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INFORMATION BOOKLET
Contents Introduction CPF MediShield Reform AIA HealthShield Gold Frequently Asked Questions Schedule Of Benefits for AIA HealthShield & AIA HealthShield Gold Annual Premiums for AIA HealthShield & AIA HealthShield Gold Appendix A Appendix B
Notes: This booklet contains product information provided by AIA. If you have any queries, please contact your AIA Financial Services Consultant for advice. It is important to note that suitable health insurance products will help you to finance your future healthcare needs. A Chinese version of this booklet is available at our website: www.aia.com.sg/healthshieldgold or by calling our AIA HealthShield Gold Hotline at 6248 8228. In case of inconsistency between the English and Chinese version of the booklet, the English version shall prevail. In case of doubt, you should always refer to the English version. This booklet is not a contract of insurance. The precise terms and conditions of the plans described are specified in the policy contract.
Introduction
This booklet explains the recent changes to CPF MediShield, how they affect your current AIA HealthShield plan and the benefits you will enjoy with the new AIA HealthShield Gold. If you have any queries on your current AIA HealthShield plan or AIA HealthShield Gold, please contact your AIA Financial Services Consultant. Alternatively, you can visit us at www.aia.com.sg/healthshieldgold or call our AIA HealthShield Gold Hotline at 6248 8228. For general queries on the CPF MediShield reform, please visit the Ministry of Healths website at www.moh.gov.sg.
Conversion Of AIA HealthShield To AIA HealthShield Gold Your current AIA HealthShield plan will be automatically converted to the new AIA HealthShield Gold. This will take effect from the policy anniversary date after 30 November 2005 of your plan (the "conversion effective date"). By converting your current plan to AIA HealthShield Gold, you will be able to continue using your CPF Medisave* to pay your premiums after 30 June 2007. Your AIA HealthShield plan will be converted as follows: AIA HealthShield Plan A AIA HealthShield Plan A Plus AIA HealthShield Plan B AIA HealthShield Plan B Plus AIA HealthShield Gold Plan A AIA HealthShield Gold Plan A AIA HealthShield Gold Plan B AIA HealthShield Gold Plan B
Please refer to Appendices A and B of this booklet for a full comparison of the benefits and premiums between AIA HealthShield and AIA HealthShield Gold. This conversion is guaranteed - no health questions asked, no medical examination needed and no new medical exclusions applied. You will receive a new AIA HealthShield Gold contract before the conversion effective date of your plan, after which you will have a free-look period of two calendar months from the conversion effective date to review your new plan. If you decide to revert to your current AIA HealthShield plan, please notify us within the two-month period. However, if you do not wish to have your plan converted to AIA HealthShield Gold, please notify us by calling our AIA HealthShield Gold Hotline at 6248 8228 at least 30 days before the conversion effective date of your plan. By keeping your current plan, please note that as per the Ministry of Health's new requirements, you will need to pay your premiums in cash (instead of CPF Medisave) after 30 June 2007. You can still convert to AIA HealthShield Gold after 30 June 2007. However, your conversion will be subject to underwriting and, depending on your health status, new medical exclusions may apply. * Up to $660 per person per year.
Annual premiums will be paid through your CPF Medisave Account, up to $660 per person per year.
