \"Per Disability/ Per Claim Deductible\".\n\nQuestion: Mrs Lim has bought a Medical Expense Insurance with a deductible for $10,000 for 1st June 2012 to 31st May 2013. On 1st Sept 2012, she encountered an accident and the total claimable medical expenses were $3,000. In March 2013, she went for surgery to remove her womb and the medical costs were $8,000. How much can Mrs Lim claim, given that a per-disability/per claim deductible applies?\nAnswer: The answer is \"$0\".\n\nQuestion: Which is the most suitable plan type to recommend to a client who has financial constraint?\nAnswer: The answer is \"both deductible and co-insurance\".\n\nQuestion: All integrated Shield Policies are guaranteed renewable. Which of the following is Not True?\nAnswer: The answer is \"Insurer cannot terminate the policy if policyowner continues to pay his premium till death occurs\".\n\nQuestion: Which of the following characteristics of group insurance describes multiple lives under one contract?\nAnswer: The answer is \"Master contract\".\n\nQuestion: Which of the following must be disclosed to the participants for Group Voluntary A&H Policies? \nAnswer: The answer is \"They have a say in the type of coverage that they want\".\n\nQuestion: Which of the following is the most important factor for the underwriter when underwriting Group Insurance?\nAnswer: The answer \"Gender & age\".\n \nQuestion: Which of the following is NOT TRUE of the employer to qualify for Transferable Medical Insurance Scheme (TMIS)? \nAnswer: The answer is \"Pay 50% of the premium for the Group Medical Expense Insurance coverage\".\n\nQuestion: Which of the following is most stringent in the definition of Total Disability under Disability Income Insurance? \nAnswer: The answer is \"Any Occupation\".\n\nQuestion: If an insured who has been receiving disability benefits under a Disability Income policy returns to work, but suffers a relapse within a specified period of time for the same cause, most insurers will: \nAnswer: The answer is \"Waive the deferment period and benefit payments will recommence immediately\".\n\nQuestion: Mary, a lecturer bought a DI Policy, became disabled on 30/6/08."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
id: 1f081176-ee5c-4267-a187-891313340c0f
encoding: FLOAT32
metadata:
{"_node_content": "{\"id_\": \"1f081176-ee5c-4267-a187-891313340c0f\", \"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\": \"8f83d0ef-a731-49e7-9ed9-fe35cf61a96b\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"e8f8a80251d0cc9a502b2d1fd78726c319aaaea8058081d07f564ad45858b2c4\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"9b7c3936-3ed1-4cd3-9108-e6b95e28a5e7\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"ae409515c3dda9c3bdd10604c57f3b421fa89052c1e1f42646895c6af403ef87\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 1402755, \"end_char_idx\": 1407155, \"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": "Question: Mary, a lecturer bought a DI Policy, became disabled on 30/6/08. \nHer details as follows:\nSalary : $8000 per month ;\nHer expenses: $3000 per month;\nAnnual Escalation Benefit : 3% ;\n6 Month Deferred Period chosen.\nWhen will she received the first payment from the insurer and for how much? \nAnswer: The answer is \"1/1/2009 for $6000\".\nRationale is that,\nDeferred period 6 months from 30/6/08, hence payable on 1/1/09. Payments = $8000 x 75% = $6000\n\nQuestion: Mary, a lecturer bought a DI Policy, became disabled on 30/6/08. \nHer details as follows:\nSalary : $8000 per month ;\nHer expenses: $3000 per month;\nAnnual Escalation Benefit : 3% ;\n6 Month Deferred Period chosen.\nWhen will the escalation benefit kicked in and how much will she get?\nAnswer: D. The answer is \"1/1/2010 for $6180\".\nRationale is that,\nEscalation will be effective on the 2nd year ie 1.1.2010 at $6180 ($6000 + $6000 x3%)\n\nQuestion: Mary, a lecturer bought a DI Policy, became disabled on 30/6/08. \nHer details as follows:\nSalary : $8000 per month ;\nHer expenses: $3000 per month;\nAnnual Escalation Benefit : 3% ;\n6 Month Deferred Period chosen.\nMary subsequently on 1/2/2010 found a job as a tutor which pays her $2000 a month. Calculate partial disability benefit payable on 1/2/2010\nAnswer: The answer is \"$4,635\".\nRationale is that, ($8000 - $2000)/$8000 x $6180 = $4635\n\nQuestion: Which of the following criteria for payment of Long Term Care Insurance Benefit is False?\nAnswer: The answer is \"Need to be hospitalised\".\n\nQuestion: In Long Term Care insurance, the deferred period is defined as a period of time:\nAnswer: The answer is \"after the insured is certified by a medical practitioner that he is unable to perform specified numbers of ADLs\".\n\nQuestion: When a person requires an assistive rehabilitation device, which of the following benefits available under a Long Term Care plan could provide it?\nAnswer: The answer is \"Financial Assistance with Adaptation\".\n\nQuestion: Which of these exclusions apply to Long term Care Insurance?\nAnswer: The answer is \"Participation in a felony, riot or insurrection\".\n\nQuestion: 100% Acceleration Dread Disease Policy is MOST suitable for clients who:\nAnswer: The answer is \"has sufficient life insurance\".\n\nQuestion: Mr Tan has a Critical Illness Policy with a 50% acceleration benefit. The policy also has a Critical illness waiver of premium rider attached to it. After a dread disease claim by Mr Tan, which of the following statement(s) regarding the premium is most true?\nAnswer: The answer is \"premium reduced in proportion to how the basic sum assured is reduced\".\n\nQuestion: Group Dental Care will terminate under which event?\nAnswer: The answer is \"Insured enters full time military service\".\n\nQuestion: Which of the following is TRUE regarding claims on Group Dental Care?\nAnswer: The answer is \"Insured have to make payment first and file a claim with insurer for reimbursement if he uses his own dentists\".\n\nQuestion: How does Managed Healthcare Organizations control expenditure on healthcare?\nAnswer: The answer is \"Accessibility\".\n\nQuestion: Which of the following is not a feature of the cost management of Managed Healthcare Organisations?\nAnswer: The answer is \"Government subsidies on hospitals\".\n\nQuestion: Which one of the following models do the physicians actively continue to develop their own private practices?\nAnswer: The answer is \"Independent Practitioners Association (IPA) HMO\".\n\nQuestion: When making a claim under Managed Healthcare Insurance, the documents to be provided are :-\nAnswer: The answer is \"original medical bill\".\n\nQuestion: To buy any of the approved products, such as Private Integrated Shield Plans using Medisave savings, which of the following is true? \nAnswer: The answer is \"Premium is limited to $800 (per person per year) if the insured is below 65 years old\".\n\nQuestion: Which of the following is NOT true of restrictions imposed on Medisave? \nAnswer: The answer is \"It covers unlimited outpatient treatments\".\n\nQuestion: The main difference between CPF MediShield Scheme and a Private Integrated Plan is:\nAnswer: The answer is \"Annual limits are applicable for both\".\n\nQuestion: Which of the following is not for the poor and needy Singaporeans?\nAnswer: The answer is \"Eldershield\".\n\nQuestion: Which of the following key features of Eldershield Schemes is/are FALSE?\nAnswer: The answer is \"None of the above\"."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
id: 9b7c3936-3ed1-4cd3-9108-e6b95e28a5e7
encoding: FLOAT32
metadata:
{"_node_content": "{\"id_\": \"9b7c3936-3ed1-4cd3-9108-e6b95e28a5e7\", \"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\": \"1f081176-ee5c-4267-a187-891313340c0f\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"bbc453c4d26d2d1ca498d508e6303aba7ffc6e1932d319e9875a47646f43e099\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"db66feb2-9470-4cd7-942f-efee758f15a7\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"c7287f7a7c93d666671b20cf0b81a588ccaedd69c0ee0679092eb4c12ca5cf38\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 1406992, \"end_char_idx\": 1411527, \"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": "Answer: The answer is \"Eldershield\".\n\nQuestion: Which of the following key features of Eldershield Schemes is/are FALSE?\nAnswer: The answer is \"None of the above\".\n\nQuestion: In a Health Insurance Policy Contract, what is included in Policy Schedule?\nAnswer: The answer is \"Premiums and effective date of cover\".\n\nQuestion: The Renewal Provision describes:\nAnswer: The answer is \"Insurer\u2019s right to cancel the coverage\".\n\nQuestion: Physical examination provision is included in Disability Income Polices to enable insurer to;\nAnswer: The answer is \"have the insured examined by the insurer\u2019s doctor at the insurer\u2019s expense\".\n\nQuestion: Which of the following key factors is NOT used in computing premium for Health Insurance Products?\nAnswer: The answer is \"Occupation\".\n\nQuestion: Underwriters look particularly for applicant\u2019s earning and overall financial situation in underwriting:\nAnswer: The answer is \"Disability Income Insurance\".\n\nQuestion: Cognitive assessment is normally required during the underwriting stage for which plan?\nAnswer: The answer is \"Long Term Care Insurance\".\n\nQuestion: Which of the following factor is most important for underwriting Critical Illness Insurance?\nAnswer: The answer is \"Family history\".\n\nQuestion: Agent\u2019s statement is needed to:\nAnswer: The answer is \"Indicate applicant\u2019s approximate net worth\".\n\nQuestion: Which of the following is considered an offence and liable to a fine not exceeding $25,000 or imprisonment for a term not exceeding 12 months or both?\nAnswer: The answer is \"Failure to provide and explain the benefit illustration or product summary to the insured\".\n\nQuestion: What is not included under the Product Information Section in the LIA & GIA Guidelines on Disclosure Requirements?\nAnswer: The answer is \"Waiting period\".\n\nQuestion: The requirement of using fact find form, LIA Guidelines on Needs- Based Sales Process for individual health insurance products does not apply to: \nAnswer: The scenarios \"Direct marketing\", \"Personal Accident Policy\" and \"Eldershield\".\n\nQuestion: \u201cApplication Type 1\u201d in the Fact Find Form means: \nAnswer: The answer is \"Full completion of the Fact Find Form and the client wishes to receive the representative\u2019s recommendation of product suitability\".\n\nQuestion: What is true of the minimum requirements when the client chooses Type 1, 2, or 3 of the Application Types in the Fact Find Form? \nAnswer: The answer is \"Personal Information\".\n\nQuestion: Calculate Maintenance Cost given these assumptions:\nMonthly income needed = $1,500\nNo. of years income needed = 21\nRate of return = 5%\nInflation rate = 2%\nExisting Life Insurance = $150,000\nAnswer: The answer is \"$135,794\".\nRationale is that, \n$1500 X 12 = $18,000\n$18,000 X 15.8775 (table A2\u2013 21 yrs; 3%) = $$285,794\n$285,794 \u2013 $150,000 (life insurance )= $135,794\n\nQuestion: During need analysis, when recommending a Critical Illness Insurance, what must an advisor advise a client? \nAnswer: The answer is \"Coverage\".\n\nQuestion: Quantify the level of Medical Expense needed, given the following:\nBasic average medical expenses = $24,000\nBenefits paying under Group policy = $18,240\nAmount payable under Incomeshield Plan = $7,335\nAnswer: The answer is \"No Shortage of medical expense protection\".\nRationale is that, $24,000 \u2013 ($18,240 +$7335) = ($1,575); no shortage\n\nQuestion: Voluntary Welfare Organisations does not refer to an organization that________________.\nAnswer: The answer is \"is profit making\".\n\nQuestion: Means Testing in public hospitals was introduced,\nAnswer: The answer is \"to provide B2 and C class subsidies in a fair manner with the lower income group\".\n\nQuestion: The other benefits provided by the insurers under Medical Expense Insurance include,\nAnswer: The answer is \"Miscarriage Benefit\".\n\nQuestion: Under Medical Expense Insurance, when the Insured Person is a recipient, Major Organ Transplant Benefit covers,\nAnswer: The answer is \"Cost of Surgeries\".\n\nQuestion: Nelson Tan has a medical expense insurance policy which has a deductible of $2000 per policy year from 1st Jan to 31st Dec 2013. He was warded for high fever in 1st Apr and incurred a bill of $1200 for a two day stay in the hospital. Four months later, he was treated in hospital due to a fracture of the leg and incurred a hospital bill of $2100. How much can Nelson claim from the insurer under per annum deductible?\nAnswer: The answer is \"$1300\". Rationale is that, $1200 + $2100 - $2000 = $1,300.\n\nQuestion: Waiting Period is Not applicable for,\nAnswer: The answer is \"Accidental Injury\"."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
id: db66feb2-9470-4cd7-942f-efee758f15a7
encoding: FLOAT32
metadata:
{"_node_content": "{\"id_\": \"db66feb2-9470-4cd7-942f-efee758f15a7\", \"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\": \"9b7c3936-3ed1-4cd3-9108-e6b95e28a5e7\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"ae409515c3dda9c3bdd10604c57f3b421fa89052c1e1f42646895c6af403ef87\", \"class_name\": \"RelatedNodeInfo\"}, \"3\": {\"node_id\": \"cb68f129-405c-4945-9777-f19b756e7fe7\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"cf9eeea06404d7a7a66d316f48fcac338f7bf5d58e5eda22ae5c3dfc33224474\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 1411385, \"end_char_idx\": 1416540, \"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": "Rationale is that, $1200 + $2100 - $2000 = $1,300.\n\nQuestion: Waiting Period is Not applicable for,\nAnswer: The answer is \"Accidental Injury\".\n\nQuestion: A waiting period protects _____________, by ensuring that individuals are not able to make claims shortly after joining and cancelling membership.\nAnswer: The answer is \"members within the portfolio\".\n\nQuestion: Which of the following exclusions and limitations under Medical Expense Insurance is FALSE?\nAnswer: The answer is \"To avoid the policyowner selecting against the insured\".\n\nQuestion: Which type of Group Medical Expense Insurance Plans gives the employees some control over the plan?\nAnswer: The answer is \"Voluntary Plan\".\n\nQuestion: Which of the following factors are considered the most important to the underwriters in Individual Insurance underwriting?\nAnswer: The answer is \"Health and financial status\".\n\nQuestion: Peter is covered with a Disability Income and has been receiving benefits. However, he recovered from his disability, \nAnswer: The answer is \"the insurance cover will continue covering if Peter starts paying premium\".\n\nQuestion: Mr. Sim has requested for a Disability Income Policy with a short benefit period. Hence insurer will\nAnswer: The answer is \"Charge a lower premium\".\n\nQuestion: The disability benefit payable under a Disability Income policy will be reduced by the following sources of income\nAnswer: The answer is \"any continuing salary derived by the insured from the occupation engaged immediately prior to disability\".\n\nQuestion: Disability Income is similar to Long Term Care in that,\nAnswer: The answer is \"If insured recovers from the disability, payment will stop but policy will not be terminated if premiums are paid by the insured\".\n\nQuestion: Benefits under a Disability Income Insurance policy will cease upon occurrence of any of the following events,\nAnswer: The answer is \"when the benefit period expired\".\n\nQuestion: Which of the following is not true of Group Insurance? \nAnswer: The answer is \"Premium is age related\".\n\nQuestion: How does the \u201ccontinuation benefits\u201d under the TMIS benefits the employee?\nAnswer: The answer is \"To continue enjoying hospitalization coverage from the termination for 12 months\".\n\nQuestion: What is Extended Care Benefit under Long Term Care Insurance? \nAnswer: The answer is \"An extra monthly benefit given to the insured\".\n\nQuestion: In Long Term Care Insurance, Financial Assistance with Adaptation Benefit is,\nAnswer: The answer is \"A specified amount, 2 times the monthly benefit\".\n\nQuestion: The following features of LTCI are FALSE EXCEPT,\nAnswer: The answer is \"Should the insured recover from his disability, payments will stop\".\n\nQuestion: Which of the following is NOT a feature of Hospital Cash Insurance?\nAnswer: The answer is \"Waiting period applies for illness and injury\".\n\nQuestion: Which of the following situation will be covered during the waiting period for a Hospital Cash Insurance Policy? \nAnswer: The answer is \"Food poisoning\".\n\nQuestion: Group Dental Insurance usually does NOT cover\nAnswer: The answer is \"Replacement of stolen dentures\".\n\nQuestion: Which of the following does Group Dental Care insurance NOT cover?\nAnswer: The answer is \"Medicine given\".\n\nQuestion: Which of the following is provided under Emergency Medical Evacuation in the Medical Expense Benefits under Travel Insurance?\nAnswer: The answer is \"Covers the cost of moving insured to another place to seek treatment because of inadequate local medical services\".\n\nQuestion: Which of the following type is the most restrictive under Managed Healthcare Plans? \nAnswer: The answer is \"Health Maintenance Organisations\".\n\nQuestion: Which of the following is NOT true of Managed Healthcare Insurance?\nAnswer: The answer is \"Deductibles and Co-insurance do not apply in Managed Healthcare Insurance\".\n\nQuestion: Deductibles and Co- Insurance are found in which kind of policy?\nAnswer: The answer is \"Managed Healthcare Insurance\".\n\nQuestion: Which is true regarding claims procedure for Managed Healthcare?\nAnswer: The answer is \"Members who use in network care are not required to file any claims with insurer\".\n\nQuestion: Which of the following is not a feature of MediShield?\nAnswer: The answer is \"Meant to help pay for hospitalization at class B1 \u2013 C Class Wards\".\n\nQuestion: How is MediShield Cover effected for Singaporeans and Permanent Residents?\nAnswer: The answers are \n- If their births are registered in Singapore on or after 1 Dec 2007\n- If they are under 21 years old as of 30 June 2010\n- If they get married or registered their marriage in Singapore\nAll of these scenarios are how MediShield Cover effected for Singaporeans and Permanent Residents.\n\nQuestion: Claiming under MediShield & Integrated Shield Plan is similar in that,\nAnswer: The answer is \"Insured does not need to submit their claim to the insurer\".\n\nQuestion: The purpose of Eldershield is to,\nAnswer: The answer is \"provide long-term care protection to elderly Singaporeans in the event of severe disabilities\".\n\nQuestion: Government has launched a new severe disability scheme where premiums can be paid from CPF member\u2019s Medisave."}


created_at: 2024-03-15 18:52:31
topic: persistent://default/default/71e17ef0-3bc9-4074-a848-f5d2cfa67ab5
id: cb68f129-405c-4945-9777-f19b756e7fe7
encoding: FLOAT32
metadata:
{"_node_content": "{\"id_\": \"cb68f129-405c-4945-9777-f19b756e7fe7\", \"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\": \"db66feb2-9470-4cd7-942f-efee758f15a7\", \"node_type\": \"1\", \"metadata\": {}, \"hash\": \"c7287f7a7c93d666671b20cf0b81a588ccaedd69c0ee0679092eb4c12ca5cf38\", \"class_name\": \"RelatedNodeInfo\"}}, \"text\": \"\", \"start_char_idx\": 1416421, \"end_char_idx\": 1419898, \"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": "Question: Government has launched a new severe disability scheme where premiums can be paid from CPF member\u2019s Medisave. The Scheme is _________________. \nAnswer: The answer is \"Eldershield\".\n\nQuestion: Physical examination provision is included in Disability Income Polices to enable insurer to,\nAnswer: The answer is \"have the insured examined by the insurer\u2019s doctor at the insurer\u2019s expense.\"\n\nQuestion: Which of the following least describes pre-existing condition?\nAnswer: The answer is \"Of which the insured is not aware.\"\n\nQuestion: What is included in the \u201cEntire Contract Clause\u201d in a Health Insurance Contract? \nAnswer: The answer is \"Policy Document and Proposal Form\".\n\nQuestion: The following statement about parameters in pricing of Health insurance is true?\nAnswer: The answer is \"Increase in persistency will decrease premiums\".\n\nQuestion: Modified Underwriting does not include,\nAnswer: The answer is \"Reduce premium-paying\".\n\nQuestion: The detection of any early cognitive impairment is essential when underwriting,\nAnswer: The answer is \"Long Term Care Insurance\".\n\nQuestion: In group underwriting, over representation by a highly paid class could result in,\nAnswer: The answer is \"Higher than average medical claim\".\n\nQuestion: For which of the following is \u2018extra premiums\u2019 NOT commonly used for sub-standard risks?\nAnswer: The answer is \"Medical Expense Insurance\".\n\nQuestion: Which of the following constitutes the Best Practice Standards on Information Disclosure and Provision Of Advice? \nAnswer: The answer is \"Opinions must be unambiguously stated that it is a statement of opinion\".\n\nQuestion: Post- sales disclosure, in the form of a \u201cfollow-up\u201d letter\u201d must be made by the insurer through telemarketing channels. This letter does not attempt to do,\nAnswer: The answer is \"Highlights the 30 days grace period\".\n\nQuestion: Regarding post-sale disclosure on modifications to the product information or key product provision, insurer must observe which of the following that is true?\nAnswer: The answer is \"Obtain written acceptances of the modified terms\".\n\nQuestion: Under LIA Guidelines, insurer is required to intervene to rectify erroneous recommendations by its representatives during which period? \nAnswer: The answer is \"Free Look Period\".\n\nQuestion: Client wants to replace existing Health Policy. The insurer should advise on which of the following? \nAnswer: The answer is \"Insurer should advise on the disadvantages of replacing health insurance policy\".\n\nQuestion: Mr. Lim has recently bought Dread Disease Insurance. He is concerned about Mrs. Lim, who is a housewife, his son who is a newborn and their future daily expenses should anything happen to him. Given that his family\u2019s monthly expenses amount to $3,000, with existing inflation rate of 2% and investment return of 7%, how much would Mrs. Lim require in the event that Mr. Lim is not around, assuming number of years income needed is 21. \nAnswer: The answer is \"$484,639\".\n\nQuestion: Generally you should do a review with your existing clients under which of the following circumstances? \nAnswer: Under the following circumstances, a review with existing clients is required,\n- At the birth of a child.\n- Changes to CPF rulings.\n- Launching of new products.\nThese 3 scenarios are the triggers for a review.\n\nQuestion: Which of the following method is fairer in determining the sum assured for group health insurance?\nAnswer: The answer is \"Employee\u2019s Salary X Standard Factor\"."}


# embedding_metadata

key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
Health Insurance       Strictly for Internal Use Only     
 
 
Prudential Assurance Company Singapore (Pte) Limited   1 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  
 
 
 
 
 
 
HEALTH INSURANCE  
(5th Edition) , Supplementary Notes -  Version 1.3  
 
Chapter Review  
Chapters 1 to 15  
 
 
 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   2 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Chapter 1 –  Overview of Healthcare Environment in 
Singapore  
 
1. Rising healthcare cost is a concern for most gov ernments . The challenge faced by most 
governments is how to balance the rising expectations for quality healthcare, and yet keep cost affordable.   
 
 Healthcare  Philosophy  
Enhancing Accessibility  
 
• Healthcare infrastructure will 
be ramped up, with plans to 
increase acute- and 
community hospital beds 
by 2020.  
 
• MOH is building up its 
manpower capability & 
building a strong core  of 
healthcare professionals to 
support infrastructure 
expansions  eg:  
• Providing flexi, part -time  
 in the community through 
 its Place & Train 
 Programme.  
 
• New remuneration  
 framework for senior 
 doctors to better 
 recognize doctors in their 
 diverse roles in clinical 
 care, education, research 
 & administration.  
 
•  MOH act ively drives 
innovation & productivity in 
both public & ITLC sectors to simplify workflow 
process so that healthcare 
workers can focus on caring 
for their patients.  
  
 Healthcare 2020 Masterplan focuses  
on 3 strategic objectives.  
Enhancing Quality of Care  
 
• MOH will move away from 
doctor -centric services & 
adopt a multi -disciplinary 
team approach to enhance 
chronic disease 
management. Eg healthcare 
clusters.  
 
• MOH will enhance primary 
care as Singapore's 
population ages so that 
residents can be better 
cared for in a community. Egs:  
• Strengthening primary 
   healthcare providers, 
   such as polyclinics & 
   GPs;  
 
• Building more  
 polyclinics.  Ensuring Healthcare 
Remains affordable  
 
The Government has 
enhanced support for 
Singaporeans in the 
following ways:    
 
• Increasing 
Government share of 
national healthcare 
expenditure - thro 
enhanced subsidies 
for services in SOCs & drugs in public 
hospitals and list of 
subsidized drugs.  
     
• Medisave expanded 
to use for more 
types of outpatient 
treatment.  
 
• Enhancing collective 
responsibility  for 
healthcare through MediShield Life. The 
Government bears 
most of the cost of 
this universal 
coverage.  
 
 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   3 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 2. Healthcare System in Singapore consists of :  
 
 
 
 
 
2a. Primary Healthcare Services   
• Provided by both public and private sectors.  It involves provision of basic medical 
treatment,  preventive healthcare and health education.  
 
• In public sector, primary healthcare services are provided through network of 
outpatient polyclinics .  Under Community Healthcare Assist Scheme (CHAS), 
lower -to-middle income household can receive subsidized treatments at GPs and 
dental clinics, without the need to travel to Polyclinics.  
 
• The Scheme also covers treatment for Chronic Disease Management Programme (CDMP) such as diabetes, hypertension,  root canal treatment and crowning .  
 
• Patients under CHAS can also enjoy subsidized rates at Specialist Outpatient Clinics.  
 
2b. Hospital Services   
• There are 9 public hospitals and within these public hospitals, choices of different 
types of ward accommodation.  81% of public hospital's beds are B2 and C which are 
heavily subsidized.   19% with lower subsidy at 20% for Class B1 and no subsidy  for 
Class A wards.  
 
• Government has restructured all its acute hospitals and specialty centres to run as 
private companies, wholly owned by G overnment , to allow greater autonom y and 
flexibility .  Commercial Accounting Systems have been introduced to give a accurate 
picture of operating costs , instilling greater  financial discipline and accountability.


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
Commercial Accounting Systems have been introduced to give a accurate 
picture of operating costs , instilling greater  financial discipline and accountability.  
 
• Public hospitals received annual government subvention or subsidy for the pr ovision of 
subsidised medical services of patients.  These are to be managed like not -for- profit 
organisations.  
 Healthcare  System in Singapore  
Primary Healthcare 
Services Hospital Services  Intermediate Long 
Term Care (ILTC) 
Services Traditional 
Chinese Medicine  3 main types of healthcare  
Western Medical Science  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   4 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 2c.  Intermediate & Long Term Care (ITLC)  
 ITLC services are for people who need further care after discharge from acute hospitals as 
well a s community dwelling seniors who may need assistance with their activities of daily  
living .  This can be through:  
 a) Home -based services,  which are provided within their homes of frail and home - 
  bound elderly.  
  b) Centre- based healthcare services, whi ch cater to older persons who require care 
  services during the day, usually on a regular basis, located within the community.  
  This allows working caregivers to drop their seniors at during work.  
 
 c)  Residential ILTC services, comprises community hospitals, chronic sick hospitals, 
  nursing homes, inpatient hospices and sheltered home for the ex -mentally ill patients.  
 
 
3. Singapore Healthcare financing framework comprises of Government subsidies, individual 
 savings and insurance.  
 
 
 
4. The Singapore Government provides universal coverage through these multiple layers of 
 protection:  
 a) Government S ubsidies  
• Government subsidies across primary, acute rehabilitative and nursing care; and  
• Universal access, but no 100% subsidy to avoid over -consumption.  
  
 b)  Compulsory H ealthcare Savings   
• Individual medical savings accounts - Medisave.   
 
c)  Risk -Pooling via Insurance Schemes  
• National basic health insurance scheme -  MediShield Life;  
• Private health insurance for additional coverage -  Medisave approved Integrated 
Shield Plans (IPs); and  
• Severe disability insurance for old age - ElderShi eld and ElderShield Supplements.  
 
d) Ultimate safety net for the needy  
• Endowment  fund set up by the Government for needy Singaporeans through Medifund.   Singapore Healthcare Framework  
Government Subsidies  
 
Government provides 
significant subsid ies across all 
healthcare settings to help with 
healthcare costs.  Individual Savings  
 
Through the Medisave Scheme, it helps individuals 
care for their own as well as 
immediate family's medical 
expenses.  Insurance  
 
• MediShield Life  
• Medifund  
• ElderShield  
(cross ref - chapter 8)  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   5 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Chapter 2 –  Medical Expense Insurance  
 
1. There are broadly 3 categories of Health Insurance which can provide:  
• A reimbursement for the cost of medical treatment or nursing care; or  
 
• A periodic income upon disability or hospitalization; or  
 
• A fixed cash  amount upon disability or suffering from a major illness.  
 
 
2. What is a Medical Expense Insurance  (MEI)?  
Also known as Hospital  and Surgical  (H&S) Insurance, which provides inpatient and some 
outpatient benefits.  Examples of MEI include MediS hield  Life, P rivate In tegrated Shield Plans 
and managed healthcare schemes.  
 
3.  
 Medical Expense Insurance  
Inpatient Expenses  
 
 Daily  room & board;  
 Intensive care unit;  
 Short stay ward;  
 Hospital miscellaneous;  
 Surgeon’s fees;  
 Anaesthetist’s fees;  
 Surgical implant & 
prosthesis;  
 Confinement in 
community hospitals;  
 Inpatient psychiatric treatment;  
 Congenital anomalies;  
 Inpatient pregnancy  
complications.  Outpatient Expenses  
 Pre-hospitalization 
diagnostic and 
laboratory tests;  
 Pre-hospitalization 
specialist consultation;  
 Post hospitalization 
specialist consultation;  
 Emergency accidental treatment charges.


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
Catastrophic Outpatient 
Expenses  
 
 Outpatient kidney 
treatment;  
 Outpatient cancer 
treatment.  covers  
Covers the 
following charges:  
Please note the following covered expenses below:  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   6 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 3a. Inpatient Expenses   
a. Daily Room and Board Charges refers to the charges for standard room     
 accommodation , meals and general nursing services incurred while insured is 
hospitalized.  
 
b.  Intensive Care Unit Charges –  charges incurred during the confinement in the ICU of the 
hospital.  
 
c.  Short –stay ward –  incurred during confinement in the short stay ward in an accident  and 
emergency dept of a hospital for inpatient monitoring and treat ment up to 24 hrs to allow 
doctor to decide whether to discharge the patient or further admitted as an inpatient.  
 
d. Hospital Miscellaneous  Expenses includes services and supplies (other than room and 
board and general nursing care):  
• Laboratory services;  
• X ray examinations;  
• Medicines and drugs;  
• Surgical dressings;  
• Operating room expenses;  
• Oxygen and their administration; and  
• Ambulance service.  
  
e. Surgeon’s Fees –  surgeon’s fees for surgery, includes day surgery and gamma knife.  
 
f.  Anaesthet ist’s Fees –  for the supply and administration anaesthesia.  
 g. Surgical Implant & Prosthesis  - actual costs of surgical implant of artificial devices used 
to replace missing part of a body.  
 
h.  Confinement in Community Hospital –  charges incurred for accommodation, meals  and 
general nursing  services.  A referral from the attending physician from the hospital is 
required and the admission to the community hospital must be within a time frame 
following his discharge from the hospital.  
 i. In-Hospital Psychi atric Treatment – must be received as an inpatient of the hospital.  A 
waiting period may apply.  Treatment for self inflicted, suicide, drug addiction or abuse of 
drug or alcohol is excluded.  
 
j. Congenital Anomalies –  inpatient treatment of any congenital anomalies, including 
hereditary conditions.  A waiting period apply.  
 
k. Inpatient Pregnancy Complications –  inpatient treatment for pregnancy complications.  
Waiting period  apply.  This benefit may be restricted to the following pre-  defined list of  
complications:  
• Ectopic pregnancy;  
• Pre- eclampsia or eclampsia;  
• Disseminated intravascular coagulation;  
• Miscarriage after 13 weeks of pregnancy(not resulting from voluntary or m alicious 
act); 
• Antepartum haemorrhage;  
• Intrauterine death;  
• Choriocarcinoma and hydatidiform mole;  
• Acute fatty liver pregnancy;  
• Breech delivery  and placenta previa and p ostpartum hemorrhage.  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   7 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 3b.  Outpatient Expenses  
a.   Pre-hospitalization Diagnostic and Laboratory Test Charges  
 Charges incurred for diagnostic and laboratory tests as prescribed by the attending 
physician.  This benefit is payable if incurred within a specified number of days before the date of hospitaliz ation.  
 b. Pre- hospitalization Specialist Consultation Charges  
 Charges incurred for consultation of a specialist as recommended by the attending 
physician.  This benefit is payable if insured is hospitalized  or undergoes days surgery 
within a specified number of days from the date of consultation of the specialist.  
 
 c.  Post – Hospitalization Specialist Consultation Charges  
Charges incurred for follow up treatment after hospitalization, eg physiotherapy etc. This 
benefit is payable for up to a specified number of days after his discharge from the 
hospital.  
 
 d.  Emergency Accidental Treatment Charges  
Charges incurred for emergency outpatient treatment of accidental  bodily injuries, within 
24 hours of the accident.  
 
 
3c.  Catastrophic Outpatient Expenses   
 a.  Outpatient Kidney  Treatment Charges  
Charges incurred for kidney dialysis at a legally registered dialysis centre.  Includes 
examinations and tests ordered by the physician.  Exclude purchase or rental of the 
dialysis machine.


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
Includes 
examinations and tests ordered by the physician.  Exclude purchase or rental of the 
dialysis machine.  
 
 b. Outpa tient Cancer  Treatment  Charges  
Charges incurred for chemotherapy, radiotherapy, immunotherapy and/or stereotactic 
radiotherapy, provided by the hospital.    
  
 
 
4 .  Other Benefits Under MEI   
 
1. Major Organ Transplant  
  
 
Where the insured person is a recipient  
  
Where the insured person is a donor  
 
Refers to the cost  of surgeries for the 
transplantation of kidneys, lungs, heart, 
liver or cornea , where the insured person is 
the recipient of any of the organs. It also 
includes the costs of immunosuppressant 
drugs where are part of the treatment to 
reduce rejection episodes.   
 
 
 
 
 Covers charges for major organ transplant 
operations of the kidney,  or liver  where the 
insured person is a living donor, provided:  
I. Transplant is carried out in a hospital 
in Singapore;  
 
II. Recipient of the organ must be insured 
person’s family member ; 
 
III. The recipient’s kidney or liver failure is 
first diagnosed by the attending 
physician, or the symptoms of which 
first appeared, after a waiting period 
of 24 months .  
 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   8 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 2. Specific Disease Insurance  
Provides a lum p sum payment in the event of the diagnosis fr om the specific disease 
covered by the policy.  
 
 
3. Miscarriage Benefits  
Not applicable to willful termination of a pregnancy that is not medically necessary but 
provides reimbursement in the event of a miscarriage or ect opic pregnancy.  
 
 
4. Private Nursing Home Care  
Pays for the cost incurred in hiring the services of a fulltime/ part time qualified nurse in 
the insured’s home for the cont inuing treat ment  of a medical condition whi ch is covered 
under the policy for which the insured person has been hospitalized.  
 
 5. Daily Hospital Cash  
A daily cash benefit is payable to the insured if he is hospitalized as a result of an injury or illness.  (refer chapter 6)  
 
 6. Emergency Overseas Medical Treatment  
Refers to the costs incurred for an emergency inpatient treatment outside of Singapore.  
Benefit is subject to reasonable and customary charges for equivalent medical 
treatment in Singapore.  
 
 7. Emergency Medical Evacuation  
Refers to costs incurred for overseas medical evacuation if the insured person cannot  
obtain treatment needed locally and has to be evacuated to the nearest suitable hospital 
or repatriated  to his home country to that he can be treated in familiar surroundings, near 
to his family.  
 
 8. Final Expenses Benefit  
  Death occurring during hospitalization  or within a specified number of days after hospital 
discharge, and provided death is a result of the cause of the hospitalization.  In the case 
of an Integrated Shield Plan, the final expenses benefit is usually a waiver  of deductible 
and co- insurance components up to the stated amount in the policy.      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   9 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 5. Key Features Of Medical Expense Insurance  
 
Features of Medical 
Expense  Details  
  
What are the limits on the 
covered expenses?  
 
