CMFAS Health Insurance (HI) Exam Free Trial

In the event of a claim, the insurer will require submission of the following supporting documents:
(a) claim form; and
(b) hospital discharge summary and bills.

Travel Insurance usually does not cover any claims directly or indirectly arising from or in connection with:
– Routine health check-up, or cosmetic (aesthetic) or plastic surgery.
– Pregnancy or childbirth or any sickness associated with pregnancy or childbirth.
– Sexually transmitted disease, AIDS and HIV conditions or AIDS related infections.
– War, invasion, act of foreign enemy, hostilities or warlike operations.
– Driving or riding in any kind of race, engaging in any professional sport, ice or winter sport, mountaineering requiring the use of guides and ropes.

Group Dental Care Insurance policies also impose certain exclusions which include:
(a) dental procedures that are not specified in the Schedule of Allowances;
(b) hospital charges;
(c) injuries arising directly or indirectly from war (declared or undeclared), revolution, or any warlike operation;
(d) medicine given;
(e) treatment which is purely cosmetic in nature;
(f) treatment resulting from self-inflicted injury, while sane or insane; and
(g) replacement of broken, lost or stolen dentures.

MHC refers to an overall strategy for containing medical care costs, while assuring that people receive appropriate medical care. It will pay for most of the medical bills, when an individual sees a General Practitioner (GP), specialist or receives treatment in a hospital. Such strategies make use of a number of MHC techniques related to how medical care is accessed, provided and paid for.

The waiting period is imposed to prevent consumers from buying the policy only when they suspect that there is something wrong with their health; a practice known as anti-selection. If a person is found to be suffering from any of the critical illnesses before or during the waiting period, the insurer will void the policy and refund the premiums paid.

This type of CI Insurance cover can be issued as a packaged policy or rider. As the name implies, this type of cover provides for the pre-payment of a portion (e.g. 50%) or the full sum assured (i.e. 100%) of the basic policy to which it is packaged or attached.

Additional Benefit Critical Illness (CI) Insurance Cover is available on a stand-alone basis or as a rider.
 On a stand-alone basis, the sum assured will be paid upon the diagnosis of a covered critical illness, and the policy will be terminated.
 As a rider, it pays an amount in addition to the sum assured of the basic policy to which it is attached.

Claims procedures for individual or group disability income are similar. In the event of a claim, the insured must notify the insurer within a specified period of time (e.g. 60 days) from the date of commencement of the disability. Failure to comply with this requirement might cause the claim to be invalidated, unless the insured could prove that it was not possible for him to notify the insurer within the specified period, and that he had tried his best to do so.

The insured need not be hospitalised to be eligible for the LTC benefits. He can use the benefits received under his LTC to pay for the costs of engaging a domestic helper (maid), to pay for the costs of staying in a nursing home, or to provide coverage of expenses in an assisted-living facility or home-care programme.

Many elderly people may suffer short periods of dependence after a stay in hospital for an illness or injury, and a deferred period will ensure that short-term claims are avoided and, therefore, reduce the premium costs. Insurers that offer hospital benefits as an extension to the LTC cover may impose a shorter deferred period for such benefits to take effect.

While most insureds prefer the policy benefits to be payable as long as they live, the premiums for such plans may be too expensive for them to buy. Some insurers allow customers to choose the benefit payment term. This means that the benefits will be payable for the chosen period (e.g. 12 years of benefits). The premiums payable for a shorter benefit payment term will be cheaper and more affordable. During the benefit payment period, premiums payable are waived.

Disability Income Insurance benefits are payable on a monthly basis for up to a fixed number of years (such as five or ten years), or until the insured reaches a certain age, While Permanent Disability Benefit is payable in instalments, or one lump sum, depending on the terms and conditions as specified in the Life Insurance policy.

This definition considers the occupation the insured is engaged in. Here, total disability is defined as: “the insured’s inability to perform the material duties of his own occupation”.
This refers to the insured’s own occupation at the time that the disability begins.

Occupation is a crucial underwriting consideration for two reasons. Firstly, some occupations have a higher risk of disability from accidents (e.g. lorry driver), or illnesses, than others. Secondly, it is easier to return to work with some degree of incapacity in some occupations than in others.

In the event of a claim, the insured required to furnish the following supporting documents to the insurer:
▪ claim form to be completed by the insured;
▪ physician’s statement by the attending doctor;
▪ discharge summary; and
▪ original medical bills.

The advantage of this scheme is that the employee can continue to be medically insured, even though he may be unemployed or is in-between jobs. This is because the coverage will continue as long as the premium is paid, regardless of his employment status. It also reduces duplication of insurance plans and premium payments.

Medical Expense Insurance, also known as Hospital and Surgical (H&S) Insurance, provides inpatient and some outpatient benefits. Besides covering
common expenses, it also provides cover for complex surgical procedures like heart by-pass surgery and organ transplant, and other costly outpatient treatments, such as kidney dialysis and cancer chemotherapy.

Residential ILTC services, which comprise community hospitals, chronic sick hospitals, nursing homes, inpatient hospices and sheltered homes for
the ex-mentally ill patients.

This refers to charges for inpatient treatment resulting from an emergency while overseas. It pays the lower of either the actual charges or reasonable expenses for equivalent medical treatment in Singapore.

Medical Expense Insurance can be offered as a rider or a stand-alone policy. If issued as a rider, it is often attached to a permanent Life Insurance policy. Note that it is not common in Singapore for Medical Expense Insurance to be offered as a rider.