When you submit a claim for hospital treatment under an integrated plan, the claims officer has to go through the following steps to process the claim:
a) Determine if the treatment is covered under the policy by looking at the coverage and exclusions.
b) Check with your previous doctors to see if you had failed to disclose previous medical condition when you applied for the integrated plan. Your claim could be rejected due to non-disclosure.
c) Look at the individual items of the bill to see which items are covered, and which are not, and see in the amount under each item exceed the "inner limit".
d) See how much of the bill can be paid after applying the deductible and the co-insurance.
e) Determine how much of the claim is covered under Medishield Life and can be claimed from the Central Provident Fund.
f) Determine how much of the bill can be paid through Medisave, which has its own set of rules
g) Finally, you are likely to bear a portion of the bill in cash.
Processing of the claim can take a lot of work and can add to the cost of the insurance. This is reflected in the premium that you have to pay for the integrated plan.
The insurance company has also to incur the expense of marketing the plan, issuing the policy, collecting the premium, etc.
We have a complicated system which is costly to administer. It adds up to the cost of insurance.
I like the system used in Japan. The patient has to pay the fee that is negotiated and fixed. 70% of the bill is paid by the government or insurance. The patient pays the remaining 30%.
I think that the patient can buy insurance to cover the 30% or have it paid by the employer. It seems to be much simpler than the complicated system adopted here.
Welcome to Singapore.
Tan Kin Lian
a) Determine if the treatment is covered under the policy by looking at the coverage and exclusions.
b) Check with your previous doctors to see if you had failed to disclose previous medical condition when you applied for the integrated plan. Your claim could be rejected due to non-disclosure.
c) Look at the individual items of the bill to see which items are covered, and which are not, and see in the amount under each item exceed the "inner limit".
d) See how much of the bill can be paid after applying the deductible and the co-insurance.
e) Determine how much of the claim is covered under Medishield Life and can be claimed from the Central Provident Fund.
f) Determine how much of the bill can be paid through Medisave, which has its own set of rules
g) Finally, you are likely to bear a portion of the bill in cash.
Processing of the claim can take a lot of work and can add to the cost of the insurance. This is reflected in the premium that you have to pay for the integrated plan.
The insurance company has also to incur the expense of marketing the plan, issuing the policy, collecting the premium, etc.
We have a complicated system which is costly to administer. It adds up to the cost of insurance.
I like the system used in Japan. The patient has to pay the fee that is negotiated and fixed. 70% of the bill is paid by the government or insurance. The patient pays the remaining 30%.
I think that the patient can buy insurance to cover the 30% or have it paid by the employer. It seems to be much simpler than the complicated system adopted here.
Welcome to Singapore.
Tan Kin Lian
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