 
 2 ways:  
• “As Charge” Benefits  
• Imposed Sub- Limits   
 
Note that payment is on a reimbursement basis, hence insurer 
will reimburse the actual amount incurred or the maximum limit stated in the policy, whichever is lower.   
 
Forms it can be purchased  • Standalone;  
• Rider  (not common in Singapore).  
 
Family coverage  • 5% discount given even if the spouse or only 1  
      child is covered.  
 
• Family members n eed not  be covered under the  
             same plan to enjoy the discount.  
 
Expense participation  3 methods are :  
1. Deductibles : a flat dollar  amount paid by insured.  
3 Types of D eductibles :  
• Per Annum; (least restrictive) ; 
 
• Per D isability Per Year; 
 
• Per Disability Per Claim.  
 
2.


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
3 Types of D eductibles :  
• Per Annum; (least restrictive) ; 
 
• Per D isability Per Year; 
 
• Per Disability Per Claim.  
 
2. Co insurance: a specified percentage  in excess of   
deductibles.  
 
3. Pro- ration factor : when insured is admitted to a ward  
            higher than the plan’s entitlement, a p ercentage is  
            applied on the actual charges incurred and covered  
 under the policy, hence benefit is r educed.  In this way it  
 ensures fairness such that a policy owner who pays a  
 lower premium for a lower plan should be encouraged to  
 use the services available only on the selected plan.  
 
 
Note : Know the egs in the text for calculating deductibles 
and co-  insurance at page 28- 29.  
 
 
 
 
 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   10 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Benefits limits  Define  :  
Lifetime limit  
Often set at a very high amount eg. S $1m.  The maximum total 
amount of all reimbursements that t he insurer is liable to the 
insured throughout insured’s l ifetime . 
 
Annual Limit  
The maximum annual reimbursements by the insurer as stated 
in the Benefit Schedule of the Policy.  
 
Event Limit  
Maximum amount payable in respect of any one disability  or  
illness as defined in the policy.  
 
 
Geographical Limit  • Most Individual Expense Insurance Policies will 
automatically ter minate  if insured resides outside 
Singapore for more than  180 days.  
 
• Treatment overseas are based on reasonable and 
customary  charges.  
 
Waiting Period   
Define waiting period:  A period of time stated in the policy 
which must pass before the coverage can begin.  A waiting 
period protects members within the portfolio, by ensuring 
individuals are not able to make claims shortly after joining and 
then cancell ing their membership.  
 This plan is subject to a waiting period.  However waiting period 
does  not apply to accidental injury.   
 
 
Age limit   
Minimum: 15 days old.  
 
Maximum : 75 years old.  
 
Premium  Age band basis.  
i.e if the person crosses to the next age band, he has to pay a 
higher premium, based on the new age band he falls under.  
 
Guaranteed Renewability  
 Insurer cannot terminate as long as insured pays the premium.  
Exclusions  • to avoid policy owner receivi ng reimbursement twice ; 
for the same charges or making a profit ; 
• to make premium more affordable;  
• to define more clearly the medical care and treatment;  
• to avoid the policy owner selecting against the insurer . 
 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   11 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  
Co- Ordination Of Benefit  
Clause    
Prevents the insured from making a profit.  Total claims made 
by the policy  owner will be equal to the total medical expense 
incurred.  
 
 
 
Underwriting  Individual MEI   
The main source o f information for individual Medical Expense 
Insurance is the proposal form .  
 
Group MEI  
For group coverage, employer is required to complete the 
Group  Fact Find form . For small group of less than 10 
members, individual employees to complete health declaration   
form . 
 
Healthcare Subsidy  • Citizens enjoy h eavy subsidy in clas s B2 and C  wards.  
• PRs received significant subsidy.  
      Foreigners – not subsided at all.  
 
 
Termination of Cover   
Apply to both individual and group policies:  
• death of the insured person;  
• date on which insured enters full time military 
service except  during National Service reservist 
duty;  
• end of policy eg (80 yrs old)  
• policy is terminated;  
• policy is expired;  
• total claim amount reached lifetime limit . 
 
Apply to group policies:  
• date of cessation as an employee.  
 
Claims  Forms to be submitted to insurer are :  
• Claims f orm;  
• Physician statement;  
• Original bills.  
 Must notify insurer within a specified period ( 90 days) after 
incurring medical costs.  
 
 
  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   12 
Produced in collaboration with Julia Sim.


key: _node_content
string_value:
{"id_": "c70b98e5-bbd7-4dc5-a3fd-18f0cccbf971", "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": "34973a1e-4198-4975-b5cf-637603dbb4b7", "node_type": "1", "metadata": {}, "hash": "4ac327104712a4c2ea714159de1efaa10d67e7fc36e704b4d16b5fa62a841112", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "b873dd38-fe9f-4a30-af34-b92648ea5884", "node_type": "1", "metadata": {}, "hash": "24ee997a9d993888a283f638b9d53488eb53cf21779f5d547d9c911e66fa7c76", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 22429, "end_char_idx": 27050, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   12 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Chapter 3 –  Group Medical Expense  
 
1. What are the characteristics of Group Insurance?   
 
 Master Contract  - issued under a single contract kept by policy – owner.  
 
 Minimum Underwr iting  – Health declaration form or waive all underwriting requirements 
and rely on pre -existing condition exclusion clauses to prevent anti -selection.  
 
 Experience rating – underwritten based on past claims experience.  
 
 Cost effectiveness  – low cost due to savings in administrative costs in view that only one 
group policy is is sued.  
 
 Plan Continuation  – renewable on a y early basis.  
 
 Eligibility requirements  – full time work; part time excluded.   
 Must be act ively at work.  
 
 
2. Ministry of Manpower requires every employer to purchase a minimum medical insurance 
coverage for t heir foreign workers and domestic workers. It is for their medical bills incurred and 
inpatient care and day surgery.  The minimum amount from 1 Jan 2020 is $15,000 for new 
applications and renewals.   
 
 
3. Group Medical Expense Insurance policies are often purchased by employers as part of their 
employee benefits to attract and retain their employees.  Group policies can also be extended to 
cover the employees’ immediate family members. For e xample, a fter th e employees have been 
confirmed, new dependents like spouse  can be included at any time within 30 days after 
marriage and child at any time between 15 and 30 days after birth.   
   
 4. Compulsory Vs Voluntary  
  
 Compulsory  
 Voluntary  
Characteristics  All employees must be covered under 
the same plan, and premium has to be 
paid by the employer .  No need for full participation  (min 
75% participation). Employees pay 
part of the premium.  
 
 
 
Advantages   
• Ease of administration since no payroll deductions to monitor;  
 
• Lower costs –  less administrative 
work;  
 
• Employer retains greater control.  Employer  
• Employees pay part of the cost;  
• Generates interest & 
appreciation;  
  
Employees  
• Employees have some form of 
control over the plan;  
• Lower premium than buying individually.  
 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   13 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 5. Differences between Individual and Group Insurance.  
   
         Individual Insurance  Group Insurance  
Eligibility  Needs only be insurable to be 
granted coverage.   
Only members who belong to the 
group and are actively at work  
are covered.  
 
Contract   
Each individual policy gets a policy 
contract.  
 One master contract is issued.  
Choice Plan  Has the right to select the coverage.   
May not have the choice to select the coverage in a 
compulsory plan.  
 
Underwriting  Individual health and financial 
status are evaluated.   
Gender and age distribution of 
the group, occupation mix and 
past claims experience.  
 
Termination of 
Cover   
Either individual or insurer chooses to terminate it.  
 Coverage for him stops when he leaves the group.  
Premium   
Cost of coverage is higher.  
Premium is age related.   
 Cost of coverage is lower.  
Premium is unit related.   
 
 
 
6. Portable And Transferable Medical Benefits For Employees  
 
To incentivize employers to make the move towards enhancing the portability of inpatient/hospitalization medical benefits for their employees, Singapore Government has 
revised the tax policy to allow employers i mplementing any of the following 3 portable medical 
benefits to enjoy higher tax deduction for medical expenses of up to 2%
 of total employees’ 
remuneration:  
 
a) Portable  Medical Benefits Scheme (PMBS);  
 
b) Transferable Medical Insurance Scheme (TMIS);or  
 
c) Provision of Medisave- Approved Integrated Shield Plan ( IP).  
 
  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   14 
Produced in collaboration with Julia Sim.


key: _node_content
string_value:
{"id_": "b873dd38-fe9f-4a30-af34-b92648ea5884", "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": "c70b98e5-bbd7-4dc5-a3fd-18f0cccbf971", "node_type": "1", "metadata": {}, "hash": "935356b0b0fe74c17fe3c84617d66423bf81624e15667d6716b11ff71a09f3ed", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "4dc1b6a6-0633-4398-8ea9-72988899f691", "node_type": "1", "metadata": {}, "hash": "b4bf0474ac2b3224cbbbae073552f4492b93b5459d8bf499a3468fb54f45dfe4", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 26760, "end_char_idx": 31117, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   14 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 6a)  Portable Medical Benefits Scheme (PMBS)  
 
• This scheme rides on the Medisave/MediS hield framework. Employer  makes 
monthly contribution to employees’ Medisave accounts that can be used to purchase 
any one of the Medisave approved medical insurance policies to cover their 
hospitalization needs, instead of providing Group Medical Insurance coverage.  
 
• Advantage is  that the employee can continue  to be covered even though he may be 
unemployed or is in between jobs.  Coverage continues as long as premium is paid 
regardless of employment status.  
 
• To enjoy the 2% tax deduction, following conditions apply ;  
o Must cover at  least 20% of the local employees;  
 
o For full time employees, the additional monthly contributions to Medisave 
accounts should be at least 1% of each employees’ gross monthly salary, 
subject to a min of $16 per calendar year.  
 
o For part -time employees, the additional monthly contributions to Medisave 
accounts should be based on 1% of their gross salary for the calendar month.   
 
However, for employers who choose not to implement either PMBS or TMIS, their tax  
deductibility in respect of medical expenses will be maintained at 1%  of total employees'  
remuneration.  
 
 
 
6b) Transferable Medical Insurance Scheme (TMIS)  
 
TMIS is an enhancement of the existing employer sponsored Group Medical Expense 
Insurance outside of the CPF Medisave framework.  It is basically an employer -sponsored 
Group Medical Insurance programme with the following 2 additional features:  
 
• Continuation of coverage; and  
 
• Transferability  
 
 
1. To qualify for TMIS, the employer must :  
• have a group size of 11 or more employees;  
 
• take up  a group Medical Expense Insurance plan (MEI);  
 
• insure at least 50%  of its local employees, subject to a minimum total of 11 employees;  
 
• pay 100%  of the premiu m for the group Medical Expense Insurance coverage;  
 
• not to  give employees the option to be insured under the group insurance plan.  
 
  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   15 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 2. Two Features under the TMIS  
 
 
Previous Employer's TMIS Plan  
Continuation Of Coverage Benefits  
   
New Employer's TMIS Plan  
Transferability of Benefits  
 
Employees to enjoy hospitalization coverage 
from their termination of employment 
(voluntary or otherwise) up to a max period 
of 12 months  (not exceeding age 62).   
Employees who resign from one company, 
which holds a TMIS policy, and joins 
another, who als o holds a TMIS policy w ill 
enjoy these benefits:  
I.  automatic coverage under the new 
employer’s group plan,  without the 
need to provide evidence of good health;  
 
II. Waiver of any exclusion on pre - existing 
medical conditions if the employee has 
been continuously insured under a  
TMIS plan for 12 months  whether with 
the pr ior employer or new employer.   
 
However, if the employee is hospitalized for 
a pre existing  condit ion when he joins the 
new employer within the first 12 months , he 
will enjoy a lower  benefit of either the new 
employer’s TMIS plan or prior employer’s 
TMIS plan. Refer to eg 3.1 in pg 52 of text.  
 
 
  
3. Medical Expenses that qualify under TMIS Special Bene fits:  
• Daily room and board charges;  
• ICU; 
• Miscellaneous hospital services;  
• In- hospital doctor’s visits;  
• Inpatient and outpatient benefits.  
 
All pre/post hospitalization outpatient, emergency outpatient accident and outpatient 
kidney dialysis/cancer treatment are not eligible  for TMIS benefits, even if they can be 
reimbursed under TMIS Plan.  
 
 
4. To be eligible for the TMIS benefits, an employee must be:  
• Below statutory retirement age (62 years from 1 Jan 1999).


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
4. To be eligible for the TMIS benefits, an employee must be:  
• Below statutory retirement age (62 years from 1 Jan 1999).  However since 1 Jan 
2012, employers are now required to offer re employment to eligible employees who 
turn 62 years, up to 65 years;  
• Singaporean or PR based in Singapore;  
• Working full tim e with the same employer;  
• Working on a permanent employment contract or on a temporary contract, with a 
term of 24 months or more.  
 
 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   16 
Produced 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 
Transferable Medical Insurance (TMIC)  at the request of an employee upon termination of 
his employment.  The TMIC must be submitted to the insurer when the employee submits a claim for Continuation Benefit, or to the new employer’s insurer should a claim arising from 
a pre existing condition be made within 12 months of joining the new employer.  
 
 
6. PMBS Versus TMIS  
  
PMBS  
  
TMIS  
 
Who purchase s the 
Policy?   
Employees purchase policy on his 
own from the contributions made by 
his employer to his Medisave 
account . 
  
Employer purchases the 
policy.  
 
What type of medical 
plan can be 
purchase?   
Only a Medical Insurance policy 
approved under the Medisave 
Scheme.    
Any group Medical Expense 
Policy, other than those approved under the Medisave 
Scheme.  
 
 
Coverage   
Lifetime for most private Integrated 
Shield Plans.  
 
Coverage continues  when the 
employee is between jobs or out of 
job as long as premium is paid.   
Expires at statutory 
retirement age.  
 
Coverage continues up to a 
max of 12 months from the 
date of termination of a job.  
 
 
Deductibles and Co-  
insurance   
Apply.  However riders can be 
purchased to offset them.   
Unlikely to apply as Group MEI rarely have these 
features.  
 
 
Pre existing Illness.   
Excluded   
Waive r on pre existing 
conditions where employees 
change jobs  and where both 
employers provided TMIS benefits.  
 
 
Who have control 
over the policy? 
  
Employees   
Employer  
  
  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   17 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 6c. Provision of Integrated Shield Plan  
• With effect from the Year of Assessment 2008, employers providing employees with a 
Shield P lan (i.e MediS hied Life or Medisave- approved Private Integrated Shield Plan) 
can claim tax deduction for medical expenses incurred, up to 2%  of their total 
employees’ remuneration, if they  meet the following:  
 
o Provide Shield plans for at least 20%  of their local employees;  
 
o Pay Shield plan premiums on behalf of their employees directly to the insurer or reimburse the premiums into their respective employees’ Medisave accounts.  
 
Tax deduction excludes  premiums for Riders on Shield Plans that cover deductibles 
and co-  insurance payments.  
  
 
 
  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   18 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Chapter 4 –  Disability Income Insurance  
 
1. 
 
  • Often sold as Income Protection  product as it helps to replace a portion of the 
insured’s income that he loses if he becomes incapacitated and unable to work as 
a result of as a result of accident or sickness.  
 
• Known as Permanent Health  Insurance because insurer cannot cancel the polic y 
no 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.  
 Also known as :  
 
 Permanent  Health Insurance;  
 
 Income Protection ;  
 
 Income Replacement.  Disability Income 
Insurance  
Why?   
4 definitions of Total Disability  
 
1. Own Occupation  
o Insured’s  inability to perform own occupation.  
 
2.


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
Disability Income 
Insurance  
Why?   
4 definitions of Total Disability  
 
1. Own Occupation  
o Insured’s  inability to perform own occupation.  
 
2. Modified Own Occupation  
o Insured’s  inability to perform any gainful occupation or similar occupation for which 
he is reasonable suited by reason of education, training or experience.  
 
3. Any Occupation  
o Insured’s inability to perform any occupation.   
 
4. Severe Disability  
o Insured’s inability to perform at least 3 of the 6 ADLs –  washing, dressing, feeding, 
toileting, mobility, transferring (follows the definition of Long Term Care Insurance in 
Chapter 5)  
 
Qn : Which of the above definition is the most restrictive ? 
 
Answer:   “Any Occupation”  Pg 62  DI will pay if insured is totally disabled and 
unable to work.  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   19 
Produced 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)  
 lies in the purpose:  
 
 DI - provides income to the insured when he is unable t o go to work.   
 
 TPD - serves to accelerate death benefit under a Life policy.   
 
 
3.  Other differences between Disability Income and Total and Permanent Disability Benefit : 
 
 
Criteria   
Disability Income Insurance   
Total and Permanent Disability 
Benefit  
 
 
Form   
Stand-  alone policy or rider.   
Incorporated into Life Insurance 
Policies.  
 
 
Maximum Sum Assured   
Up to specified percentage of the salary.  
  
Not pegged to salary.  
 
Escalation and Partial 
Benefit  
  
Available  
  
Not available  
 
Deferred Period   
Available (can choose)  
  
Usually a 6 -month waiting period.  
 
Available to who   
Working adults with earned 
income salary.  
  
No restriction on non working people.  
 
 
4. Compute total amount received from the DI Policy, given the  following information:  
  
 Monthly Income: $5000     
 Escalation Benefit: 5% per year  
 Effective Benefit Period : 30 Years  
  
 Answer  
 Monthly Benefit: $3750 ($5000 x 75%)  
 Yearly Benefit : $3750 x 12 = $45,000  
 Total Benefit Payable: $45,000 x 66.4388  (table A1 – 5%;30 Yrs) = $2,989,746  
  
   

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   20 
Produced 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:  
 
Recurrent Disability  
 (Linked Claims)  In the event if the insured who has been receiving disability 
benefits under a DI Policy, returns to work, but suffers a 
relapse within a certain period (usually 180 days), insurers 
will waive  the deferred period and benefits payments will 
recommence  immed iately.  It is treated as a continuation 
of earlier claim.   
 
Benefit Period Vs Deferred 
Period/Elimination Period  Benefit Period           
The longer  the benefit period, the higher  the Premium.  
 
Deferred Period(DP)  
• The longer the deferred period, the cheaper  the 
premium.  
 
• Shortest(DP) -  suitable for : Self Employed;  
 
• Longest (DP) – suitable for : Budget Conscious.  
 
 
Total Disability Benefit   
• Pays up to 75%of insured average income  
      prior to his disability.  
 
• Not 100% payment so that insured has inc entive to 
go back to work.  
 
 
 
Partial Disability Benefit   
• Also known as “ Rehabilitative Benefit  ”.  
 
• It provides a r educed benefit if insured is able to 
work at a reduced income of 75% % of his pre -
disability income.  This reduced benefit is based on 
this formula:  
Pre-disability Earnings –  Present Earnings  X TDB  
               Pre-disability Earnings  
 
Note : Please know the e.g at page 67 of text  
 
 
Rehabilitation Expense Benefit   
Pays for rehabilitation costs incurred.  
  Limited to a per disability basis.  Includes  
• Training courses ; 
 
• Medical aids (e.g wheelchairs); and   
 
• Workpl ace modifications.


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
Limited to a per disability basis.  Includes  
• Training courses ; 
 
• Medical aids (e.g wheelchairs); and   
 
• Workpl ace modifications.  
  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   21 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  
Escalation Benefit  
  
Useful to hedge against inflation .  
 
Note: Please know this e.g at page 69 of text:  
 Compute escalation benefit, and partial disability benefit 
given the following:  
Eddy was disabled on 30 June 2011 and he qualifies for a 
DI payment. He opted for a 3% escalation benefit per 
annum and a 6 month deferred period.  Insurer makes first 
payment  on 1.1.2012 for $6000. (75% of his monthly salary 
of $8000).  He found a job that pays him $2000 a month on 1.2.2013.  
  
 
QN : How much should insurer pays him on 1.1.2013?  
 Ans: $6,180 ($6000+$6000x3%) escalation benefit  
                  kicked in on the second year.  
 
 
QN: How much should insurer pays him on1.2.2013? 
       Ans : $4,635 
 
       Partial disability calculated as:  
       $8,000 - $2000 x $6,180 
            $8000  
 
 
  
Waiver of premium   
• Premium would be waived  during DI benefit  
payment period (applies to both Total and partial 
disability)  
 
• For annual premium, waiver will come in at next  
Premium Due Date even though DI payment  
      has started. No re fund of premium.  
   
 
Death Benefit   
A lump sum amount is paid to insured dependants.  
 
 
Limitation of Disability Clause  Disability benefit payable will be reduced by income 
received from Work Injury Compensation, any continuing 
salary or other income derived by insured’s occupation.  
However benefits will not be reduced by payment from 
Total Permanent Disability Benefit.  
 
 
 
Premium  • Level premium;  
• Premium waived during benefit period;  
• Guaranteed renewable.  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   22 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Surrender value  No  
Assignment  Not allowed  
 
Tax  Benefits Not Taxable  
 
Grace Period  Policy will lapse if premium is not paid within the 30 days’  
grace period.  
 
 
Underwriting Requirements  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Underwriting Considerations    
Individual  
Proposal form plus  
• Computerized payslip or  
• Certified letter from company, on company’s  
      letterhead, or ;  
• Notice of A ssessment ;  
• CPF Statement ( 6 months); and  
• Large  Amount questionnaire ( if annual benefit 
is more than $60,000);  
• Medical Tests based on age and amount . 
 
 
Self Employed  
Proposal form plus 
• Notice of Assessment for the last 3  years, or  
• Audited company’s account for the last 3 yrs;  
• Medical test based on age and am ount;  
• Large Amount questionnaire (if annual benefit is 
more than $60,000) . 
 
 
1.  Occupation  
     To measure :  
• Higher risk of disability from accident or sickness . 
 
• Degree of incapacity to return to work. Insurers 
have a rating structure depending on the class of 
occupation.  Some insurers may issue the policy for 
white collar occupations  
 
2.  Benefit Amount  
     To assess benefits proposed are reasonable based on  
     the type of occupation and  stated earnings.  
  3. Benefit Period  
    The duration that the insurer needs to pay out the  
     benefits.  To determine the terms of acceptance.  
 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   23 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 4.  Deferred Per iod  
     A shorter deferred period has a higher element of  
     moral hazard.  
 
 
 
  6. Differences between Cessation of Benefits and Termination of Cover.


key: _node_content
string_value:
{"id_": "1ddd335f-f507-43f2-b252-7677d1664181", "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": "3bc43400-62f1-457b-b7b0-03115fed0842", "node_type": "1", "metadata": {}, "hash": "28775a98ecb8e6a71f12d1577484d7594b1d7317e26466a1bddda55677c07115", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "c7cc892d-3014-440e-8efd-a065b8ec3671", "node_type": "1", "metadata": {}, "hash": "37f00a744a6999521b06de7d3ec1aaa15ebf302c77d28f27c2913f3591abd3f3", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 43773, "end_char_idx": 48028, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
Deferred Per iod  
     A shorter deferred period has a higher element of  
     moral hazard.  
 
 
 
  6. Differences between Cessation of Benefits and Termination of Cover.  
 
 
Cessation of Benefits   
Termination of Cover  
 
 
 Insured is fit to r eturn  to work;  
 
 When de ath occurs;  
 
 Benefit p eriod has expired.  
  
 Policy reached expiry  date;  
 
 Premium is not paid within g race period;  
 
 Insured dies or reached the expiry age;  
 
 Resides outside Spore for an  
   aggregate of more  than a specified  
   no. of days (eg 300 days) within a  
   policy;  
 
 Insured is not employed  in a full time 
occupation or profession for a continuous 
period of a specified number of days (except 
if he is disabled).  
 
   
  
  
7. Group DI can be issued as a Standalone or Rider.  However the group must have a  
 Group Term Life Policy  before they are eligible for DI Policy.  
 
 Group Long Term Disability Income policies are bought by employers to cover senior  
 management employees.  Benefits are payable if the disability is long term, hence there is a  
 waiting period.  
 
  
 
8.  Claims procedures for individual or group disability income are similar . Insured must notify 
insurer within a specified period of time (e. g 60 days ) from the date of commencement of 
disability. Documents insurer ask for includes:  
• Claim form (personal particulars, details of his occupation and disability);  
• Claimant ‘s statement;  
• Clinical Abstract form;  
• Physician’s statement;  
• NRIC/ birth certificate;  
• Evidence of earnings;  
• Letter from company certifying that the insured’s services has been terminated;  
• Medical certificates;  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   24 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) • Laboratory tests results;  
• Police report if disability is due to accident;  
• Incident report  (if incident occurs at the workplace).  
 
 
9. Foreign Residency During Claims P eriod  
If insured resides outside of Singapore while the benefits are payable, following conditions apply:  
• Insurer must be notified of the change in residence within 30 days of change;  
 
• Insurer must approve the new country of residence; 
 
• Insurer has determined that the evidence which can be submitted to make a claim under 
the policy from  the new country of residence, is of similar (or better) standard, as 
compared that which would be available if the insured were to  remain in Singapore.  
 
• Insurer has determined that the expertise and facilities for the care, treatment and 
rehabilitation of the insured in the new country of residence, are similar (or better) 
standard, as compared to those which would be available in S ingapore.   
  
• Insurer reserves the right to require an independent  examination of the insured by its  
 preferred doctor as and when reasonable.  
  
If any of these conditions are not satisfied, insurer reserves the right to suspend the benefits 
payable, until  such time the insured returns to Singapore and the insurer receives satisfactory 
evidence to resume payment of benefits.

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   25 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Chapter 5 –  Long Term Care Insurance  
 
1. Objective of Long Term Care Insurance (LTCI) is to meet costs of care to a person who as  a  
result of accident, sickness is physically impaired and unable to function independently.   They 
need assistance to perform the most basic  activities of daily living  (ADLs).  It pays in addition 
to other insurance policies, eg MediS hield  Life. 
 
 
2. Although this product is meant for the elderly, the young should buy for 2 reasons:  
 
 Cheaper  Premium;  
 
 Higher  chance of being accepted.  
 
 
 
3.


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
2. Although this product is meant for the elderly, the young should buy for 2 reasons:  
 
 Cheaper  Premium;  
 
 Higher  chance of being accepted.  
 
 
 
3. Benefits  offered under LTC  Insurance  
 
 
  Benefits of LTCI  
Daily Basis  Monthly Basis  
a) Service Based  
        
2 Types  
1) Expense Incurred  
Insurer will reimburse costs up to daily 
benefit am ount in the 
policy  (more common 
method);  
  
 
  2) Indemnity Method    
       Pay am ount in the  
       policy regardless  
       of  the cost . b)  Disability Based  
 
• Pay if meets t he  
   benefit trigger;  
  
• Benefit trigger  
  is the criteria   
  used to   
  determine  
  eligibility for LTCI  
  payments.   
• By far the most common 
type of LTC Plan found in 
Singapore;  
  
• Pay 100%  of LTCI 
monthly benefit if unable to perform 4 out of 6 
ADLs;  
 
• Pay 50% of LTCI  
     monthly benefit if  
     unable to perform 2  
     out of 6 ADLs;  
 
 
• Pays if the insured is 
diagnosed to be suffering 
from advanced dementia 
including Alzheimer’s  
disease.  
 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   26 
Produced 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 
received under his LTC to pay for the costs of engaging a maid or to pay for the costs of staying 
in a nursing home.  However, he must meet the following criteria:  
  
 
Criteria for p ayment of LTCI Benefit  
 
 
1a.  Meets the definition of inability to perform Activities  of  Daily Living:  
 Washing  / Bathing  
The ability to wash in the bath or shower (including getting into and out of the bath 
or shower) or wash by other means.  
 
 Dressing  
Ability to put on, take off, secure and unfasten all garments, any braces, artificial limbs, or surgical or medical appliances.  
 
 Feeding  
Ability to feed oneself once the food has been prepared and made available.  
 
 Toileting/Continence  
Ability to use  the lavatory or otherwise manage bowel and bladder functions through 
the use of diapers and urinary catheters, so as to maintain a satisfactory level of 
personal hygiene.  
 
 Mobility ; 
Ability to move indoors from room to room on level surfaces.  
 
 Transferri ng  
Ability to move from a bed to an upright chair or wheelchair vice versa.  
 
 
1b.  Advanced Dementia, or dementia arising from Alzheimer’s disease is covered.  The  
       important issues are that dementia must arise from an organic reason  and that the insured  
       requires continual supervision.  
 
 
2.  Meets the deferred period requirement.  
 
      Most insurers have a Deferred  Period of 90 days  commencing from the first day of any  
      continuous period of inability to perform A DLs. This is to ensure that short term claims are  
      avoided and therefore, reduce the premium costs.   
 
 
3.  Do not cover pre- existing illness  that was not disclosed in the proposal form.  If disclosed,  
     insurer may reject the application or accept the application:  
• at standard premium rates;  
• at substandard premium rates (higher premium);  
• with exclusions.  
 
 
 
 
 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   27 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 5.


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 5. Other benefits payable under LTCI are:  
  
 Death Benefit  
Small  death cover ranging from an e.g $5000 to 6 times the LTC monthly benefit;  
 
 Hospital Room and Board Benefit  
 
 Surg ical Procedure Benefit  
 
 Financial A ssistance with Ada ptation  Benefit ; 
A specified sum, such as 2 times the monthly benefit, is payable if the use of assistive 
device s is de emed necessary (eg wheelchair);  
 
 Extended Care Benefit  
An extra specified sum, such as extra monthly benefit , is payable every 3 to 5 years;  
  
 Rehabilitation Benefit  
A reduced benefit  (e.g 50% of the insured amount) when the insured makes partial 
recovery (such as if he is unable to do 2 instead of 3 ADLs) . 
  
 
6. Among the features of LTC Insurance given in the text at page 89, please know the following:  
 
 Offered on a stand -alone basis or as a rider  to a plan.  
 
 It is issued on a guaranteed renewable basis .  
 
 There is no cash value or paid up value  (with exception of Eldershield which has a paid- up 
value) at any time.  
 
 Policy is non- participating and does not share in the divisibl e surplus of the insurer.  
 
 Premiums are level and usually not guaranteed for the policy period and can be adjusted by 
the insurer.  
 
 If insured recovers from his disability, payments will stop.   However, the insured can choose 
to continue his policy by continuing to  pay the premiums, provided he h as not reached 
maximum limit under his policy.  
 
 
7.  Among the exclusions given in the text at page 89, please know the following:  
 All pre -existing illness;  
 
 Self inflicted injury;  
 
 Alcoholism or drug abuse;  
 
 Acquired Immune Deficiency Syndrome (AIDS) or infection by any human immunodeficiency 
virus (HIV), except where the infection is due to blood transfusion or resulting from 
infection incurred by medical staff  after the issue date;  
 
 Participation in a felony , riot or insurrection.  
  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   28 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  
Chapter 6 –  Other types of Health Insurance  
 
This chapter covers the following health insurance product:  
 
1. Critical illness Insurance;  
2. Hospital Cash (Income) Insurance;  
3. Medical Expense Benefits Under Travel Insurance;  
4. Group Dent al Care Insurance.   
 
 
1. Critical Illness or Dread Diseases(DD)  
1.  
 
 
 
2. Eligibility criteria for p ayment of Critical Illness Benefit .  
 
a. Policy must be in f orce;  
 
b. Life insured has not reached expiry age of Critical Illness Cover;  
 
c. Critical Illness must be one that is cov ered;  2 types   
  Acceleration Benefit;  
 Additional Benefit;  
 
Which is often known as “Packaged  Policy”?  
Ans : Acceleration Benefit  
 
 
 
 
 
 
 Dread Disease or  
Critical Illness   
Purpose  
 
• Provides a lump sum  benefit upon diagnosis of any one of the critical illness;  
 
• It is a hybrid of life and health insurance;  
 
• Can be sold as a stand -alone policy (individual or group) or as a rider to other policy;  
 
• Before 1 August 2014, CI Insurance Policies cover only a maximum of 30 out of 37 
critical illnesses. From 1 August 2014, CI benefits offered under new individual or group 
insurance policies may be launched under 2 changes:  
i. revised standardised definitions of the 37 severe critical illnesses (appendix 6a).  
 
ii. flexibility for more medical conditions to be covered.  Insurers not only can offer 
CI Insurance Policies covering beyond 37 (30 previously), but also offer single 
illness CI Plans.  Definitions for addit ional CI not covered by the 37 standardised 
definitions will be set by individual insurers.  
 
CI using the old definitions will no longer be sold from 15 Feb 2015.


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
Definitions for addit ional CI not covered by the 37 standardised 
definitions will be set by individual insurers.  
 
CI using the old definitions will no longer be sold from 15 Feb 2015.  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   29 
Produced 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;  
The definition of critical illnesses a  as specified in the policy forms an important part of 
the policy, as they will determine whether a claim is payable.  Important to explain to 
prospective client, to ensure he understands the benefits will be paid only if the disease 
qualifies and meets the definitions as specified in the policy. .  
 
e. Critical illness must meet conditions set down by insurer.  The diagnosis of the CI must 
be made by registered medical practitioners, which excludes physicians who are 
themselves (life insur eds), their spouses and other lineal relatives of theirs;  
 
f. Must meet the waiting period of  90 days  from the date of issue or reinstatement;  
 
g. Must meet the s urvival period of usually 30 days , (although can be as short as 7 days) 
from date of occurrence of a critical illness.  It applies  to Additional Type only.  
 
 
3. Among the features of Critical Illness Insurance (CI) given in the text at page 98, please know  
the following:  
 
 Can be issued as a stand- alone basis  or as a rider to a basic policy.  It does not  pay 
upon the life insured’s death or total and permanent disability;  
 
 CI rider has no cash value;  
 
 CI rider is automatically terminated once the basic policy is surrendered or converted 
into an extended term policy;    
 
 Stand –alone term CI Policy does not  acquire cash value, and thus has no non forfeiture 
option;   
  Can be packaged or attached to a Life, Endowment or Investment Linked Policy;  
 
 Packaged CI Policy which accumulates cash value (e.g whole life type of CI Policy) also 
provides non forfeiture opt ions.  However, CI cover may be terminated once  any non 
forfeiture option is exercised except Paid Up Option;  
 
 Assignment may/may not be allowed;  
 
 Maximum age entry (eg 55 years) and minimum age entry (eg 1 year), subject to a lien;  
 
 There is a minimum ( eg $10,000) and maximum (eg $1,000,000) sum assured 
restriction;  
 
 Cover w ill expire at age 65 years, or a whole life cover may be provided.  
 
 
4. There are 2 types of Critical Illness Covers;  
• Acceleration Benefit; or  
• Additional Benefit  
 
 
 
  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   30 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) a) Acceleration Benefit Critical Illness Cover  
 
. 
  Payment of :  
• S$200,000 (death  in lump sum ) or 
 
• S$200,000 (TPD in instalments basis)  S$200,000  Whole Life type of CI Policy with 50% 
acceleration benefit.  
 
Policy owner has the flexibility of choosing the 
percentage of acceleration.  
Scenario 2  
Critical Illness   Scenario 1  
Death/ TPD  
Note :  
• Policy owners who opt for less than 100% of acceleration, should attached a 
Critical Illness Waiver of Premium Rider so that  the future premiums on the 
balance sum assured will be waived.  
 
•  The cover for this type of CI Policy may be up to age of 100 years, or depending 
on the type of life policy to which is packaged/attached.  
 