Benefits Hospitalisation Benefit Daily Room and Board1 Daily ICU Charges1 Surgical Benefit Surgery Limits Table2: 1 2 3 4 5 6 7 Surgical Implants/ Approved Medical Consumables3 (per treatment) Gamma Knife (per procedure) Out-Patient Hospital Benefits4 Radiotherapy for cancer (per day) Stereotactic Radiotherapy for cancer (per treatment) Chemotherapy for cancer (per month) Immunotherapy for cancer (per month) Renal Dialysis (per year) Erythropoietin (per year) Cyclosporin (per year) Extra Cancer Benefit Limit5 Per Policy Year Per Lifetime Limit Per Policy Year Per Lifetime Deductible6 (per policy year)
AIA HealthShield Gold Limits of Compensation (in S$)* Plan A Plan B 830 1,300 450 740
10% 10% Co-insurance7 * Limits are inclusive of GST. 1 Inclusive of meals, prescriptions, professional charges, investigations and other miscellaneous medical charges. 2 Surgery Limits Table is the latest surgical operation fee listed in the Table of Surgical Procedures under the Medisave Scheme operated by Ministry of Health. 3 For the purpose of this Surgical Benefit, Surgical Implants/Approved Medical Consumables includes charges incurred per treatment for intravascular electrodes used for
4 5 6 7
electrophysiological procedures, Percutaneous Transluminal Coronary Angioplasty and interaortic balloons (or balloon catheters). Out-Patient Hospital Benefits are not subject to deductible. The Extra Cancer Benefit Limit is provided over and above the Limit Per Policy Year and Limit Per Lifetime. Deductible is the portion of costs you are liable for before any benefits are payable. Co-insurance is the fixed percentage you are liable for in excess of the deductible.
Pay Premiums Using Your CPF The annual premium will be paid through your CPF Medisave Account - up to $660 per person per year. Any excess premium can be paid in cash. AIA HealthShield Gold Age Next Birthday Plan A Plan B (S$) (S$) 30 & below 95 57 31 to 40 143 86 41 to 50 285 171 51 to 55 476 285 56 to 60 491 295 61 to 65 812 488 66 to 70 1,167 700 71 to 73 1,673 1,004 74 to 75# 1,964 1,178 ## 76 to 81 2,730 1,649 Premium rates are inclusive of 5% GST. # Maximum entry age is 75 years (based on age next birthday). ## Ages 76 to 81 are for renewal only. An Example Of How AIA HealthShield Gold Works Suppose you are covered under AIA HealthShield Gold Plan A or Plan B and are hospitalised for 53 days in a Class A ward, including 3 days in ICU, due to cancer and you undergo surgery to remove a tumour. AIA HealthShield AIA HealthShield Gold Gold Plan B Plan A Benefits Claimable Benefits Claimable $32,750 $2,400 $7,300 $4,000 $1,200 $3,000 (1 month) $49,450 $46,450 $1,600 $48,050 $46,450 $35,420 $34,220
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Actual Amount Billed In-Patient Hospital Benefits Daily Room & Board (max $830 per day) Daily ICU (max $1,300 per day) Surgery (Surgery Limits Table 7) Surgical Implants / Approved Medical Consumables (max $4,000 per treatment) Out-Patient Hospital Benefits Chemotherapy (max $1,600 per month) Total Total (in-patient bill only)
AIA HealthShield Gold Information Booklet
Less Deductible Add Total Claimable Out-Patient Amount Sub-total Less Co-insurance (10%) AIA HealthShield Gold Pays Insured Pays
$40,545^
$8,905
$30,078^
$19,372
The above claim illustrated that if you are covered under AIA HealthShield Gold Plan A instead of Plan B, you will save $10,467 ($19,372 minus $8,905). ^Effects of the benefits claimable on the Lifetime and Policy Year Limits As this is a cancer-related claim, the $40,545 (AIA HealthShield Gold Plan A) or $30,078 (AIA HealthShield Gold Plan B) will be payable under the Extra Cancer Benefit. However, as the policy year limit for the Extra Cancer Benefit is only $30,000, the difference of $10,545 (for AIA HealthShield Gold Plan A) or $78 (for AIA HealthShield Gold Plan B) will be offset against the normal policy year limit as follows: Extra Cancer Benefit Per Policy Year Per Lifetime Overall Limit Per Policy Year Per Lifetime Limit $30,000 $100,000 Payout $30,000 AIA HealthShield Gold Plan A Balance Limit $0 $70,000 AIA HealthShield Gold Plan B Balance Limit $0 $70,000
AIA HealthShield Gold Plan A Limit Payout Balance Limit $120,000 $109,455 $10,545 $5,000,000 $4,989,455
AIA HealthShield Gold Plan B Limit Payout Balance Limit 90,000 $89,922 $78 600,000 $599,922
Option To Enhance Your Coverage In the previous example, out of your total medical bill, you had to pay $8,905 if you are covered under AIA HealthShield Gold Plan A or $19,372 if you are covered under AIA HealthShield Gold Plan B. AIA has other hospital income plans that complement your AIA HealthShield Gold plan, to help you pay these amounts. One such plan is AIA Pink of Health. AIA Pink of Health is designed to complement AIA HealthShield Gold by providing a range of additional benefits such as hospital income benefit, coverage for pre and post hospitalisation expenses and hospital expense reimbursement. Premiums for AIA Pink of Health are payable using cash and cannot be paid using your CPF.
