Introduction

This Guide provides general information about health insurance and the various products that may meet your needsIt gives you the information you should have before you buy any health insurance product or discuss your needs with a financial adviser or an insurance intermediary

FREQUENTLY ASKED QUESTIONS

What is health insurance?
What type of health insurance product do I need?
How much health insurance should I buy?
What key features should I look for in health insurance products?
What should I take note of when taking up additional health insurance policies?
Questions to ask before taking up health insurance

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What is health insurance?
Health insurance prevents you and your family from suffering a financial loss as a result of an accident, illness or disabilityIt can provide an income while you are disabled or in hospital, or cover the cost of your medical treatment or nursing care

What type of health insurance product do I need?
The type of health insurance product you would need depends on what you want protection against

You can find more information about each type of product at the end of this Guide

What should I take note of when taking up additional health insurance policies?
You should check whether you are already covered under another health insurance policy before you buy a new oneIn particular, you should take note of the following:

Having several medical expense policies
With medical expense insurance, the total benefit you will get is limited to your actual expenses
So taking up extra policies does not necessarily provide extra benefits

Switching between health insurance products
Health insurance products usually do not cover any illness or disability you already have at the time you sign upSo before you switch from one health insurance product to another one that promises to give you more benefits, consider your current health statusBe aware that the new policy that you switch to may not provide you with the same coverage, should there be a change in your health status

Age limit
Most health insurance products are not available to people over a certain ageSo it is generally better for you to sign up early while you are still healthy and able to get all the benefits of health insurance

Some health insurance products provide cover for your whole life, but others cover you only up to a certain ageYou should choose a product with a length of cover that suits your needsYou can discuss your needs with a financial adviser or an insurance intermediary

Premiums
Different products may charge premiums in different waysWith regular-premium plans, you will have to pay regular premiums throughout the life of the policyWith single-premium plans, you pay one premium at the start of your cover

If you have to pay regular premiums, the amount of the premiums may change as you grow olderThese changes will be in line with a table you are given before you buy your policyThat table will show the premium you will have to pay in the future, depending on your age at that time

Whether or not the policy states that the premium will change as you grow older, the insurer may have the right to change the premium at any time by giving you written noticeYou should find out whether a policy you are considering allows the insurer to do this

You must pay any regular premiums when they become due in order to keep your coverSo before you buy any product you should make sure you can afford to pay the premiums over the long term

Renewing a policy
Some health insurance products guarantee that your cover will stay in force as long as you pay the premiums on timeOther products give insurers the right to cancel your cover by giving you written notice before your policy is due for renewal

If you buy a product that guarantees to cover you while you keep paying your premiums, you will not need to worry about your cover being cancelledHowever, even if your cover is guaranteed, some health insurance products allow insurers to change the benefits, premium rates or other terms and conditions when the policies are due for renewal (usually every year on the anniversary of the inception of the cover)Make sure you are clear about the terms and conditions of the product before you buy it

Ending a policy
Your health insurance policy may end when:

• you reach the maximum age stated in your policy;
• you have received the maximum benefits that can be paid under the policy;
• the insurer cancels your cover; or
• you fail to pay your premiums

If the policy ends because you have failed to pay any premium, you can ask your insurer to provide cover againHowever, insurers will usually consider your age and health status at the time they start to provide cover againSo when the cover starts again you may have to pay a higher premium or have extra conditions attached to the policyInsurers can also refuse to cover you again

Policy exclusions
All health insurance products contain some 'exclusions' setting out the circumstances under which benefits will not be paidAs exclusions vary from product to product, you should read the policy document carefully to find out exactly what you are or are not covered forCheck with your financial adviser or insurance intermediary if you are not sure

The most common exclusion in health insurance is a 'pre-existing condition' exclusionThis exclusion means that any illness or disability that you have, or have had, when you sign up for the product will not be coveredSo it is important that you buy health insurance while you are young and healthy in order to enjoy the full benefits of the productYou should bear in mind that the definition of 'pre-existing condition' can vary from product to product

If you already have a medical condition when you apply for health insurance, you must give details of this condition in your applicationThe insurer will then decide whether or not to provide full cover for that medical condition

What should I consider when I am making an application for health insurance?