• Depending on what type of policy CI cover is attached to, if the basic policy has no 
cash value (eg term policy), then there is no non -forfeiture option under the policy 
to 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 
force should policy  owner default s in premium payments.


key: _node_content
string_value:
{"id_": "e9886d6e-508e-4805-a2e7-80388aa43594", "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": "d44a4f06-927d-4ec1-98c3-f0a31ab1303f", "node_type": "1", "metadata": {}, "hash": "4c41d3eeb03f18e44db7ef02942b4cf73af6817aab1641bee6b85abe5615b10f", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "8082946e-eeaa-4eb9-9011-dc34418d2a06", "node_type": "1", "metadata": {}, "hash": "30cd0e79ea7165d31bb58ea32100e152a0118153e2282c71e5d9b703844196ee", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 59638, "end_char_idx": 63725, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
Payment of:  
• S$100,000 (50% of SA)  
Payment of balance Sum 
Assured  
• S$100,000  Upon Death/ TPD  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   31 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) b) Additional Benefit Critical Illness Cover.  
 
  
 
  Payment of:  
• S$100,000 (death  in lump sum ) or 
• S$100,000 (TPD in instalments 
basis)  Whole Life Policy : S$100,000.  
Add on Critical Illness Rider: S$200,000  
 
This type of CI cover is usually available on a 
stand- alone basis or as a rider.  
Scenario 2  
Critical Illness   Scenario 1  
Death/ TPD  
Note :  
• This rider pays in addition to the sum assured of the basic policy it is attached.  
 
•  The term of this rider can be shorter,  but not longer t han that of the basic policy. 
Usually expires at the age of 65 years.  The sum assured of the rider can be 
higher than the basic policy (e.g 5 times  that of basic sum assured)  
 
• Policy owners should at tached a Critical Illness Waiver of Premium Rider  so 
that they need not worry about the premiu m payments for the basic policies to 
which CI rider is attached to.  Payment of CI Rider  
• S$200,000  
Payment of Whole Life 
Policy  
• S$100,000  Upon Death/ TPD  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   32 
Produced 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  
 Severity Based CI  
 
• pays claims during the early stages and less severe critical illness.  Benefits are 
claimable at different stages of the illness, from early  to intermediate  to advanced and 
terminal .  It pays a percentage of the sum assured as a lump sum  payout to the poli cy 
owner.  The progressive lump sum payment, subject to a monetary  cap of each severity 
level, pays up to the total sum assured.   
• Offered as a term plan or a rider; 
• Offered from age 1 to age 75;  
• Premium is higher than normal CI plan.  
 
 
6. Multiple Pay Critical Illness Plan  
 Allows more than one  critical illness claim on the policy.  A second or even third claim is 
allowed if the medical condition deteriorates or if a different medical condition occurs.  Waiting 
period of the second and subsequent claims is usually waived.  
 Eg: Total payouts of up to 200% of  sum assured.  So if the sum assured is $100,000, the plan 
can pay up to $200,000.  
 
 
7. CI Polices usually have a built -in death benefits payable, hence they will come under the 
 Nomin ation of Beneficiaries framework.  Insured who is a policy owner can make a 
 nomination at the age of 18 years and above.  2 options available are Trust Nomination or 
 Revocable Nomination.  
  
8. Termination Of Cover   
• valid CI claim has been made,  
• basic l ife policy to which it is packaged matures or CI rider expires;  
• non-payment of premiums, insured dies  
• policy is converted into Extended Term Insurance Policy . 
 
 
9. In the event of a claim, insured must submit:  
• Claimant  Statement  - completed by insured;  
• Attending Physician’s  Report;  
• Proof of Critical Illness  eg histology report;  
• Written notice of claim must be submitted within 60 days  of diagnosis of CI or performance 
 of surgery;  
• Claimant’s form must be submitted 15 days  from the date the insurer sent it out ; 
• Proof of CI must be submitted within a specified period ( 60 days ) from the date of diagnosis 
 of CI.  
 
10. Group Critical Illness Policy:  
• Will expire at age 65 regardless of whether it is issued as an Acceleration or Additional type.  
• Can be issued a s a pac kage policy or as a r ider.


key: _node_content
string_value:
{"id_": "8082946e-eeaa-4eb9-9011-dc34418d2a06", "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": "e9886d6e-508e-4805-a2e7-80388aa43594", "node_type": "1", "metadata": {}, "hash": "eef622f572bdefff7a0a9c1fe9caaf0f1bf600a027b7b4cb2d4e2f4036e66445", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "c3ccf470-b6c6-45a9-bde5-3b31b9eab975", "node_type": "1", "metadata": {}, "hash": "6a2e7dcd1a8766dd143b02e52e9903b8cf233734b4a7cf616aad9075ddaae796", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 63539, "end_char_idx": 67677, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
Group Critical Illness Policy:  
• Will expire at age 65 regardless of whether it is issued as an Acceleration or Additional type.  
• Can be issued a s a pac kage policy or as a r ider. 
 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   33 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 2. Hospital Cash (Hospital Income) Insurance  
 
1. Pays a daily benefit upon hospitalization regardless of whether it is due to injury or sickness.  
This amount has no direct co- relation to the actual amount of medical fees  incurred.  However 
for sic kness, a waiting period of 30 days from issue/ reinstatement date applies. Waiting period 
does not apply to injury.  
 
2. Hospital Cash :  
• Pays daily;  
 
• Limited by specified no. of days per h ospitalization;  
 
• Limited by a lifetime limit.  
 
• It pays o n top of other benefits received from medical insurances.  
 
• Must be confined in hospital for at least  6 to 24  hours.  
 
• Premium is on age band basis .  
 
• There is a “ No Claim Discount ” given for policy  that is inforced for a consecutive period of 
insurance and free of any claim.  A certain percentage (eg 25%) will be deducted from the 
next renewal premium.  
 
3. Standalone Policy is more attractive than as a Rider in these ways:  
 
• Double Payment  –  if stays in ICU;  
 
• Triple Payment  –  hospitalized due to accident or insured is hospitalized overseas ;  
 
• Get Well B enefit;  
 
• Rehabilitation Income;  
 
• Free Accidental Death B enefit.  
 
• Involuntary loss of employment benefit (in excess of 30 days) - waiver of premiums (up to 
6 months ). 
 
4. Hospital Cash Policy is usually not written due to its small premium, however pre-existing              
medical conditions are permanently excluded under the policy.   
 
 
5. Claims  
 Require to submit the following:  
•  Claim form;  
• Hospital discharge summary bills;  
 Additional documentary evidence:  
• Attending Physician’s Report;
 
• Other relevant supporting documents .  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   34 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 3. Medical Expense Benefits under Travel Insurance  
 
1.  The benefits offered by a Travel Insurance Policy include:  
 
1. Medical Expenses and Other Related Benefits  
2. Hospital Confinement Allowance;  
3. Emergency Medical Evacuation; and  
4. Repatriation.  
 
 
1.  Medical Expenses and Other Related Benefits   
 Reimburse most of the overseas medical  and treatment  as follows:  
• Medical expenses  such as clinical, hospital surgical nursing, ambulance and medical 
supply charges, emergency accidental and miscarriage expenses, including any follow –
up medical expenses in Singapore i ncurred within a certain period (usually 31 days) 
after the insur ed returns from his trip.  
 
• Expenses incurred for treatment by Traditional Chinese Medicine physician, including 
acupuncturist, bonesetter, chiropractor, herbalist or physiotherapist, up to a limit (e.g 
S$750)  
 
The above is subject to a n overall limit of indemnity (e.g S$2,000,000) . 
Lower limit will apply to a child (from one to 18 years) or elderly (above age of 70 years).  
 
• Reasonable additional accommodation  and travelling expenses  incurred by insured 
person (and a travel companion if required) to remain in the overseas country of visit for 
medical treatment, up to a limit (e.g $25,000) and  
 
• Hospital visit –  accommodation expenses necessarily incurred by one relative or friend 
of the insured who has been hospitalized overseas for more than 5 days to visit and stay 
with him until he is medically fit to return home up to a limit (e.g S$10,000).  
 
 
2.


key: _node_content
string_value:
{"id_": "c3ccf470-b6c6-45a9-bde5-3b31b9eab975", "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": "8082946e-eeaa-4eb9-9011-dc34418d2a06", "node_type": "1", "metadata": {}, "hash": "30cd0e79ea7165d31bb58ea32100e152a0118153e2282c71e5d9b703844196ee", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "fb21a992-21cd-4849-bdc3-27197e197e24", "node_type": "1", "metadata": {}, "hash": "74eb7105e50890e4b7c2141cb95370a81d29409a467ad341e8b5258e83533e04", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 67675, "end_char_idx": 72390, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
2. Hospital  Confinement Allowance  
This entitled the insured to claim if he is hospitalized abroad for:  
• A daily cash payment (e.g S$200 per day);  
 
• Up to a certain period (e.g 250 days) or   
 
• Up to a certain amount  (e.g S$50,000)  
 
• Double benefit for overseas hospitalization in an intensive care unit resulting from an 
accident up a certain period (e.g 10 days).  
 
For hospitalization in Singapore when treatment is sought within a certain period ( e.g 7 days) 
upon return, the limits are lower (e.g S$100 per day payable up to 10 days).  
 
The benefits are payable upon his return to Singapore, when he submits a claim with all 
relevant supporting documents.  
 
  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   35 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 3. Emergency Medical Evacuation   
Emergency evacuation means that, in the event of a critical  situation in which the insured 
person suffers a serious illness or injury abroad, and has to be evacuated to another place to 
seek emergency treatment, because local medical services are inadequate or unavailable.   
 
Insured must  contact a specialist company  contracted by the insurer to provide emergency 
medical evacuation.  Such specialist company shall then decide whether  or not the insured 
requires emergency evacuation.  A 24 hr multilingual hotline phone number of such specialist 
company is specified in the policy.  
 
There is usually a maximum benefit limit (e.g S$500,000) payable for the lower coverage plan.  
However for the higher coverage plan, the coverage amount is usually unlimited.   
  
4.  Repatriation  
• Emergency medical repatriation occurs when, as a result of an unfortunate illness or 
accident abroad, the insured has to be repatriated to his country of origin (e.g return to 
Singapore).  The decision as to whether he should be repatriated strictly rests with the 
attending medical doctor or the insurer’s contracted specialist company.  
 
• Repatriation of remains means the transportation of and return of the deceased 
insured’s mortal remains to his country of origin.  
 
• There is usually a maximum benefit limit (e.g S$30,000) payable for the lower coverage 
plan.  However for the higher coverage plan, the coverage amount is usually unlimited  
 
 
2.  Exclusions  
 Among the exclusions given in the text at page 115, please know the following:  
•  Driving or riding in any kind of race, engaging in any professional sport, ice or winter  
sport, mountaineering requiring the use of guides and ropes, or underwater activity 
involving the use of underwater breathing apparatus;  
 
•  Aerial activity other than air travel as a fare paying passenger in a licensed passenger - 
 carrying aircraft;  
 
• 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 
policy already issued or the trip already commenced before the date of publication or advisory; or  
 
•   Travel booked or undertaken against medical advice, or for the purpose of obtaining or  
 seeking any medical care or treatment abroad.  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   36 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 4. Group Dental Care  
 
1. Group Dental Care:   
 
• Offered on a group basis without underwriting . 
 
• It can be a rider attached to a Group Hospital & Surgical or as a Sta ndalone policy.  
 
• Coverage is usually on a 24 hrs worldwide basis, only employees who are actively at  
work are covered and it is usually on a non contributory  basis.  
 
• Pre-existing dental conditions are covered as well.  
 
• Affected by the Limit ation Clause, hence reimbursement will be affected by workmen’s 
compensation or other dental plans.  
 
 
2. Exclusions:  
• Dental procedures that are not specified in the schedule of allowances;  
• Hospital charges;  
• Injuries arising from war (declared or undeclared), revolution, or any warlike operation;  
• Medicine given;  
• Treatment which is purely cosmetic in nature;  
• Treatment resulting from self – inflicted injury, while sane or insane and  
• Replacement of broken, lost or stolen denture s.  
 
 
3.


key: _node_content
string_value:
{"id_": "fb21a992-21cd-4849-bdc3-27197e197e24", "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": "c3ccf470-b6c6-45a9-bde5-3b31b9eab975", "node_type": "1", "metadata": {}, "hash": "6a2e7dcd1a8766dd143b02e52e9903b8cf233734b4a7cf616aad9075ddaae796", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "147e01fa-6106-41e2-b336-f650eb362f4a", "node_type": "1", "metadata": {}, "hash": "4cec7dee794a01d50d6c4a8982aec6e9962c7d51e99c3eb899f43bc7b7b077f2", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 72388, "end_char_idx": 76770, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
3. Terminations:  
• The date of termination of the insured employee’s active full time employment;  
• The date of termination of the policy;  
• The date of expiration of the period for which the last premium payment is made in respect of the insured employee’s cover’  
• The date on which the insured employee enters full time military, naval, air or police service, except during peacetime National Service reservist duty or 
training;  
• The date of expiration of the period within which the insured employee reaches a 
specified age (usually age of 65 years)  
  
4. Claims  
 For employee who uses his own dentist , they need to pay first and file a claim with the insurer.   
 Documents are:  
 
• Claim f orms  
 
• Original receipt  & itemized bills.  
 
 For insurer that has its panel of dentist , employee need only produce the m embership card  
 whenever he visits the dentist and the clinic will bill insurer directly.   
  
  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   37 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Chapter 7 –  Managed Health Care (MHC)  
 
1. 
 
An overall strategy for containing medical care costs, while receiving 
appropriate medical care. It will pay for most of the medical bills when an 
individual sees a General Practitioner, specialist or receive treatment in a 
hospital.     
 
     
 Managed Health Care  
(MHC)  
Purpose  
Cost    - 4 methods  
• Capitation;  
Capitation means   
MHCO prepays their  
providers a flat 
amount  for each  
member’s medical care 
on a monthly basis.  
 
• Discounted fee for  
Service (e.g discount 
of 10% on physician 
fees)   
 
• Salary;  
 
• Fee schedule .  
 Quality of care.   
 
Health care 
providers must 
possess  requisit e 
skills, training and licenses as MHCO 
is concerned 
about the quality 
of care for a good 
reputation as that 
is what attracts 
new members and 
keep existing 
ones.  
  
 
 
 3 components to contain and control Healthcare 
expenditure  
Qn:   
Which of the above payment methods used do 
not discourage the provision of unnecessary 
medical services? 
  
Answer: Discounted Fee For Service &  
              Fee Schedule  A primary care physician is 
usually a general 
practitioner.  He is often 
known as:  
 
 Personal Physician  
Serves the member as his “personal physician”, 
but also acts as the first 
contact with MHC.  
   
 Gatekeeper  
Member must obtain a 
referral from the PCP 
before seeing a 
specialist, hence called 
“gatekeepers”.  
 Accessibility  
• Easily accessible;  
 
• Requires members to  
     select one doctor to be  
     their Primary Care  
     Physician (PCP) . 
 
 
 
 
 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   38 
Produced 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  
 Managed Healthcare Plans  
Health Maintenance 
Organisation (HMO)  Point of Service 
Plan (POS)  
1. Staff Model  
HMO  Preferred Provider 
Organisation (PPO)  
2. Group 
Model HMO  3. Network 
Model HMO   5. Mixed 
Model HMO  4. IPA 
Model HMO  
1. Staff Model HMO  
• HMO employs PCPs who usually work together in a centre to treat members who 
are only members of the HMO.  Specialist care need is refereed to certain 
contracted specialist.     
• Very effective in managing costs as have control over the physicians they employ. 
Compensates physicians on a predetermined salary.  
 
• Physicians have no financial incentive to over treat the patients.  
  
2.  Group Model HMO   
• Made up of 2 entities : HMO is the organizational entity that runs the healthcare 
business and it will contract a large group medical practice to provide medical care services to its members.  
 
• Same cost –management potential as Staff Model HMO as the group practice 
obtains all or a vast majority of its patients from the HMO, thus giving HMO a high 
degree of leverage over the negotiation of payments.  
  
3.


key: _node_content
string_value:
{"id_": "147e01fa-6106-41e2-b336-f650eb362f4a", "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": "fb21a992-21cd-4849-bdc3-27197e197e24", "node_type": "1", "metadata": {}, "hash": "74eb7105e50890e4b7c2141cb95370a81d29409a467ad341e8b5258e83533e04", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "1f5cb6b3-6977-4ac4-92fb-d8c6b1a53969", "node_type": "1", "metadata": {}, "hash": "f43bd4a594628bf3c3052433ad690cff8e92e070f572c698d5b7c0bb78213f78", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 76768, "end_char_idx": 81180, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
3.  Network Model HMO   
• Similar to Group Model HMO, except that in this model, it contracts with a relatively 
large number of group  practices and even individual physicians.  
 
• Physicians operate out of their own offices or facilities provided to them by their 
group practice. Physicians may provide services to more than one HMO.  
 
• Does not have as tight control over utilization management as the above 2 
models as physicians may t reat patients on a fee for service basis and HMO 
arranges for hospital services rather than physicians.  
 
 
  
 a b  c 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   39 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  
 
 
 
 
2b. Preferred Provider Organisations (PPOs )  
 
 Similarities  
 
PPOs are similar to HMOs in that they enter into contractual arrangements with healthcare 
providers who together form a “ provider network”.  Physicians provide care at lower rate in 
exchange for more patients directed towards them . 
 
 Differences  
 
1.  Unlike HMO, members do not have a PCP (“ gatekeeper ”) and are not restricted to use only 
the provider network for their care, as they can choose to see a non network provider.  
 
2. PPO member does not have to get a referral to see a specialist.  
 3.  PPOs are less restrictive than HMO in the choice of healthca re providers.  However they 
tend to require greater “out of pocket” payments from members.  
 
 
 
2c. Point -of- Service Plan (POS)  
• Combination of a HMO and PPO . 
 
• Encourage, but does not require a member to choose a PCP.  
 
• Allows members to use a provider who is not in the net work  for his care, however he 
has to pay higher co -payments and/or deductibles than member who uses a PCP.  
 
• Known as  point -of –service plan because, at the point when a member needs  
healthcare 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 
PCP. 
 
 
  4.  Independent Practitioners Association (IPA) Model HMO  
• Also contract with other entities to provide medical care services to its members.  
 
• IPA physicians continue to develop their own private practices and in fact, HMO members represent only a small percentage of their patient list.  
  
5. Mixed Model HMO  
• Combination of 2 or more of the above 4 types of plans.  
 
• They offer broader  consumer  choice of physicians and clinical settings.  
 
 
 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   40 
Produced 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  
 Know this diagram well  for 3a and 3b   
 
 
 
 
3a. In ascending order, list the models given below from the most cost effective  to the least cost   
 ineffective.    
  
 POS, Network Model HMO, IPA, Staff Model HMO, PPO  
 
 Answer : Staff Model HMO/Network Model HMO/IPA/POS/PPO  
 
 
3b. In descending order, list the given models in question 3a from most flexibility to least flexible.  
 
 Answer:  PPO/POS/IPA/Network Model HMO/Staff Model HMO  
 
  Group Mod el HMO  
 PPO  
IPA HMO  POS  Traditional Medical Expense Insurance (highest premium ) 
Staff Model HMO  
(lowest premium )  Network Model HMO  
 
Degree of choice of providers  
Cost Control  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   41 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 4. Revision of MHC Plans:  
  
Clues  Model  
1. This model is most effective in managing cost . 
 Staff Model HMO  
2. This model is made up of 2 entities. The organizational entity that 
does everything it takes to run a healthcare business except actual 
practice of medicine.   
Group Model 
HMO  
 
3.


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
This model is made up of 2 entities. The organizational entity that 
does everything it takes to run a healthcare business except actual 
practice of medicine.   
Group Model 
HMO  
 
3. The physicians in this model develop their own  private practices .  IPA Model HMO  
 
4. Offer combinations of a few HMOs.  They offer broader choice 
consumer choice of physicians.  Mixed Model 
HMO  
 
5. This model contracts a large number of group practices, including 
individual physicians.  Network Model 
HMO  
 
6. Members do not have a PCP (“gatekeeper”) and are not restricted 
to use only the provider network for their care.  PPO  
 
 
7. The members in this model do not need to choose how to receive 
services until they need them. Combination of HMO and PPO.  POS  
 
 
  
 
5. Benefits offered include:  
• Primary care;  
• Specialist care;  
• Hospital care;  
• Emergency care;  
• Preventive  care;  
 
 
6. Like other types of traditional Health Insurance, elements of co -insurance and deductible may 
be found  in MHC Insurance.  
 
 
7. One exclusion  under MHC Insurance Policy states that payment from MHC plans will be 
excluded by reimbursements from Workmen Compensation and other forms of i nsurance 
coverage.  
  
  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   42 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 8. Claims for MHC  
  
 
In- the- network providers 
  
Out-of-network providers 
Members who use in -the-network providers  
need not file claims with the insurer  Members who use out -of-network providers 
need to file claims with the MHCO. 
Supporting documents to be submitted 
include:  
• Claimant’s statement; and  
 
• Original itemized medical bill.  
 
.  
  
  
   

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   43 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Chapter 8 –  Healthcare Financing  
 
1. 
 
  
 
2. Government Subsidies include the following:  
  
Government Subsidies   
In Public Hospitals  
Inpatient  Specialist Outpatient Clinics 
(SOCs)  Other services  
• Ward classes differ only in 
the physical amenities and 
level of comfort, however the standard of medical care is 
the same regardless of the 
ward's class.  
 
• In Jan 2009, means testing 
in public hospitals was 
introduced to better target 
the heavy subsidies for 
class B2 & C  wards at the 
lower -income group. The 
subsidy received depends on 
the monthly income of the 
patient.  B2 or C class 
patients who require follow -
up at the specialist 
Outpatient Clinic (SOCs) will 
continue to receive 
subsidies.  
 • Subsidy for lower -to-middle  
 income is 70% &  60% 
respectively, while the rest of 
the subsidised patient  is 
50%.  
 
• For standard drugs :  
Lower -to middle- income  
receives a 75% subsidy; 
while the rest of the 
subsidised patient is 50%.  
 
• The eligibility for higher subsidy is based on the 
household monthl y income 
per person, or annual 
value of residence (for 
households with no 
income ) and is aligned with 
the eligibility for the 
Community Health Assist 
Scheme(CHAS).  • Day surgery and 
Accident & 
Emergency (A&E) 
services are not 
means-  tested.  Singapore Healthcare Philosophy  
 
Affordab ility and Accessib ility of 
Basic Healthcare  
        
• Heavy subsidies for basic 
services  (primary, acute and 
step down care) .   Individual and Collective 
Responsibility  
 
• Individual medical savings account;  
  
• Co-payment by individuals; and  
  
• Risk-pooling for catastrophic 
illnesses and for serious long- term 
disability.   
      based on  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   44 
Produced in collaboration with Julia Sim.


key: _node_content
string_value:
{"id_": "acac1f32-f566-4da7-9dbe-791f91a03bb7", "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": "1f5cb6b3-6977-4ac4-92fb-d8c6b1a53969", "node_type": "1", "metadata": {}, "hash": "f43bd4a594628bf3c3052433ad690cff8e92e070f572c698d5b7c0bb78213f78", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "e300149d-5f0c-4e5a-9b99-0adfe72c79ad", "node_type": "1", "metadata": {}, "hash": "a9e1c4c0497f99e9f1ba0bf467ab02ee058215627f0a830a344807dd720b8b67", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 85016, "end_char_idx": 89273, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
based on  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   44 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )                                                     
                                                      Government Subsidies  
Other Public / Community Services  
Government Polyclinics  
• Services provided is subsidised at about 
50%.  75%  if the patient is a child or 
elderly.  
 
• Standard drugs -  subsidy  of 75% for 
lower -to-middle income patients. Means -
testing aligned to CHAS.  
 
• With CHAS,  lower -to-middle 
Singaporeans will receive subsidised primary care at GPs and dental clinics in 
their neighbourhood.  
 Voluntary Welfare Organizations(VWOs)  
• Provides healthcare services such as 
renal dialysis, mental rehabilitation and nursing home care.  
 
• MOH funds 50%  of operating expenses 
of these VWOS and 90%  of their capital 
expenditure.  
 
3.  CPF Healthcare Financing Schemes  
 CPF Schemes which can be used to meet members’  healthcare needs are : 
 
A. Medisave;   
B. MediS hield Life;   
C. Integrated Shield Plans and  
D. ElderShield and ElderShield Supplement . 
 
  
A. Medisave  
1. National healthcare saving scheme where the amount contributed is from the CPF members 
and their employers.  Amounts in the MA earn an annual interest rate of 4%  and can be used 
to pay for a member or their immediate family's medical expenses.  Immediate family refers to 
spous e, children, parents and grandparents .  Grandparents must be  Singaporeans o r 
Singapore Permanent Residents (SPRs) .   
 
2. 2 Changes f rom 1 Jan 2016 :  
 
1.  Basic Healthcare Sum (BHS)  
• Medisave Contribution Ceiling is the maximum balance a member can save in his 
Medisave Account (MA) will be renamed as the Basic Healthcare Sum(BHS ) set at 
$49,800 (as of Jan 2016) for CPF member.  If the member is of age 65 years & 
above in 2016, this sum  will be his BHS for life.  However if he is below age of 65 
years, BHS applicable to him will be adjusted yearly in January .  When a CPF 
member reaches the age of 65, the BHS for him will be fixed at the BHS that year 
and the amount will not change for the rest of his life.   
 
• Amount in the MA up to the BHS cannot  be withdrawn.  Medisave contributions will 
go into the MA until it reaches the BHS, any amount above the BHS will be 
automatic ally transferred to the members' Special or Retirement Accounts to boost 
his monthly payouts . If the member already met his Full Retirement Sum, amount will 
flow to his OA, can be withdrawn as cash from age 55.   
 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   45 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 2. Removal Of Medisave Minimum Sum  
• Medisave Minimum Sum has been removed , hence CPF member will no longer be 
required to top up his Medisave Account  to the Medisave Minimum Sum when 
withdrawing his CPF Savings (OA & SA) at the age of 55 years. This provides 
certainty  on how much a CPF member can withdraw from his OA & SA after the age 
of 55 years.  
 
3. Uses of Med isave  
 Medisave can be used to pay for hospitalisation and selected outpatient treatment   
 expenses  (up to the withdrawal limit s) such as :  
• Colonoscopies;  
• Mammograms ;  
• Chemotherapy and radiotherapy.  
 
 It can also be for the following subject to withdrawal limits and other conditions:  
a. Inpatient Expenses -  daily ward charges, doctor's fees  & inpatient charges of medical 
treatment, investigations, medicines, implants, prostheses introduced during surgery . 
 
b. Day Surgery And Surgical Operation.  - CPF members age 50 and above can use their 
Medisave to pay for their screening of colonoscopies & mammograms at approved 
medical centres up to speci fied limit .  
  
c. Inpatient Psychiatric Treatment .


key: _node_content
string_value:
{"id_": "e300149d-5f0c-4e5a-9b99-0adfe72c79ad", "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": "acac1f32-f566-4da7-9dbe-791f91a03bb7", "node_type": "1", "metadata": {}, "hash": "01345cbaacc426336c28a6c66ca73bce4ad0ad483a3273e73a8afd646b0c7d97", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "20e863f2-d2ea-40f4-b152-b779ce2130ab", "node_type": "1", "metadata": {}, "hash": "790b47d4d6c32b51cd27a39afd67d7cd3c45d632646dd624f836529ef0024b48", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 89237, "end_char_idx": 93686, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
c. Inpatient Psychiatric Treatment .  
 
d. Inpatient Stay in C ommunity/Convalescent Hospital & Inpatient Hospice and Approved 
Treatment in Day Hospital & Day Rehabilitation Centre . 
 
e. Outpatient Treatment For Approved Chronic Disease Under The Chronic Disease 
Management Programme (CDMP).  
1.  Medisave can be used to pay for outpatient  treatment for 19 approved chronic 
 diseases under CDMP such as diabetes, high blood cholesterol, hypertension 
 or  asthma .  These diseases can:  
• result in serious complications like heart disease, kidney failure and leg 
amputations if not well managed; and  
 
• have high cost of treating them over the long term if poorly controlled.  
 
2. The aim of allowing Medisave use under CDMP is to :  
• lower long- term healthcare costs; and  
 
• improve care for patients with chronic diseases, resulting in better health 
outcomes.  
 
3. Under CDMP, Medisave can be used to pay for :  
• consultations;  
• drugs/medications (including non standard drugs);  
• laboratory tests;  
• diagnostic tests, eg eye screening, foot screening; and  
• allied health services, such as nursing and physiotherapy as referred by 
the doctor . 
 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   46 
Produced 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, 
blood pressure monitoring equipment, wheelchairs, prostheses, or other home 
nursing equipment.  
 
5. To avoid over -consumption patients must make a 15% cash co-payment for all 
CDMP claims.  The amount of Medisave that can be used for CDMP is $400 per 
immediate family member's MA per calendar year, up to 10 MAs can be used for 
each claim.  
  
f. Approved Outpatient Treatments  
• Approved vaccinations (e.g Hepatitis B, pneumococcal disease, Human 
Papillo mavirus (HPV), vaccinations on National Childhood Immunization 
Schedule).  
• Screening mammograms;  
• Renal dialysis;  
• Cancer treatment (Chemotherapy, radiotherapy and related diagnostics); and  
• Outpatient scans required for diagnosis and/or treatment of a medic al condition.  
  
g. Maternity Charges & Assisted Conception Procedure Treatments  
• Medisave Maternity Package allows a f emale CPF member  or her family 
member to use Medisave to  pay for pre delivery expenses and delivery 
expenses  (eg consultations and Ultrasound) and delivery expenses.  
 
• Couples can use their Medisave up to a lifetime limit of S$15,000 per patient to 
pay for Assisted Conception Procedure  treatments which must be performed 
locally.  Only Medisave accounts of the patient a nd her spouse  can be used.  
  
h. Buying Medical Insurance  
  Medisave can be used to pay for approved Integrated Shield Plans , ElderShield and 
  ElderShield Supplements from approved insurers.  The use of Medisave to pay for  
  insurance premiums is subject to withdrawal lim its. (cover later).  
 
 
4.  Where Can Medisave Be Used?  
 In all public healthcare institutions, as well as approved private hospitals and medical 
 institutions.  
 
 
5.  Whose Medisave Can Be Used?  
• Patient's immediate family members (i.e spouse, parents and children) can use their 
Medisave to pay for the hospitalisation bill. Eg. 2 children can specify how much each 
will pay for their mum's hospitalisation bill.  
 
• If immediate family members' MAs is not enough  to pay for the bill, then non immediate 
family members e.g brothers and sisters can appeal to help settle the bill. This option is 
only available if the patient qualifies under certain conditions, e.g stayed in class B2 or 
C ward of a public hospital   and has exhausted the moneys in his own and 
immediate family members' MAs.  
 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   47 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 6. Distribution of Medisave Upon Demise 
 
 
 
 
 Remaining Medisave balance :  
• If a nomination is made -  Payable to the nominated beneficiaries.


key: _node_content
string_value:
{"id_": "20e863f2-d2ea-40f4-b152-b779ce2130ab", "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": "e300149d-5f0c-4e5a-9b99-0adfe72c79ad", "node_type": "1", "metadata": {}, "hash": "a9e1c4c0497f99e9f1ba0bf467ab02ee058215627f0a830a344807dd720b8b67", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "fabe35c7-dd48-4a31-a037-bebed5249939", "node_type": "1", "metadata": {}, "hash": "2ec3aeff069e77f61167d5ec1a9cd3fc8f96a6f917e568c33c1147ca2c2e316c", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 93540, "end_char_idx": 97967, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
Distribution of Medisave Upon Demise 
 
 
 
 
 Remaining Medisave balance :  
• If a nomination is made -  Payable to the nominated beneficiaries.  
 
• If no nomination is made, balance would be distributed by the 
Public Trustee to his family members under the Intestacy laws for 
non-Muslims, or the Muslim Inheritance laws for Muslims.   Admission to hospital  just before death  
Patient had authorised  to use his 
Medisave to pay his medical bill, all his Medisave balance will be used to pay in 
full, without being subject to withdrawal 
limits to pay his last medical bill.  Patient had not signed the Authorization 
Form before his demise, his immediate  family 
member / relative could sign the form to pay 
his last inpatient medical bill .  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   48 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) B. MediShield Life  
1.  Unlike Medisave which is a savings scheme, MediShield Life is a basic healthcare insurance 
 scheme which replaced  MediShield on 1 Nov 2015.  It is compulsory  for all Singaporeans  
 Citizens an d SPRs, regardless of where they reside.  They is no need to apply for MediShield 
 Life, all are cov ered for life, in line towards universal insurance coverage from 1/11/2015.  
 
 
2. It offers :  
• Better protection and higher payouts , so that patients pay less Medisave/cash for 
large subsidised hospital bills;  
 
• For protection for all Singapore C itizens and SPRs, including very old and those who 
have pre- existing illness;  
 
• Protection for life .   
 
 
3. Benefits will be enhanced under MediShield Life, with higher claim limits and lower co-
 insurance rates, so that MediShield Life pays more and patients pay less. (Table at pg 24 of 
 text).  
 
 
4. MediShield Life premiums will be higher than MediShield premiums due to:  
a. Better benefit s than MediShield;  
 
b. Cover Singaporeans with pre -existing conditions. Those with serious pre- existing 
conditions may have to pay additional premiums (of 30% of standard MediShield 
Life premiums) for 10 years .  The additional premiums does not reflect actual 
costs of coverage as the Government bears most of the cost;  
 
c. More even distribution over lifetime : Premiums are higher during working age,  
so that premiums will rise lesser in old age.  
 
 
5. MediShield Life Subsidies  
 
MediShield Li fe Subsidies  
 
Type of Subsidy  
 Subsidies R eceived  
Premium Subsidies  
 
Criteria :  
• For lower -to-middle income families;  
 
• Monthly income per person of S$2,600  and 
below and living h omes of an Annual Value 
(AV) of S$21,000 and below.  AV covers all 
HDB flats and some  private properties.  
Those with more than 1 property will not be 
eligible for this subsidy.  
 
 
   
 
 
50%  of their premiums.  PRs will received 
1/2 the subsidy rate applicable to 
Singapore Citizens.  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   49 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  
 
 
6. MediShield Life Claim Payouts   
• It pays on a reimbursement basis , subject to the limits imposed on the covered medical 
expenses, as well as deductibles, co- insurance and pro-ration factors.  
 
• Deductible is the fixed amount  payable by the insured once every policy year.  However 
insured member need not pay deductible  for outpatient treatments covered under 
MediShield Life.  
 
• Co-insurance is the percentage of the claimable amount which insured will have to pay on 
top of the deductible.  The larger  the bill, the lower will be the co- insurance payable.  
 
• Pro-ration is the percentage that the CPF Board will use to pro -rate a patient's bill to the 
equivalent full subsidy bill size.  Thus bills incurred in Class A, B1 or B2 + wards  in public 
hospitals /private hospitals are pro -rated to the equivalent B2/C (MediShield Life is sized 
for B2/C class wards in public hospitals) bills and then subject to the MediShield Life claim 
limits.


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
• Hence with limits imposed on the covered medical expenses, as well as deductibles, co -
insurance and pro -ration factors, the scheme will never  pay the full bill (Eg 8.1 of text) . 
    
Pioneer Generation Subsidies  
• Pioneers refer to living Singaporeans who 
meet 2 criteria :  
a.  Age 16 yrs and above in 1965 (born on  
     or  before 31/12/1949, which also means  
    that they are 65 yrs and above in 2014);  
    and 
  
b.  obtained citizenship on or before 31 Dec  
    1986.  
    ( Pg. 4 1, 7.1) 
  
 
• Between 40% & 60%; regardless of their household monthly income per 
person or AV of their home.  
 