Notes: AIA HealthShield Gold is jointly insured by AIA and the CPF Board as the operator of CPF MediShield. Please note that you can only be covered under one Medisave-approved medical insurance scheme at any one time.
AIA HealthShield Gold is a guaranteed yearly renewable plan. The premium rates for this plan are not guaranteed. These rates may be adjusted based on future experience.
Gold Plan A has a higher deductible of $3,000 compared to $2,500 for AIA HealthShield Plan A Plus. However, the co-insurance is reduced to 10% compared to 15% for AIA HealthShield Plan A Plus. In addition, AIA HealthShield Gold Plan A does not have a Final Expenses Benefit, whereas AIA HealthShield Plan A Plus has a Final Expenses Benefit of $5,000. iv) AIA HealthShield Plan B Plus Compared to AIA HealthShield Gold Plan B The benefit limits under AIA HealthShield Gold Plan B and AIA HealthShield B Plus are the same. Please note that under the Ministry of Healths new requirements, the minimum deductible for stays in Class B1 wards is $2,000. As such, AIA HealthShield Gold Plan B has a higher deductible of $2,000 compared to $1,500 for AIA HealthShield Plan B Plus. However, the co-insurance is reduced to 10% compared to 15% for AIA HealthShield Plan B Plus. In addition, AIA HealthShield Gold Plan B does not have a Final Expenses Benefit, whereas AIA HealthShield Plan B Plus has a Final Expenses Benefit of $3,000.
2. Are there any additional general exclusions to the benefits for AIA HealthShield Gold compared to AIA HealthShield? Yes, there are additional general exclusions to the benefits for AIA HealthShield Gold, as follows: Treatment for sub-fertility, assisted conception or any contraceptive operation and sex change operations Nursing home services Purchase of durable medical equipment such as wheelchairs and hospital beds used at homes Transport-related services including repatriation of mortal remains emergency evacuation, assistance and
Normal out-patients consultations other than selected outpatient services for treatment for catastrophic conditions, such as radiotherapy and chemotherapy for cancer, kidney dialysis and immuno-suppressants for organ transplant
3. Can I keep my current AIA HealthShield plan and opt not convert to AIA HealthShield Gold? Yes. If you would like to keep your current AIA HealthShield plan, please notify us by calling our AIA HealthShield Gold Hotline at 6248 8228 at least 30 days before the conversion effective date of your plan. By keeping your current plan, please note that as per the Ministry of Health's requirements, you will need to pay your premiums in cash (instead of CPF Medisave) after 30 June 2007.
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4. Can I revert to my current AIA HealthShield plan after it has been converted to AIA HealthShield Gold? Yes. You will receive a new AIA HealthShield Gold contract before the conversion effective date of your plan, after which you will have a free-look period of two calendar months from the conversion effective date to review your new plan. If you decide to revert to your current AIA HealthShield plan, please send a written request to our Policy Services Department AIA HealthShield Section, 1 Robinson Road, AIA Tower, #09-00, Singapore 048542 within the two-month period. By reverting to your current plan, please note that as per the Ministry of Health's requirements, you will need to pay your premiums in cash (instead of CPF Medisave) after 30 June 2007.