Your duty to provide information
An insurance contract is based on trustWhen you apply for health insurance, you must provide all the information asked forSuch information would include your age and occupation, and any history of illnesses, medical conditions or disability
If you do not provide important information when you apply for health insurance, the policy you take up may not actually cover youIf you are not sure whether certain information is important, you should still provide the detailsThis includes any information you may have given to the financial adviser or insurance intermediary but not included in your application

Accepting your application
The insurer will assess the information you have given them, and decide whether or not to accept your applicationIf you are not in good health, the insurer may refuse to provide certain benefits, or increase the premium charged, or reject your application

How should I make a claim?
To make a claim, you usually need to fill in a claim form from the insurer and provide proof (such as hospital bills, medical reports, test results and declarations of income) to support your claimYou may be asked to provide additional supporting documents if the insurer needs more information to assess your claim

You should make any claim as soon as possibleMost health insurance policies set a period in which you must tell the insurer about a claim

What else should I know when I take up health insurance?

Advice
If you need advice on whether or not to buy health insurance, and what type of insurance to buy, you may approach a financial adviser or an insurance intermediary regulated by the Monetary Authority of Singapore (MAS)It is important that you ask whether the representative or intermediary has the necessary health insurance qualificationYou can refer to the Financial Institutions Directory on the MAS website (www.mas.gov.sg) for a list of the entities regulated by MAS

14-day 'free look'
You have 14 days to review your new policyDuring this time, if you decide that the policy does not meet your needs, the insurer will refund all your premiums less any medical and other expenses they have had to payYou will need to send the insurer written notice that you want to cancel your policy within 14 days of the date you receive your policy

When you are in hospital
In Singapore, high-quality public and private healthcare is easily availableHowever, the cost of healthcare differs greatly between private and public hospitals, and between different types of ward
So when you need to go into hospital you should:

• check the ward charges and the costs of medical treatment recommended by your doctor;
• check whether the benefits under your health insurance will cover all the costs;
• consider the options available to you; and
• choose your ward or treatment according to what you can afford

Worldwide cover
Health insurance products generally provide you with cover anywhere in the worldHowever, some products have 'geographic limits' which mean that treatment provided in certain countries or regions will not be covered

You should also know that for treatment provided overseas, some products will pay only up to the amount that would be charged in Singapore, if that treatment is available locallyIf you are likely to be living or working overseas, you should discuss your specific needs with your financial adviser or insurance intermediary before you take up the policy

Information on specific types of health insurance products
The following section briefly explains what each type of health insurance product covers, and provides general information about the different productsAs the terms and conditions may not be exactly the same for every health insurance product, you should check the details of your policy and speak to your financial adviser or insurance intermediary if you are not sure

Medical expense insurance (or hospital and surgical insurance)
Medical expense insurance pays medical expenses incurred as a result of an accident or illnessThe policy will pay expenses for inpatient medical treatment or surgery, some outpatient charges for day surgery, consultations with specialists before and after the hospital stay, and X-rays and laboratory tests

'Major' medical expense insurance will pay expenses for longer hospital stays due to a major illness or for major surgery such as heart bypass surgery or organ transplant

Medical expense insurance will not pay you more than the actual medical expenses incurred, regardless of the number of policies you haveThere are also limits to the amount you can claim under each medical expense policyThe policy may include limits for all claims as well as limits for each illness, disability, year or lifetimeYou can combine the limits of two or more policies to get higher benefitsPolicies may also have exclusions for treatment of certain illnesses, such as pre-existing conditions, or treatment that is not for medical reasons

Some medical expense policies may also have 'deductible' and 'co-insurance' features(A deductible is a fixed amount you have to pay yourself before policy benefits are paidCo-insurance is the amount of expenses remaining, after taking off the deductible, which will not be covered by the policy and which you will have to pay yourself) The co-insurance is usually expressed as a percentage of the expensesSo you will not receive the full medical expenses from this type of policy