• Will also received S$200 to S$800 a year in Medisave top- ups (depend on 
year of birth) for life, which can be used 
for their MediShield Life  premiums.  
(Pg 42,7.1.3)  
 
 
Transitional Subsidies  
To ease the shift to MediShield Life for all  
Singapore Citizens whose net premiums (after  
all the above subsidies) increase in  
comparison to MediShield premiums,  
regardless of their household income or AV of  
their home.   
• Available for the first 4 years of 
MediShield Life;  
 
• 1st Year - Government will pay 90% of 
the net premium increase (after above 
subsidies);  
 
• 2nd to 4th years  -  Government will 
cover 70%, 40% & 20% of the net 
premium increase of MediShield Life.   
 
 
Additional Premium Support  
Families needing assistance with their 
premiums even after above subsidies and 
Medisave use.  
  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   50 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 7. MediShield Life Scheme Act   
 Keys features of the Act are:  
• Extension of lifelong, universal coverage and better benefits for all Singapore Citizens 
and SPRs;  
 
• Establishment of the MediShield Life Council to review the administration of the Scheme 
in line with the policy intent;  
 
• Providing for access to information to facilitate the extension of MediShield Life prem ium 
subsidies to eligible households and scheme administration; and  
 
• Powers for the recovery of premiums from willful defaulters as a last resort, to ensure  
that the premiums are paid in a timely manner.  
 
 
Section 10 of the MediShield Life Scheme Act  2015 states that :  
1. Rights and benefits of an insured person arising from the insurance cover under the 
 Scheme are not assignable or transferable.  
 
2. Policy does not  create any legal or equitable trust.  
 
3. Section 73 of the Conveyancing and Law of Property Act (Cap.61) and Section 49L  of 
 the Insurance Act (Cap 142) do not apply  to any policy under the Scheme;  
 
4. The Insurance Act does not  apply to the Scheme or anything under this Act.  
  
8. MediShield Life Fund    
• MediShield Life is a not -for-profit , long term insurance scheme.  
 
• Renewal of MediShield Li fe policy every year is guaranteed, reg ardless of whether they 
develop serious illness after they join.  
 
• Premiums co llected are put in the MediShield Life Fund, based on the actuarial principles 
and to be self -sustaining with each age group paying premiums to support its own current 
and future claims.  Premiums are adjusted every 3 to 5 years, taking into account any 
variation in claims experiences and benefits enhancement .   
  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   51 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) C. Integrated Shield Plan (IPs)  
 
1. IPs are Medisave- approved hospitalisation insurance plans, made up of 2 parts:  
 
 
• On 1 Nov 2015, those w ho have IPs are covered under MediShield Life and there is no 
duplication of coverage between IPs and MediShield Life.


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
• The following plans are IPs:  
• AIA HealthShield Gold Max;  
• Aviva MyShield;  
• Great Eastern SupremeHealth;  
• NTUC IncomeShield;  
• Prudential's PruShield.  
 
 
2. Insurance representative to highlight to client:  
 
a. If they wish to stay in private or subsidised ward in a public or private hospital and if 
they wish to choose their own doctors.  From the usage of IP Policyholders, it seems 
to show t hat there is a significant degree of overconsumption in the purchase of IPs.  
 
b. Premiums for IPs are higher than MediShield Life and increase significantly as an  
insured persons get older and they are not guaranteed.  
 
c. The private component of the IPs premiums may not be fully payable by Medisave.   
Policyholders may have to pay part of their IP premium in cash.  
 
d. There are different benefits provided in the IP Policy and plans can be "as charged" 
or "non -as-charged" (sub limits imposed).  
 
 • Provides higher coverage  (e.g covers costs 
of private hospitals or Class B1 or A  wards in 
public hospitals).  
 
• Managed by a private Insurer . 
    
       MediShield Life  • Enough to cover your large hospital bills in 
class B2 or C  wards in public hospitals .  
 
• Managed by CPF Board.   
Additional Private 
Insurance Coverage An Integrated Shield Plan has 2 parts:  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   52 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 3.  Integrated Structure Of IPs   
 
 
 
 
 2. A person insured under IPs will also be able to receive the applicable MediShield  
  Life subsidies eg.  
• Premium Subsidies for lo wer-to-middle income;  
• Pioneer Generation Subsidies;  
• Transitional Subsidies.  
 
but will not  be eligible for Additional Premium Support .  Those who cannot afford to  
pay IP should remain on MediShield Life.  
 
 
3. Changes to MediShield Life will affect private insurers.  Increase in coverage in  MediShield 
Life is expected to reduce claims from private insurance components of  the IPs. However 
this does not mean that the private insurer will pay less.  They will need to factor in claims 
experience and medical inflation along the benefits offered to decide on the level of 
premiums for additional private insurance coverage.   
 
IPs insurers have committed to leave the private insurance component of premiums unchanged for 1 year from the launch of MediShield Life.  Nonetheless overall IPs 
premium will increase when MediShield Life is launched owing to the higher premiums for 
MediShield Life component of the IPs.  
  Structure & Premiums  
• IP policy holders will enjoy the benefits of MediShield 
Life within his IP Policy.   
 
• He will pay one premium to his private insurer who 
will then arrange with CPF Board on the amount claimable under MediShield Life component.  
 
• He need not liaise with both parties.   
 
Coverage for IP  
IP insurers are allowed to risk -load insured members 
with pre -existing conditions for the private insurance 
components of the IPs.  
 
Coverage - MediShield ife  
• He will be covered for pre- existing conditions  for 
life under MediShield Life even though the condition 
may excluded by the IP Insur ers.  
     
       MediShield Life   
Additional Private 
Insurance Coverage 1. An Integrated Shield Plan has 2 parts.  The premiums paid to private insurers also 
 comprises 2 parts:  
• Premium for MediShield Life component; and  
• Premium for additional coverage by the IP insurer.  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   53 
Produced 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   
 
MediShield Life 
 Integrated Shield Plan  (IP) 
Administrated by CPF Board .  Administrated and insured by only insurers  as 
approved by MOH .  
 
Designed for B2 and C class  ward in 
public hospital stay . Provides for enhanced coverage beyond 
MediShield Life with various plans types 
available for private and/or Class B1/A  public 
hospital stay s. 
 
Covers all pre -existing conditions.  May decline or imposed with exclusions and/ or 
restrictions, arising from pre -existing conditions.  
 
No maximum age limit.  May have a maximum entry age limit.


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
May decline or imposed with exclusions and/ or 
restrictions, arising from pre -existing conditions.  
 
No maximum age limit.  May have a maximum entry age limit.  
Sub-limits applicable.  Typically as charged basis, though insurers still 
offer sub -limits  plans . 
MediShield Life premiums are fully 
payable under Medisave.  Private insurance component of the IP premium 
is payable by Medisave up to the Additional 
Withdrawal Limit , the rest is payable by cash.  
 
 
 
5.  Medisave Use for IP Premiums   
 
 
 
6. Riders  
• IP Insurers are allowed to sell rider which pays for co -insurance and deductible portion 
of the IP payouts. These riders are not approved or regulated by MOH and cannot be 
paid using Medisave. Insurers are not allowed  to market riders as part of IPs.  
 
• Agent should highlight distinction between IP and riders and share that riders can be 
paid using only cash.  Important to remind policyholders that rider premiums rise 
significantly with age. Instead of paying f or a rider, the deductible and co-
insurance portion incurred in the event of hospitalisation can be save for and 
paid via Medisave or cash.  Additional private insurance coverage premium can be 
paid by Medisave up to the Additional Withdrawal 
Limit  (AWL).  The AWL is set per insured person per 
policy year, as follows:  
 
• Age Next Birthday (ANB) 40 and below : S$300  
• ANB 41 to 70 years : S$600 
• ANB 71 years and above : S$900  
    
       MediShield  
           Life   
 Private Insurance 
Coverage Integrated Shield Plan  
MediShield Life Premium is fully payable by Medisave.  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   54 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 7.  a. Downgrading IP   
• Can downgrade to a lower coverage plan within the same insurer at any point of time 
 without underwriting.  
 
• Can downgrade to basic MediShield Life, without any exclusions imposed.  
 
  b. Switching Insurer for IP  
•  His original IP will automatically terminated  when he switches to a new IP with 
another insurer.  
 
•  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 
be able to re -apply for his original coverage subsequently.  
 
8. Improvements to IP Regulatory & Accountability Framewor k 
• Insurer's disclosure documents include:  
• Product Summary;  
• Proposal form;  
• Offer letter . 
 
• Insurers need to highlight:  
• Distinction between MediShield Life and IPs;  
 
• Limitation of upgrading, switchi ng and the option to downgrade  and 
 remain  covered by MediShield Life;  
 
• Intermediaries selling IPs to undergo a minimum of 2 hrs of training on 
 MediShield Life and IPs.   
 
9.  All insurers will be required to offer Standard IP in 2016.  Standard IP will provide adequate 
  "no frill" coverage at Class B1 level  and will serve as a benchmark for consumers to  
  compare premiums offered by different IP insurers. 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   55 
Produced 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 . 
 
Admission to hospital  
1. Under IP Policy  Sign the Medical Claims Authorisat ion Form to :  
i.   allow hospital to claim from his insurer;  
 
ii.  authorize CPF Board to pay hospital  bill from his Medisave account, while the  
    insurer settles the claim which may take some time.  
Pay a cash deposit with hospital  
No Yes / No  
2. Non IP Private Insurance  
Hospital will trigger a  “Letter of 
Guarantee"  (LOG) to waive the upfront cash required up to a cap of S$10,000. 
LOG is not applicable if hospitalised due 
to pre -excluded conditions.  
 
For claims from MediShield Life, IP/or Medisave :  
Hospital will submit the claim on his behalf through the 
Medi Claim online system.


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
For claims from MediShield Life, IP/or Medisave :  
Hospital will submit the claim on his behalf through the 
Medi Claim online system.  
 
• Some hospital will sent the bill 
directly to the CPF members non IP 
Insurer or employer to work out the 
amount to bear.  
 
• In other cases, insured member will 
have to submit the bill himself to the 
insurer.  Need to show his insurance card 
provided by some insurers for certain 
Medical Expense Insurance Plans.  
a.  For IP Claims   
 Hospital will submit the claims 
 electronically to the Insurers directly.  
 IP will calculate how much to pay 
 based on IP benefi ts, and CPF Board 
 will calculate how much MediShield 
 Life will pay.  The eventual payment 
 will be the higher of the 2 amount.  
b.  For MediShield Life Claims without 
 IP 
 CPF Board will calculate how much 
 MediShield Life will pay and settle the 
 amount directly with the hospital.  
c.  Medisave to pay for his bill  
 Hospital will  submit the claims 
 electronically to CPF Board based on 
 prevailing Medisave withdrawal limits.  
Any outstanding amount not covered by the above, have to be settled in cash.  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   56 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) D. Elder Shield  & ElderShield Supplements   
 
Plan 
 Elder Shield  
Purpose   
A new Severe Disability Insurance Scheme  to provide long term  care 
to the elderly Singaporean to help defray out of pocket expenses in the 
event of severe disability. Any member who is a Singaporean or 
Permanent Resident who attains the age of 40 years is automatically 
covered unless he opts out . 
 
Plans  1. Elder Shield  300 - launched in Sept 2002  
    Payout of S$300  per month for maximum of 60 months if unable to  
    perform at least 3 ADLs.  
 
2. ElderS hield 400 - launched in 2007  
    Improved coverage of S$400 per month for maximum of  72 months  
    if unable to perform at least 3 ADLs.  
   Note : ADLs’ definition is the same as Chapter 5.  
   
3.  ElderShield Supplement covers :  
• increasing monthly payout;  
• extending payout period;  
• a combination of both.  
 
Only existing ElderS hield insured can purchase ElderShield 
Supplement.  
Premium can be paid from Medisave up to $600 (per insured per 
calendar year ) or by cash.  
  
Premium  • Level premium, paid from Medisave ; 
 
• Premiums payable up to age 65 yrs, but remains insured for lif e. 
 
• Premiums are not guaranteed, review every 5 yrs.  
 
• 2  types of premium plan available  
• Regular P remium Plan;  
• 10 year premium plan (Not available now) . 
 
• Insured members who do not have sufficient Medisave, may use their spouse, children, parents or grandchildren Medisave to pay 
for their premiums.  
 
Run By  
 • Aviva Ltd  
• NTUC Income Insurance Co- Operative Ltd   
• Great Eastern Life Assurance Co Ltd  
 
 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   57 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Eligibility Criteria  • Waiting period of 90 days  from commencement date.  
 
• Scheme will pay (either $300 or $400) if insured is unable to 
perform at least 3 of the 6 ADLs.  
 
• Deferment period:  90 days from c laim date.  Does not apply if 
insured suffers a relapse from the sa me cause within 180 days 
of recovery, prov ided he has been disabled for at least 90 days  
during the first disability.  
 
Claim  • Insured complete a claim form ; 
 
• Insured has to make an appointment with one of the insurer’s 
appointed assessors to have a medical assessment done.  
 
• It will cost S$50  for assessment at the assessor's clinic and 
S$150 if insured requires  assessor to make a house call.  The 
fees for the initial or subsequent assessments are borne by the 
insurer  if the claims is assessed to be payable.  
 
How are  ElderShield 
Benefits Paid?


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
The 
fees for the initial or subsequent assessments are borne by the 
insurer  if the claims is assessed to be payable.  
 
How are  ElderShield 
Benefits Paid?  • Payable on a monthly basis  
 
• Premium waived during disability;  
 
• Payments stop  if insured recovered from his disability, premium 
payment will resume.  However he can still make a claim under 
his policy, as long as he has not claimed more than 60 months  
or 70 months in total.(depending on his  ElderShield Plan).  
 
• Cash payout is not tied to insti tutional care. It can be used 
to pay for any expenses .  
 
Non forfeiture Option   
Premiums are prefunded.  Policy will be converted to a paid up policy 
should he decides to stop paying his premiums after the policy is 
inforce for a number of years.  Insured will enjoy a reduced benefits .  
Key Features   • Has a minimum  (i.e 40 y rs old) and maximum  entry age (i.e 6 4 
years old);   
 
• 60 days’  free look period from commencement date;  
 
• 75 days’  grace period for payment of overdue premium;  
 
• Reinstatement allowed within 180  days from the expiry of grace 
period, subject to evidence of insurabi lity and pay ment of 
overdue premiums and interests;  
 
• When the insured is oversea at the time of claim, insurer has 
the right to compute the benefit payments to a single payment 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   58 
Produced 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 
claim payment if it is unable to assess the claim after having 
made reas onable attempts to do so.  
 
• No surrender value.  
 
 
 
4. Other Healthcare Financing Schemes for the Poor and Needy Singaporeans:  
 1. Pioneer Generation Package  
  1. Outpatient Care   
• Additional 50% off :  
• subsidised services at polyclinics and Specialist Outpatient 
 Clinics (from Sept 2014).  
 
• subsidised medications at polyclinics and Specialist  
 Outpatient Clinics (from Jan 2015).  
 
• Special subsidies at participating GP and dental clinics under CHAS  
  (from Sept 2014).  
 
• Cash of S$1,200 a year for those with moderate to serve functional  
  disabilities under the Pioneer Generati on Disability Assistance Scheme  
  (from Sept 2014).  
 
2. MediShield Life - Pioneer Generation Subsidies -  cover earlier.  
 
3. Medisave Top- ups - From S$200 to S$800 annually for life (from July 2014) as  
 follows:  
• Born 1934 and earlier -  $800  
• Born 1935- 1939 - $600  
• Born 1940- 1944 - $400  
• Born 1945 - 1949 - $200  
 
4.  Pioneer Generation Disability Assistance Scheme - Pioneers who need assistance 
in at least 3 of the  ADLS (as defined earlier under ElderShield) will receive lifelong 
cash assistance of S$100 each month to help Pioneers with their care expenses.  
 
   

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   59 
Produced 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)  
 
  1. Those who are not eligible for Elder Shield Scheme for 2 reasons ; age or health  can 
  apply to IDAPE.  
 
  2.  It is a social scheme to help people cope with their medical expenses in the event 
  they suffer a sev ere disability. 
  3. Premiums need not be paid.  Payments under the scheme depend on individual’s per 
  capita household income.


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
3. Premiums need not be paid.  Payments under the scheme depend on individual’s per 
  capita household income. (see table)  
 
      IDAPE Payout  
 
Per Capita Household Income  IDAPE Payout (with effect from 1 July 201 3) 
 
S$0 to S$1, 800 S$250 per month up to 72 months  
S$1,801 to S$2, 600 S$150 per month up to 72 months  
    
   An IDAPE applicant from a household with no income will qualify for the S$250  
   monthly payout if the annual value of his place of residence is $13,000 or lower.  
 
 
  4. IDAPE is administered by NTUC Income.  It is similar to ElderShield except for :  
   
a. To making a claim under IDAPE will be subject to a means testing administered 
 by Ministry Of Heath Holdings(MOHH); and  
 b. The recipient of the payout will need to pay only a nominal fee of S$10  for a clinic 
 assessment (or S$40 if assessment is done at ho me) for each assessment in the 
 event of a claim.  The rest of the fees are subsidised by the Government . 
 
 
 3.  Medifund  
 An endowment fund set up by the government to help the poor pay for their hospital  bills 
 that despite Government subsidies in public  healthcare institutions.  
  
 Medifund Silver and Medifund Junior were set up in 2007 and 2013 respectively to target 
 the elderly and children.  
  
 Patients unable to pay for their medical bills can apply for Medifund assistance through 
 Medical Social Work ers (MSWs) at the Medifund approved institutions .  
 
  
 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   60 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Chapter 9 –  Common Policy Provisions  
 
Health Insurance policy is a written evidence of a contract between Insurer and Policyholder. It  
contains 7 sections. They are:  
 
1. Policy Schedule  
2. Insurance Clause and Definitions  
3. General Conditions  
4. Benefit Provisions  
5. Exclusions  
6. Claim Conditions  
7.  Endorsements  
 
1. Policy Schedule  
 It contains details of the policy owner, insured person(s) as well as the insurance coverage.  
 There is a clause in the policy stating that this schedule and the policy must be read 
 “together as one contract”.  It includes:  
• Policy number,  
• Effective date of cover and expiry date  of cover;  
• Issue date;  
• Currency;  
• Name, NRIC, age gender of insured person;  
• Name of plan, riders and premiums.  
 
Adviser need to go through this schedule with the policy owner to ensure no typographical error .  
  
2. Insuring Clause and Definitions  
 
 
Insuring Clause  • Also known as the operative clause, it rep resents insurer’s  
promises to pay.  
 
• Often viewed as the foundation of a Health Insurance Policy.  
 
 
Definitions  
a) Accident  
 
 
b) Day of Hospital  
    Confinement  
 
c)  Medically Necessary  
    Service, Supply or  
    Day  of Hospital  
    Confinement  
 
 
 
 
 
 
  
 
a) It means an incident caused by accidental,  violent,  external   
     and vi sible means.  
 
b) It refers to a full 24 hours during a period of  hospital  
    confinement.  
 
c) It means a service, supply or day of hospital confinement which is  
    ordered by a physician and which is:  
• Provided  for the diagnosis of direct treatment;  
• Appropriate and consistent with symptoms for treatment;  
• In accordance with accepted medical practices;  
• Not of an experimental nature or research purposes.  
 
The fact that the insured’s physician prescribes a service 
supply or day of confinement does not  automatically means 
is medically necessary.  
 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   61 
Produced in collaboration with Julia Sim.


key: _node_content
string_value:
{"id_": "c29b594b-0b0e-4246-b575-ed1d1aca490a", "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": "7d2ee423-ef82-4b3a-85e7-bc0184612fa2", "node_type": "1", "metadata": {}, "hash": "11a342a617b9ed0b770aac2235c40a8a1d7a4d6586dc5f280931a043c8fc5f61", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "e0e09eb8-d1c7-4c6c-ae1a-a0469c78bcd7", "node_type": "1", "metadata": {}, "hash": "06e43f906d0789c3b2b9820684b32b3bf57afcfa1695b5e712127fdecfc887e4", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 122418, "end_char_idx": 127125, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   61 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  
d) Period of Hospital  
    Confinement  
 
 
 
 
e) Pre existing condition  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
f) Usual , customary and  
    reasonable charges  
 
 
 
g) Per Policy Year Limit   
 
 
 
h) Lifetime L imit  
 
  
d) It means a continual, medically necessary period of time  
    during which an insured is confined to a hospital as a  
    registered inpatient. Patients have to stay for a period of  
    6 to 24 hours before being considered hospitalized.  
 
 
e) Defined as a condition which have existed  and :  
• For which insured received tr eatment  or medical advice;  
 
• In respect of which insured showed s ymptoms;  
 
• Of which insured was aw are;  
 
• Of which insured should reasonably  have been aware;  
Prior to the date policy issue or the date the cover was 
reinstated.  
 
Moratorium Underwriting  
Insured does not need  to make medical declarations when he 
applies for cover. Pre- existing conditions can be covered after a 
continuous period of e.g 5 years fr om the effective date of 
coverage, reinstatement date whichever is later.  For the 
specified years, insured must not have experienced any 
symptoms, seek consultation, received treatment or medication 
for the condition.  
 
 
f)  It refers to the standard char ge for the provider and the  
     amount does not exc eed the amount usually charged in  
     the same geographical area for an equivalent service.  
 
 
g)  Maximum amount a MEI Policy will pay for an insured within  
     each policy year.  
 
 
h)  Maximum amount a MEI Policy will pay under the policy .  
 
 
 
  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   62 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 3. General Conditions  
• Outlines the rights of both policyholder and insurer.  
• It includes the following :  
 
 
Entire Contract Clause  • Also known as “The Policy Contract Clause”;  
 
• In consideration of first premium  received, insurer will start 
providing benefits;  
 
• In a Health Insurance Contract the policy document , 
proposal form  and endorsements are the entire contract 
between insured and insurer.  
 
 
 
Effective D ate Of Cover   
• For sickness – it will commence after the waiting period.  
 
• For injury – it will commence as at the effective date of 
insurance.  
 
 
Premium Warranty Clause  
  
Policy shall not be in force, unless premium  is paid on or before 
the inception date of the policy.  
 
 
Free Look Period   
Policy  owner may review within 14 days  from the receipt of the 
policy and return for a refund of premium  (less medical fees 
incurred) . The policy document is deemed to have received by 
the policy owner within 3 days after Insurer dispatched it.  
 
 
Actively At Work  
  
Not eligible for cover if he is absent from work because of 
sickness, injury, on the otherwise effective date of coverage.  
  
 
 
Renewal   
Renewal Provision describes the c ircumstances which the 
insurer has the right :  
• not to renew ; 
• to cancel ; 
• to increase the amount of premium payable.   
 
HI polices can be issued on these basis:   
• Cancelable  -  Terminates the policy at any time for any  
 reason.  
 
• Optionally Renewable -  Refuse to renew the policy on  
 certain dates, usually the policy anniversary or premium   
 due date.  
 
• Conditionally Renewable -  Refusal to renew cannot be  
 related to insured’s health, but rather age and  
 employment status.  
 
 
 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   63 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  
• Guaranteed Renewable - Insurer relinquishes the rights to  
 cancel the policy.  Renewal is guaranteed as long as  
 insured pays the premium.  
 
• Non renewable –  examples are: Term Insurance,  
Travel Insurance, Student Personal Accident.   
 
 
Mis-statement of age or sex    
Insurer will adjust premium based on correct  age or sex .


key: _node_content
string_value:
{"id_": "e0e09eb8-d1c7-4c6c-ae1a-a0469c78bcd7", "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": "c29b594b-0b0e-4246-b575-ed1d1aca490a", "node_type": "1", "metadata": {}, "hash": "a467bc9b5a2aac7e0844e28a1ce1cb3544b0f32bb20588ed5701f00389964d74", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "764ba759-9ed9-4d3d-9ca2-92b4a6f6ff59", "node_type": "1", "metadata": {}, "hash": "afdba1e82cf192775f7f7fd28994ad70e7be75383f7b1dd8ad386a1e4ec57880", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 126932, "end_char_idx": 131764, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
• Non renewable –  examples are: Term Insurance,  
Travel Insurance, Student Personal Accident.   
 
 
Mis-statement of age or sex    
Insurer will adjust premium based on correct  age or sex .  
 
 
 
Grace Period   
Usually 30 days from premium due date. Coverage remains in 
force during grace period.  
 
 
Reinstatement   
This provision states that if certain conditions are met, the 
insurer will reinstate a lapsed policy for non premium payment, 
provided insured person pays any overdue premium and 
complete a health warranty.  
 
 
Incontestability   
This provision stops  the insurer from repudiating liability under a 
policy purely on grounds of breach of utmost food faith, except 
fraud has been proven.  
 
 
Co- Ordination O f Benefit   
Also known as  
• Over -insurance provision;  
  
• Cont ribution provision.  
 To prevent the insured from  making a profit from sickness/illness.  
Will cause the insurer to reduce the benefits payable under the 
policy.  
 
 
Cancellation   
Allows the insured to cancel the policy by giving written notice to 
the insurer.  
 
 
Change Of Plan   
A MEI Policy has a provision to allow the insured to upgrade or downgrade the coverage plan, at the insured’s expense.  Any 
application of change should be submitted to insurer at least 30 days before the policy renewal date or Premium due date.   
 
 
Currency   
Payments of all claims and benefits will be made in Singapore 
Currency.  
  
 
 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   64 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  
Last Payer Status   
This clause appears in MediShield and Private Integrated 
Shield Plans where it states the insurer shall  be the last payer  
reimbursing the claims if the insured has any other Medical 
Insurance, such as workman compensation. The insured person 
shall provide insurer with the full details of such other insurance 
policies or employee’s benefit.   
 
 
Policy Owner’s Protection 
Sche me (PPF)   
• Effected since 1 Jan 2012, to protect policy owners in 
the event of failure of a life or general insurer which is a 
PPF Scheme member .   
 
• The scope of this scheme includes individual and group short -term or long- term accident and health policies (e.g 
Hospital Cash, Medical Expense, Personal Accident, Disability Income, Long term Care Insurance.)  
 
• Is administered by the Singapore Deposit Insurance 
Corporation.   Coverage for PPF is automatic and no 
further action is required from the policy owner.  
 
 
 
 
4. Benefit Provisions  
 This provision is the essence of insurance policy.  It set forth insurer’s promises and each 
 benefit is  usually drafted in utmost care.    
 
 
5. Exclusions   
  Exclusions refer to the circumstances under which the insurer will not pay.   No benefits will be 
paid for charges which are in excess of the usual, cust omary and reasonable charges.  
Sickness contracted wit hin the waiting period, pre- existing conditions are not covered.  
   
6. Claims Conditions  
• Includes provisions that define insured’s obligation to provide timely  notification of loss  
 to the insurer.   
 
• Physical Examination Provisions –  usually included in most individual and group  
  Disability Income Policies.  After the insured submits a claim, the insurer has the right  
 to have the insured person examined by a doctor of the insurer’s choice, the insurer’s  
 expense t o validate claim.  
 
• Mediation/Arbitration and Legal Actions Provisions  
• Health Insurance Policy will include a Dispute Resolut ion Clause.  All dispute under 
  the policy should be referred to Financial Industry Disputes Resolution Centre 
  Ltd  (FIDReC).  If the dispute cannot be dealt with by FIDReC, it will be referred to 
  and decided using arbitration , according to the Arbitration Rules of the Singapore 
  International Arbitration Centre. Insurer will not be legally liable unless insured  
  first received an award under arbitration.  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   65 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) • Where both mediation and arbitration fail to settle the dispute, the insured may 
  seek legal actions against the insurer.  Legal provision limits the time during   
  which the insured who disagree with the insurer’s claim decision has the right to 
  sue for the rightful amount.


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
Legal provision limits the time during   
  which the insured who disagree with the insurer’s claim decision has the right to 
  sue for the rightful amount.  The Policy state s that no action in law or equity will be 
  brought under the policy until after the expiration of 60 days from the date a  
  satisfactory proof of claim has been furnished to the insurance company.  
 
 
7. Endorsements  
  An endorsement is a separate document that modifies the policy to which it is attached.  
Modifications can be:  
 
• Supplementary agreements (e.g maternity benefits for attachment to Hospital and 
Surgical Policy).  
 
• Exclusions  (e.g exclude pre -existing conditions)  
  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   66 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Chapter 10 –  Health Insurance Pricing  
 
1.  7 keys factors used to calculate Health Insurance P remium s are: 
 
 
1.  Morbidity Experience   
The primary  consideration for Health Insurance Pricing. It 
measures rate of sickness or failure of health.  
 
2.  Investment income  Increase in investment income will lead to a  decrease  in 
premium.  
 
 
3.  Operating expenses  Increase in operating expenses will lead to a n increase  in 
premium.  
 
 
4.  Medical Inflation   
Medical inflation will lead to a n increase  in premium.  
 
5.  Scope of benefits  Increase in scope of benefits will lead to a n increase  in 
premium.  
 
 
6.  Insurer’s Profit  Loading is added to n et premium to provide a profit margin.  
Hence depending on company’s p rofit strategy, it will affect 
this loading.  (increase premium ) 
 
7.  Modes of premium  
     Payment  
  
• Annually  – once a year;  
• Bi- annually – twice a year;  
• Quarterly – once every 3 months;  
• Monthly – once a month (most expensive).       
 
 
2. Parameters For Premium Rating :  
1. Age 
 
2. Gender  - Women’ s premium is higher than male for health insurance products.  
 
3. Physical Condition –  refers to proposed health status of the proposed insured. (eg pre- 
existing conditions ).  
 
4. Occupation – the higher the risk of injury or illness resulting from an occupation, the higher 
the insurance premium.  
 
5. Persistency – Refers to the percentage of policies renewed each year.  If the persistency 
rate of a type of coverage is expected to be high , then the insurer will reduce the amount of 
premium charge.  
 
6. Claims Experience –  Claims experience demonstrates the general health condition of the 
group and the propensity of the group members to file claim. Key factor for affecting 
premium rate charged for group plans .  
 
7. Participation Level –  Low participation means there will be greater chance that a higher  than 
normal proportion of unhealthy  lives will seek coverage.  This is called anti selection.  
 
8. Life Style  -  Can influence premium charge.  Eg hazardous sport will call for extra premium. 
The most important lifestyle factor is smoking, which will attra ct a higher premium  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   67 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Chapter 11 –  Health Insurance Underwriting  
 
1.  
 
 
 
 
 
 
 
 
 
 
 
 
 
2. Factors affecting Risk  
 
 
Medical Factors  
  
Non Medical Factors  
 
1.   Medical History    
     Insurers review history of previous  
conditions to determine :  
 
• Possibility of recurrence;  
 
• Effect of a medical history on proposer’s general health;  
 
• Complications that may arise;  
 
• Normal progression of any 
impairment.  
       
 
2.   Curr ent Physical Condition  
 
The proposer’s statement on a 
proposal and medical examinations 
results are the first indicators of 
present physical conditions, before 
underwriters  request for other test s. 
  
1.  Financial Factors  
     Important consideration in underwriting 
     individual Disability Income Insurance.  
  
2.  Occupational Factors 
     Accident hazards –  eg painter  
     Health Hazards – e.g handling asbestos will lead 
     to respiratory failure.  
 
 
3.  Age 
     Older – more thorough because of possibility of  
     health problems.  
 
 
4.


key: _node_content
string_value:
{"id_": "ae7bd4bf-5034-41b3-8ae6-6fa1115265d0", "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": "764ba759-9ed9-4d3d-9ca2-92b4a6f6ff59", "node_type": "1", "metadata": {}, "hash": "afdba1e82cf192775f7f7fd28994ad70e7be75383f7b1dd8ad386a1e4ec57880", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "19058b19-749a-4050-86fa-6609af9c3e80", "node_type": "1", "metadata": {}, "hash": "535761dc86182ea91c0e6a3567b33f7a86039e5b21202252a2597fde7ba1485b", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 136118, "end_char_idx": 140917, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
3.  Age 
     Older – more thorough because of possibility of  
     health problems.  
 
 
4.  Avocations / L ife Style Risk  
      a. Examples of Life Style risks -  Drug abuse,  
          hazardous occupations, multiple sexual  
          partners . 
 
a. Habits  
           Eg drinking and drug use .  
 
 
 
  Underwriting  
The main purpose of underwriting is a process  to ensure premium charged 
correspond closely  with the r isk that each proposer  represents.  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   68 
Produced 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 
 Products .   
 
 
Health Insurance Plans  
  
Factors  
 
Medical Expense Insurance  
 • Medical history ;  
• Current physical condition.  
 
 
Disability Income Insurance  • Size and stability of earnings;  
• Overall financial situation;  
• Occupation risks –  only white collar workers are 
permitted.  
 
 
Long Term Care Insurance  • Detection of cognitive impairments;  
• Morbidity risk.  
 
 
Critical Illness  • Medical history  
• Current physical condition 
• Smoking habit;  
• Family history.  
 
 
Managed Healthcare  • For Individual – Medical history and current 
physical condition;  
• For Group – age and gender.  
 
 
 
4. Types of Underwriting Methods for Medical Expense Insurance   
 
Full Medical Underwriting 
  
Moratorium Underwriting 
• Proposed insured completes  a health 
declaration when he applies for cover.  
 
• Pre-existing conditions are excluded.  
 
 
 
 
 
 
 
 
 
Advantage  
• Insured has certainty  as to what is 
covered at the point of joining rather 
than when he needs to make a claim.  • No need  to fill in a health declaration . 
 
• Insurer will automatically exclude  any pre-
existing conditions  (for which insured has 
been treated)  during the 5 years 
immediately preceding the commencement 
date of cover.  However, if insured does 
not have any symptoms, treatment etc for 
those pre- existing conditions for a 
continuous period ( usually 2 to 5 years), 
then he is covered when the conditions 
recur, subject to the terms and conditions.  
 
 Advantage  
• Provides only basic information about 
himself, but must understand that any pre-
existing condition are excluded from cover, 
unless he can satisfy moratorium criteria 
for pre -existing condition (as per  point 
above).  
 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   69 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 5. Group Underwriting Factors  
 
1. Reason For Existence  
The reason for the existence of a group applying for group coverage must be for some 
purpose other than  for purchasing insurance.  This is to prevent anti - selection.   The 
group members must be actively at work on a full time regular basis and have a fairly 
predictable income.  
 
2. Group Stability  
An ideal group for insurers is one in which there is a steady  flow of new members to 
replace those who leave, but not  massive influx or outflow of members.  
 
3. Group Size  
Group size is important, as it provides a better spread and diversification of risk.  
 
4. Insured company’s nature of business  
Certain lines of business are more risky than others.  
 
5. Employee Classes  
Over -representation by a highly paid class can result in higher than average medical 
claims.  Over -representation by a class which the employees earn low income  can result 
in a higher -than –desired rate of turnover.  
 
6. Level of Participation  
Especially in a contributory plan as members’ participation is on a voluntary basis.  Insurers 
normally specify a minimum participation level requirement of e.g 70% to 90%  to prevent 
anti- selection.  
 
7. Age and Gender  
Age is important in underwriting, as it increases the mortality of the group.  Gender in the 
form of ratio of males to females is important as females  have lower mortality rates, but 
higher morbidity rates than males.  
  
 
  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   70 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 6.


key: _node_content
string_value:
{"id_": "19058b19-749a-4050-86fa-6609af9c3e80", "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": "ae7bd4bf-5034-41b3-8ae6-6fa1115265d0", "node_type": "1", "metadata": {}, "hash": "2bdab126f12ffb81d0218b127c294d48e40586168fe9ce96b9c7fa74f5910a77", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "79f82a30-dac8-471d-9881-1ecbb28e06da", "node_type": "1", "metadata": {}, "hash": "f0fa128740ea29814775f0c05cce315eb5de9479e3c0d5830cc819bd6db4f807", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 140866, "end_char_idx": 145507, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 6.  Sources of Underwriting Information 
  
1. The proposal (application) form is the primary source of underwriting information for the  
insurer.  It will form the contract and used as a basis when a claim is filed.  
  
