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Q: How do I make a claim under MyCare?

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MyShield & MyHealth Plus

Most popular questions

A:
For MyShield Plan 1, 2 and 3

Any Singapore Citizen or Singapore Permanent Resident may apply as proposer (payer)/assured provided the proposer (payer)/assured is a Singaporean or Singapore Permanent Resident and has a CPF Medisave account.

For dependant(s), they need not be a Singapore Citizen or Singapore Permanent Resident but must be residing in Singapore to enjoy this coverage. Dependants are defined to be the proposer (payer)’s legal spouse, parent(s) or grandparent(s) and/or biological or legally adopted children.

Note: For Plan 3, only Singapore Citizens or Singapore Permanent Residents may apply.

  Minimum Entry Age (ANB) Maximum Entry Age (ANB) Expiry Age
Proposer (Payer)/Assured

17

NA^

NA

Dependant/Life assured

15 days old or the date of discharge from Hospital after birth, whichever is later

75

NA.
The product offers lifetime cover

^If the proposer (payer)/assured is also the life assured, the maximum entry age of 75 (ANB) will apply.

 

For MyShield Standard Plan

Any Singapore Citizen or Singapore Permanent Resident may apply as proposer (payer)/assured provided the proposer (payer)/assured is a Singaporean or Singapore Permanent Resident and has a CPF Medisave account but the life assured must be a Singapore Citizen or Singapore Permanent Resident.

For dependant(s), they must be a Singapore Citizen or Singapore Permanent Resident to be eligible for coverage.

  Minimum Entry Age (ANB) Maximum Entry Age (ANB) Expiry Age
Proposer (Payer)/Assured

17

NA

NA

Dependant/Life assured

15 days old or the date of discharge from Hospital after birth, whichever is later

NA

NA.
As the product offers lifetime cover

A: To be eligible for coverage, the life assured must be between 15 days old and 75 years old at age next birthday on the cover start date and the life assured of a MyShield policy.

 

Minimum Entry Age (ANB)

Maximum Entry Age (ANB)

Expiry Age

Assured/ Proposer (Payer)

17

N.A.^

N.A.

Life assured/ Dependant* 15 days old or the date of discharge from hospital after birth, whichever is later

75

Critical Illness Benefit expires on the Policy Anniversary date following which the life assured attains the age of 65 years old.

All other benefits have no expiry age.

^If the proposer (payer)/ assured is also the life assured, the maximum entry age of 75 (ANB) will apply.

*Dependants are defined to be the proposer (payer)’s legal spouse, parent(s), grandparent(s) and/or biological or legally adopted children.

A: The guide below shows how a claim can be made when you are hospitalised or need a day surgery.

  • On the day of hospital admission/surgery, inform the hospital/clinic of the intention to file a claim under MyShield.
  • You will be asked to complete the consent in the “Medical Claims Authorisation Form” (Single or Multiple version) at the hospital/clinic. The hospital/clinic will usually E-file your claim to us within 2 weeks after hospital discharge. We will administer all payouts and inform you on the outcome of the claim including that of the MediShield Life claim. We will be the single point of contact and service.
  • Once Aviva receives your claim, we will do our assessment to decide if it is payable, not payable or requires further information.
  • From the assessment, you may be informed by Aviva that you need to provide additional documents/information. Please provide us with the required documents/information as soon as possible so that we can process the claim.
  • After we complete the assessment, we will pay the claimable amount to the hospital/clinic. If you have made any payment to the hospital/clinic, the relevant refund will be made by the hospital/clinic to you or your Medisave account (if applicable).

If you are covered under MyHealthPlus, Aviva will automatically assess this benefit together with MyShield and pay the relevant claimable amount to you or the hospital/clinic, where applicable. However, if there are outstanding requirements for your MyHealthPlus claim, Aviva will assess only the MyShield claim first and update you accordingly on your MyHealthPlus claim.

A: In the event that the assured is unable to pay the upfront cash deposit or the Medisave account of the assured or family member is insufficient to cover the deposit required by the hospital, the LOG will be used to request the hospital to waive the admission deposit, up to S$15,000 (with effect from 1 January 2018).

Upon admission or on the day of surgery, the hospital staff will check whether you are eligible for LOG by verifying through the eLOG system. eLOG allows the waiver of hospital deposit required by the hospital in the event of a hospitalisation or surgery at participating hospitals if the claimant’s estimated medical bill is above the plan deductible.