Premiums 5. Will My Premiums Increase Upon Conversion to AIA HealthShield Gold? i) Conversion from AIA HealthShield Plan A to AIA HealthShield Gold Plan A Yes, your premiums will increase and the amount of increase will depend on your age. Please refer to Appendix B, Table 1 of this booklet for a comparison of annual premiums between AIA HealthShield Plan A and AIA HealthShield Gold Plan A. ii) Conversion from AIA HealthShield Plan B to AIA HealthShield Gold Plan B Yes, your premiums will increase and the amount of increase will depend on your age. Please refer to Appendix B, Table 2 of this booklet for a comparison of annual premiums between AIA HealthShield Plan B and AIA HealthShield Gold Plan B. iii) Conversion from AIA HealthShield Plan A Plus to AIA HealthShield Gold Plan A In order to be consistent with CPF MediShield, AIA HealthShield Gold premiums are based on your age next birthday, rather than your age last birthday, as is the case for your current AIA HealthShield plan. As a result, your premium will increase if you are changing to the next age group at your next policy anniversary. For example, if you are aged 40 at your next policy anniversary (i.e. in the 31 to 40 age group for calculation of premiums), when you convert to AIA HealthShield Gold you will be considered age 41 on an age next birthday basis. As a result, you will pay the higher premium for age 41 (i.e. in the 41 to 50 age group for calculation of premiums) instead of age 40. Please refer to Appendix B, Table 1 of this booklet for a comparison of annual premiums between AIA HealthShield Plan A Plus and AIA HealthShield Gold Plan A.
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iv) Conversion from AIA HealthShield Plan B Plus to AIA HealthShield Gold Plan B. In order to be consistent with CPF MediShield, AIA HealthShield Gold premiums are based on your age next birthday, rather than your age last birthday, as is the case for your current AIA HealthShield plan. As a result, your premium will increase if you are changing to the next age group at your next policy anniversary. For example, if you are aged 55 at your next policy anniversary (i.e. in the 51 to 55 age group for calculation of premiums), when you convert to AIA HealthShield Gold you will be considered age 56 on an age next birthday basis. As a result, you will pay the higher premium for age 56 (i.e. in the 56 to 60 age group for calculation of premiums) instead of age 55. Please refer to Appendix B, Table 2 of this booklet for a comparison of annual premiums between AIA HealthShield Plan B Plus and AIA HealthShield Gold Plan B.
6. How do I pay the premiums for AIA HealthShield Gold? The annual premium, as illustrated in the tables in Appendix B of this booklet, will be paid through your CPF Medisave Account - up to $660 per person per year. Any excess premium can be paid in cash. Please note that the premium rates for AIA HealthShield and AIA HealthShield Gold are not guaranteed and may be adjusted based on future experience.
Medical and Underwriting 7. Do I automatically qualify for conversion to AIA HealthShield Gold, without the need for underwriting?
Upgrade from AIA HealthShield Plan B/B Plus to AIA HealthShield Gold Plan A 8. Is underwriting required if I want to upgrade my plan from AIA HealthShield Plan B/B Plus to AIA HealthShield Gold Plan A? Yes, underwriting will be required if you want to upgrade your plan.
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9. Do I need to pay additional premium if I upgrade my plan from AIA HealthShield Plan B/B Plus to AIA HealthShield Gold Plan A? When will the upgrade of my plan be effected? Yes, you need to pay additional premium for AIA HealthShield Gold Plan A as the benefit limits for AIA HealthShield Gold Plan A are higher. Upgrading of AIA HealthShield Plan B/B Plus to AIA HealthShield Plan A can only be effected from the next policy anniversary date of your plan. You can submit your upgrade application, with the help of your AIA Financial Services Consultant, any time before the 15th of the month before your next policy anniversary date. For example, if the next policy anniversary is 1 November 2005, your application for upgrade (effective 1 November 2005) needs to be received by AIA before 15 October 2005. If it is received later than 15 October 2005, the upgrade will be effected 1 November 2006. Please note that you will be covered under your current AIA HealthShield Plan B/B Plus before the effective date of the upgrade.