Sections of a Proposal Form  
i. Heading and identification of the parties  
• States the names of the insurer  and contact details.   
• “Particulars of the life to be insured” and “Particulars of the Proposer” serves 
   2 reasons.  First ly is to distinguished the proposer from others having a  
 similar name, secondly, to provide relevant information to the underwriter to  
 assess the risk.  
 
ii. Particulars of policy applied for   
Details of the policy and sum assured.  
 
iii. Information regarding pas t applications and existing policies  
Proposer needs to indicate whether he is purchasing this policy to replace an 
existing policy.   
iv. Personal health details and habits of the proposed insured  
This section is critical as it provides a detailed description of the propos ed 
insured’s medical history, physical conditions, habit etc.  
 
v. Declaration  
Serves the following purposes that the proposed insured:  
• has disclosed all material facts truthfully;  
• has not withheld any material facts;  
• is aware that the benefits may be lost if material facts are not disclosed;  
• agrees and authorizes insurer to release to any medical source or insurance 
office, any information concerning him, regardless of whether the proposal is eventually taken up.  
 
2. The Agent’s Statement –  to indicate :  
• Knowledge of any information on the proposer that is not in  the proposal form;  
• Proposer’s net worth , earned income, income from other sources.  
 
3. Medical Examinations /Tests  
Namely for these plans:  
• Disability Income Insurance  
• Critical Illness Insurance  
• Long Term Care Insurance  
 
4. Attending Physician Statement  
To enable the underwriter to have a better insight into the applicant’s medical history  that 
is not available from the medical examination.  
 
5. Supplemental Questionnaires  e.g financial questionnaires are to gather information about net worth and unearned 
income.  
 
  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   71 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 7. Final Underwriting Decision 
 
 1.   Standard Risk   
• Policy issued is based on premium rates stated in the rate book.  
 
2. Sub Standard Risk  
The following can occurs:  
 
1. Modifications of cover  
 Specific Exclusions  
E.g. excl uding disease of the intestines, commonly usually used in Medical 
Expense Insurance.   
 
 Extra Premium  
Usually used for these plans:  
Disability Income Insurance, Critical Illness Insurance.  
 
 Modifications of Benefits offered. E.g reduction in monthly benefits . 
 
2. Postponement  
Eg: going for an operation.  
 
3. Declined  
Usually for serious medical reasons . 
 
 
8.  Commencement of Risk  
Risk commences when the applicant agrees to the terms stated in the letter of acceptance  
and pays premium.  
 
  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   72 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Chapter 12 – Notice No: MAS 120 – Disclosure and 
Advisory Process Requirements For Accident And 
Health Insurance Products 
 
1. This Notice covers the following products:  
 
•  A & H Policies; and  
 
•  Life Policies with A & H Benefits.  
 
 
2.  This Notice applies when a financial adviser provides advice or arranges contracts of  
 insurance or both, in respect of accident and health insurance policies and life policies that  
 provides accident and health benefits but does not apply  where:  
 
• Such policies are in respect of reinsurance o f liabilities under insurance policies; and  
 
• Such policies provide that the accident and health benefits are paid out only if  the 
insured becomes totally and permanently disabled, as defined under that policy.  
 
 
3.  This Notice comprises the following 2 parts:   
 
 (a).  Part 1 –  Mandatory Requirements;  
 
i. Division 1: Disclosure requirements for accident and health policies;  
 
ii.


key: _node_content
string_value:
{"id_": "79f82a30-dac8-471d-9881-1ecbb28e06da", "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": "19058b19-749a-4050-86fa-6609af9c3e80", "node_type": "1", "metadata": {}, "hash": "535761dc86182ea91c0e6a3567b33f7a86039e5b21202252a2597fde7ba1485b", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "a526536e-a957-41ba-a97b-9b5d0c3b2a80", "node_type": "1", "metadata": {}, "hash": "2f28429a0ac6877fa2865a7001497d6d8ed742d6a2edca0f6434ab0155bf11ff", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 145328, "end_char_idx": 149874, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
3.  This Notice comprises the following 2 parts:   
 
 (a).  Part 1 –  Mandatory Requirements;  
 
i. Division 1: Disclosure requirements for accident and health policies;  
 
ii. Division 2 : Disclosure requirements for life policies that contains accident and 
health benefits;  
 
iii. Division 3 : Additional requirements for direct insurers;  
 
iv. Division 4  : Requirements on provision of advice relating to accident and health 
policies;  
 
v. Division 5 : Requirements on provision of advice relating to the life policies that 
contains accident and health benefits;  
 
vi. Division 6 : Offences relating to this Part;  
 
 (b). Part 2  - Non- Mandatory Best Practice Standards on Information Disclosure and  
   Provision of Advice.  
  
4. This Notice shall come into effect on 1 April 2004.  
  
  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   73 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Part 1 – Mandatory Requirements  
 
Division 1: Disclosure Requirements for Accident and Health Policies  
 
Please note : (Division 6)  -  Failure to comply with the following  (Pt 1 to 4)  are considered 
offences liable on conviction to a fine not exceeding S$25,000 or to imprisonment for a term 
not exceeding 12 months  or both:  
 
1. General Information about the A&H intermediary and the status of an A& H insurance  
    Representative.  
 An A&H insurance intermediary shall disclose to the insured in writing  its business name under 
 which it conducts its insurance business, its business address and its telephone number and 
 when there is a change in such information, to inform insured in writing.  
 
 
2.  Remuneration of the A& H Insurance Intermediary  
 An A&H insurance intermediary shall, upon the request of the insured, disclose in writing  to the 
 insured all remuneration, including any commission, fee, and other benefit, that it has received or 
 will be receiving for providing advice on any accident and health policy.  
  
3. Conflict of Interest  
   An A&H insurance intermediary shall disclose to the insured in writing  any actual  or potential 
 conflict of interest arising from any connection to or association with any insurer, including any 
 material information that may compromise its objectivity in advice provided.  
 
 
4.  Disclosure when Providing Advice   
 1.  An A&H insurance intermediary shall disclose to the insured the following information . 
  The insured can refers to an individual or policy owner of a group policy .  
  For voluntary group to disclose to each person as if it is dealing with the individually:  
 
a)  Nature and objective of the policy;  
 
b)  Details of the insurer;  
 
c) Contractual rights and obligations;  
 An intermediary to explain to the insured:  
• The party against which the insured may take action to enforce his rights with 
respect to the policy he has purchased;  
 
• An intermediary to explain to the insured that he ( insured) is responsible  for the 
accuracy and completeness of the information when applying for the policy and making a claim.  Any misstatement or non disclosure of material facts may affect 
validity of the policy.  
 
• Amount and frequency over which the payment is to be made, and whether the premium rate is guaranteed or non- guaranteed  
  
d) Benefits of the Policy  
• Conditions under which the payment of policy moneys (guaranteed/non 
guaranteed) is to be made or not made to the insured;  
• Any lien on the policy.  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   74 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) e) Risks of the Policy  
• Whether insurer may alter the terms of contract, and if so, what may be altered 
and under what conditions would the alterations be all owed;  
 
• Whether insurer may decline to renew the policy or unilaterally terminate the 
policy.  
  
2. Where a benefit illustration or a product summary in respect of accident and health policy 
prepared by the insurer or the A& H insurance intermediary is available, it shall be 
furnished and explain to the insured.  
  
3.


key: _node_content
string_value:
{"id_": "a526536e-a957-41ba-a97b-9b5d0c3b2a80", "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": "79f82a30-dac8-471d-9881-1ecbb28e06da", "node_type": "1", "metadata": {}, "hash": "f0fa128740ea29814775f0c05cce315eb5de9479e3c0d5830cc819bd6db4f807", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "4b93314e-770f-4d07-94f1-863d1c8d62e9", "node_type": "1", "metadata": {}, "hash": "9e446e3d1229d9e4db1a9d68bd5fa316d90668ecfa0496732184d03b6351e35d", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 149648, "end_char_idx": 154379, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
2. Where a benefit illustration or a product summary in respect of accident and health policy 
prepared by the insurer or the A& H insurance intermediary is available, it shall be 
furnished and explain to the insured.  
  
3. In the case of a personal accident  policy,  shall ensure that insured is aware that the policy 
moneys shall be payable in the event:  
• of an injury to, or disability as a result of accident;  
 
• of death by accident;  
 
• combination of above.   
  
 
Please note: (Division 6): Failure to comply with the followi ng (Pt 4(4) to 6) are 
considered offences liable on conviction to a fine not exceeding S$12,500 : 
 
4. When a n A&H insurance intermediary prepares a benefit illustration or a product summary, 
it shall be prepared in accordance to the industry standards, if any set for the insurers.  
 
 
5.  Marketing Materials  
 Representatives shall only use marketing materials approved by the A&H Insurance  
 Intermediary  for which the representative acts.  
 
 
6. Telemarketing and Direct Marketing  
1.  In the case of using telemarketing over the phone to solicit and close a sale, A& H 
 intermediary shall, where no advice is provided,  communicate to the insured a warning 
 that: 
•  insured may wish to seek advice from an A&H insurance intermediary before 
 purchasing the policy;  
 
•  in the event the insured choose not to seek  advice, he should consider suitability  of 
 the policy; and  
 
Intermediary shall maintain a record of all conversations made over the phone sufficient 
for the purpose of conducting audit checks where necessary.  
  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   75 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  
  2.  In the case of marketing A&H policies using direct response  advertising communications 
  through any medium including mail, print, TV, radio and electronic media to solicit and  
  close a sale, A& H intermediary shall include, in all its marketing materials a prominent  
  warning that:  
 
•  insured may wish to seek advice from an A& H insurance intermediary before 
 purchasing the policy;  
 
•  in the event the insured choose not to seek advice, he should consider suitability of 
 the policy.  
 
 
    
Division 2 : Disclosure requirements for L ife Policies that C ontains Accident and  
Health Benefits  
  
This Division is somewhat similar to Division 1  
 
    
Division 3 : Additional Requirements for Direct Insurers  
 
1.  When a direct insurer prepares a benefit illustration or a product summary for policies it 
 underwrites, it shall be prepared according to industry standards, if any.  This shall not apply 
 to policies underwritten by insurers other than a registered insurer.  
 
 2.  Any alterations made in the terms of the contract, the direct insurer shall discl ose and 
explain  the new terms and the manner in which insured may accept these new terms or the 
circumstances under which the insured will be deemed to have accepted the new terms.  
Such information should be furnished to the insured in writing at least 30  days  before the 
variation or amendments take effect.    
 
 
 
  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   76 
Produced 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  
Policies  
 
1. This Division shall not apply  to: 
 
•  Circumstances where no recommendation is made or where only factual information 
is provided  with respect to any health policy; or  
  
•  Any advice provided in respect of ElderShield Policy.  
  
 
 
Please note: (Division 6): Failure to comply with the following in this Division are 
considered offences liable on conviction to a fine not exceeding S$12,500:  
 
2.  An A&H Intermediary shall have a reasonable basis for providing advice to the insured.  For 
 the purpose of ascertaining that the advice is reasonable, the representative shall give regard 
 to the information such as the insured’s objective, financial situation, particular needs, etc.  
 
3.  In providing advice on health policies to the insureds, A&H intermediary shall comply with  
a.  Know - Your Client  
 
b. Needs analysis; and  
 
c. Documentation and r ecord keeping.  
 
 
   
3a.


key: _node_content
string_value:
{"id_": "4b93314e-770f-4d07-94f1-863d1c8d62e9", "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": "a526536e-a957-41ba-a97b-9b5d0c3b2a80", "node_type": "1", "metadata": {}, "hash": "2f28429a0ac6877fa2865a7001497d6d8ed742d6a2edca0f6434ab0155bf11ff", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "db0c94b4-ef04-41d3-8085-774d36b3a514", "node_type": "1", "metadata": {}, "hash": "954c5e119a9f26acc26959305fb534339731d906700f32d6400c9a715d0b8106", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 154376, "end_char_idx": 159102, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
3a. Know Your Client  
 
Individual  
 Group  
 
• Objectives of insured;  
• Employment status;  
• Income;  
• Existing health insurance, including 
policy from CPF;  
• Any medical conditions;  
• Whether policy is to include 
dependants.  
  
• Objectives of the insured;  
• Size and composition of the group 
including age, gender, income, 
occupation;  
• Claims history of the group;  
• Any medical conditions of members of 
the group.  
 
A& H intermediary shall highlight in writing the following:  
 
a.  information provided will be the basis  on which advice will be made;  
 
b.  any inaccurate or incomplete information provided may affect suitability .  
 
 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   77 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  3b. Needs Analysis   
• A&H intermediary shall analyze the information provided;  
 
• Where the A& H Intermediary is unable to identify a suitable policy, it shall inform  
the insured accordingly.   
  
  Where an insured does not want to provide any information requested in (a), or accept 
  the advice of the A&H insurance intermediary and chooses to purchase another policy 
  which is not advised by the intermediary, then the intermediary:  
• may proceed to the insured’s request but it shall properly document  the decision 
of the insured; and  
 
• inform the insured that it is the insured’s responsibility  to ensur e suitability of the 
policy selected.  
 
 
3c.  Documentation and Record Keeping   
  Before the insured signs on the application form for the purchase of a Health Policy or 
  gives consent for withdrawal or surrender of a Health Policy, A&H Intermediary shal l  
  furnish to its insured a document containing a summary  of the information gathered and 
  the basis of the advice given and where applicable a statement that the insured does 
  not want to provide information or received advice of the A&H insurance intermediary . 
  
 
 
4.  Switching of Accident and Health Insurance Policies   
 An A&H insurance intermediary shall not cause the insured to switch products that would be 
 detrimental to the insured.  The following are examples of detrimental switch:  
  
a. whether the insured suffers any penalty for terminating the original policy;  
 
b. whether the insured will incur any transaction cost without gaining  any real benefit;  
 
c. whether the replacement policy confers a lower level of benefit at a higher cost  or 
 same c ost; or the same level of benefit at a higher cost ; 
 
d. whether the replacement policy is less suitable.  
      
     An  A&H insurance intermediary shall disclose to an insured , any fee or charges  the insured 
 would have to bear for switches, in order to ensu re the insured is able to make an informed  
 decision on whether to switch.  
 
 
  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   78 
Produced 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  
Contains Accident and H ealth Benefits  
 
This Division is somewhat similar to Division 4 . 
 
 
Division 6: Offences Relating to This Part  
Covered in the respective parts above.  
 
 
 
Part Two –  Non Mandatory Best Practice Standards on Information Disclosure and 
Provision of Advice   
 
1. Encourage to observe but not a crim inal offence. They are : 
 
• Information disclosed in any advertisement should be in pl ain language , jargons 
explained ; 
 
• Information provided should be sufficient ( not limited to this Act) to help insured make an  
informed decision ; 
 
• Information should not be ambiguous.  It should be disclosed in an objective and 
unbiased manner.  There should be a reasonable basis  for expressing an opinion, and 
it should be unambiguously stated that it is an opinion;  
 
• Documents should be kept up to date .  
  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   79 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Chapter 13 –  LIA & GIA Guidelines  
 
1.


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Chapter 13 –  LIA & GIA Guidelines  
 
1.   This Chapter consists of:  
  
•  LIA & GIA Guidelines on disclosure requirements for Accident and Health (A&H) products 
 as specified in Appendix 13A;  
 
•   LIA Guidelines on Needs -based Sales Process for Individual Health Insurance Products 
 as specified in Appendix  13B; 
 
•  GIA Guidelines on Needs -based Sales Process for Individual and Group Health 
 Insurance Products as specified in Appendix 13C  
 
 
LIA & GIA Guidelines on Disclosure Requirements for A&H Products –  Appendix 13A  
 
1.  Compulsory Documents to be presented to client at Pre -Sales Stage  
 
 
Documents at Pre -Sales Stage 
 
Individual  (pg 241)  
 Corporate  (pg 246)  
• Your Guide to Health Insurance  
 
Insurer to reproduce in verbatim this document.  
 • Same (under voluntary plan)  
 Insurer to reproduce in verbatim this document  
• Product Summary  
 • Same (under voluntary plan)  
• *To ensure p roposers to sign the 
proposal form t o confirm that they 
are given a copy of the documents and 
that the contents of these have been 
explained to them.  
 • **Same except that members applying 
for insurance under voluntary plans  
shall be required to sign on the Policy 
Health Declaration Form  and to confirm 
that they have read and understood 
these 2 documents.  
 
 
 
2.  Specific Guidelines to Product Summary   
 1.  Product Summary aims to provide prospective buyers with details on key product  
  information and features, contract provisions, or terms and conditions that may  
  affect their  decisions to purchase the policy.  
  
 
 2.  *For Individual Business   
• To ensure proper disclosure and acknowledgment of information presented, the original signature of the prospective client and the intermediary  must be 
obtained and both these endorsements must be made on the front page of 
Product Summary .   
 
• A copy of the duly signed Product Summary must be filed with the insurer for 
record purposes.  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   80 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) • Disclosures of distribution costs, charges & expenses in the “Product Summary” is 
not mandatory , however it should be clear in the document that such information 
will be made available at the client’s request.  
   
  **For Corporate  
  The final proposed terms are to be signed by the client or a legally appointed   
  representative of the client and members applying for insurance under voluntary plans 
  shall be required to sign on the Policy Health Declaration Form .  
 
 3.  Product Summary comprises 2 sections  for both Individual and corporate business:  
a. Product Information  
 
b. Key Product Provisions  
  
 
Product Summary (pg 242,247)  
 
Product Information  
 Key Product Provisions  
• Summary of benefits or covered events;  
• Benefits schedule table;  
• Premium rates;  
• Premium payment duration;  
• Duration of policy cover;  
• Definition of ADLs.  
 
 • Cancellation / Termination clause;  
• Renewability of Policy;  
• Premium guarantee;  
• Waiting period;  
• Benefits limitation;  
• Pre-existing conditions;  
• Deferment period;  
• Survival period.  
  
 For Individual Business  
3. Application of the guidelines to direct marketing and telemarketing channels   
 
 1.  Most of which is s imilar to Chapter 12 (Division 1, Pt 6 of this Review ). 
 
 2. In the case of direct marketing, the insurer must have control over  the entire process, 
  from publication and distribution of promotional materials to delivery of the policy  
  document.  For telemarketing, the insu rer must have sufficient control  over its  
  telemarketing staff, or the telemarketing firm if the function is outsourced, such that the 
  information conveyed on product features is accurate.  
 
 3.   The insurers must make adequate arrangements to provide appropriate post -sales  
  disclosures to policyholders who have purchased health insurance products through  
  direct marketing or telemarketing channels.


key: _node_content
string_value:
{"id_": "a148ddaf-4228-4c75-b066-408b5abb5118", "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": "db0c94b4-ef04-41d3-8085-774d36b3a514", "node_type": "1", "metadata": {}, "hash": "954c5e119a9f26acc26959305fb534339731d906700f32d6400c9a715d0b8106", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "f5feeb67-b394-4776-830d-927d5ef1314b", "node_type": "1", "metadata": {}, "hash": "d2bd3f0de46ad1c025d62f009bb4e3e3e516f3ecd708f5272015d9184b55aab5", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 163104, "end_char_idx": 168046, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
3.   The insurers must make adequate arrangements to provide appropriate post -sales  
  disclosures to policyholders who have purchased health insurance products through  
  direct marketing or telemarketing channels.  Such post -sales disclosures include a  
  “follow -up letter”  which:  
• advises the proposer to read the 2 compulsory  disclosure documents enclosed;  
 
• highlights to the proposer that he is entitled to a “ 14-day Free Look ” period and 
can cancel his coverage without penalty within this period if he deems the product 
unsuitable;  
 
• requests the proposer to return the enclosed pre -pay reply card to the insurer to 
confirm his receipt  of the disclosure documents.  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   81 
Produced 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 
  apply to direct marketing and t elemarketing:  
   
• Having the proposer sign on the proposal form stating that he has been given the 
   2 compulsory disclosure documents, and that the contents of these have been 
   explained to his satisfaction; and  
 
• Having the proposer sign on the first page of the Product Summary.  
 
 
4.  Individual Business -  Disclosure requirements for personal accident products  -  
 Similar to Chapter 12, Division 1(Pt 4 (3) of this review)  
 
 
 
5. Individual Business  
 Post -Sales Disclosure  
 
 1.  Continual disclosures  to be made to policyholders whenever there are modifications to 
  the Product Information or Key Policy Provisions specified in the Product Summary.  
  Circumstances that would require continual disclosure include:   
• Premium rates or premium rates table;  
 
• Policy benefits or coverage;  
 
• Exclusion clauses;  
 
• Change in definition of contract provision.  
    
 Both  the existing and modified benefits/terms need to be shown .  In cases where 
 some original benefits are withdrawn or new exclusions are added with no change in 
 premium rates, this must be highlighted to the policyholders.  
 
 
 2. Insurers are required to give policyholders advance written notice of at least 30 days   
  before the modifications take effect.  
 
 
 3. To modify any original terms of the original policy contract, insurer may:  
• obtain written acceptances of the modified terms from policyholders; OR  
 
• where no written acceptances of the modified terms is sought, the insurer  must 
ensure that all of the following conditions are fulfilled:  
I. policyholders are given the option to reject the modified terms and cease 
cover;  
 
II. in the notification letter to policyholders:  
a. the modified terms must be conspicuously indicated on the front 
page of the notification letter,  
b. the modified terms must be highlighted in bold print  on the 
notification letter and  
c. the print size of the modified terms should not be smaller  than the 
rest of the text on the notification letter.  
 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   82 
Produced 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 
letter:  
“ Please be advised that unless otherwise advised by the Owner of the 
policy, receipt of the renewal premium by the Company shall be construed 
as an acceptance of the modified terms and the modified terms shall take 
effect from the date of policy renewal”.  OR  
 
“ Please be advised that unless otherwise advised by the Owner of the 
policy  by DD/MM/YY (expiry date of the advance notice), the modified 
terms shall take effect from DD/MM/YY(effective date of the modified terms)”.  
 
 
6. Corporate Business   
 
 1.  Information to be disclosed to clients at the Pre Sales Stage:  
• Name of Insurer underwriting the product;  
• Duration of cover, premiums rates , benefit schedules, period of validity;  
• Key product terms and conditions  
• Whether premium rates and renewals are guaran teed;  
• Whether the product qualifies under TMIS;  
• Whether free look is applicable;  
• Upon request by the client, commission amounts must be disclosed  
 
 
 2. The rest covered above.  
 
  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   83 
Produced in collaboration with Julia Sim.


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
The rest covered above.  
 
  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   83 
Produced 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 
Products  –  Appendix 13B  
 
1.  The objective of the Guidelines is to set a minimum standard for the needs -based sales  
 process for insurance representatives.  It is important for a representative to obtain relevant 
 information on a client, analyze the information before making appropriate recommendations 
 on product suitability.  
 
2.  The Guidelines apply to:  
• Health Polic ies (including health insurance bundled with or riders to life policies) sold to 
individuals by insurance representatives  i.e life insurance agents, general insurance 
agents, brokers, and representatives of financial representatives, banks and financial 
institutions.  
 
3. The following requirements:  
a. Disclosure of representative’s status  
b. Use of fact find form  
c. Use of needs analysis/recommendation form  
 
do not apply to :  
 
• Direct  marketing (provided no advice has been given)  
- includes internet as a tool of DM, but not as an e -intermediary  
 
• Personal Accident Policy with or without Medical Reimbursement du e to Accident only  
 
• Hospital cash due to Accident only  
 
• Elder Shield, where advice is for a person who has previously opted out to re-opt into 
Elder Shield. 
 
 
  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   84 
Produced 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  
 
1.  The following forms appended below are adopted as the minimum industry standard : 
• “Know Your Client” Form  (Individual Health Policies) –  Appendix 1A of text.  
 
• “Our Advice and Reasons Why” Form  – Appendix 1B  
  
Note:  Insurer may incorporate the Fact Find Form and Needs Analysis & Recommendation 
for Life and Health Products into one form but the “ Application type” is to be distinguished 
for life and health insurance.  Fact Find and Need Analysis  & Recommendation pertaining to 
Health Insurance is also required when a health product that is bundled with or riders to life 
policies.  
 
 
2. Application T ype for individua l accident and health policies.   
 “Application Type” in the fact find form is to be ticked by the client and signed off as follows:  
  
1. Type 1  
 “I/We have disclosed relevant information for comprehensive planning” .  
Meant for those who wish to complete the  fact find form in full , so as to receive 
recommendations on product suitability.  
 
 
2. Type 2 “I/We have disclosed relevant information for specific need(s) planning”  
 Meant for those with partial completion  of fact find form. Suitable for those who wish to 
 receive recommendation on product suitability.  
 
 
3. Type 3 
  “I/We did not undergo any needs analysis in this review and it is my/our   
 responsibility to ensure product suitability”               
Meant it is mandatory to explain  product features, fees and charges to the client.  
  
4. Minimum Requirements for each Application Type selected by the client.  
 
Minimum requirements  
 Application Type  
 1 
 2 3 
Personal Information  Compulsory  Compulsory  Compulsory  
Dependent  Compulsory  Good to have  Not applicable  
Existing health policies  Compulsory  Good to have  Not applicable  
Personal priorities  Compulsory  Compulsory  Not applicable  
Health conditions  Compulsory  Compulsory  Not applicable  
Replacement of policy  Compulsory  Compulsory  Not applicable  
Needs analysis  Compulsory  Compulsory  Not applicable  
Recommendation  Compulsory  Compulsory  Not applicable  
Client’s choice of App. Type  Compulsory  Compulsory  Compulsory  
Acknowledgement by client  Compulsory  Compulsory  Compulsory  
 
  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   85 
Produced in collaboration with Julia Sim.


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Responsibilities of Life Insurer/Principal of Life Insurance Representative  
 
• Insurer and principal of representative shall keep  a copy of the Fact Find Form, Needs 
Analysis and Recommendation Forms for a length for necessary audit trail.  
 
• Principal must ensure that a register  is set up and maintained by itself or its distribution entity 
for audit by MAS.  The register should refle ct the “Application Type” chosen by the client.  
 
• Insurer to ensure that it underwrites proposals submitted only if accompanied by the required  
form duly completed and signed .  
 
• Intervention to rectify any erroneous recommendation is to be taken before the  expiry of the 
free- look provision.  
 
 
Responsibilities of  Supervisors of Representative  
 
• Supervisor of representative must sign off on the register as soon as practicable.  Supervisor 
to ensure if applicable to his organizational structure , to set up and maintain a Register  for 
the submissions of the said Forms by his representatives  to be recorded.  
  
Responsibilities of Life Insurance Representative  
 
• To ensure that at each separate occasion of purchase, his client and him sign off  afresh  
together on the Fact Find Form, “Our Advice and Reasons Why” Form.  A copy of the Fact 
Find Form which was completed on an earlier occasion may be used, provided the information 
is still current.   
 
• Ensure to provide a copy of the Fact Find, Needs Analysis and Recommendation Forms to the  
client and to his supervisor  as soon as practicable.  
 
• Treat information with confidentiality.  
 
 
Remedies for Non- Compliance by Life Insurance Representatives  
Representatives found not  to have submitted duly completed and signed Fact Find Form, and 
Needs Analysis/Recommendation Form to the insurer for underwriting, or to the client, or to the supervisor will be penalized as follows:  
 
• 1
St offence – counseling 
  
• 2nd offence –re-training on HI  
 
• 3rd offence – letter of warning   
 
• 4th offence - 3 months suspension  
 
• 5th offence – termination of contract  
 
Insurer to ensure that supervisors validated the Recommendation Form submitted by their reps as 
soon as practicable and take appropriate and timely actions to rectify an erroneous 
recommendation made by their representatives.  
  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   86 
Produced 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 
Products  For Individual Health Products -   Appendix 13 C  
 
1.  This Guideline for individual health product is similar to LIA Guidelines covered above except 
 these areas:  
  
LIA Guidelines  
 GIA Guidelines  
 
Application  
 
1. The following requirements:  
a. Disclosure of representative’s status  
b. Use of fact find form  
c. Use of needs analysis/recommendation  
form 
 
do not apply to:  
 
• Direct  marketing (provided no advice has  
been given)  
- includes internet as a tool of DM, but 
not as an e -intermediary  
 
  
 
Offence  
Offence for not submitting duly completed F act Find Form and Needs 
Analysis/Recommendation Form  
 
 
• 1St offence – counseling 
  
• 2nd offence –re-training on HI  
 
• 3rd offence – letter of warning   
 
• 4th offence - 3 months suspension 
 
• 5th offence – termination of contract  
 
 
  
• 1St offence – counseling 
  
• 2nd offence –re-training on HI  
 
• 3rd offence – letter of warning   
 
• 4th offence - 3 months suspension 
 
• 5th offence – Report to GIA -ARB  
Be permanently barred from selling 
health insurance .   
 
  Similar to LIA 
Guidelines  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   87 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) GIA Guidelines on Needs -Based Sales Process  
For Group Health Insurance Products Appendix 13C – Pg 276   
 
1.  The Group Insurance Fact -Find Form (GIFF) serves as a means for the collection of certain 
 basic information; needs analysis and documentation of any recommendation made.  
 
 
2.


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
The Group Insurance Fact -Find Form (GIFF) serves as a means for the collection of certain 
 basic information; needs analysis and documentation of any recommendation made.  
 
 
2.  Scope of Application  
 The GIFF is applicable to all distribution channels for : 
  
• Compulsory and voluntary or participatory programmes  
 
• Group health only  
 
  The GIFF do not apply to:  
• 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.  
 
• Standalone Group Personal Accident Products 
 
 
3.  Signatory Requirements  
 For direct sale s, the client’s signature plus the insurance executive’s signature as witness are 
 to be appended.  For sales made via intermediaries, the client’s signature plus the 
 intermediary ’s signature to be appended.  
  
4. Code of Conduct /Practice for Insurers  
• The contents in the GIFF serve as minimum  industry standards.  
 
• Insurer must ensure that it will not issue any quotation and/or accept any application 
proposal form (except for off -the-rack pa ckage product), that is not accompanied by 
the GIFF duly completed and signed.    Incomplete form or forms without required 
signatures are NOT to be accepted.  
 
• Holding ins urer must provide all the information requested in the GIFF, particularly the 
claims experience  of the  policy for the period insured is with the holding insurer.  
 
 
5. Documentation and Record Keeping  
 Insurer shall keep the GIFF for a length of time for necessary audit trail.   

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   88 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  
Chapter 14 –  Financial Need Analysis  
 
1. Advantages of needs selling compared to product selling are:  
 
• Service  Oriented;  
• Not Pre ssure Selling;  
• Relationship Based.  
  
2. Stage 1 – Fact-Finding  
 
 Fact-finding is the process of obtaining answers to a series of questions about a prospective 
 client’s personal circumstances, finance  ambitions etc to enable you to have a better 
 understanding of the client’s objectives, needs for a proper basis to rec ommend suitable 
 Accident and Health (A&H) Insurance Products.  
  
Basic Sections of a Fact Find Form  
Sections  Purposes  
 
a. Important Notice to Clients  Enables the prospective client to know:  
 
1. Which inter mediary’s product the reps is selling;  
 
2. Highlight to client the importance of completing Fact 
Find Form for appropriateness of product 
recommendation to his needs.  
 
 
 
 
 
 
 
b. Application Type  
       
Type 1 :  
“I/We have disclosed relevant information for            comprehensive planning”  
 
Meant for those who wish to  complete the fact find in full, 
so as to receive r ecommendations on product suitability.  
 Type 2 :  
“I/We have disclosed relevant information for  specific 
need(s) planning”  
 Meant for those who do not wish to or unable to provide 
all information requested.  Suitable for those who wish to 
receive recommendation on product suitability.  
 
Type 3:   
“I/We did not undergo any needs analysis in this 
review and it is my/our responsibility to ensure 
product suitability”               
 
Meant for those who already know w hich medical 
insurance product and the amount of coverage they want.  
 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   89 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  
 
c. Personal In formation  
• Essential for admin purposes on the part of the 
company;  
 
• Provides reps with a preliminary assessment on 
type of products that will like likely be needed;  
 
• Age – needed or underwriting and premium                    
determination.  
 
 
d. Employment Details  
 
• Employed/ Unemployed 
 
• Monthly Income  
 
• Occupational Hazard 
 • Determines whether eligible for DI , as Di is not 
issued to any unemployed person ; 
 
• Determines the def erred period  for DI , (self 
employed –shortest deferred period compared to 
one who is employed)  
 
• Determines affordability ; 
 
• May need to ask for more details to assist in  
underwriting.


key: _node_content
string_value:
{"id_": "2f1a2a85-6840-49d6-92f7-e5592643a558", "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": "55b54253-9469-4adc-96bb-e13f776d45b7", "node_type": "1", "metadata": {}, "hash": "4eac0abf2d1da463d00015277c3892cc201104bf873383add6d7939396dcb7aa", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "33ef0430-ecc0-4f24-9b42-055df3049bf1", "node_type": "1", "metadata": {}, "hash": "338b3e9f6a1b8e27aea607cb89a20855a159ff527f8102855c8405c3cf5e6365", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 181272, "end_char_idx": 185471, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
e. Details of Spouse &  
    Dependant   
• Identification in event of claim ; 
• Premium  determination (to cover dependant);  
• Occupational hazard of spouse;  
• Determines eligibility & whether a need to  
               provide A& H cover for dependants.  
 
 
 
f.  Existing HI Polices   
Serves as a refer ence point for further A & H insurance 
recommendations.  Avoid replacement or caused insured 
to be over insured for those policies which is subject to 
Co- Ordination of Benefit Clause.  
 
 
 
g.  Personal Priorities   
• Enables reps to know client’s priorities with  
regard to A& H polices;  
 
• Help client to re – prioritize  his needs based on  
overall profile of the client.  
 
 
h.  Health Condition   
• Determines insurability and on what terms;  
• Obtain relevant reports for underwriting.  
 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   90 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  
i.  Replacement of Policy  
  
Explain consequences  of replacement.  
E.g: higher premiums, terms and conditions may be less 
beneficial.  
 
 
j. Representative’s Declaration   
Information in Fact Find Form will be treated as confidential, use strictly for determining product suitability.  
 
  
3. Stage 2 – Identifying and Quantifying Needs  
 
 Analyze information gathered during Fact -Find Stage. Examples:  
 
 Emer gency Fund  
 Useful to guard against breadwinner’s loss of a job or short term disability.  
 
 If a client has no emergency fund, it may aff ect ability to service policies that he 
may purchase from you.  
 
 
 7 Life Stages  
 It has an eff ect on product recommendations ; 
 
 Disability Income Insurance Pol icy is needed to protect income for all stages  
 except childhood.  H owever , it is not available to the unemployed.  
 
 
 Dependants  
 Provision should be made for medical expenses  should dependant becomes disabled,
 it will be a financial burden to the family’s finances.  
 
 
 Clients’ Existing Polices.   
If the prospective client has the given policies, you need to compare the benefits under 
his existing insurance with his current needs to see of the prospective client is sufficiently 
covered.     
 Disability I ncome;  
 Medical Expense Insurance;  
 Managed Healthc are ; 
 Critical Illness ;  
 Long Term Care Insurance;  
 Hospital Cash Insurance   
 Work  Injury Compensation Insurance  
 Pays in the event of any accident resulting in hospitalization, permanent incapacity  
 and/or death arising in the course of employment.  
 
