As advisers, we often receive enquires from clients who are unsure about the claiming process for personal and/or company health insurance plans. Hence, we have come up with a handy guide for easy reference.
This is the number 1 most commonly asked question.
For Integrated shield plans (eg AIA Healthshield, Prushield, Incomeshield, etc), in order to be claimable, the procedure /surgery has to be listed on MOH List of Approved surgeries.
In addition, the hospital / clinic has to be able to file the claim electronically on your behalf.
Here is the List of Accredited clinics
TIP! Where applicable, it’s best to request for Pre-authorisation for planned surgeries, and if possible to seek treatment from the insurers’ panel specialist clinics, to keep out-of-pocket expenses low.
Here is a list of FAQs to help you navigate the claim process smoothly.
For Singaporean & PRs, you are advised to do it via electronic filing, commonly known as E-File. You may request the admission office of the hospital you’re admitted in to do the electronic filing. This process only facilitates a direct billing to your insurer. It must not be mistaken as an approval of the admission claims.
For Foreigners, unless your health insurer provides a direct billing facility, you’re required to pay the bill on your own and, subsequently submit the claim for reimbursement.
Most Insurers provide electronic Letter of Guarantee, kindly speak with the hospital admission officer and they shall check and advise you on this. Most insurers work directly with hospitals for eLOG issuance. Please be aware that LOG is by no means a claim submission or approval. It is simply a letter to reduce the upfront cash deposit by patients during admission and/or surgeries.
While MOH FAQs recommends that you claim from your employer benefit insurance first before your Integrated Shield Plans, based on our experience, e-filing under your personal Shield plan often provides a seamless claim process.
Upon discharge from the hospital/surgery or when the “Finalised Bill” is available, but preferably not more than 3 months after the procedure.
For Singaporean/PRs, you can only submit your Inpatient Integrated Shield Plan insurance claim via electronic filing by the hospital. For pre/post hospitalization Outpatient bills, you can submit manually to your respective insurer’s email / portal.
For Foreigners with Integrated Shield Plan insurance, you may submit directly to your insurer portal online.
Do contact your adviser for the relevant links.
For those who are covered by their company medical insurance, you may submit your claim through your employee benefit portal (broker/insurer portal).
Minimally, you should submit the following documents:
You may claim from multiple policies as long as the total amount of reimbursement across all insurers shall not exceed total bill paid.
In the event there is any overlapping claim reimbursement across insurers, the insurer with first payor status shall reimburse the insurer with last payor status.
Medishield Life & Integrated Shield Plans reserve the last payor status, while company health insurance has the first payor status.
If you’re still unsure about your entitlement/insurance benefit, do reach out to us to review your existing coverage for peace of mind.
Wishing you best of health!
Important: The information and opinions in this article are for general information purposes only. They should not be relied on as professional financial advice. Readers should seek independent financial advice that is customised to their specific financial objectives, situations & needs. This advertisement or publication has not been reviewed by the Monetary Authority of Singapore.
Winnie is a Certified Financial Planner with more than 10 years experience in financial advisory services, helping many of her clients to achieve their financial dreams, while protecting their families.
With more than a decade of insurance claims experience, she has tangibly helped many clients receive their claims pay-outs successfully, relieving their financial burden.
As part of her community outreach program, she finds it very meaningful to conduct financial talks for companies where the staff can benefit from the talks. Some of the companies who have benefitted include National Kidney Foundation, Singapore National Eye Centre and Singtel.
Despite her busy schedule, she enjoys working out at the gym and playing the piano (currently pursuing Grade 6 ABRSM).
