Claims and Procedures Flashcards

What is a 'pre-authorisation' requirement in Singapore health insurance?

Answer: Some IP insurers require advance approval before certain treatments or procedures to confirm coverage, especially for elective procedures

Pre-authorisation involves getting the insurer's approval before undergoing certain treatments. This helps manage costs and confirms that the procedure is medically necessary and covered under the policy.

What is a 'waiting period' in Singapore health insurance?

Answer: A period after policy commencement during which certain conditions or treatments are not covered, typically 30-120 days depending on the condition

Waiting periods are exclusion windows after policy inception. For example, pre-existing conditions may have a 12-month waiting period, while general conditions may have a 30-day waiting period.

How does the Medisave claim process work at Singapore hospitals?

Answer: Patients present their NRIC; the hospital submits the Medisave claim directly to CPF Board for automatic deduction from the patient's Medisave account

The Medisave claim process is largely automated. Present your NRIC at the hospital, and the institution submits the claim electronically to CPF Board. Eligible amounts are deducted from your Medisave account directly.

What should a policyholder do if their health insurance claim is rejected in Singapore?

Answer: Review the rejection reason, gather supporting documents, file an appeal with the insurer, and if unresolved, escalate to FIDReC or the insurer's internal dispute resolution

First, understand why the claim was rejected. Gather additional documentation (medical reports, referral letters). File a formal appeal with the insurer. If still unresolved, FIDReC can mediate the dispute.

What is 'Medisave utilisation limits' and how do they work?

Answer: Daily and overall withdrawal limits set by MOH that cap how much can be withdrawn from Medisave for hospitalisation, day surgery, and outpatient treatments

MOH sets Medisave withdrawal limits including daily limits for hospitalisation, per-procedure limits for day surgery, and annual limits for outpatient treatments like chronic disease management.

Can Medisave be used for family members' medical expenses in Singapore?

Answer: Yes, Medisave can be used for the account holder, spouse, children, parents, and grandparents within the prescribed limits

Medisave can be used for immediate family members: spouse, children, parents, and grandparents. This allows family members to help cover each other's medical costs within the withdrawal limits.