 
 
 
 Covered in the respective 
chapters already  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   91 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 )  Quantifying Needs  
  
1. Quantify Maintenance cost  using the Total and Permanent Disability Benefit Method,  
 given:  
 
 Salary per month:  $3000 
 Expenses per month: $1,500 
 Rate of return 5%; Inflation rate 2%  
 Number of year  income needed: 21  
  
 Covered under the following :  
 Group Term Life : $100,000 
 His own e xisting life Insurance $50,000  
   
 Answer: $135,795  
  
 Workings:  
 $1,500 X 12 = $18,000  
 $18,000 X 15.8775  (table A2: 3%;  21 years)  = $285,795  
 $285,795 – ($100,000 + $50,000)  
 = $135,795  
 
 
 
2. Quantify Medical Cost  given:  
 
 Mr. Lim would like to based his average annual medical expenses to be $50,000  
 He has the following policies to cover him:  
 a)  Group Policy (max pay able) = $18,000  
 b)  Income Shield (total amount payable) = $7,000  
 
 
 Answer : $25,000  
 
 Workings:  
 Average Medical Expenses = $50,000  
 Less amount payable under Group P olicy = $18,000 
 Less amount payable under his MediShield  = $7,000 
 Hence shortfall =  $25,000 
 
 
3.


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
Quantify the following Hospital Cash Insurance  (per day) policy given:  
 
 Monthly expenses: $5, 000 
 Existing Cash Benefit per month: $500  
 
 Answers :$150 per day  
 
 Workings:  
 ($5,000 - $500)/ 30  
 = $150 per day  
  
 
 
 

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   92 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) 4. Stage 3-  Product Recommendations and Presentation  
  
1. Product Recommendations  
 
 2 basic principles:  
  
• recommend products  only if client needs  them;  
 
• recommend products which are most suitable for him, given the circumstances.  
 Product suitability calls for good product know ledge.  
 
 
 
2. Product Presentation   
 
It is advisable to follow a Systematic Process for presenting your recommendations:  
 
• Purpose of product;  
 
• Description  and nature  of product;  
 
• Benefits and limit ations of product ; 
 
• Explanations on options  within the product;  
 
• Give reasons for recommendations;  
 
• Explain Benefit Illustration  and highlight guaranteed and non guaranteed;  
 
• Disclose distribution costs, charges and expenses under the policy   
 
 
 
 
5. Stage 4 – Client Review – Necessary because of :  
 
• Change in client’s circum stances ; 
 
• Exter nal development  such as changes in CPF ruling etc which can have an impact 
on the client’s financial position;  
 
• Original product purchased is not sufficient  to cover all his needs;  
 
• New product launch.  
  

Health Insurance                                                                                                  Strictly for Internal Use Only                                           
 
Prudential Assurance Company Singapore (Pte) Limited   93 
Produced in collaboration with Julia Sim. B ased on 5th Edition, Version 1.3 ( 21/3/2016 ) Chapter 15 – Case Studies   
 
This chapter brings out 2 case studies; one on individual and the other on group.  
  
Individual  
 
 
1.   Source of Information:  
      Fact Find Form   
  
2.  After calculating maintenance cost,  
     the most suitable product are :  
 
• Disability Income Insurance   
  – must be employed 
 
• TPD /Personal Accident Policy            
– if unemployed 
  
3.  Products to meet Medical cost are:  
 
• Medical Expense Insurance ;  
 
• Managed Healthcare Insurance ; 
 
• Long Term Care Insurance;  
 
• Cri tical Illness Insurance ;  
 
• Hospital Cash Insurance ;  
 
• Personal Accident Policy  
 (with medical expense benefit)  
  Case Study  
Group  
 
 
1.  Source of Information:  
     Group Fact Find Form  
  
2.  Determine Sum assured for Group  
        Term Life Insurance in 2 ways:  
 
• By R ank    
   Advantage: Easy to manage 
 
 Disadvantage: Does not take into  
 consideration the length of service 
 of the staff.  
 
• Number Of Times Of Employee  
 Basic Salary.  
 Advantage: More equitable  
 
 
3.  Obtain the company’s past 3 years of  
 claim history  for premium  
 determination.  
  
 4.  Client and representative must  
 sign on the Group Fact Find Form to  
 enable Insurer to give a quotation.    
 
 
5.  Rep to go through quotation, and once  
 client accepts the quotation, reps to  
assists on the completion of necessary  
forms and to submit to insurer with  
 payment.  

Health Insurance                                                                                                                                                  Quick comparison at a glance   
      Managed HealthCare  Medical Expense  Disability  Income  Long Term Care  Critical Illness(CI)  Hospital Cash  
Definition  & Purpose  
Overall strategy for 
appropriate medical care 
yet containing medical 
cost.  
3 components:  
1. Accessibility  
   PCP-   are called     
   “Personal Physician” ,  
   “Gatekeeper”  
2.  Quality of care  
3. Cost  
    4 methods –    
• Capitation  
• Salary  
• discounted fee  
• fee schedule  Reimbursement 
benefits for specific medical expenses that 
result from accidental 
& sickness.  
 
- Inpatient Expenses  
( 11 points)  
 - Outpatient 
Expenses  
(4 points)  
 
-    Catastrophic  
       Outpatient  
- Kidney and  
- cancer treatment  
 Income replacement to 
safeguard one’s earning capacity if one 
is totally disabled and 
unable to work.  
 
Also known as -
Permanent Health 
Insurance, Income 
Protection, Income 
Replacement.  Pays daily or monthly 
benefits.


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
Also known as -
Permanent Health 
Insurance, Income 
Protection, Income 
Replacement.  Pays daily or monthly 
benefits. Cover cost of care of person who is 
physicall y impaired and 
that no longer able to 
function independently 
and have to depend on 
others to help perform 
ADLs.  Lump sum upon 
diagnosis of one of 37  
or more dread 
diseases or undergoing 
surgical procedure covered under the 
policy.  
 
New: Severity based 
CI Plans pay claim 
during early stages and 
severity of CI (% of 
SA). Premium is higher 
than normal CI.  
 
New: Multiple Pay CI  Daily cash benefit if 
one is hospitalized due 
of accident or illness  
Premium   
Fixed Annual Premium  Age Band  Level  Level  Usually level and non 
guaranteed. For 
policies on yearly 
basis – age band  Age band  
Waiting Period  
 
 Apply, but not to 
accidental injury  Can choose deferred 
period  90 days from inability to 
perform ADLs  
 • 90 days waiting 
period from date of 
issue 
/reinstatement  
• 30 days survival 
period from 
occurrence of CI  
 
 
 Apply, but not to  
accidental injury  

Health Insurance                                                                                                                                                  Quick comparison at a glance   
      Managed HealthCare  Medical Expense  Disability  Income  Long Term Care  Critical Illness(CI)  Hospital Cash  
Min /Max Age of Coverage  
 
 
 15 days -75 years old  
 
 Must be working  
 
 Min age – determine by 
insurer.  
Max : 70 to 75 yrs next 
birthday  Min age: 1  
Max age : 55  
cover may expire at 65 
or whole life  
 Up to age 65 or 70 
years old 
 
 
Types  
• Staff HMOs  
• Group HMOs  
• Network HMOs  
• Independent 
Practitioners 
Association (IPA)  
• Mixed Model  
• Preferred Provider organizations (PPOs)  
• Point of Service Plans (POS)  
 
 
 • Other benefits 
under Med 
Expense ( 8 points. 
Impt to know:  
major organ 
transplant,  
miscarriage 
benefit, private 
nursing home, final expense).  
• Diff b/w indiv and 
Group Policy.  
• Diff b/w compulsory & 
voluntary plans  
• PMBS VS TMIS  • Total disability 
benefits. 3 Types  
- own occupation  
- similar occupation  
- any occupation  
 
• Partial disability 
benefit or 
Rehabilitation 
expense benefit  
• Escalation benefit  
• WP benefit  
• Death benefit  • Pays daily or 
monthly.  
 
Daily (2 methods )  
 1. Service Based  
 2. Disability Based     
    (Benefit  Trigger)  
 
Monthly  
(most common)  
100% - unable to  
perform 4 out of 6 ADLs  
 
50% - unable to 
perform 2 out of 6 
ADLs
. 
 
Alzheimer’s disease covered  
 
• Hosp R&B  
• Surgical procedure  
• Financial. 
Assistance with 
adaptation  
• Extended care 
  
 • Acceleration i.e. 
advances sum 
assured plus 
bonuses  
 
• Additional i.e. pays 
out dread disease 
sum assured 
without touching 
death benefit.  
 
• Severity based CI Plan - pays out 
from early to 
intermediate to 
advanced  and 
terminal.  
 
• Multiple pay CI -  
allows more than 1 CI claim.  • Daily benefit 
chosen at 
inception subject to 
specified no. Of 
days and lifetime 
limit. 
 
• Fixed cash amount 
is not related to 
actual cost 
incurred.  

Health Insurance                                                                                                                                                  Quick comparison at a glance   
      Managed HealthCare  Medical Expense  Disability  Income  Long Term Care  Critical Illness(CI)  Hospital Cash  
Features  
1. Standalone only  
2. Expense participation  
  - Deductibles  
  - Co insurance  
3. Can be extended to  
   dependents.  
 
 1. Standalone or rider  
 
2. 2 types  -  “as 
charged” benefits 
or sublimits 
imposed subject to per policy yr & per 
lifetime limits  
3. Family coverage  
4. Reimbursement  
5. Expense 
participation ie. 
Deductible & co-
insurance, pro-  
ration factor.  Note 
insurers do not 
imposed 
deductibles on 
outpatient 
treatments.  
6. Benefit Limits i.e. 
Lifetime, annual, 
event  
7. Covered charges  
 
8.


key: _node_content
string_value:
{"id_": "4036d204-c682-491c-967e-cdc511d7c255", "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": "92f5df94-c2b7-456a-a63b-70d958213ee8", "node_type": "1", "metadata": {}, "hash": "802cf14b7a2b1f44d3e21d8f429f8be47ce3fd1b62341115ba20eb0e0be580f8", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "0d33ba26-7031-4229-8b0a-71a669b12d32", "node_type": "1", "metadata": {}, "hash": "d6a6728a56af85ed44691177c16bd9d0ad604ce21457be3e3f6fb17118577b61", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 193923, "end_char_idx": 197330, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
6. Benefit Limits i.e. 
Lifetime, annual, 
event  
7. Covered charges  
 
8. Geographical limit 
(Policy terminates).   
 
9. Guaranteed 
renewability basis  
10. Co –ordination of 
benefit clause.  
 
 
 1. Standalone or rider  
 
2. Mthly income 
3. Ben may be level 
or increase at given rate  
4. Ben include death, partial & total 
disability during 
benefit period  
 
5. Guaranteed renewable  
6. WP during benefit 
period  
7. Rehabilitation exp 
benefit.  
8. No surrender value  
9. No assignment  
10. 30 days grace 
period  
11. Benefits -  non 
taxable  
 1. Standalone or rider  
 
2. Guaranteed 
renewable  
3. Non- participating  
4. Recover from 
disability, payment stop 
5. No cash value or 
paid up value.  1. Standalone or Rider  
2. Only 1 dread 
disease claim to be 
made on one policy  
3. Lump sum upon diagnosis of DD  
4. Policy must be in 
force  
5. CI must be one 
that is covered.  
6. Meets definition  
7. Diagnosis meets 
conditions.  
8. Limitation on total 
amt to minimize 
moral hazard 
(S$1m)  
9. 24-hrs a day 
worldwide coverage  
10. No surrender value  
11. Assignment may or 
may not be allowed 
12. For package DD Policies, DD cover 
will be terminates 
once NFO is exercised, except 
paid up option.  1. Standalone or 
rider. Standalone more attractive 6 
points) . 
2. Fixed  amt per day 
hosp benefit  
3. Cap to max amt payable on single 
life 
4. Ben not affected 
by payment from 
other med insurance policies  
5. Mostly worldwide 
coverage  
6. Hospital 
confinement (6 –  
24 hrs)  
7. Guaranteed 
renewable  
8. No surrender value  
9. No assignment  
10. No claim discou nt 
given (25%)  

Health Insurance                                                                                                                                                  Quick comparison at a glance   
      Managed HealthCare  Medical Expense  Disability  Income  Long Term Care  Critical Illness(CI)  Hospital Cash  
Exclusions  
1. Pre-existing conditions  
2. Congenital anomalies, 
hereditary conditions 
.Mental illness & 
personality disorders  
3. Fertility -related  
4. STD 
5. AIDS & related  
6. Self-inflicted  
7. Drug or alcohol addiction  
8. Private Nursing Charges  
9. Kidney dialysis 
machine, iron lung, 
prosthesis  
10. Private nursing  
11. Civil commotion, riot, 
strike  
12. Childbirth & related  
13. Reimbursement by Workmen comp  
 1. As in MHC  1. Pre-existing 
conditions  
2. AIDS and related  
3. Self-inflicted  
4. Drug or alcohol indulgence  
5. Invasion, riot, 
strike, civil 
commotion  
6. Pregnancy or 
childbirth except 
where disability 
continues for more 
than 90 days after 
termination of 
pregnancy  
7. Injuries while in service of armed 
forces (except for 
reservist training)  
8. Aerial activity  
9. Professional or hazardous sports  1. Pre-existing 
conditions  
2. Mental or nervous 
disorders without 
demonstrable 
organic disease  
3. AIDS & related 
except from blood 
transfusion or if 
medical staff is 
inflicted.  
4. Self-inflicted  
5. Drug or alcohol 
abuse  
6. Felony, riot or 
insurrection  
7. War or any act of war 
 1. Pre-existing 
conditions  
2. Congenital or 
inherited disorder  
3. AIDS or related  
4. Self-inflicted  
5. Drug or alcohol 
misuse  
6. War & civil 
commotion  
7. Flying other than a fare paying 
passenger.  1. As in MEI  
Underwriting  
Important Factors in 
Underwriting.


key: _node_content
string_value:
{"id_": "0d33ba26-7031-4229-8b0a-71a669b12d32", "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": "4036d204-c682-491c-967e-cdc511d7c255", "node_type": "1", "metadata": {}, "hash": "acc2dbd4e407dfb88804ff997fc8dd92f2f603cd880cdd36cb1fd9fb3ff742eb", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "91bd1094-8bb9-4099-877a-d628e71b0e28", "node_type": "1", "metadata": {}, "hash": "2013e6f1e803db269a0808feafc437d9f154f53e28aec543138424cc5ae29f8d", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 197163, "end_char_idx": 201706, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
Drug or alcohol 
misuse  
6. War & civil 
commotion  
7. Flying other than a fare paying 
passenger.  1. As in MEI  
Underwriting  
Important Factors in 
Underwriting.  
• Medical history  
• Current physical 
condition  
 
 
 
 
 
 Important Factors in Underwriting:  
 Individual  
• Medical history  
• Current physical 
condition  
 
 
 Important Factors in 
Underwriting  
• Size & stability of earning  
• Overall financial 
situation  
 
 
 
 
 Important Factors in Underwriting  
• Detection of early cog impairment  
• Morbidity risk  
  
 
 
 
 Important Factors in Underwriting  
• Family history  
• Smoking habit  
• Medical history  
• Current physical 
condition  
 
 
 
  Not underwritten due 
to its small premium.  
Pre existing conditions 
are permanently excluded.  

Health Insurance                                                                                                                                                  Quick comparison at a glance   
      Managed HealthCare  Medical Expense  Disability  Income  Long Term Care  Critical Illness(CI)  Hospital Cash  
Sources of Underwriting  
• Individual  
   -   Proposal form  
 
• Group  
- Group fact find form  
- Individual health  
     declaration form  
     (for small group)  Source of Underwriting  
• Proposal form  
 
Group  
• Group fact find  
• Below 10 
employees - 
Individual 
employee fil ls up 
health declaration form.  
  Source of Underwriting  
 
• Individual  
Proposal form  
-  Computerised 
payslip/ letter from Company.  
- Notice of 
Assesssement  
- CPF Statement 
(6months)  
- Large amt questionnaire if 
benefit is more 
than $60,000  
- Medical test  
 
• Self Employed  
Proposal form     
 - Notice of 
Assessment or audited co a/c for past 3 years.  
 -  Large amt 
questionnaire  
- Medical tests  
 
  
 
 
 
 Source of Underwriting  
• Proposal form  
• Some may ask for 
detailed medical 
info or undergo 
clinical assessment  Source of Underwriting  
• Lower non medical limit 
compared to 
application for a 
life policy  
• Medical & family history  
• Occupational risk  

Health Insurance                                                                                                                                                  Quick comparison at a glance   
      Managed HealthCare  Medical Expense  Disability  Income  Long Term Care  Critical Illness(CI)  Hospital Cash  
Termination of Cover  
 • Death of insured  
• Life time limit 
reached  
• Policy terminated  
• Non- payment of 
premium  
• Insured dies 
• End of yr expiry 
age reached  
• Date on which 
insured enters full -
time military ser 
except NS reservist duty.  
• Leave employer/ 
policyowner 
(group)  • Policy expires  
• Non- payment of 
premium  
• Insured dies  
• Expiry age 
reached  
• Unemployed for 
more than 
specified 
time(except if he is 
disabled)  
• Resides outside Spore for an 
aggregate of more 
than 300 days 
within 1 policy yr.  • Policy expires  
• Nonpayment of premium  
• Reached max limit  
• Insured dies  • Valid DD claim 
made  
• Basic plan matures 
or expires  
• Policy lapse due to non-payment of 
premium  
• Surrender or 
convert to 
extended term under NFO.  
• Insured dies  
• Expiry age 
reached  • Per lifetime limit 
reached  
• Basic matures  
• Policy lapses due 
to non- payment of 
premium  
• NFO  
• Insured dies  
• Expiry age reached  
Claims  
In-network care, no claims 
required.  
 
 
 
 
Out-of-network:  
• Claimant’s statement  
• Original med bills  • Claim form  
• Physician 
Statement  
• Original med bills  • Claim form  
• Physician Statement  
• NRIC/BC  
 
• Evidence of 
present or pre-
disability earnings  
• Letter from 
company  
• Copies of med 
certs &  test results  • Proof of inability to perform ADLs on 
co. furnished forms  
• NRIC/BC  
 
• Proof of med 
examination  
• Death cert  • Claimant statement  
• Attending 
Physician Stt 
• Original bills  
• Proof of DD  
• Original policy doc  
• Written notice of claim submitted 
within 60 days  of 
diagnosis.  
• Submission of claimant’s form 
within 15 days 
after insurer sent 
out. • Claim form  
• Original bills  

Health Insurance                                                                                                                                                  Quick comparison at a glance   
      Managed HealthCare  Medical Expense  Disability  Income  Long Term Care  Critical Illness(CI)  Hospital Cash  
• Proof of CI 
submitted within 60 
days from date of 
diagnosis.


key: _node_content
string_value:
{"id_": "91bd1094-8bb9-4099-877a-d628e71b0e28", "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": "0d33ba26-7031-4229-8b0a-71a669b12d32", "node_type": "1", "metadata": {}, "hash": "d6a6728a56af85ed44691177c16bd9d0ad604ce21457be3e3f6fb17118577b61", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "50c5d31b-e2da-4fc9-b06d-8ca4954e8761", "node_type": "1", "metadata": {}, "hash": "973ee1b68a78e985e89aaf42b8362d6d757f30965f9e1bad6d53b779e0d90258", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 201714, "end_char_idx": 206046, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
7TH EDITION
Version 1.4Healt h
INSURANCE


 
IMPORTANT NOTICE  
Any reproduction or redistribution of this Study Text in part or in its entirety, without granted permission, 
other than for the purpose of your examination preparation, is strictly prohibited and will be tantamount to 
a copyright infringement. Legal action will be taken to protect our copyright.  
 
Any website references are correct as of the time of publication.  
 
 
WARNING TO ALL EXAMINATION CANDIDATES  
 
You WILL NOT BE ADMITTED  into the examination room (whether virtual or on -site) if you:  
 
1. Produce unacceptable identification documents (IDs).  
2. Your name/ID Number on the acceptable ID DOES NOT MATCH EXACTLY THE NAME (including 
Hanyu 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.  
Please bring along the ID that you used during your examination registration for your admission. If the 
name/ID number on the ID that you bring to the examination room differs from the name/ID number 
that 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 
or reschedule of examinations will be entertained.  You will need to re -register for the examination and 
pay all fees again.  
(If you are unsure of which ID you had used during your examination registration, you can email SCI at 
talk2us@scidomain.org.sg  during office hours to check at least ONE WORKING DAY before the 
examination day.)  
3. Are late for the examination.  No reasons are entertained.  
 
Candidates must  produce the same Registration ID  as the one that they had registered with, before they can 
be allowed to sit for the examination:  
 
 For Singapore Citizens or Singapore Permanent Residents , the acceptable IDs are valid 
NRIC/Passport/Singapore Driving License.  
 
 For Foreigners , the acceptabl e IDs are valid Passport, Employment Pass, Work Permit OR S Pass*  (*S Pass 
does not refer to Student Pass)  
 
For Regulars or Full- time National Servicemen (NSFs) belonging to (Singapore Armed Forces/Singapore 
Police Force/Singapore Civil Defence), the acce ptable IDs are valid and original SAF/SPF/SCDF Card, 
respectively.  
 
Note: WE DO NOT ACCEPT 11B Card for those who are NO LONGER REGULARS OR FULL- TIME NATIONAL 
SERVICEMEN (NSFs).  
 
No soft copies are allowed. No other forms of identification are allowed.  
SCI does not accept police reports of lost IDs as a document for admission.  
No appeals for refunds or reschedule of examinations will be entertained.  You will need to re -register for 
the examination and pay all fees again.  
 
Candidates who arrive more than 30 minutes after  the commencement of the examination will NOT  be 
allowed to sit for the examination and will be recorded as being “Absent”. If candidates are refused admission, 
their examination fees are non-refundable, non-deferrable, and non- transferable.   

 
HEALTH INSURANCE  
 
7th Edition, Version 1.0 –  1 July 2020  
7th Edition, Version 1.1 –  25 August 2020  
7th Edition, Version 1.2 –  26 March 2021  
7th Edition, Version 1.3 –  15 February 2022  
7th Edition, Version 1.3a –  15 April 2022  
7th Edition, Version 1.4 –  1 October 2022 
 
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
© 202 0 by Singapore College of Insurance Limited. All rights reserved.  
 
Any reproduction or redistribution of this Study Text in part or in its entirety, without granted permission, other 
than for the purpose of your examination preparation, is strictly prohibited and will be tantamount to a copyright 
infringement. Legal action will be taken to protect our copyright. Any website references are cor rect as of the time 
of publication.  
 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 
provide 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.


key: _node_content
string_value:
{"id_": "50c5d31b-e2da-4fc9-b06d-8ca4954e8761", "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": "91bd1094-8bb9-4099-877a-d628e71b0e28", "node_type": "1", "metadata": {}, "hash": "2013e6f1e803db269a0808feafc437d9f154f53e28aec543138424cc5ae29f8d", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "ec1f76cb-ab53-4329-8f61-4df8a58d3137", "node_type": "1", "metadata": {}, "hash": "e670c65c139a78012b8d817dc82dbc2939a1d59792455a7f5f71a39e3f553bc2", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 205865, "end_char_idx": 209762, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
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.  This material should in no way be used as an original source of authority on legal matters. 
Any names used in this Study Guide are fictitious and have no relationship to any persons living or dead.  
 
First Edition published in 2001.  
Second Edition publishe d in 2004.  
Third Edition published in 2007.  
Fourth Edition published in June 2010.  
Fifth Edition published in June 2013.  
Sixth Edition published in October 2016.  

Health Insurance   
 
Copyright reserved by the Singapore College of Insurance Limited [Version  1.4] Table of Act Changes  
 
Except for the Notices which were extracted in full from  the MAS website, 
amendments were only made to the title of the Acts in the relevant  paragraphs  of the 
study text.   
 
As the respective notices are still pending release from MAS, they will be updated 
once MAS has published them.   
 
Version 1.2 : Version 1.3  
Amended to:  
Enlistment Act (Cap. 93)  Enlistment Act 1970  
Sections 35TA and 64(2) of the 
Insurance Act (Cap. 142)  Sections 71 and 154(4) of the 
Insurance Act 1966  
Part IIIC of the Insurance Act (Cap. 
142) Part 3C of the Insurance Act 1966  
Trust or Irrevocable Nomination 
(Section 49L of the Act)  Trust or Irrevocable Nomination 
(Section 132 of the Act)  
Revocable Nomination  
(Section 49M of the Act)  Revocable Nomination  
(Section 133 of the Act)  
Insurance Act (Cap. 142)  Insurance Act 1966  
Section 25(5) of the Insurance Act 
(Cap. 142)  Section 23(5) of the Insurance Act 
1966  
Sections 35P, 35TA and 64(2) of the 
Insurance Act (Cap. 142)  Sections 67, 71 and 154(4) of the 
Insurance Act 1966  
Financial Advisers Act (Cap. 110)  Financial Advisers A ct 2001  
Section 55(2) of the Insurance Act 
(Cap. 142)  Section 142(3) of the Insurance Act 
1966  
 
 
Please note that there are no changes in the Table of Acts in V1.4  

Table of Contents  
Copyright reserved by the Singapore College of Insurance Limited  [Version 1. 4] i 
Contents  Chapter 1  Overview Of Healthcare Environment In Singapore 1 
 Chapter Outline  
 Learning Outcomes  
1. Introduction  
2. Singapore’s Healthcare Philosophy  
3. Healthcare 2020 Masterplan  
4. Healthcare System In Singapore  
   
Chapter 2  Medical Expense Insurance 11 
  Chapter Outline  
 Learning Outcomes  
1. Introduction  
2. Health Insurance   
3. Key Features Of Medical Expense Insurance  
4. Underwriting  
5. Healthcare Subsidy Level  
6. Termination Of Cover  
7. Claims  
8. Notice No: MAS 117 -  Training and Competency 
Requirements – Health Insurance  
Appendix 2A –  Sample Medical Expense Insurance Benefit 
Schedule  
Appendix 2B –  Sample Schedule Of Surgical Benefits  
Appendix 2C –  Table Of Healthcare Subsidy Level  
Appendix 2D –  Notice No: MAS 117 -  Training and 
Competency R equirement: Health Insurance  
 
Chapter 3  Group Medical Expense Insurance  50 
  Chapter Outline  
 Learning Outcomes  
1. Introduction  
2. Group Insurance  
3. Individual & Group Medical Expense Insurance 
4. Portable, Transferable Medical Benefits & Shield Plans 
For Employees  
Appendix 3A - Transferable Medical Insurance Certification  
 
Chapter 4  Disability Income Insurance 64 
 Chapter Outline  
 Learning Outcomes  
1. Introduction  
2. What Is Disability Income Insurance?  
3. Disability Income Insurance & Total And Permanent 
Disability  
4. Computation Of Disability Income Insurance Benefit  
5. Definitions  
6. Benefits Offered Under Disability Income Insurance 
7. Features Of A Disability Income Insurance Policy 
8. Underwriting  

Health Insurance  
ii Copyright reserved by the Singapore College of Insurance Limited  [Version 1. 4] Contents  9. Cessation Of Benefits  
10. Exclusions  
11. Termination Of Cover  
12.


key: _node_content
string_value:
{"id_": "ec1f76cb-ab53-4329-8f61-4df8a58d3137", "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": "50c5d31b-e2da-4fc9-b06d-8ca4954e8761", "node_type": "1", "metadata": {}, "hash": "973ee1b68a78e985e89aaf42b8362d6d757f30965f9e1bad6d53b779e0d90258", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "29f0c172-eef4-464f-85fb-88ca764cb637", "node_type": "1", "metadata": {}, "hash": "f4d69e81c1e098ec7fbf4aef92dd169ff84772609f8cc3260aecfc1e3808bfa2", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 209675, "end_char_idx": 213373, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
4] Contents  9. Cessation Of Benefits  
10. Exclusions  
11. Termination Of Cover  
12. Group Disability Income Insurance  
13. General Underwriting Principles For Group Disability 
Income Insurance  
14. Disability Income Claims  
15. Conclusion  
Appendix 4A - Clinical Abstract Form   
 
Chapter 5  Long- Term Care Insurance 88 
 Chapter Outline  
 Learning Outcomes  
1. Introduction  
2. What Is Long- Term Care (LTC) Insurance?  
3. Benefits Offered Under LTC Insurance  
4. Other Benefits Provided Under LTC Insurance  
5. Maximum Benefit  
6. Benefit Payment Term  
7. ElderShield  
8. CareShield Life  
 Chapter 6  Critical Illness Insurance  101 
 Chapter Outline  
 Learning Outcomes   
1. Introduction  
2. Critical Illness  (CI) Insurance 
3. LIA Critical Illness Framework  
4. Benefits Offered Under Critical Illness Insurance 
5. Variation Of Illness Insurance  
6. Underwriting  
7. Factors To Consider In Determining Adequacy of Critical 
Illness Coverage  
8. Exclusions  
9. Termination Of Cover  
10. Claims  
11. Group Critical Illness Insurance Policy  
 Appendix 6A –  Standard Definitions for Severe Stage of 37 
Critical Illnesses: Version 2019  
Annex 1 -  List of changes to the standard list of 37 critical 
illness under the Critical Illness Framework 2019 
 
Chapter 7  Other Types Of Health Insurance  140 
 Chapter Outline  
 Learning Outcomes  
1. Introduction  
2. Hospital Cash (Income) Insurance  
3. Medical Expense Benefits Under Travel Insurance 
4. Group Dental Care Insurance  

Table of Contents  
Copyright reserved by the Singapore College of Insurance Limited  [Version 1. 4] iii 
Contents  Appendix 7A –  Sample Schedule Of Allowances Under Group 
Dental Insurance  
 
Chapter 8  Managed Healthcare  155 
 Chapter Outline  
 Learning Outcomes  
1. Introduction  
2. What Is Managed Healthcare (MHC)  
3. How Does MHC Work?  
4. What Are The Common Types Of MHC Plans?  
5. Choice Of Providers Versus Cost Control  
6. Managed Healthcare (MHC) Insurance  
7. MHC Model In Singapore 
 
Chapter 9  Part I Healthcare Financing  167 
Chapter Outline  
 Learning Outcomes   
1. Introduction  
2. Healthcare  Subsidies  
3. Medi Save 
4. MediShield Life  
5. Integrated Shield Plans (IPs)  
Appendix 9A –  Withdrawal Limits for Inpatient, Outpatient, Long -
Term Care and Insurance Premiums  
Appendix 9B – MediShield Life Ben efits 
Appendix 9C – LIA Standardise Pre -Authorisation Form  
 
Chapter 9  Part II Healthcare Financing          203 
Chapter Outline  
 Learning Outcomes  
6. ElderShield & ElderShield Supplements  
7. CareShield Life & CareShield Life Supplements  
8. Other Healthcare Financing Schemes Set Up By The 
Singapore Government  
 
Chapter 10  Common Policy Provisions  221 
 Chapter Outline  
 Learning Outcomes   
1. Introduction  
2. Sections Of A Policy Contract  
3. Policy Schedule  
4. Insuring Clause & Definitions  
5. General Conditions  
6. Benefit Provisions  
7. Exclusions  
8. Claim Conditions  
9. Endorsements  
10. Conclusion  
Appendix 10A - Policy Schedule  

Health Insurance  
iv Copyright reserved by the Singapore College of Insurance Limited  [Version 1. 4] Contents  Chapter 11  Health Insurance Pricing  246 
 Chapter Outline  
 Learning Outcomes  
1. Introduction  
2. Key Factors Used In Premium Computation  
3. Parameters For Premium Rating  
 
Chapter 12  Health Insurance Underwriting  254 
 Chapter Outline  
Learning Outcomes  
1. Introduction  
2. What Is Underwriting?  
3. Underwriting Factors That Affect The Risk  
4. Sources Of Underwriting Information  
5. How An Insurance Representative  Can Help In The 
Underwriting Process  
6. Final Underwriting Decision  
7. Commencement Of Risk  
8.


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
Sources Of Underwriting Information  
5. How An Insurance Representative  Can Help In The 
Underwriting Process  
6. Final Underwriting Decision  
7. Commencement Of Risk  
8. Conclusion  
Appendix 12A –  Sample Supplementary Lifestyle 
Questionnaire  
Appendix 12B –  Sample Individual Hospital & Surgical 
Insurance Proposal Form  
Appendix 12C –  Sample Group Hospital & Surgical Insurance 
Proposal And Health Declaration Form  
 
Chapter 13  Notice No: MAS 120 –  Disclosure And Advisory Process   280 
  Requirements For Accident And Health Insurance Products  
 Chapter Outline  
Learning Outcomes  
1. Introduction  
2. Scope Of Notice No: MAS 120  
3. Structure Of Notice No: MAS 120  
Appendix 1 3A – Notice No: MAS 120  
 
Chapter 14  Financial Needs Analysis  313 
 Chapter Outline  
Learning Outcomes  
1. Introduction  
2. Needs Selling Versus Product Selling  
3. What Is Fact Finding?  
4. Identifying & Quantifying Needs  
5. Product Recommendations  
6. Presenting Your Recommendations  
7. Periodic Client Review  
 Appendix 14A –  Top 10 Conditions Of Hospitalisation  
  Appendix 14B –  Hospital Bill Size By Conditions/Procedures  
 

Table of Contents  
Copyright reserved by the Singapore College of Insurance Limited  [Version 1. 4] v 
Contents  Chapter 15  Case Studies  337 
 Chapter Outline  
 Learning Outcomes  
1. Introduction   
2. Case Study 1 –  Individual Health Insurance  
3. Case Study 2 –  Group Health Insurance  
Appendices 15A & 15B – Mr Tang’s Existing Health Insurance 
Policies  
 
Tables  356 
 
LIST OF CHANGES  
 
 
   

1. Overview of Healthcare Environment in Singapore  
Copyright reserved by the Singapore College of Insurance Limited [Version  1.4]                        1  
 
      CHAPTER 1  
OVERVIEW OF HEALTHCARE ENVIRONMENT IN SINGAPORE  
 
 
 
CHAPTER OUTLINE  
 
1. Introduction  
2. Singapore’s Healthcare Philosophy  
3. Healthcare 2020 Masterplan  
4. The Healthcare System In Singapore  
 
 
LEARNING OUTCOMES  
 
After studying this chapter, you should  be able to : 
▪ understand  the Singapore G overnment’s healthcare philosophy  
▪ know the key goals of the Healthcare 2020 Masterplan  
▪ understand  the difference s between  primary  healthcare  services , hospital services , 
and Intermediate and Long -Term Care  servic es 
▪ know the other healthcare services provided – dental, traditional chinese medicine 
and support services  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Health Insurance   
2 Copyright reserved by the Singapore College of Insurance Limited [Version  1.4] Contents  
CHAPTER OUTLINE  ................................ ................................ ................................ .............  1 
LEARNING OUTCOMES  ................................ ................................ ................................ ...... 1 
1. INTRODUCTION  ................................ ................................ ................................ .........  3 
2. SINGAPORE’S HEALTHCARE PHILOSOPHY  ................................ ............................  3 
A. Enhancing Accessibility  ................................ ................................ ........................  3 
B. Enhancing Quality Of Care  ................................ ................................ ...................  4 
C. Ensuring Healthcare Remains Affordable ................................ ............................  4 
3. HEALTHCARE 2020 MASTERPLAN  ................................ ................................ ...........  5 
A. Better Access  ................................ ................................ ................................ .........  5 
B. Higher Quality  ................................ ................................ ................................ ....... 5 
C. More Affordable  ................................ ................................ ................................ .... 6 
D. Living Well  ................................ ................................ ................................ .............  6 
4. HEALTHCARE SYSTEM IN SINGAPORE  ................................ ................................ ... 7 
A. Primary Healthcare Services and Facilities  ................................ ..........................  7 
B. Hospital Services ................................ ................................ ................................ ... 8 
C. Intermediate & Long -Term Care (ILTC) Services  ................................ .................  9 
D. Other Healthcare Services  ................................ ................................ ..................  10


key: _node_content
string_value:
{"id_": "192eb32b-776a-452c-af2b-1ef5e37db1c4", "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": "29f0c172-eef4-464f-85fb-88ca764cb637", "node_type": "1", "metadata": {}, "hash": "f4d69e81c1e098ec7fbf4aef92dd169ff84772609f8cc3260aecfc1e3808bfa2", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "08a56f3f-4408-48fc-9262-954079c96d2b", "node_type": "1", "metadata": {}, "hash": "2c2b3a7a7e6b1ecaddbf27d6688d49d8d6e93b829370231e084c0c883fce78e2", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 217853, "end_char_idx": 220697, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
1. Overview of Healthcare Environment in Singapore  
Copyright reserved by the Singapore College of Insurance Limited [Version  1.4]                        3  
1. INTRODUCTION  
 
1.1 Rising healthcare costs is a concern f or most governments. Advances in 
medical sciences , the greater use of expensive medical technology and drugs, 
as well as an ageing population  with longer  life expectancy , are some reasons 
that contribute to rising healthcare costs. In most developed countries, 
healthcare expenditure ha s grown much faster  than the economy, and absorb s 
an increasing share of the nation’s resources. This is a concern , as the resources 
that countries can devote to healthcare are finite , and there is a limit to the 
financial burden that households can bear. At the same time,  consumers  have 
rising expectations that the quality of healthcare must improve or at least be 
maintained. The challenge faced by most governments is how to balance th e 
rising expectations for quality healthcare and yet keep the costs affordable.  
 