If the life assured is covered under MyShield only (without MyHealthPlus), the annual deductible and coinsurance will not be included in the eLOG. Upon issuance of the eLOG, the assured is still required to bear the deductible and co-insurance.

Do note that the eLOG is subject to acceptance by the hospital and does not guarantee a waiver of deposit. At the time of discharge, the hospital may require the assured to fully settle the hospital bill despite eLOG being issued.

While we provide this facility to our customers to ease the admission process (so no upfront cash is required up to the eligible amount approved by the eLOG system), Aviva has the right to review each claim submitted after discharge. If the claim is payable, Aviva will be responsible for the eligible claim amount. If the claim is not payable, Aviva or the hospital will request any amount not covered under the policy.

A: The premium you pay to Aviva for MyShield includes premiums for both the MediShield Life portion and the additional coverage provided by Aviva.

A: You will still be able to receive the applicable MediShield Life subsidies (i.e. premium subsidies for lower- to middle-income, Pioneer Generation subsidies, and transitional subsidies) if you meet the eligibility criteria, even if you are insured under MyShield. You do not have to downgrade your MyShield plan to receive the subsidies.

Premium subsidies for those who are currently insured under MyShield will be based on the MediShield Life component of the premiums.

A: There is no duplicate coverage.

MyShield is made up of two parts – a basic MediShield Life portion run by the CPF Board, and additional coverage provided by Aviva.

MyHealthPlus, which you can purchase from Aviva on top of MyShield, covers the co-insurance and/or deductible that you otherwise have to pay.

Here are some of the MediShield Life and MyShield benefits at a glance:

Features

MediShield Life

MyShield

Hospital / ward type

Provides cover at restructured hospitals, class B2 or C ward.

Depending on the selected plan type, provides cover at private hospital, class A or B1 ward at public hospitals as well.

Pre- & post-hospitalisation treatment

No cover

Provides cover for Plan 1, 2 or 3
No cover for Standard Plan

Coverage

Capped at various claim limits

As-charged basis for most benefits for Plan 1, 2 or 3
Capped at various limits for Standard Plan

Option to cover co-insurance and/or deductible

No

Yes, with MyHealthPlus for Plan 1, 2 or 3.
Not available for Standard Plan

Allows choice of doctor

No

Yes

A: Yes, there will be different limits for Singaporeans/Singapore PR. You can withdraw money from the Medisave account up to the applicable limits to buy a MyShield policy. Please refer to the Product Summary and visit our website www.aviva.com.sg for the details on the withdrawal limits.

A: Yes. You can choose to complement MyShield by getting MyHealthPlus Option A or Option C.

A: Here are the benefits offered under Option A and Option C.

 

Option A

Option C

Co-Insurance Benefit

Yes

Yes

Critical Illness-Related Benefits

Yes

Yes

Hospital-Related Benefits

Yes

Yes

Free Cover for Child(ren)

Yes

No

Accidental Cover for Child Benefit

Yes

Yes

Advanced Benefits under MyShield

Yes

Yes

Panel Benefits

Yes

Yes

Preferred Rate for Child(ren)

No

Yes

Deductible Benefit

No

Yes

A: If both parents have been issued with either MyShield Plan 1 or 2, their child(ren) who is/are 20 years old (age next birthday) and below, up to a maximum of 4 children can be covered under MyShield Plan 2’s Family Discount for Child(ren) benefit.

The maximum of four (4) children includes children that enjoy existing coverage under the previous Free Cover for Children (FCC).

A: The final payout of the Integrated Shield Plan (IP) is based on the higher of benefits under MyShield or MediShield Life. If MediShield Life payout is more than that of the MyShield, claim is fully paid by MediShield Life.

Medishield Life limits are higher than the existing Medishield. If the admission is on or after the launch of Medishield Life, the new limits will be applicable.

There will only be a single point of contact with Aviva, and thus there is no need to file 2 separate claims.

A:

For MyShield 1, 2 and 3
You are covered for inpatient emergency overseas treatment and planned overseas treatment. An emergency refers to a medical condition that requires immediate attention by a doctor within 24 hours of an accident or illness taking place.

You have to first settle the bill with the hospital. Together with a medical report, you can seek reimbursement from us with the original bill

However, any pre- & post-hospital treatment bills incurred under emergency overseas treatment are not covered, regardless of where the pre- and post-hospitalisation treatment is received.

For MyShield Standard Plan
You are not covered for any inpatient emergency overseas treatment and planned overseas treatment.

