Claims and Procedures Flashcards

What are the common exclusions in Singapore health insurance policies?

Answer: Cosmetic surgery, fertility treatments, pre-existing conditions (during waiting period), experimental treatments, and self-inflicted injuries

Common exclusions include cosmetic/elective procedures, fertility treatments, dental (unless due to accident), pre-existing conditions during waiting periods, experimental treatments, and injuries from dangerous activities.

What is 'direct billing' (cashless hospitalisation) in Singapore health insurance?

Answer: An arrangement where the hospital bills the insurer directly, and the patient only pays the deductible, co-insurance, and any non-covered items

Direct billing means the insurer settles the bill directly with the hospital. The patient pays only their share (deductible, co-insurance, non-covered items). This is common with panel hospitals.

How are outpatient specialist visits covered under Singapore health insurance?

Answer: Coverage depends on the policy: MediShield Life covers selected costly outpatient treatments; IPs may offer outpatient coverage through riders at additional premium

MediShield Life covers selected outpatient treatments (chemotherapy, dialysis). For general outpatient specialist visits, an IP rider or separate outpatient plan may be needed for coverage.

What is the claims turnaround time standard for Singapore health insurers?

Answer: Insurers are expected to settle straightforward claims within 30 days of receiving complete documentation

Industry guidelines expect insurers to process and settle straightforward claims within 30 days of receiving all required documentation. Complex claims may take longer but should be communicated to the policyholder.

What documentation is typically required for a health insurance claim in Singapore?

Answer: Hospitalisation leave certificate, detailed hospital bill, medical report, claim form, NRIC copy, and any referral letters

A complete claim typically requires: the insurer's claim form, detailed hospital bill, medical report or discharge summary, proof of identity, and any specialist referral or pre-authorisation letters.

What is the role of the Life Insurance Association (LIA) in health insurance disputes in Singapore?

Answer: LIA provides guidelines for the industry and facilitates resolution of complaints; unresolved disputes can be escalated to FIDReC

The LIA sets industry standards and handles initial complaints against its member insurers. If complaints remain unresolved, they can be escalated to FIDReC for independent mediation and adjudication.