 
2. SINGAPORE’S HEALTHCARE PHILOSOPHY  
 
2.1 Singapore’s healthcare philosophy is anchored on individual responsibility and 
affordable healthcare for all.  
 
2.2 The philosophy consists o f three pillars :  
(a) Building up a healthy population with preventive health care and 
encourag ing healthy lifestyles.  
(b) Emphasi sing personal responsibility towards healthy living through the 
“3M” (Medisave, Medishield and Medifund) system.   
(c) Keeping healthcare costs down by controlling the supply of healthcare 
services and providing heavy subsidies in respect of fees charged by  
public healthcare institutions.  
 
A. Enhancing Accessibility  
 
2.3 Singapore’s  healthcare infrastructure will be ramped up, with pla ns to increase 
the number of acute general hospital and community -hospital beds. These beds 
will come from the new hospitals which will be constructed across the country. 
The increase in community hospitals will allow more patients to recover in a 
more app ropriate setting.  
 
2.4 MOH is actively  building up its manpower capability and building a strong core 
of locals among healthcare professionals to support its infrastructural 
expansions. This is carried out through various initiatives, such as providing 
more o pportunities for flexible, part -time work in the community through its 
“Place and Train” Programme in the aged care sector,  as well as implementing 
a new remuneration framework for senior public sector doctors, to better 
recognising doctors for their diver se roles in clinical care, education, research 
and administration. At the same time, MOH actively drives innovation and 
productivity in both the public and ILTC sectors to simplify workflow processes, 
so that healthcare workers can focus on caring for the patients.


key: _node_content
string_value:
{"id_": "08a56f3f-4408-48fc-9262-954079c96d2b", "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": "192eb32b-776a-452c-af2b-1ef5e37db1c4", "node_type": "1", "metadata": {}, "hash": "632c9817fd1e3a0cf5eb5ac1ea3ab5265f3202b4f302ccbca316a24751088838", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "80b10533-c3c6-4107-86ff-0d10280fd721", "node_type": "1", "metadata": {}, "hash": "9a184b46f742e752b2fb833f52d76b34477e770376b0d17e35c3840cfd3def21", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 220706, "end_char_idx": 223738, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
Health Insurance   
4 Copyright reserved by the Singapore College of Insurance Limited [Version  1.4] B. Enhancing Quality Of Care    
 
2.5 Singapore’s ageing population is a strong driver for healthcare demand. As 
patient needs become more complex, MOH will have to move away from 
doctor -centric service s and adopt a multi -disciplinary team approach to 
enhance chronic disease management . The he althcare clusters are embarking 
on new programmes, so that Singaporeans can access quality care in the most 
suitable setting, including in the comfort of their own homes.  
 
2.6 The e lderly are four times more likely than younger people to need hospital 
care. Demand for hospital and nursing home care will rise. Hence, it is important 
to make changes to how we organise and deliver healthcare, to ensure good 
quality care for Singaporeans. As Singapore’s population ages, MOH is 
enhancing primary care, so that  residents can be better cared for in the 
community . One such move is to strengthen primary healthcare providers, such 
as polyclinics and General Practitioners (GPs). MOH is planning and 
constructing more polyclinics, and will also be stepping up efforts to wor k with 
the GPs to explore different models of care and collaboration .  
 
C. Ensuring Healthcare Remains Affordable  
 
2.7 As Singapore’s population ages and families become smaller, there is a need 
for greater collective responsibility to ensure that Singaporeans do not face 
life’s uncertainties alone.  
 
2.8 The Government has enhanced support for Singaporeans in the following 
ways: 
(a) Increasing the Government ’s share of national healthcare expenditure – 
through enhanced subsidies for services in the Specialist Outpatient 
Clinics (SOCs) and drugs in public hospitals, as well as a list of subsidised 
drugs.  
(b) Gradually expanding MediSav e use to even more types of outpatient 
treatment, further reducing out -of-pocket costs for outpat ient care.  
(c) Extending CHAS to cover all Singaporeans for selected chronic 
conditions, regardless of income.  
(d) Enhancing collective responsibility for healthcare – MediShield Life, a 
basic hospitalisation insurance scheme meant to cover large hospital bills 
and selected costly outpatient treatments, was launched on 1 November 
2015 to provide lifetime peace of mind for all Singaporeans, including the 
elderly and tho se with pre -existing conditions. The Government  bears 
most of the costs of providing coverage for those with pre -existing 
conditions. CareShield Life was launched in 2020. This new long -term care 
insurance scheme is an enhancement of the ElderShield scheme , and will 
provide better protection against long -term care costs, especially in old 
age. 
(e) Providing seniors in the Pioneer Generation (PG) and Merdeka Generation 
(MG) more support for their healthcare costs. These seniors receive 
MediSave  top-ups, additional subsidies for outpatient care, and additional 
premium subsidies for MediShield Life. PG and MG seniors who join


key: _node_content
string_value:
{"id_": "80b10533-c3c6-4107-86ff-0d10280fd721", "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": "08a56f3f-4408-48fc-9262-954079c96d2b", "node_type": "1", "metadata": {}, "hash": "2c2b3a7a7e6b1ecaddbf27d6688d49d8d6e93b829370231e084c0c883fce78e2", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "fb5a6379-2799-4ad1-89ff-7eddaff044f0", "node_type": "1", "metadata": {}, "hash": "bb88b5d2e38e8a0496e2c0e620180357fb4538203e46a7ae68911ad83c7a461e", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 223742, "end_char_idx": 228227, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
1. Overview of Healthcare Environment in Singapore  
Copyright reserved by the Singapore College of Insurance Limited [Version  1.4]                        5  
CareShield Life also receive additional participation incentives for doing 
so. 
  
2.9 For more details of the above mentioned su pport and schemes, please refer to 
Chapter 9  of this study guide . 
 
 
3. HEALTHCARE 2020 MASTERPLAN  
 
3.1 The Ministry of Health (MOH) had put together a “Healthcare 2020” Masterplan 
in 2012 to improve the provision of healthcare for Singaporeans. It aims to 
shape the future of healthcare in Singapore by identifying, developing and 
experimenting with game -chan ging systems -level concepts and innovations in 
the key areas of health promotion, illness prevention and the delivery of care.  
 
3.2 Its goals were to improve access, affordability and quality of healthcare services 
for Singaporeans. Many improvements have si nce been made.  
 
A. Better Access  
 
3.3 MOH is expanding its services and building new facilities to make it easier for 
Singaporeans to seek healthcare. These include developing new polyclinics and 
clinics nearer our homes.  
 
B. Higher Quality  
 
3.4 Singapore’s healthcare p rofessional workforce had expanded by 9,000 between 
2011 and 2014. It was on track to expand by another 11,000 by 2020. The 
government enhanced salaries across all professions, with additional funding 
from government, and improved career progression to imp rove retention.  
 
3.5 In 2015, local medical and nursing intakes were up by 29% and 17% compared 
to 2012. Other initiatives included the establishment of Singapore’s third 
medical school, the Lee Kong Chian School of Medicine and new allied health 
degree progra mmes at the Singapore Institute of Technology from 2016.  
 
3.6 There have been also initiatives related to better career development. For 
example, the National Nursing Taskforce came up with recommendations to 
boost nursing profession. The role of Assistant Nurse Clinician was introduced 
and greater support was render ed to encourage doctors to undergo post -
graduate training in family medicine.  
 
3.7 In terms of enhancement of recognition, there has been salary increases for 
public healthcare and MOH funded intermediate and long -term care sector staff.  
 
3.8 Initiatives relating to building further skills and knowledge have also been 
introduced such as increased funding, training and a dedicated AIC Learning 
Institute for staff working in long -term care.  
 
 
 


Health Insurance   
6 Copyright reserved by the Singapore College of Insurance Limited [Version  1.4] C. More Affordable  
 
3.9 More subsidies have been rolled out for lower to middle income patients.  
 
3.10 Higher subsidies have been granted for long -term care services, with more 
patients able to enjoy subsidies. For subsidised specialist care in the public 
hospitals —patient pays up to 40% less. For standard outpatient drugs in the 
public hospitals and polyclinics —patient pays up to 50% less.  
 
3.11 The government has introduced universal healthcare insurance for lifelong 
protection. MediShield Life gives better protection, for all Singaporeans, for life. 
This is part of a more inclusive so ciety, where Singapore residents look after 
one another.  
 
3.12 Other initiatives to make healthcare costs more affordable are expanded 
Medisave use to reduce out -of-pocket payment. For example, Flexi -Medisave 
affords seniors to use additional $200/ year for out patient medical treatment. It 
gives $300/ year for outpatient scans and 19 chronic conditions (up from 10 
conditions in 2011) are covered at $400/ year.  
 
3.13 To help Singaporeans build up more Medisave for their healthcare needs, an 
additional 1%  point Medisav e contribution from employers have been 
implemented since Jan 2015. There has been Government top -ups for lower -
income, elderly under the GST -Voucher scheme not to mention an increase 
from $3,000 to $4,0001 in Medisave Grant for newborns born on or after 1 Jan 
2015.  
 
D. Living Well  
 
3.14 MOH has been expanding home care services and eldercare centres so that it 
can help seniors to be cared for at home.  Nursing home care will also be 
expanded for seniors who cannot be cared for at home.  
 
3.15 Enhanced standards for nursing homes and guidelines for eldercare centres, 
home care and end -of life care ensure that Singapore seniors receive better, 
more holistic and safer care.


key: _node_content
string_value:
{"id_": "fb5a6379-2799-4ad1-89ff-7eddaff044f0", "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": "80b10533-c3c6-4107-86ff-0d10280fd721", "node_type": "1", "metadata": {}, "hash": "9a184b46f742e752b2fb833f52d76b34477e770376b0d17e35c3840cfd3def21", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "37d8bbdc-7436-4e66-860b-733e398e3e4e", "node_type": "1", "metadata": {}, "hash": "3ac2a93ffa2f0e6bf0a78073fc1132b273b6aa005f009b624316ce2b0c5c8b0a", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 228038, "end_char_idx": 231839, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
3.15 Enhanced standards for nursing homes and guidelines for eldercare centres, 
home care and end -of life care ensure that Singapore seniors receive better, 
more holistic and safer care.  
 
3.16 The Ministerial Committee on Ageing unveiled key new features of a $3 bil lion 
national plan to help Singaporeans age confidently and lead active lives, with 
strong bonds with family and community.  
 
3.17 Other supportive measures include the Seniors’ Mobility and Enabling Fund 
which provides subsidies for seniors in the community for :  
 
▪ wheelchairs, pressure relief cushions, commodes and other devices  
▪ diapers, wound dressings and other consumables  
▪ transport to eldercare and dialysis centres  
 
 
1 If the child is not a Singapore Citizen at birth, the grant amount will depend on the date that he/she 
becomes a Singapore Citizen.   

1. Overview of Healthcare Environment in Singapore  
Copyright reserved by the Singapore College of Insurance Limited [Version  1.4]                        7  
3.18 There is also the Foreign Domestic Worker grant of $120 for families with an 
elderly with m oderate disability, to help with the cost of employing a foreign 
domestic worker.  
 
3.19 Launched in 2014, the Healthy Living Master Plan promotes healthy living as 
accessible, natural, and effortless for all Singaporeans. It encourages 
Singaporeans to adopt healthy behaviours by bringing healthy living options to 
the "doorstep" of every home, workplace, and school by 2020.  
 
 
4. HEALTHCARE SYSTEM IN SINGAPORE   
 
4.1 There are three main  types  of healthcare services  : 
(a) primary healthcare  services  and facilities  
(b) hospital services  
(c) Intermediate and Long Term Care (ILTC) services.   
 
A. Primary Healthcare Services  and Facilities  
 
4.2 Primary healthcare services are provided by professionals —usually general 
practitioners — in polyclinics and private medical clinics within the community. 
These healthcare professionals are often the first point of contact with patients.   
 
4.3 Primary  healthc are involves the provision of basic medical treatment, 
preventive healthcare and health education. In Singapore, primary healthcare 
services are provided by the public sector, as well as the private sector.  They 
provide holistic and personalised care for patients of different age groups. They 
treat acute conditions such as upper respiratory tract infections, manage 
chronic illnesses such as diabetes, and keep the population healthy through 
preventive measures such as targeted health screening. They also he lp to 
coordinate patients' care with other providers and help patients who require 
more specialised medical attention to navigate the healthcare system.  
 
4.4 In the public sector, primary healthcare services are provided through a network 
of outpatient polycli nics.  
 
4.5 Under the Community Health Assist Scheme (CHAS), eligible Singapore 
Citizens can also receive subsidised treatments at participating GPs and dental 
clinics, without the need to travel to the polyclinics.  CHAS enables all Singapore 
Citizens, includi ng and Merdeka Generation (MG) and Pioneer Generation (PG) 
cardholders, to receive subsidies for medical and/or dental care at participating 
General Practitioner (GP) and dental clinics.  
 
4.6 Besides subsidies for care at CHAS clinics, CHAS, MG and PG cardhol ders enjoy 
subsidised referrals to public Specialist Outpatient Clinics (SOCs), as well as 
subsidised referrals to the National Dental Centre Singapore and National 
University Centre for Oral Health Singapore*, if required.  The colour of the 
CHAS card indi cates the subsidy tier that cardholders are entitled to, namely 
the CHAS Blue, Orange or Green tier.  
 
*Only for CHAS Blue, CHAS Orange, MG and PG cardholders


key: _node_content
string_value:
{"id_": "37d8bbdc-7436-4e66-860b-733e398e3e4e", "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": "fb5a6379-2799-4ad1-89ff-7eddaff044f0", "node_type": "1", "metadata": {}, "hash": "bb88b5d2e38e8a0496e2c0e620180357fb4538203e46a7ae68911ad83c7a461e", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "a43043d1-c5d5-49ba-820f-86d586a9888e", "node_type": "1", "metadata": {}, "hash": "fb46bb657dab60ee2116194b41111458a2788d9b06c7366c940e0f099f83ac5b", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 231784, "end_char_idx": 234949, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
*Only for CHAS Blue, CHAS Orange, MG and PG cardholders   


Health Insurance   
8 Copyright reserved by the Singapore College of Insurance Limited [Version  1.4] 4.7 Clinics  participating in CHAS partner with MOH to provide common outpatient 
medical treatments and basic dental services to eligible patients. The scheme 
also covers treatments for chronic diseases under the Chronic Disease 
Management Programme (CDMP), such as diabetes mellitus and hypertension. 
To find out more,  visit: www.chas.sg.   
 
B. Hospital Services   
  
4.8 MOH’s role as the dominant health care provider allows her to influence the 
supply of hospital beds, the introduction of high -tech/high -cost medicine and 
the rate of cost increases in the public sector, which sets the bench mark in 
terms of pricing for the private sector.  The general hospitals provide multi -
disciplinary acute inpatient and specialist outpatient services and a 24 -hour 
emergency department. In addition, there are national specialty centres for 
cancer, cardiac, eye, skin, neuroscience  and dental care , as well as medical 
centre s for multiple disciplines  (e.g. Jurong Medical Centre, Admiralty Medical 
Centre) . 
 
4.9 There are  ten public hospitals, also known as restructured hospitals comprising 
eight  general hospitals, a women's an d children's hospital, and a psychiatry 
hospital. General hospitals provide multi -disciplinary inpatient and specialist 
outpatient services, and 24 -hour emergency departments.  
 
4.10 There are s ix national specialty centres that provide cancer, cardiac, eye, sk in, 
neuroscience and dental care.  
 
4.11 The government has also introduced community hospitals for intermediate 
healthcare for the convalescent sick and aged who do not require the care of 
the general hospitals. There are currently nine community hospitals in 
Singapore.  
 
4.12 Within the public hospitals, patients have a choice of the different types of ward 
accommodation on their admission and subsidies provided differ according to 
the ward class. The wards with basic amenities like C class wards are heavily 
subsid ised up to 80% while B2 is subsidi sed from 50 -65%. Whereas those who 
desire more amenities can choose a higher ward class but will receive less 
subsidies with Class B1 admissions subsidi sed at 20% while there is no subsidy 
for Class A ward admissions.  However, patients will be able to receive up to 
80% in subsidies regardless of whether they are admitted to B2 or C class wards 
from  1 November 20222.    
 
4.13 The Government has restructured all its acute hospitals and specialty centres 
to be run as private companies wholly owned  by the Government. This is to 
enable the public hospitals to have the management autonomy and flexibility 
as well as the ability to  respond more promptly to the needs of the patients. In 
the process, commercial accounting systems have been introduced, providing 
a more accurate picture of the operating costs and instilling greater financial 
 
2https://www.moh.gov.sg/cost -financing/healthcare -schemes -subsidies/subsidies -for-acute -inpatient -care-at-public -
healthcare -institutions


key: _node_content
string_value:
{"id_": "a43043d1-c5d5-49ba-820f-86d586a9888e", "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": "37d8bbdc-7436-4e66-860b-733e398e3e4e", "node_type": "1", "metadata": {}, "hash": "3ac2a93ffa2f0e6bf0a78073fc1132b273b6aa005f009b624316ce2b0c5c8b0a", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "a7a2675e-5ab0-4cec-bc27-80a96302ecfa", "node_type": "1", "metadata": {}, "hash": "1b8cd539debdfbe757ca8912a85e4124b27849b10644a23a2c6bf66180d14ba4", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 234956, "end_char_idx": 238732, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
1. Overview of Healthcare Environment in Singapore  
Copyright reserved by the Singapore College of Insurance Limited [Version  1.4]                        9  
discipline and accountability. The public hospit als are different from the other 
private hospitals in that they receive an annual Government subvention or 
subsidy for the provision of subsidised medical services to the patients. They 
are  managed like not -for-profit organisations. The public hospitals a re subject 
to broad policy guidance by the Government through MOH . 
 
4.14 The public hospitals are structured by regions split into  three clusters: National 
University Health System (NUHS), National Healthcare Group (NHG) and 
SingHealth. The last reorganisation of these clusters was announced in January 
2017, with  six clusters merged into three , based on location.    
 
4.15 For more information on the regions and the healthcare institutions under each, 
please visit the MOH website at:  https://www.healthhub.s g/directory/hospitals  
 
C. Intermediate & Long -Term Care  (ILTC)  Services   
 
4.16 These continuing care facilities are for patients who no longer require the level 
of care dispensed by a hospital, but nevertheless require continued care. ILTC 
comprise:  
▪ Residential IL TC services care, for patients who stay in these facilities both 
in the day and at night.   
▪ Community -based ILTC services, both centre -based and home -based, 
provided to patients during the day.  
 
4.17 ILTC services are typically required for persons who need further care and 
treatment after being discharged from an acute hospital , as well as community -
dwelling seniors who may be frail and need supervision or assistance with their 
activities of daily living.  The types of ILTC services are : 
(a) Home -based services,  which are provided within the homes of frail and 
home -bound elderly. The se services address the health and social needs of 
these elderly and support families in the care of their seniors  with the aim 
to help seniors age in p eace ; 
(b) Centre -based healthcare se rvices,  which cater to elderly  who require care 
services during the day, usually on a regular basis.  These centres are 
mostly located within the community, enabling those in need to receive 
services in a familiar environment close to their homes, and allow  working 
caregivers to conveniently drop off their seniors during work ; and  
(c) Residential ILTC services , which  comprise community hospitals, chronic 
sick hospitals , nursing homes , inpatient hospices , rehabilitation homes  and 
sheltered home s for persons in mental health recovery.  
 
  


Health Insurance   
10 Copyright reserved by the Singapore College of Insurance Limited [Version  1.4] D. Other Healthcare Services  
 
(a) Dental Services  
Public dental services are available through the National Dental Centre and 
in some polyclinics and hospitals. The Health Promotion Board primarily 
focuses on preventive dentistry, targeted mainly at school pupils .  
 
(b) Traditional Chinese Medicine  
MOH bases its healthcare services on Western medical science. However, 
the ethnic groups in Singapore occasionally consult traditional medicine 
practitioners for general ailments. Interest in Traditional Chinese Medicine 
(TCM) and other traditional or alternative me dical treatments is increasing 
both here and around the world. MOH is therefore reviewing standards of 
training and practice of TCM in Singapore. Its aim is to ensure a higher 
quality of TCM practice, for the benefit of patients who consult TCM 
practitione rs. 
 
(c) Support Services  
Support services to hospitals and primary healthcare programmes include 
forensic pathology, pharmaceutical services and blood transfusion service.


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
2
OVERVIEW OF HEALTHCARE 
ENVIRONMENT IN SINGAPORE
IMPORTANT CONCEPTS DEFINITIONS/EXPLANATIONS
Singapore Government’s 
healthcare philosophySingapore’s healthcare philosophy is anchored on individual responsibility and 
affordable healthcare for all.
The philosophy consists of three pillars:
1.Building up a healthy population with preventive health care and encouraging
healthy lifestyles.
2.Emphasising personal responsibility towards healthy living through the “3M”(Medisave, Medishield and Medifund) system.
3.
Keeping healthcare costs down by controlling the supply of healthcare servicesand providing heavy subsidies in respect of fees charged by public healthcareinstitutions.
Three key strategies for the Healthcare 2020 Masterplan•
Enhancing Accessibility.
•Enhancing Quality of Care.
•Ensuing Healthcare Remains Affordable.
Primary healthcare servicesPrimary healthcare services are provided by professionals—usually general practitioners — in polyclinics and private medical clinics within the community. These healthcare professionals are often the first point of contact with patients.
Hospital services
There are ten public hospitals comprising eight general hospitals, a women's and 
children's hospital, and a psychiatry hospital. General hospitals provide 
multidisciplinary inpatient and specialist outpatient services, and 24-hour 
emergency departments. Six national specialty centres provide cancer, cardiac, eye, 
skin, neuroscience and dental care.
Intermediate and Long-
Term 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:•
Residential ILTC services care, for patients who stay in these facilities both in theday and at night.
•
Community-based ILTC services, both centre-based and home-based, providedto patients during the day.CHAPTER01


2. Medical Expense Insurance  
Copyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] 11  
      CHAPTER 2  
MEDICAL EXPENSE INSURANCE  
 
 
 
CHAPTER OUTLINE  
 
1. Introduction  
2. Health Insurance   
3. Key Features Of Medical Expense Insurance  
4. Underwriting  
5. Healthcare Subsidy Level  
6. Termination Of Cover  
7. Claims  
8. Notice No: MAS 117 - Training and Competency Requirements – Health Insurance  
Appendix 2A – Sample Medical Expense Insurance Benefit Schedule  
Appendix 2B – Sample Schedule Of Surgical Benefits  
Appendix 2C – Table Of Healthcare Subsidy Level  
Appendix 2D  – Notice No: MAS 117 - Training and Competency Requirements – Health 
Insurance  
 
 
LEARNING OUTCOMES  
 
After studying this chapter, you should be able to:  
▪ describe the three categories of Health Insurance  
▪ know the types of coverage provided under a Medical Exp ense 
Insurance policy  
▪ understand the various benefits offered by insurers under a Medical Expense 
Insurance policy  
▪ describe the key features of Medical Expense Insurance:  
- stand -alone or a rider  
- choice of plans  
- family coverage  
- reimbursement of expenses  
- expense participation (deductible, co -insurance and pro -ration factor)  
- benefit limits  
- covered charges  
- geographical limit  
- waiting period  
- age limits  
- premiums  
- renewability  
▪ know the common exclusions and limitations (co -ordination of benefits) under 
Medical Expense Insurance  
▪ know the  sources of  underwriting information  for both individual and group cover s 

Health Insurance   
12 Copyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] ▪ know the rationale for the subsidy distinction between citizens and non -citizens  
▪ know when the coverage of an insured person under a Medical Expense Insurance 
policy will terminate  
▪ know the documents to be furnished in the event of a claim  
▪ know the training and competency requirement s for health insurance as stated in 
Notice No.:  MAS 117  - Training and Competency Requirements  - Health Insurance.  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

2. Medical Expense Insurance  
Copyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] 13  
Contents  
CHAPTER OUTLINE  ................................ ................................ ................................ ...........  11 
LEARNING OUTCOMES  ................................ ................................ ................................ .... 11 
1. INTRODUCTION  ................................ ................................ ................................ ....... 15 
2. HEALTH INSURANC E................................ ................................ ...............................  15 
A. What Is Medical Expense Insurance?  ................................ ...............................  15 
A1. What Is Covered Under Medical Expense Insurance?  ..............................  16 
A2. Inpatient Expenses  ................................ ................................ .....................  17 
A3. Outpatient Expenses  ................................ ................................ ..................  20 
A4.


key: _node_content
string_value:
{"id_": "f021c939-01df-4c67-8c65-0ce47d8a5c8e", "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": "a7a2675e-5ab0-4cec-bc27-80a96302ecfa", "node_type": "1", "metadata": {}, "hash": "1b8cd539debdfbe757ca8912a85e4124b27849b10644a23a2c6bf66180d14ba4", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "21f95357-e21e-4add-a0c7-ad5e31054608", "node_type": "1", "metadata": {}, "hash": "ff017ec5b9b67e9bc3656b4052ec54a233237bdc375e2bb540cb01fdfbe86533", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 243673, "end_char_idx": 248556, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
..............................  16 
A2. Inpatient Expenses  ................................ ................................ .....................  17 
A3. Outpatient Expenses  ................................ ................................ ..................  20 
A4. Catastrophic Outpatient Expenses  ................................ ............................  20 
B. Other Benefits Under Medical Expense Insurance  ................................ ..........  21 
B1. Specific Disease Insurance  ................................ ................................ ........  21 
B2. Miscarriage Benefit  ................................ ................................ ....................  22 
B3. Private Nursing Home Care  ................................ ................................ ....... 22 
B4. Daily Hospital Cash  ................................ ................................ ....................  22 
B5. Emergency Medical Evacuation  ................................ ................................  22 
B6. Final Expenses Benefit  ................................ ................................ ...............  22 
C. What Are The Limits On The Covered Expenses?  ................................ ...........  23 
3. KEY FEATURES OF MEDICAL EXPENSE INSURANCE  ................................ ..........  23 
A. Stand -alone Or Rider  ................................ ................................ ........................  23 
B. Choice Of Plans  ................................ ................................ ................................ . 23 
C. Family Coverage ................................ ................................ ................................  24 
D. Reimbursement Of Expenses  ................................ ................................ ...........  24 
E. Expense Participation ................................ ................................ ........................  25 
E1. Deductible  ................................ ................................ ................................ ... 25 
E2. Co-insurance  ................................ ................................ ...............................  27 
E3. Pro-ration Factor  ................................ ................................ .........................  27 
F. Benefit Limits  ................................ ................................ ................................ ..... 28 
G. Covered Charges  ................................ ................................ ...............................  29 
H. Geographical Limit  ................................ ................................ ............................  29 
I. Waiting Period  ................................ ................................ ................................ ... 30 
J. Age Limits  ................................ ................................ ................................ ..........  30 
K. Premiums ................................ ................................ ................................ ...........  30 
L. Renewability  ................................ ................................ ................................ ...... 31 
M. Exclusions & Limitations  ................................ ................................ ..................  31 
M1. Exclusions  ................................ ................................ ................................ ... 31 
M2. Limitations (Co -ordination Of Benefits) ................................ .....................  32 


Health Insurance   
14 Copyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] 4. UNDERWRITING  ................................ ................................ ................................ ...... 32 
5. HEALTHCARE SUBSIDY LEVEL  ................................ ................................ ...............  32 
6. TERMINATION OF COVER  ................................ ................................ .......................  33 
7. CLAIMS  ................................ ................................ ................................ .....................  33 
8. NOTICE No.: MAS 117 - TRAINING AND COMPETENCY REQUIREMENTS – 
HEALTH INSURANCE ................................ ................................ ...............................  34 
APPENDIX  2A ................................ ................................ ................................ ....................  35 
APPENDIX  2B ................................ ................................ ................................ ....................  36 
APPENDIX  2C ................................ ................................ ................................ ....................  40 
APPENDIX  2D ................................ ................................ ................................ ....................  41


key: _node_content
string_value:
{"id_": "21f95357-e21e-4add-a0c7-ad5e31054608", "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": "f021c939-01df-4c67-8c65-0ce47d8a5c8e", "node_type": "1", "metadata": {}, "hash": "a8e23136dc814cfaca2d3fa15a808d4aa8d4d5d2e2ba595405be648c1a9897c1", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "d5042368-1504-4aba-8d81-67a6d330b105", "node_type": "1", "metadata": {}, "hash": "1e3d010d7c5004a6234f6e25a3d925d4c3ec4605c444017c29ef2251c257fc79", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 248616, "end_char_idx": 251542, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
2. Medical Expense Insurance  
Copyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] 15  
1. INTRODUCTION   
 
1.1 As mentioned in Chapter 1  of this Study Guide, like in other countries, rising 
medical costs are a major concern in Singapore, particularly in view of a 
growing ageing population. Today, many people may be relying on their 
Medisave  and MediShield Life to pay the costs of their med ical needs and  
treatments. However, these schemes may not be sufficient to pay for the costs 
of prolonged hospital treatment or a major surgery, particularly those who 
choose to stay in a B1 or A class ward or in a private hospital, since these 
medical bil ls are higher with little to no government subsidy . As such, there is 
a need to have other sources of funds to help to pay for one’s medical expenses, 
especially in the event of serious illness requiring prolonged and expensive 
treatments.  
 
1.2 Insurers have developed a range of Medical Expense Insurance products 
designed to provide benefits for specific medical expenses that an insured 
person incurs. In this chapter, we will discuss what general Medical Expense 
Insurance is, its common character istics, and the general supplementary 
benefits offered.  
 
 
2. HEALTH INSURANCE   
 
2.1 Health Insurance provides the individual and his family with financial benefits 
which will help to defray some of the incurred medical costs , or recover some 
or all of the financi al losses suffered as a result of an  injury, illness or disability.  
 
2.2 There are broadly three categories of Health Insurance which can provide  for: 
▪ a reimbursement for the cost of medical treatment or nursing care; or   
▪ a periodic income upon disability or hospitalisation; or  
▪ a fixed cash amount upon disability or suffering from a major illness.  
 
2.3 Insurers  and their financial adviser representatives providing advice on or 
arranging contracts of insurance or both, in respect of Health Insurance 
products, must comply with Notice No: MAS 117 on “Training And Competency 
Requirement: Health Insurance”. This Notice essentially covers minimum 
examination requirements, and Continuing Professional D evelopment ( CPD) 
requirements in respect of shield plans.   
 
2.4 In this chapter, we will cover  Medical Expense Insurance. The other types of 
Health Insurance will be covered in the next few chapters.  
 
A. What Is Medical Expense Insurance?  
 
2.5 Medical  Expense Insurance, also known as Hospital and Surgical (H&S) 
Insurance, provides inpatient and some outpatient benefits. Besides covering 
common expenses which are listed below, it also provides cover for complex 
surgical procedures like heart by -pass sur gery and organ transplant, and other 
costly outpatient treatments, such as kidney dialysis and cancer chemotherapy. 
Examples of Medical Expense Insurance include Medisave -approved Integrated


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
Health Insurance   
16 Copyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] Shield Plans (IPs) offered by private insurers, MediShield Life S cheme and 
Managed Healthcare Schemes. Appendix 2A gives an example of the Medical 
Expense Insurance benefit schedule.  
 
A1. What Is Covered Under  Medical Expense Insurance?  
 
2.6 Most  of the Medical Expense Insurance plans in Singapore generally cover the 
basic benefits as described below:  
 
(i) Inpatient Expenses  
▪ daily room and board charges;  
▪ intensive care unit charges;  
▪ short stay ward;  
▪ hospital miscellaneous expenses;  
▪ surgeon’s fees;  
▪ anaesthetist’s fees;  
▪ surgical implant and prosthesis charges;  
▪ stay in community hospitals;  
▪ inpatient psychiatric treatment;  
▪ congenital anomalies;  
▪ inpatient pregnancy complications;  
▪ radiosurgery;  
▪ stem cell transplant;  
▪ emergency overseas inpatient treatment;  
▪ accident inpatient dental treatment;  
▪ major organ transplant ; 
▪ living donor organ transplant . 
 
(ii) Outpatient Expenses  
▪ pre-hospitalisation diagnostic and laboratory tests charges;  
▪ pre-hospitalisation specialist consultation charges;  
▪ post-hospitalisation special ist consultation charges;  
▪ accident and emergency (A&E) treatment;  
▪ emergency accidental treatment charges.  
 
(iii) Catastrophic Outpatient Expenses  
▪ outpatient kidney treatment charges;  
▪ outpatient cancer treatment charges;  
▪ major organ transplant approved immunosuppressant  drugs . 
 
 
 
 

2. Medical Expense Insurance  
Copyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] 17  
2.7 Some  policies also extend cover to include:  
▪ emergency medical evacuation; and  
▪ private nursing home care.  
 
2.8 Let us now look at each of the covered expenses in turn.  
 
A2. Inpatient Expenses    
 
2.9 If inpatient treatment is received in a luxury or deluxe suite or any other special 
room of a hospital, the inpatient bill will be pro -rated based on the actual 
charges that the insured person would have paid under his plan type. The lower 
of either the reasonable expenses or the pro -rated amount of the total bill, will 
be paid.  
 
(a) Daily Room & Board Charges  
This refers to the charges for  a standard room  accommodation, meals and 
general nursing services incurred by the insured person , while he is 
hospitalised. The reimbursement is on a per day basis up to a specified 
maximum number of days per hospitalisation. This also includes charges 
for a high depende ncy ward accommodation.  
 
(b) Intensive Care Unit (ICU) Charges  
This refers to charges incurred during confinement in the ICU of the 
hospital.  
Like Daily Room & Board, the reimbursement for ICU charges is also on a 
per day basis up to a specified maximum number of days per 
hospitalisation.  
 
(c) Short -stay Ward  
This refers to charges incurred during confinement in the short -stay ward 
in an accident and emergency department of a hospital, where the patient 
needs a short period of inpatient observation, monitori ng and treatment, 
usually up to 24 hours. This will allow the attending doctor to decide 
whether the patient is fit for discharge, or he should be further admitted 
as an inpatient.  
 
(d) Hospital Miscellaneous Expenses   
This refers to the services and supplies  (other than room and board and 
general nursing care) furnished during a hospital stay , and will usually 
include the following:  
▪ laboratory services;  
▪ X-ray examinations;  
▪ medicines and drugs;  
▪ surgical dressings;  
▪ operating room expenses;  
▪ oxygen and its administration; and  
▪ ambulance service s.