A medical expense policy may have a waiting period during which expenses will not be paid unless they relate to accidental injuries

Hospital cash insurance (or hospital income insurance)
Hospital cash insurance pays a fixed amount of benefit for each day you are in hospital for medical treatment or surgery, regardless of the actual expenses incurred for your hospital stayThis means that the total amount paid under the hospital cash insurance may be more or less than your actual expenses

A hospital cash policy may have a waiting period, which means benefits are paid only after you have been in hospital for more than a set number of daysThe benefits may also be paid for only a set number of days each year, or for the life of the policy(In this case, the policy will end once the lifetime limit has been reached) Waiting periods and benefit limits may vary across policies

Critical illness insurance (or dread disease insurance)
Critical illness insurance pays a lump sum either when you are first diagnosed with a disease covered by the policy, or after first having a type of surgery covered by the policy. The lump sum does not depend on your going into hospital or your actual medical expenses.

Disability income insurance
Disability income insurance pays a fixed amount each month to replace the income you would lose if you were not able to work as a result of an accident or illnessThese policies aim to ease your financial burden, and are not intended to completely replace the income you earned before the accident or illnessSo disability income insurance usually pays no more than 80% of your average monthly salary

Disability income insurance may have a waiting period during which benefits will not be paidPayment of benefits will usually start to be paid only if you are continuously disabled for longer than the waiting periodThe monthly income benefit will usually be paid for up to five or 10 years, or until you are 60 or 65Payment of benefits will stop once you can start working again, or it may be reduced in proportion to any recovery you make(Any recovery is decided through medical check-ups carried out by the insurer)

The most important thing to consider when taking up disability income insurance is the definition of disability used in the policySome policies define disability as not being able to perform your usual work, while others define it as not being able to do any work at allAs the probability of claiming under the second definition is lower than under the first, the premium will also be lower (as long as all other terms and conditions are the same)You should also bear in mind that there are other definitions of disabilityCheck with your financial adviser or insurance intermediary on the definitions used in your policy

Long-term care insurance
Long-term care insurance pays a fixed amount of benefit each month towards expenses for long-term nursing treatmentThere is usually no age limit for this type of cover

Benefits are paid when you cannot perform some 'activities of daily living'These include bathing, dressing, feeding, going to the toilet and moving aroundThe definitions of 'activities of daily living' and the minimum number of activities you must not be able to perform to qualify for the payment of benefits may vary from one policy to anotherPayment of benefits will stop once the number of activities you cannot perform falls below the minimum stipulated in your policy

Some long-term care policies pay benefits for up to a set number of yearsOnce the benefits have been paid for that number of years, the policy will endOther long-term care policies pay benefits for life as long as you meet the conditions for making a claimThere is also a waiting period, so benefit payments will begin only after you have not been able to perform the minimum number of activities for at least a set period of time

Questions to ask before taking up health insurance

• What will my health insurance policy cover?
• Am I already covered for the same thing under another health insurance policy?
• What doesn't the health insurance policy cover and when will I not be covered?
• How much will I be paying for my health insurance and will I be able to afford the premiums over the long term?
• How often will the premium be charged and will it be a fixed or variable sum?
• Will my policy automatically be renewed and what is the penalty if I do not pay any premium on time?
• When or in what circumstances will my health insurance policy end?
• How do I end my policy?
• How do I make a claim?
• Are there any limits to the benefits that can be paid out from my policy?
• How will my future premiums be affected after I have made a claim?
• Will I be covered for medical treatment performed outside Singapore?
• How is my health insurance policy affected by other schemes that pay for healthcare?

Contacts

Life Insurance Association of Singapore
20 Cross Street #02-07/08 China Court,
China Square Central Singapore 048422
Tel: 6438 8900 Fax: 6438 6989
Email: lia@lia.org.sg Web: www.lia.org.sg

General Insurance Association of Singapore
112 Robinson Road #05-03 HB Robinson,
Singapore 068902
Tel: 6221 8788 Fax: 6227 2051
Email: feedback@gia.org.sg
Web: www.gia.org.sg