A: Annual deductible is not applied to claims under major outpatient treatment. Co-insurance is applied to both inpatient and outpatient claims.

A: It is the percentage as expressed in the Benefit Schedule which will be applied on the hospital bills (including pre- and post-hospital treatment) incurred. It will be used in the event that the life assured is admitted to a ward/hospital higher than what he/she is entitled to under his/her policy. The pro-ration factor is not applicable to Plan 1.

Example 1 (MyShield Plan 2 without MyHealthPlus Option A or C)
Madam Tan was hospitalised for 10 days for surgery. She was admitted to Thomson Medical Centre. A 50% pro-ration is applied to the bill before deductible and co-insurance:

Private hospital

Amount

Thomson Medical Centre

$20,000

Pro-ration

$20,000 X 50% = $10,000

Deductible

$10,000 - $3,500 = $6,500

Co-insurance

$6,500 X 10% = $650

MyShield pays

$5,850

Policyholder pays

$14,150


Example 2 (MyShield Plan 1 with MyHealthPlus Option C)
Madam Fatimah was hospitalised for 10 days for surgery. She was admitted to Thomson Medical Centre. No pro-ration is applied as Madam Fatimah stayed within her entitled ward:

Private hospital

Amount

Thomson Medical Centre

$20,000

Pro-ration

NIL

Deductible

$20,000 - $3,500 = $16,500

Co-insurance

$16,500 X 10% = $1,650

MyShield pays

$14,850

MyShield Option C pays

$1,650 (co-insurance) +
$3,500 (Deductible)

Policyholder pays

$0


Example 3 (MyShield Standard Plan)
Madam Goh was hospitalised for 4 days and had surgery done (MOH surgical operation fees table 1). She was admitted to a B1 ward of Singapore General Hospital. No pro-ration is applied as Madam Goh stayed within her entitled ward:

Expenses

Benefit Limits

Amount incurred & covered by MyShield Standard Plan

Daily room, board and medical
related services (for 4 days)

S$1,700 per day

S$2,600

Surgical benefit (MOH surgical operation
fees table 1)

S$590 per surgery

S$400

Total bill

 

S$3,000

 
Annual deductible

S$2,500

Co-insurance
[10% x (S$3,000-S$2,500)]

S$50

Policyholder pays

S$2,550 (S$2,500+S$50)

MyShield pays

S$450 (S$3,000-S$2,550)


Example 4 (MyShield Standard Plan)
Madam Chan was hospitalised for 4 days and had surgery done (MOH surgical operation fees table 1). She was admitted to Thomson Medical Centre. A 50% pro-ration is applied to the bill before deductible and co-insurance:

Expenses

Benefit Limits

Amount Incurred

Pro-rated Amount
(50% pro-ration factor)

Amount Covered by MyShield Standard Plan

Daily room, board and medical
related services (for 4 days)

S$1,700
per day

S$8,000

S$4,000

S$4,000

Surgical benefit (MOH surgical
operation fees table 1)

S$590
per surgery

S$2,000

S$1,000

S$590

Total bill

 

S$10,000

S$5,000

S$4,590

 
Annual deductible

S$2,500

Co-insurance
[10% x (S$3,000-S$2,500)]

S$209

Policyholder pays

S$8,119 (S$10,000-S$1,881)

MyShield pays

S$1,881 (S$4,590 - S$2,500 - S$209)


If the life assured is admitted to a ward/hospital that is the same or lower than what the life assured is entitled to under the policy but their pre- and/or post-hospital treatment is in a hospital or clinic higher than what the life assured is entitled to, we will apply the pro-ration factor to the pre- and/or post-hospital treatment as specified in the Benefits Schedule.

If, during hospitalisation, there is a change of ward, we will base on the ward immediately before the discharge to determine whether the pro-ration factor should be applied to the hospital bills.

For avoidance of doubt, the pro-ration factor is only not applicable to expenses incurred in:
a Singapore restructured hospital for major outpatient treatment, day surgery, pre-hospital treatment and post-hospital treatment; or
a subsidised dialysis or cancer centre in Singapore for major outpatient treatment.

If the life assured receives inpatient treatment in a luxury or deluxe suite or any other special room of a hospital, we will calculate the pro-rated amount of the actual charges which the life assured has to pay for each type of plan as follows:

For plan 1:
Charge for a single-bedded A1 ward in Mount Elizabeth Orchard    X    total bill
Room Charge which the life assured had to pay

For plan 2:
Charge for a standard A1 ward in Singapore General Hospital     X     total bill
Room Charge which the life assured had to pay

For plan 3:
Charge for a standard B1 ward in Singapore General Hospital     X     total bill
Room Charge which the life assured had to pay

We pay the minimum of reasonable expenses or the pro-rated amount of the total bill, whichever is lower.

