HI Claims and Procedures 2 — Questions and Answers
Question 1: What are the common exclusions in Singapore health insurance policies?
- Nothing is excluded
- Cosmetic surgery, fertility treatments, pre-existing conditions (during waiting period), experimental treatments, and self-inflicted injuries (Correct answer)
- Only dental is excluded
- Only overseas treatment is excluded
Correct 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.
Question 2: What is 'direct billing' (cashless hospitalisation) in Singapore health insurance?
- The patient pays nothing ever
- An arrangement where the hospital bills the insurer directly, and the patient only pays the deductible, co-insurance, and any non-covered items (Correct answer)
- Only available at public hospitals
- A type of medical loan
Correct 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.
Question 3: How are outpatient specialist visits covered under Singapore health insurance?
- All outpatient visits are fully covered
- Coverage depends on the policy: MediShield Life covers selected costly outpatient treatments; IPs may offer outpatient coverage through riders at additional premium (Correct answer)
- Outpatient visits are never covered
- Only GP visits are covered
Correct 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.
Question 4: What is the claims turnaround time standard for Singapore health insurers?
- No standard exists
- Insurers are expected to settle straightforward claims within 30 days of receiving complete documentation (Correct answer)
- Claims must be settled within 24 hours
- Claims can take up to one year
Correct 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.
Question 5: What documentation is typically required for a health insurance claim in Singapore?
- Only the hospital bill
- Hospitalisation leave certificate, detailed hospital bill, medical report, claim form, NRIC copy, and any referral letters (Correct answer)
- Only the claim form
- Only verbal confirmation from the doctor
Correct 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.
Question 6: What is the role of the Life Insurance Association (LIA) in health insurance disputes in Singapore?
- LIA sells insurance directly
- LIA provides guidelines for the industry and facilitates resolution of complaints; unresolved disputes can be escalated to FIDReC (Correct answer)
- LIA has no role in disputes
- LIA only handles life insurance, not health
Correct 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.
HI Claims and Procedures 2
What are the common exclusions in Singapore health insurance policies?