MyShield & MyHealth Plus FAQ

Yes, you can choose to complement MyShield by getting MyHealthPlus Option A-II or Option C-II (from 1 January 2019).

For MyShield Plan 1, 2 and 3

Any Singapore citizen or PR may apply as proposer (payer)/assured provided the proposer (payer)/assured is a Singapore citizen or PR and has a Medisave account.

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

Note: For Plan 3, only Singapore citizens or PRs may apply.

Your existing IP will be automatically cancelled upon commencement of MyShield. The pro-rated premiums (if any) for the terminated plan will be refunded to your Medisave account.

In order to commence MyShield, the premium has to be successfully deducted from the Medisave account. In the event, the annual premium exceeds the Additional Withdrawal Limits (“AWLs”) for Singapore citizens and PRs or Medisave Withdrawal Limits for foreigners, for a Medisave approved IP, or the balance in the Medisave Account is insufficient to pay the full annual premium, you can pay the balance of the annual premium via cash/cheque/GIRO.

You will need to inform us of any change in your health condition(s) before your application is accepted and/or before your cover starts.

You are required to submit the “Request for Changes to Individual Health Policies” form. The form is available on Aviva’s corporate website at www.aviva.com.sg.

You can contact us at 6827 7788 or your Financial Adviser Representative for assistance.

Yes. The paid annual premium for the unexpired period of coverage will be pro-rated and refunded to you.

You can enjoy the following benefits and get greater reassurance about your claim outcome with our Certificate of Pre-authorisation.

i. Cashless hospitalisation up to the approved amount at participating hospitals/clinics

ii. Higher policy year limit of up to S$2 million for MyShield Plan 1

iii. Extended pre-hospital treatment benefit of up to 180 days

iv. Extended post-hospital treatment benefit of up to 365 days

v. No or lesser co-payment for MyHealthPlus

Pre-authorisation is available provided:

• The inpatient treatment or day surgery is done at a private hospital or private clinic in Singapore;

• The principal doctor must be our panel specialist;

• You make the request at least 5 working days before the admission date; and

• The admission date is within 6 weeks from the request date.

We will:

• Work with your doctor(s) on your request;

• Inform you within 5 working days on the outcome of the pre-authorisation; and

• Send you an email with the Certificate of Pre-authorisation if your pre-authorisation is approved.

If your doctor is not available, e.g. overseas, we will require more time to complete your request.

If the admission is at a participating hospital/clinic, the life assured is a Singapore citizen/PR and the pre-authorisation request is approved:

We will send a copy of the Certificate of Pre-authorisation to the hospital/clinic. The hospital/clinic will waive the deposit/payment required for the admission, subject to the approved amount. Upon discharge, Aviva would settle the eligible medical expenses directly with the hospital/clinic. The list of participating hospitals and clinics can be found at www.aviva.com.sg/medicalspecialists.

If the admission is at a non-participating hospital/clinic:

A copy of the Certificate of Pre-authorisation will NOT be sent to the hospital/clinic. You will need to make a deposit or payment for the admission, as required by the hospital/clinic. However, if the life assured is a Singapore citizen/PR, the hospital/clinic may still help you to electronically file (Efile) the claim to Aviva.

If the life assured is a foreigner:

A copy of the Certificate of Pre-authorisation will NOT be sent to the hospital/clinic. You will have to settle the bill with the hospital/clinic first, then seek reimbursement by sending a claim to Aviva.

With effect from 1 February 2020, you can download and launch Aviva ClaimConnect on your mobile device via Apple’s iTunes store or Google Play. Alternatively, you can access the Aviva ClaimConnect web portal at www.aviva.com.sg/claimconnect.

The following features will be available:

The final payout of the 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.

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

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.

Please note that we will only pay these benefits if the life assured is a Singapore resident on the date of his/her admission. We define residency in a country to mean being physically present in that country for a continuous period of at least 183 days. Please refer to section 3.1(e) for an explanation on our definition of residency.

For MyShield Standard Plan

You are not covered for any inpatient emergency overseas treatment and planned overseas treatment.

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

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)

Madam Tan was hospitalised for 10 days for surgery. She was admitted to Thomson Medical Centre. A 50% pro-ration factor is applied to the bill before deductible and co-insurance:

Example 2 (MyShield Standard Plan)

Madam Goh was hospitalised for 4 days and had surgery done (MOH Surgical Table 1). She was admitted to a B1 ward of Singapore General Hospital. No pro-ration factor is applied as Madam Goh stayed within her entitled ward:

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) a Singapore restructured hospital for major outpatient treatment, day surgery, pre-hospital treatment and post-hospital treatment; or

b) 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 Hospital/Room Charge which the life assured had to pay) x total bill

For plan 2:

(Charge for a standard A1 ward in Singapore General Hospital/Room Charge which the life assured had to pay ) x total bill

For plan 3:

(Charge for a standard B1 ward in Singapore General Hospital/Room Charge which the life assured had to pay) x total bill

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

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 of 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.

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 of 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.

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 direct bank credit, cheque or the relevant Medisave account.

To be eligible, the estimated bill size has to be above deductible and reason for the hospitalisation or surgery does not fall within general exclusions listed in the Product Summary.

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.

In the event that the proposer (payer)/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 participating hospital to waive the admission deposit based on the following table:

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 admission 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 co-insurance 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.

The list of participating hospitals and clinics can be found at www.aviva.com.sg/medicalspecialists.

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

a) The hospital may require the patient to fully settle the bill despite eLOG being issued

b) 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.

c) 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 or A-II and/or B-II or C-II

(whichever is applicable).

d) eLOG is not a policy benefit and is not part of the MyShield policy document.

e) 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.

f) No employer or third party insurer has provided any Letter of Guarantee.

g) The eLOG cannot be used in conjunction with the Certificate of Pre-authorisation.

MyHealthPlus provides complementary protection to MyShield by providing coverage for the deductibles and/or co-insurance so that you can pay less or lower expenses for your medical bills.

Only policyholders who have MyShield coverage are eligible to purchase MyHealthPlus.

*MyHealthPlus annual deductible applies.

To be eligible for coverage, the life assured must be the life assured of a MyShield policy and meet the following criteria.

^ 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), sibling(s) and/or biological or legally adopted child(ren).

# To be eligible for the Critical Illness Benefit under this policy, the life assured must be aged between 1 year old and 65 years old at age next birthday.

Parents who are both insured under MyShield Plan 1 or 2 attached with MyHealthPlus Option A, Option C, Option A-II or Option C-II (whichever is applicable) can cover their children for free (up to a maximum of 4 children) under MyHealthPlus Option A-II Plan 2 if the children are:

a) entitled to Family Discount for Child(ren) or Free Cover for Child(ren) under MyShield; and

b) less than 20 years old at age next birthday.