A: Yes, you can. You are required to file the claim under MyShield policy upon admission to hospital. You will need to complete the claim form (provided by the hospital) and note that submission is via the online claim system, in which Aviva will receive the claim. Therefore you do not have to manually submit any documents to Aviva. After the settlement of the MyShield policy, you will receive the original tax invoice from the hospital. Thereafter, you can submit the original final tax invoice to your company/other medical insurance company where the company medical insurer will work out the relevant amount and reimburse Aviva for their share. Aviva will top up the balance annual claimable limit accordingly based on the payment received.

Should you not make the claim in this order and the Group insurer paid directly to the hospital, we will pay the balance of the claim under MyShield or the expense incurred, whichever is lower. You need to be aware that if you choose not to E-file the claim and only wish to claim the balance from MyShield, we will still request for the claim to be submitted through the online claim system because Aviva and/or Medishield Life will be the payers of the balance benefits where applicable.

This means that you must return to the hospital to E-file the claim and be charged an administrative fee. We urge you to E-file through the online claim system. Even if the Group Insurance guarantees full or partial payment, you can still submit via the online claim system. Another advantage is that MyShield will pay for the GST that’s not payable under Group Insurance. If you have your own private medical insurance (not company/employer), the process on reimbursement is similar.

MyShield’s Last Payer Status helps to conserve your MyShield policy claim limits.

For every claim, the total reimbursement to be made should not exceed the expenses actually incurred.

A: Simply mail the original pre- or post-hospital treatment bills to Aviva for claims assessment. Upon receipt of the bills, Aviva will assess and pay any claimable amount to you by cheque or the relevant Medisave account.

A: To be eligible, the estimated bill size has to be above deductible and reason for the hospitalisation or surgery does not fall within the following list of pre-excluded conditions:

  • Pregnancy or childbirth
  • Self-inflicted injury or suicidal attempt
  • Congenital or birth defect
  • Cosmetic surgery or treatment
  • Infertility, sterilisation, impotence, sexual dysfunction, sex change operations
  • Treatment for weight reduction or weight improvement

Do note that if your admission is for a condition that was specifically excluded (substandard terms) by Aviva after underwriting, the eLOG can still be issued. After we have done our assessment, we will reject the claim as it is excluded. If the admission was for a different condition, the claim will be admitted (assuming it is not a pre-existing condition).

If the life assured is a foreigner, he/ she will not be eligible for Aviva’s eLOG.

A:

Restructured Hospital

Private Hospital

Alexandra Hospital

Concord International Hospital

Changi General Hospital

Farrer Park Hospital

Khoo Teck Puat Hospital

Gleneagles Hospital

KK Women’s and Children’s Hospital

Mount Alvernia Hospital

National University Hospital

Mount Elizabeth Orchard Hospital

Singapore General Hospital

Parkway East Hospital

Singapore National Eye Centre

Novena Surgery Pte Ltd

Tan Tock Seng Hospital

Mount Elizabeth Novena Hospital

Ng Teng Fong General Hospital

Thomson Medical Centre

 

Raffles Hospital


This eLOG service is subject to these key terms and conditions:

  1. The hospital may require the customer to fully settle the bill despite eLOG being issued
  2. eLOG will not be issued if the patient’s estimated medical bill is below the plan’s annual deductible amount or the medical condition to be treated is an exclusion defined in the policy document.
  3. Annual deductible and/or co-insurance would not be included in the eLOG, unless the patient is also covered under MyHealthPlus Option A and/or B or C.
  4. eLOG is not a policy benefit and is not part of the MyShield policy document.
  5. The issuance of an eLOG is subject to Aviva’s review and discretion. It does not mean that Aviva approves or admits any claim made under the MyShield and/or MyHealthPlus policy contract or any claim amount payable (if at all) in respect of any such claim. Aviva will assess the claim upon receipt of the bill from the hospital.
  6. No employer or third party insurer has provided any Letter of Guarantee.
  7. The eLOG cannot be used in conjunction with the Certificate of Pre-authorisation.

 

Please refer to MyShield FAQs and MyHealthPlus FAQs to view the complete FAQs.

 

 

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