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
Health Insurance   
18 Copyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] (e) Surgeon’s Fees  
This refers to the surgeon’s fees for surgery. Charges for day surgery and 
gamma knife are also payable. The level of reimbursement in the surgical 
schedule varies , or depends on the type and complexity of the specific 
surgery. To find out how much MediShi eld Life reimburses this benefit, 
just refer to the website of the Ministry of Health (MOH) at 
www.moh.gov.sg , to view a full list of the types of Surgical Operations 
and the Medisave withdrawal limits for each category. In some insurance 
policies, there is also a limit on the maximum number of days from the 
date of surgery that the insurer will pay for the surgeon’s visits and post -
operative care. For Group Hospital and Surgical (H&S) Insurance, 
reimbursement fo r surgical fees is usually set out in a Schedule  of Surgical 
Benefits attached to such a Group H&S Insurance policy. A sample in 
Appendix 2B  shows a Schedule of Surgical Benefits with limits.  
 
While there are Medical Expense Insurance policies in the marke t that still 
impose sub -limits on different surgical procedures, the majority of 
insurers have started to offer plans with “as charged” benefits.  
 
(f) Anaesthetist’s Fees  
This refers to the fees for the supply and administration of anaesthesia by 
an anaesthet ist for a surgery.  
 
(g) Surgical Implant & Prosthesis Charges  
This refers to the actual costs of surgical implant or prosthesis1. 
 
(h) Stay In Community Hospital  
This refers to charges incurred in a community hospital for 
accommodation, meals and general nursing services. A referral from the 
attending physician from the hospital, where the insured person has 
received inpatient treatment is usually required, and admission to the 
community hospital must be within a time frame following his discharge 
from the hospita l. 
 
(i) In-hospital Psychiatric Treatment  
This refers to charges for psychiatric treatment received as an inpatient of 
the hospital. All treatment s must be administered under the direct control 
of a registered psychiatrist. A waiting period may apply before this benefit 
is payable. Treatment for self -inflicted injury, suicide, drug addiction, or 
abuse of drug or alcohol is excluded.  
 
(j) Congenital Anoma lies 
This refers to charges for inpatient treatment of any congenital anomalies, 
including hereditary conditions. A waiting period may apply before this 
benefit is payable.  
 
(k) Inpatient Pregnancy Complications  
This refers to charges for inpatient treatment for pregnancy 
complications. A waiting period may apply before this benefit is payable. 
 
1  Prosthesis is an artificial device used to replace a missing part of the body.  


2. Medical Expense Insurance  
Copyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] 19  
Note that not every pregnancy complication is covered. This benefit may 
be restricted to a pre -defined list of pregnancy complications, including 
but not limited to:  
▪ ectopic pregnancy;  
▪ pre-eclampsia or eclampsia;  
▪ disseminated intravascular coagulation;  
▪ miscarriage after 13 weeks of pregnancy (not resulting from voluntary 
or malicious act);  
▪ antepartum haemorrhage;  
▪ intrauterine death;  
▪ choriocarcinoma and hydatidiform mol e, which is the occurrence of a 
histologically confirmed choriocarcinoma and/or molar pregnancy;  
▪ acute fatty liver pregnancy;  
▪ breech delivery;  
▪ placenta previa; and  
▪ postpartum haemorrhage.  
 
(l) Radiosurgery  
This refers to charges for Gamma Knife and Novalis radiosurgery 
(including day surgery) by a surgeon in a hospital.  
 
(m) Stem Cell Transplant  
This refers to charges for stem cell transplant surgery. All other costs 
incidental to the stem cell transplant , such as costs of harvesting, 
laboratory tests, i nvestigations, storage, transport and cell culture , as well 
as outpatient therapies , where there is no surgery or admission , are not 
covered.  
 
(n) Emergency Overseas Inpatient Treatment  
This refers to charges for inpatient treatment resulting from an emergency  
while overseas. It pays the lower of either the actual charges or reasonable 
expenses for equivalent medical treatment in Singapore. Pre - and post -
hospital treatments which are given before and after emergency overseas 
treatment are not covered.


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
It pays the lower of either the actual charges or reasonable 
expenses for equivalent medical treatment in Singapore. Pre - and post -
hospital treatments which are given before and after emergency overseas 
treatment are not covered.  
(o) Accident Inpatient Dental Treatment  
This refers to charges to remove, restore or replace sound natural teeth 
which have been lost or damaged in an accident. Treatment must be 
received within 14 days following the accident.  
 
(p) Major organ transplant  
This refers to the costs of surgeries for the transplantation of kidneys, 
lungs, heart, liver or cornea, where the insured person is the recipient of 
any of the organs.  
 
 
 
 

Health Insurance   
20 Copyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] (q) Living donor organ transplant  
This refers t o charges for major organ transplants of the kidney or liver , 
where the life insured is a living donor , provided that:  
(i) the transplantation is carried out at a hospital in Singapore;  
(ii) the recipient of the kidney or liver must be the insured person’s 
family member (i.e. parent, sibling, spouse or child); and  
(iii) the recipient’s kidney or liver failure is first diagnosed by the 
attending physician, or the symptoms of which first appeared, after 
a waiting period of 24 months as specified in the policy.  
 
This benefit is not payable if the transplantation is illegal or arises from 
any illegal transaction or practice involved.  
 
A3. Outpatient Expenses  
 
2.10 (a) Pre-hospitalisation Diagnostic & Laboratory Test Charges  
This refers to the charges incurred by the insured person for diagnostic 
and laboratory tests as prescribed by the attending physician or specialist. 
This benefit is payable if incurred within a specified number of days before 
the date of hospitalisation.  
 
(b) Pre-hospitalisation Specialist Consultati on Charges  
This refers to the charges incurred by the insured person for consultation 
of a specialist as recommended by the attending physician. This benefit is 
payable only if the insured person is hospitalised , or undergoes day 
surgery within a specified  number of days from the date of consultation 
of the specialist.  
 
(c) Post -hospitalisation Specialist Consultation Charges  
This refers to the expenses incurred by the insured person for follow -up 
treatment s after hospitalisation, e.g. physiotherapy after an a rthroscopy 
surgery. This benefit is payable for up to a specified number of days after 
his discharge from the hospital.  
 
(d) Accident & Emergency (A&E) Treatment  
This refers to treatment in the accident & emergency department of a 
hospital up to 24 hours , before an inpatient treatment for the same injury 
or illness.  
 
(e) Emergency Accidental Treatment Charges  
This refers to the charges incurred for emergency outpatient treatment of 
accidental  bodily injuries of the insured person, within 24 hours of the 
accident.  
 
A4. Catastrophic Outpatient Expenses  
 
2.11 (a) Outpatient Kidney Treatment Charges  
This refers to the charges incurred for kidney dialysis at a legally 
registered dialysis centre. Cover may also include examination and tests 
ordered by the attending physician for the course of treatment, as well as 
 


2. Medical Expense Insurance  
Copyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] 21  
erythropoietin , as part of the treatmen t for chronic renal failure and 
ambulatory peritoneal dialysis ordered by the attending physician.  
 
Any additional formulated solution not prescribed by the attending 
physician or other prescribed medications (apart from erythropoietin) will 
not be covered . In addition, the cost of purchase or rental of the dialysis 
machine will not be covered.  
 
(b) Outpatient Cancer Treatment Charges  
This refers to the charges incurred for chemotherapy, radiotherapy, 
immunotherapy and/or stereotactic radiotherapy treatment (or any other 
cancer treatment approved by the insurer) provided by the hospital or at 
a legally registered cancer treatment centre, including examinations and 
tests ordered by the attending physician for the course of treatment.  
 
(c) Major Organ Tra nsplant Approved Immunosuppressant Drugs  
This refers to costs of immunosuppressant drugs approved by the Health 
Science Authority as part of necessary medical treatment , as an outpatient 
after a major organ transplant to reduce the rate of rejection episod es.  
 
The list of covered drugs includes, but is not limited to:  
(i) Cyclosporin;  
(ii) Tacrolimus;  
(iii) Azathioprine;  
(iv) Prednisolone; and/or  
(v) other approved immunosuppressant drugs for Major Organ 
Transplant.


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
The major organ transplant must first be approved under the policy.  
 
B. Other Benefits Under Medical Expense Insurance  
 
2.12 Insurers  may also provide additional benefits, such as the following:  
▪ specific disease insurance;  
▪ miscarriage benefit;  
▪ private nursing home care;  
▪ daily hospital cash;  
▪ emergency medical evacuation benefit; and  
▪ final expenses benefit.  
 
2.13 Let us look at the benefits provided by the above additional covers in detail.  
 
B1. Specific Disease Insurance  
 
2.14 Specific  Disease Insurance provides for a lump sum payment (e.g. S$50,000) in 
the event that the insured person is diagnosed to be suffering from the specific 
disease (e.g. cancer) covered by the policy.  
 

Health Insurance   
22 Copyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] B2. Miscarriage Benefit  
 
2.15 This refers to the costs incurred in a miscarriage or ectopic pregnancy. 
However, the coverage is not applicable to wilful termination of a pregnancy 
requested by the insured person that is not medically necessary.  
 
B3. Private Nursing Home Care  
 
2.16 This ref ers to the costs incurred in hiring the services of a full -time or part -time 
registered and qualified nurse in the insured person’s home. It is for the 
continuing treatment of a medical condition that is covered under the policy for 
which the insured perso n has been hospitalised.  
 
B4. Daily Hospital Cash   
 
2.17 This refers to a daily cash benefit payable directly to the insured person if he is 
hospitalised as a result of an injury or illness.  
 
2.18 In Singapore , in order for  insurers to keep medical claims costs low, especially 
in private hospitals, daily hospital cash is often packaged in Medical Expense 
Insurance and payable only upon hospital or ward downgrade. This is to 
encourage the insured person to stay in a public ho spital, or a ward that is lower 
than his covered plan.  
 
B5. Emergency Medical Evacuation  
 
2.19 Normally  provided for in global medical plans, this refers to the costs of getting 
the insured person to a place for accessibility to medical treatment because of 
a serious injury or serious sickness whil e overseas. It must be medically 
appropriate and safe to move him to another location or to return him to 
Singapore for treatment. The evacuation method may include air ambulance, 
surface ambulance, regul ar air transportation, railroad or any other appropriate 
means . The final destination will be made by the treating doctor and the 
emergency medical assistance company , and this will be based solely on 
medical necessity.  
 
B6. Final Expenses Benefit  
 
2.20 In the event of death occurring during hospitalisation or within a specified 
number of days after hospital discharge, and provided that death is a result of 
the cause of the hospitalisation, a final expenses benefit is payable. In the case 
of an Integrated Shield  Plan (IP), the final expenses benefit is usually a waiver 
of deductible and co -insurance components up to the stated amount in the 
policy schedule.  
 
2.21 Note: Different insurers may have varying definitions of each of the above 
described benefits. Hence, ins urance representatives should check their own 
insurers’ definitions.  
 
 


2. Medical Expense Insurance  
Copyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] 23  
C. What Are The Limits On The Covered Expenses?  
 
2.22 Medical Expense  Insurance policies provide separate benefits for the different 
expenses covered. While most insurers now offer plans that have “as charged” 
benefits, there are still many plans that impose sub -limits, e.g. based on a table 
of surgical operations and a max imum limit on Room & Board benefit, etc. 
MediShield Life is just one of the Medical Expense Insurance schemes with 
limits imposed. Besides the limits, deductibles and co -insurance are also 
common features of these policies. Also, all policies are subject t o per policy 
year/period and lifetime claimable limits.  
 
2.23 Note that the payment of this Medical Expense Insurance policy is on a  
reimbursement basis. Hence, the insurer will reimburse the actual amount 
incurred (for “as charged” plans) or the maximum limit as stated in the 
Schedule of Benefits, whichever is lower. The policy owner may not get a full 
reimbursement for the medical ex penses incurred by the insured person in 
some cases . It is important to highlight this clearly to the prospective client and 
explain what is precisely covered in the Schedule of Benefits.


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
It is important to highlight this clearly to the prospective client and 
explain what is precisely covered in the Schedule of Benefits.  
 
 
3. KEY FEATURES OF MEDICAL EXPENSE INSURANCE  
 
3.1 Although the Medical Expense Insurance policies offered in the market vary in 
coverage and limits, they generally share the common features  as described 
below : 
A. Stand -alone Or Rider  
 
3.2 Medical Expense Insurance can be offered as a rider or a stand -alone  policy . If 
issued as a rider, it is often attached to a permanent Life Insurance policy . Note 
that it is not common in Singapore for Medical Expense Insurance to be offered 
as a rider.  
B. Choice Of Plans  
 
3.3 Insurers normally offer Medical Expense Insurance with a var iety of plans , 
giving the policy owner  the option to choose a plan that best meets his needs 
and budget in terms of the  following : 
▪ amount of general medical  expenses provided by the policy, such as hospital 
type and/or room and board charges;  
▪ per policy year, per disability and per lifetime limits; and/or  
▪ amount of deductible and/or co -insurance which he needs to bear.  
 
3.4 These plans are designed to cover the different amounts that the hospital 
charges for its various wards. Plans with higher benefit s will cost more 
premiums.  Lower plans are meant for people who prefer to stay in the four to 
six bedded wards  in a public hospital , while the higher plans are for those who 
wish to stay in double or single -bedded wards. Usually , the insured person is 
free to choose the hospital or ward type when he is hospitalised.  
 
Medical 
Expense 
Insurance 
Riders  
 
Basic  
Life Policy  

Health Insurance   
24 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 
under which the insured  person is insured . Should the insured person wish to 
stay in a higher ward (i.e. from Ward B to Ward A), the insurer will apply the  
pro-ration factor  accord ingly.  
 
C. Family Coverage  
 
3.6 Unlike other types of Health Insurance, most Medical Expense Insurance 
policies allow the policy owner  to include immediate family members (i.e.  
spouse and children) in the policy. Most insurers also give the policy owner  the 
flexibility of selecting different plans for his family members. In addition, some 
insurers give a family discount (e.g. 5%) if the application is submitted at the 
same time.  
 
3.7 Example 2.1  illustrates how the premium for a family coverage plan is arrived 
at. 
 
Example 2.1: Illustration Of The Calculation Of The Premium For A Family 
Coverage Plan 
 
Assuming Mr Andy Ang is buying a policy for himself and his wife and two 
children. The premium is calculated as follows:  
 
Mr Ang  S$800.00  
Mrs Ang  S$800.00  
Two Children  S$620.00  
Total Gross Premium  S$2220.00  
Less: 5% Family Discount  (S$111.00 ) 
Premium Payable  S$2,109.00  
 
 
D. Reimbursement Of Expenses  
 
3.8 Expenses eligible for reimbursement under the Medical Expense Insurance are 
those incurred during the period of insurance for medically  and reasonably 
necessary  treatments resulting from  accident, illness or disease.   
 
3.9 Benefits under the Medical Expense Insurance are provided on a 
reimbursement basis, i.e. the insurer will reimburse the policy owner  up to a 
maximum dollar amount , or limit for each medical expense item covered under 
the policy which the  insured person incurs.  
 
3.10 For plans which do not specify the limits for each treatment, the insurer will 
reimburse the actual amount of covered medical expenses incurred by the 
insured  person .  
 
3.11 In other words, the policy owner  is not allowed to claim more than  the actual 
medical treat ment expenses incurred , nor can he claim more than the limits as 
stated in his policy.  
 
 
 
 

2. Medical Expense Insurance  
Copyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] 25  
3.12 When the insured  person receives medical treatment, he normally has to pay 
the charges first , and thereafter seek  reimbursement from the insurer for the 
expenses covered under the plan by filing a claim.


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
4] 25  
3.12 When the insured  person receives medical treatment, he normally has to pay 
the charges first , and thereafter seek  reimbursement from the insurer for the 
expenses covered under the plan by filing a claim. For any patient claiming 
under an Integrated Shield Plan  approved under Medisave, all he need s to do 
is to inform the hospital of the name of his insurer , fill in a s tandard claim form , 
and the hospital will file the claim on his behalf for inpatient expenses  through 
an online  network called MediC laim System . This applies to public hospitals 
and major private hospitals . 
   
E. Expense Participation  
 
3.13 Some  Medical Expense Insurance policies require the policy owner  to share in 
the payment of the medical expenses incurred. This requirement encourages 
the insured  person to keep medical expenses to a minimum, as well as helps to 
sieve out small claims. In turn , this helps to reduce the premiums  payable . 
  
3.14 The three  expense participation methods used by insurers are deductibles , co-
insurance and pro -ration factor , and all Integrated Shield Plans , includ ing 
MediShield Life Scheme, come with  these  features. Some  insurers offer plans 
with no expense participation , and these plans are  payable by cash (i.e. not 
Medisave approved) . Obviously, these types of plans will cost a lot more. They 
are more suitable for self -employed people who most likely will not have any 
form of Medical Expense Insurance , except maybe for their MediShield Life 
Scheme and Medisave savings . Such plans will enable them to enjoy maximum 
reimbursement of their hospitalisation expenses from the first dollar onwards.   
 
3.15 Although the Integrated Shield Plans offered in Singapore come with 
deductible , co-insurance and pro -ration factor , there are some  insurers  that will 
offer a rider  (at an extra  premium ) to cover the deductible and co -insurance 
components.  
 
E1. Deductible  
 
Claim from Insurer S$3,500  
 
 
Policy owner pays 
Deductible S$1,500  
 
 
3.16 A deductible is a flat dollar amount of medical expenses that the policy owner 
must pay out of his own pocket, before the insurer will begin making any benefit 
payment under the policy. It is usually on a per year basis, i.e. it is applicable 
again on the yearly renewal of the policy.  
 
3.17 As mentioned, d eductibles are found  in all  Integrated Shield Plans . It is common 
to find that the deductible  is tiered to the Class of Ward that the patient stays in. 
The higher the Class of Ward, the higher the deductible  (e.g. Class C - S$1,500 , 
Class B2 /B2+ - S$2,000 , Class B1 - S$2,500 , and Class A and private hospital - 
S$3,500 ). The higher deductibles for hi gher Ward Classes are to ensure that 
premiums remain affordable and that such insurance focuses on larger bills.  

Health Insurance   
26 Copyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] 3.18 There are basically three types of deductibles as follows:  
▪ per annum deductible;  
▪ per disability/per year deductible;  and 
▪ per disability (or per claim) deductible.  
 
3.19 Under a per annum deductible, all the e ligible expenses incurred by the insured  
person for a variety of covered illnesses or injuries within a policy year will be 
used to satisfy the deductible amount. This type of de ductible is the most 
common one used by insurers  in Singapore.  
 
3.20 As for the per disability/per year deductible, the deductible amount must be 
satisfied by eligible medical expenses that are attributable to the same illness 
or injury within the same policy y ear.  
 
3.21 The per disability deductible is the most restrictive , as the policy owner  has to 
bear the deductible each time that he makes a claim , regardless of whether the 
claim is made within the same policy year.  
 
3.22 Example 2.2 illustrates  how the three types of deductibles work . 
 
Example 2.2: Illustration Of The Working Of Per Annum Deductible, Per 
Disability/Per Year Deductible & Per Claim Deductible  
 
Billy had a Medical Expense Insurance policy with a S$2,000  deductible for the 
period 1 January 2019  to 31 December  2019 . He suffered a high fever on 1  
June 2019 and was admitted to  the hospital for two days.


key: _node_content
string_value:
{"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"}


key: chroma:document
string_value:
He suffered a high fever on 1  
June 2019 and was admitted to  the hospital for two days. The hospital bill was 
S$800 which was within the deductible amount. On 16 July 2019 , he 
developed some skin problems and was hospitalised for observation and 
treatment. The hospital bill was S$1,800 .  
 
For per annum deductible, Billy would  have met the deductible  on the second 
hospitalisation and able to claim some expenses , as the total  eligible 
expense s from the two causes exceeded the required S$2,000  within the 
policy year.  
 
For per disability/per year deductible , no amount w ould be paid from the 
insurance because for each disability, the bill would be within the S$2,000 
deductible .  
 
Similarly, for per disability deductible , Billy would  not be able to claim from 
the insurance.   
 
3.23 The higher the deductible, the cheaper will be the premium. Most insurers do 
not impose deductibles on outpatient treatments.  
 
3.24 Deductible is applicable separately on each of the family members insured 
under the policy. For example, a husband cannot combine his medical expenses 
with his wife’s medical expenses , to satisfy the deductible under the policy for 
the same policy year.  

2. Medical Expense Insurance  
Copyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] 27  
E2. Co-insurance  
 
3.25 Once the policy owner has satisfied the deductible, he is then eligible for 
reimbursement under the policy. However, if there is co-insurance, he is 
required to pay a specified percentage (e.g. 1 0%) of the total covered medical 
expenses wh ich are in excess of the deductible.  This helps to  reduce over -
consumption . 
 
3.26 Example 2 .3 illustrates  how the deductible and co -insurance principles are 
applied to a Medical Expense Insurance policy.  
 
Example 2.3: Illustration Of The Application Of Deductible & Co-insurance 
Under A Medical Expense Insurance Policy  
 
Charlie  held a Medical Expense Insurance policy with a per annum deductible 
of S$2,000 and a 20% co -insurance. He met with a car accident in June 2019 
and was admitted to the hospital for one day  of observation. The hospital 
charges were  S$1,000 . As this amount was below the deductible, he had to 
pay the full cost of S$1,000  from his own pocket.  Even though this amount 
was not claimable, he was advised to file the claim for the insurer , to consider 
it as fulfilling par t of the deductible amount for that policy year.  
 
In August 2019 , Charlie was admitted to the hospital for remov al of a kidney 
stone. The total hospital bill was S$5,000 . Assuming that the entire S$ 5,000  
fell within the limit allowed under his policy, the amount payable to him by 
the insurer would be S$3,200, calculated as follows:  
 
 
Hospital charges     S$5,000  
Less: Deductible *   (S$1,000 ) 
Claimable Amount     S$4,000  
Less: Co -insurance  (20%)   (S$  800)  
Benefits Paid by Insurer    S$3,200  
                                                    
In the 2nd hospitalisation , Charlie would need only to pay S$1,800 out of the 
S$5,000  that he ha d incurred , and this could be settled using Medisave and/or 
cash.  
 
* Having  fulfilled a S$ 1000 deductible during the June 2019 hospital stay , the 
deductible that Charlie must pay is the difference.  (i.e. S$2,000 - $1000)  
 
E3. Pro-ration Factor  
 
3.27 When the insured person is admitted to a hospital better than and/or ward 
higher than what he is entitled to under his existing insured plan, a percentage 
(expressed as pro-ration factor in the benefit schedule) is applied on the actual 
charges incurred and covered under the policy. Therefore, t he benefit payable 
is reduced , to take into account the differences in the G overnment subsidi es 
applicable to the ward type of the insured plan . 
 

Health Insurance   
28 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 
premium s for lower plan s should be encouraged to use the services available 
only on the selected plan s.


key: _node_content
string_value:
{"id_": "91b7da61-f4d6-4617-8aa8-f4060c63f8e6", "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": "e4548c23-e9fc-4956-89bc-9e45991d5b69", "node_type": "1", "metadata": {}, "hash": "944fb3b9c6aa70deb9e5806e1567e02bc96cdd10f5cb7b747cd6f01fa1edfe03", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "b2f76c6a-3fb5-475e-b072-9908d1677d2c", "node_type": "1", "metadata": {}, "hash": "f6010540aedd328b7d553b24aa60804ba5b75d8d9a029bd1e52df246d85ebc7f", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 280729, "end_char_idx": 284547, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
4] 3.28 This ensures fairness within the portfolio , such that those  who pay  lower 
premium s for lower plan s should be encouraged to use the services available 
only on the selected plan s. 
 
3.29 Example 2.4 illustrates how pro -ration factors, deductible and co -insurance 
principles are applied to a Medical Expense Insurance policy.  
 
Example 2.4 : Illustration  Of The Application Of Pro -ration Factors, Deductible 
and Co -insurance Under A Medical Expense Insurance Policy  
 
Plan Entitlement :  Restructured Hospital – any standard B1 ward  
Hospitalisation :  Private Hospital in Singapore  
Pro-ration Factor :  35% 
Ward of discharge :  Standard Single Bed  
 
Expenses  Limits  Amount 
incurred  Pro-rated 
amount  Amount 
covered by 
insurance  
Daily room, board 
and medical 
related services  As charged  S$4,000  S$1,400  S$1,400  
Surgical Benefits  As charged  S$20,000  S$7,000  S$7,000  
Total Bill   S$24,000  S$8,400  S$8,400  
Annual Deductibles  S$3,500  
Co-insurance :  
10% x (S$8,400 – S$3,500)  S$490  
You Pay  S$S$3,500 + S$490 + S$15,600 = 
S$19,590  
Insurer Pays  S$4,410  
 
F. Benefit Limits  
 
3.30 Most Medical Expense Insurance plans have maximum  limits on the  benefits 
that can be claimed. The three main types of limits are as follows:  
 
 
 
 
 
 
 
3.31 Lifetime limit is often set at a very high amount, e.g. S$1,000,000. This amount 
is the maximum total amount of all reimbursements that the insurer is liable to 
the policy owner  throughout the life insured’s  lifetime. Once this limit is 
reached, the policy will terminate . There is no such limit in some Medical 
Expen se Insurance policies recently issued by some insurers.  
 
 
 Lifetime 
Limit  Annual  
Limit  Event  
Limit  THREE MAIN TYPES OF BENEFIT LIMITS  

2. Medical Expense Insurance  
Copyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] 29  
3.32 Annual limit , lesser  than lifetime limit , is the amount of reimbursable costs 
payable over an annual period, either a calendar year or a policy year. Simply 
stated, it is the maximum annual reimbur sement for benefits payable by the 
insurer as stated in the Schedule of Benefits of the policy .  
 
3.33 Event limit is the maximum  amount payable per disability or illness as defined 
in the policy.  
 
3.34 There will also be limits on the individual items of the benefit schedule  and 
these are known as sub -limits. Examples of sub -limits are room and board 
charges (S$300 per day) or surgical benefits ( S$10,000  per claim).  For benefits 
that are  represented as “ as charged”, sub -limits are not applicable , but lifetime 
and annual limits will still apply.   
 
G. Covered Charges  
 
3.35 All Medical Expense Insurance policies will specify the expenses and its limits 
that will be covered under the plan . Charges, services  and expenses are three 
interrelated terms used. The covered services and treatments typically include 
all or some of the following medical expenses:  
▪ room and board;  
▪ intensive care;  
▪ miscellaneous hospital services, such as laboratory fees, X -rays, medicati on 
and the use of an operating room;  
▪ surgery  (including anaesthesia and oxygen administration) ; 
▪ hospital consultation;  
▪ ambulance service s; 
▪ in-hospital doctor’s fees;  and 
▪ specified outpatient expenses, such as specialist consultation, emergency 
accidental t reatment and post -hospitalisation treatment, etc.  
 
H. Geographical Limit  
 
3.36 Most  Individual Medical Expense Insurance policies will automatically 
terminate if the insured resides outside of Singapore  for more than a specified 
period of time (e.g. 180 days). Ho wever, some insurers will terminate the policy 
only if the insured is not a Singapore Citizen or Singapore Permanent Resident 
(SPR).


key: _node_content
string_value:
{"id_": "b2f76c6a-3fb5-475e-b072-9908d1677d2c", "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": "91b7da61-f4d6-4617-8aa8-f4060c63f8e6", "node_type": "1", "metadata": {}, "hash": "2b80fd84685b22a52017934b4f4d5889c602085f530964f6d08599be004666e6", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "7395dc0c-2282-4728-af60-9832b4953c73", "node_type": "1", "metadata": {}, "hash": "7ab94035e3cfbe2d076036d787107780189e9f8ed61cbfe6a3c19eccbb926717", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 284399, "end_char_idx": 288595, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
180 days). Ho wever, some insurers will terminate the policy 
only if the insured is not a Singapore Citizen or Singapore Permanent Resident 
(SPR).    
  
3.37 In addition, some insurers will still pay for the medical treatments even though 
the insured has resided outside of Singapore longer than the specified period 
allowed, but any medical expenses incurred overseas will be based on the 
reasonable and customary ch arges for that particular medical treatment in 
Singapore, and will be subject to the limits as stated in the policy.  
 
  


Health Insurance   
30 Copyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] 3.38 If the insured is a Singapore Citizen or SPR, the insurer will usually allow the 
policy to renew at an extra premium, even though the i nsured is stationed 
overseas after a specified period of time, subject to the insured's written 
confirmation of the insurance cover for the insured.   
 
3.39 Some high -end Individual Medical Expense Insurance plans also allow the 
insured to seek medical treatment  overseas, although the medical treatment is 
available in Singapore. However, the reimbursement of such incurred medical 
expenses will be based on the reasonable and customary charges for that 
particular medical treatment in the country of treatment, and w ill be subject to 
the limits as stated in the policy.   
 
I. Waiting Period   
 
3.40 When an individual signs up for a new Health Insurance policy, the cover may 
not start on the policy issue date. Some insurers impose a waiting period – a 
period of time stated in the policy which must pass , before some or all of his 
Health Insurance coverage can begin. In other words, the insurer is liable to pay 
any claim amount filed only after this waiting period. The waiting period is not 
applicable  for accidental injury. This means that , in the case of injury caused by 
an accident, the insured will be covered immediately.  
 
3.41 A waiting period protects members within the portfolio , by ensuring that 
individuals are  not able to make claim s shortly after joining and then cancelling 
their membership. This kind of behavio ur will result in increased premiums for 
all members. Some insurers may impose a  waiting period for pre -existing 
conditions.  
 
J. Age Limit s 
 
3.42 Most insurers issue this policy to people who are as young as 15 days old and 
below a specified maximum age of entry, e.g. 74 or 75 years old . Children are 
allowed to be insured under the parent’s policy up to the age 18 or 25 years , if 
he is still pursuing full -time tertiary education.  
 
K. Premiums  
 
3.43 The premiums for Medical Expense Insurance are usually based on age band 
and increase as one ages,  i.e. if a person crosses to the next age band, he has 
to pay a higher premium  upon renewal , based on the new age band that he falls 
under. Premium  rates are not guaranteed  and may be adjust ed on the premium 
due date or next renewal  date to account for higher claims, medical inflation , 
etc. However, the  insurer  will need to give advance notice  (e.g. 30 days) to the 
policy owner before effecting the premium increase.    
 
3.44 Premiums can be  payable on a monthly, quarterly, half-yearly  or yearly basis , 
and are normally higher for female lives . Note that insurers may use the same 
premium tables for male and female lives.  
 
  

2. Medical Expense Insurance  
Copyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] 31  
L. Renewability  
 
3.45 Some Medical Expense Insurance policies are issued on a guaranteed 
renewable basis. This means that the insurer cannot terminate the policy owing 
to poor claims experience , so long as the policy owner  pays his premium to 
keep the policy in force. All the IP policies are guaranteed renewable.  
 
3.46 However, there are policies which are cancellable at the option of the insurer , 
by giving a specified number of days’ notice (e.g. 60 days) to the policy owner .  
 
M. Exclusions & Limitations  
 
3.47 All Medical Expense Insurance policies have limitations and exclusions that 
specify the circumstances under which a claim will not be payable .


key: _node_content
string_value:
{"id_": "7395dc0c-2282-4728-af60-9832b4953c73", "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": "b2f76c6a-3fb5-475e-b072-9908d1677d2c", "node_type": "1", "metadata": {}, "hash": "f6010540aedd328b7d553b24aa60804ba5b75d8d9a029bd1e52df246d85ebc7f", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "09a1ab87-2cf1-4648-8a2e-8670fecbe813", "node_type": "1", "metadata": {}, "hash": "db686f5795077686515afcd186ce6c804d89d5d553517c18eb4de2c1e357e25c", "class_name": "RelatedNodeInfo"}}, "text": "", "start_char_idx": 288379, "end_char_idx": 292633, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}


key: chroma:document
string_value:
60 days) to the policy owner .  
 
M. Exclusions & Limitations  
 
3.47 All Medical Expense Insurance policies have limitations and exclusions that 
specify the circumstances under which a claim will not be payable . 
 
3.48 Generally, exclusions and limitations are designed for the following reasons:  
▪ to avoid the possibility of a policy owner  receiving reimbursement twice for 
the same charges , or making a profit from his insurance;  
▪ to make the premium more affordable;  
▪ to define more clearly the necessary medical care and treatment; and  
▪ to avoid the policy owner  selecting against the insurer  (i.e. anti -selection).  
 
M1. Exclusions  
 
3.49 The common exclusions under Medical Expense Insurance policies usually 
include:  
▪ pre-existing conditions that were present during a specified period (e.g. 12 
months) prior to the inception of the insurance;  
▪ congenital anomalies;  
▪ cosmetic surgery, dental tre atment and vision care;  
▪ convalescent and special nursing care, general medical check -up; 
▪ pregnancy, infertility, birth control , childbirth  and their related 
complications;  
▪ mental or nervous disorder, drug addiction and alcoholism;  
▪ Acquired Immune Deficienc y Syndrome ( AIDS ) and its related complications, 
sexually transmitted diseases;  
▪ flying or aerial activity, other than as a fare -paying passenger on a regularly 
scheduled flight of a commercial aircraft;  
▪ hazardous sports, such as mountaineering, scuba diving, ice skating, bungee 
jumping, etc.; 
▪ illnesses or injuries arising from war, nuclear, participation in str ike, riot or 
civil commotion;  
▪ self-inflicted injuries and injuries resulting from a criminal or unlawful act; 

Health Insurance   
32 Copyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] ▪ purchase of hospital -type equipment, such as wheelchair, dialysis machine, 
etc.; and 
▪ treatment for obesity, weight reduction or improvement.  
 
3.50 Exclusions vary from insurer to insurer. Clients should be advised and 
reminded to read the policy documents i.e. they need to understand the specific 
exclusions imposed by their insurers.  
 
M2. Limitations (Co -ordination Of Benefits)  
 
3.51 Most Medical Expense Insurance policies are issued with the Co -ordination of 
Benefits Clause.  The purpose of this Clause is to ensure that the total claims 
made by the policy owner cannot exceed  the total actual medical expenses 
incurred.   
 
3.52 Hence, should t he policy owner be able to obtain payments from other sources 
(e.g. employer’s Group H&S Insurance policy or Work Injury Compensation  
Insurance policy , etc .), the amount payable by the insurer under a Medical 
Expense Insurance policy will be reduced , so th at the total benefits received will 
not exceed  the total incurred medical expenses.  
 
 
4. UNDERWRITING  
 
4.1 The main source of underwriting information for individual Medical Expense 
Insurance is the proposal form. For group coverage , the empl oyer is required 
to complete a G roup Insurance Fact-Finding (GIFF) Form which is the main 
source of information for the un derwriting assessment. For small groups (e.g. 
below 10 members /employees ), the underwriter may also require the individual 
employee to complete a health declaration form.  
 
 
5. HEALTHCARE SUBSIDY  LEVEL  
 
5.1 Citizens, SPRs and foreigners  in Singapore  are charged differently for public 
healthcare services. Citizens enjoy heavy subsidies in Class B2 /B2+ and C 
wards. SPRs receive significant subsidy , while foreigners are not subsidised at 
all. The subsidy level distinction reflects the privi leges of citizenship, and to 
further sharpen the distinction between citizens and SPRs. Refer to Appendix 
2C for the Table of Subsidy Level .   
 
5.2 Owing to the differences in healthcare subsidy  for citizens, SPR and foreigner s, 
some insurers apply a citizenship factor on the hospitalisation claims. 
Citizenship factor means a percentage applied to the medical expenses o f an 
insured person (who is not a Singaporean) , that is claimable under th e policy.  
 
 
 
 
 

2. Medical Expense Insurance  
Copyright reserved by the Singapore College of Insurance Limited [ Version 1. 4] 33  
6.