Deductible and Co-insurance 10. How do the deductible and co-insurance work? The deductible is the portion of costs you are liable for before any benefits are payable and is applied to the claimable amount, not the total bill amount. The claimable amount is calculated based on the schedule of benefit limits for AIA HealthShield Gold Plan A and Plan B. The deductible applies on a policy year basis. Once the total claimable amount for claims arising within the same policy year exceeds the deductible, the deductible will not apply to further claims arising within the same policy year. No deductible is applied for out-patient claims. Co-insurance is the fixed percentage you are liable for in excess of the deductible and is applied to both in-patient and out-patient claims. For AIA HealthShield Gold Plan A and Plan B, the co-insurance is 10%.
Carrying Forward of Claims from Current AIA HealthShield Plan to AIA HealthShield Gold 11. I have made claims before under my existing AIA HealthShield plan. Will the claims affect the Limit Per Lifetime and Limit Per Policy Year upon my automatic conversion to AIA HealthShield Gold? Yes. All claims previously paid under your existing AIA HealthShield plan will be accumulated for the purposes of assessing the Limit Per Policy Year (for the relevant policy year) and the Limit Per Lifetime under your new AIA HealthShield Gold plan.
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Claims Under AIA HealthShield Gold 12. If I am hospitalised 3 times in a year and each time the bill is less than the deductible but collectively, it is above the deductible, can I make claims under AIA HealthShield Gold? Yes, you can claim in this circumstance. As the deductible is applied on a policy year basis, the hospital bills can be accumulated within the same policy year until they are above the deductible. 13. How do I make a claim? If you are admitted to hospital, you will be required to fill up a claim form. Upon your discharge, the hospital will send your completed claim form to AIA for assessment. The hospital will also provide details of the bill to AIA through the Central Claims Processing System. After we have completed the assessment of your claim, we will notify the hospital of the claim amount payable under AIA HealthShield Gold. The hospital will then send you a copy of the final hospital bill stating the payment details. We will administer all payouts to our AIA HealthShield Gold policyholders, including any payouts due under the reformed MediShield. You can call your AIA Financial Services Consultant or our AIA Customer Care Hotline at 1800 248 8000 for assistance in the event of a claim.
AIA Pink of Health 14. How do I find out more details on AIA Pink of Health? You can call your AIA Financial Services Consultant or our AIA Customer Care Hotline at 1800 248 8000 for more details on AIA Pink of Health. 15. Can premiums for AIA Pink of Health be paid using CPF? No. Premiums are payable by cash, cheque or through GIRO payment, and cannot be paid using CPF.
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Appendix A
SCHEDULE OF BENEFITS Table 1 Limits of Compensation* Benefits AIA HealthShield Plan A (S$) 500 800 AIA HealthShield Plan A Plus (S$) 720 1,150 AIA HealthShield Gold Plan A [NEW] (S$) 830 1,300
Hospitalisation Benefits Daily Room and Board1 Daily ICU Charges1 Surgical Benefits Surgery Limits Table2: 1 2 3 4 5 6 7 Surgical Implants/ Approved Medical Consumables3 Gamma Knife (per procedure) Out-Patient Hospital Benefits4 Radiotherapy for cancer (per day) Stereotactic Radiotherapy for cancer (per treatment) Chemotherapy for cancer (per month) Immunotherapy for cancer (per month) Renal Dialysis (per year) Erythropoietin (per year) Cyclosporin (per year) Extra Cancer Benefit Limit5 Per Policy Year Per Lifetime Final Expenses Benefit Overall Limit Per Policy Year Per Lifetime Deductible6 (per policy year) Co-insurance7
1
12,600
12,600
14,000
200 NA 1,000 800 24,000 6,000 6,000 NA NA 5,000 90,000 270,000 2,500 15%
330 2,500 1,500 1,000 30,000 6,000 6,000 30,000 100,000 5,000 120,000 1,000,000 2,500 15%
400 2,750 1,600 1,100 30,000 6,000 6,000 30,000 100,000 Nil 120,000 5,000,000 3,000 10%
* Limits are inclusive of GST. Inclusive of meals, prescriptions, professional charges, investigations and other miscellaneous medical charges. 2 Surgery Limits Table is the latest surgical operation fee listed in the Table of Surgical Procedures under the Medisave Scheme operated by Ministry of Health. 3 For the purpose of this Surgical Benefit, Surgical Implants/Approved Medical Consumables includes charges incurred per treatment for intravascular electrodes used for electrophysiological procedures, Percutaneous Transluminal Coronary Angioplasty and inter-aortic balloons (or balloon catheters). 4 Out-Patient Hospital Benefits are not subject to deductible. 5 The Extra Cancer Benefit Limit is provided over and above the Limit Per Policy Year and Limit Per Lifetime. 6 Deductible is the portion of costs you are liable for before any benefits are payable. 7 Co-insurance is the fixed percentage you are liable for in excess of the deductible. AIA HealthShield Gold Information Booklet 15
Table 2 Limits of Compensation* Benefits AIA HealthShield Plan B (S$) 300 500 AIA HealthShield Plan B Plus (S$) 450 740 AIA HealthShield Gold Plan B [NEW] (S$) 450 740
Hospitalisation Benefits Daily Room and Board1 Daily ICU Charges1 Surgical Benefits Surgery Limits Table2: 1 2 3 4 5 6 7 Surgical Implants/ Approved Medical Consumables3 Gamma Knife (per procedure) Out-Patient Hospital Benefits4 Radiotherapy for cancer (per day) Stereotactic Radiotherapy for cancer (per treatment) Chemotherapy for cancer (per month) Immunotherapy for cancer (per month) Renal Dialysis (per year) Erythropoietin (per year) Cyclosporin (per year) Extra Cancer Benefit Limit5 Per Policy Year Per Lifetime Final Expenses Benefit Overall Limit Per Policy Year Per Lifetime Deductible6 (per policy year) Co-insurance7
9,600
9,600
9,600
160 NA 800 600 19,200 4,800 4,800 NA NA 3,000 65,000 195,000 1,500 15%
280 2,000 1,200 700 24,000 5,000 5,000 30,000 100,000 3,000 90,000 600,000 1,500 15%
280 2,000 1,200 700 24,000 5,000 5,000 30,000 100,000 Nil 90,000 600,000 2,000 10%
* Limits are inclusive of GST. 1 Inclusive of meals, prescriptions, professional charges, investigations and other miscellaneous medical charges. 2 Surgery Limits Table is the latest surgical operation fee listed in the Table of Surgical Procedures under the Medisave Scheme operated by Ministry of Health. 3 For the purpose of this Surgical Benefit, Surgical Implants/ Approved Medical Consumables includes charges incurred per treatment for intravascular electrodes used for electrophysiological procedures, Percutaneous Transluminal Coronary Angioplasty and inter-aortic balloons (or balloon catheters). 4 Out-Patient Hospital Benefits are not subject to deductible. 5 The Extra Cancer Benefit Limit is provided over and above the Limit Per Policy Year and Limit Per Lifetime. 6 Deductible is the portion of costs you are liable for before any benefits are payable. 7 Co-insurance is the fixed percentage you are liable for in excess of the deductible. AIA HealthShield Gold Information Booklet 16
Appendix B
Annual Premiums Table 1 AIA HealthShield Plan A (S$)
92 92 138 138 138 138 138 138 138 138 138 138 275 275 275 275 275 275 275 275 275 275 457 457 457 457 457 457 457 457 457 457 731 731 731 731 731 1,004 1,004 1,004 1,004 1,004 1,338 1,338 1,338 1,571 1,571 2,184 2,184 2,184 2,184 2,184
Note: The premium rates for AIA HealthShield and AIA HealthShield Gold are not guaranteed and may be adjusted based on future experience.
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Note: The premium rates for AIA HealthShield and AIA HealthShield Gold are not guaranteed and may be adjusted based on future experience.
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