Know which ward/hospital you are entitled to
Before your hospital admission, find out which hospital and ward your integrated shield plan is meant for. What you want to know is whether your integrated shield is meant for private or government hospitals.
If your entitlement is government hospital, find out whether the policy is meant for “A” class, “B1”, “B2” or “C”. There is no such thing as “C class corridor” though…
If you are unsure which ward/hospital your policy is meant for, just opt for ‘C’ class. You can always upgrade later. However, downgrading is very difficult.
Remember to e-file your inpatient claims
When you are admitted to hospital, remember to e-file your insurance claim. This is done during the mandatory financial counselling at the beginning of the admission period and NOT at the time of discharge. If you forget to e-file, your insurance agent/ financial adviser cannot file the claim for you.
There is at least one private hospital that imposes a penalty if the e-file is done after the patient is discharged from the hospital.
Letter of Guarantee is not guaranteed
You may also wish to request for Letter of Guarantee (LOG) when you e-file at the hospital and this can reduce or even waive the entire hospital deposit. However, the LOG is non-contractual in nature and it is not the right of the patient to ask for it.
Some insurers will not issue the LOG if the policy was recently purchased.
Usually financial advisers / insurance agents are not able to obtain the LOG in time for admission. Fortunately, a number of hospitals are able to obtain the LOG using the software provided by the insurer.
Payment after discharge
You may need to settle any outstanding bills immediately after discharge or on another day. This depends on the individual hospital practices.
Payment for the final bill
After the insurer reimburse the hospital, you will receive the final invoice to settle any outstanding balance. This is only applicable if your integrated shield plan is not an as-charge/first dollar policy. My advice is do NOT make payment immediately. This is because the hospital may adjust the bill resulting in you underpaying or worst overpaying. All you need to do is to remember to make payment by the due date.
Claims for pre and post hospitalization
All pre and post hospitalization outpatient claims can only be done through manual claim submission through the financial adviser/ insurance agent. However, certain outpatient treatment like chemotherapy has to be done by e-filing.
If the outpatient treatment has to be filed using manual claim, only the final ‘tax invoice’ or receipt is accepted. ‘Interim’ tax invoice cannot be accepted. Moreover, the ‘tax invoice’ need to show evidence that the outstanding payment has already being made.
Do not use Medisave for outpatient bills
If you have intention to claim the outpatient bills under the integrated shield plan’s pre and post outpatient benefits, I strongly recommend that you do NOT use Medisave to make any payment for such outpatient treatments.
Using Medisave for payment increases the time required to obtain the finalized tax invoice / bill. Sometimes the final invoice never arrives. The waiting period for the finalized invoice can be so long that the patient would have forgotten to make a claim. For the financial adviser, it is also very frustrating to tell the client that interim invoices cannot be used. The insurance company has to keep on rejecting the claims involving interim invoices and this gives the impression that the insurer is being unreasonable. So it creates a customer service nightmare.
By the way, tax invoice with the heading ‘duplicate’ cannot be used for claims too. So if the finalized invoice is lost through mail, you are unlikely able to make a claim even if you can obtain a ‘duplicate’ invoice.
Normally the patient will get the finalized invoice immediately after making cash payment at the healthcare institution for which the treatment was sought.
The bottom line: DO NOT use Medisave to make any payments for pre/post outpatient bills if you have intention to claim from a private integrated shield plan.
Seek treatment from Medishield Accredited healthcare institutions only
The private integrated shield plan is based on the Medishield Life framework. Naturally it has to follow rules set by the Medishield Life scheme. Thus, the private integrated shield plan can only be used for institutions that are accredited by Ministry of Health (MOH) under its Medisave/ Medishield Accreditation scheme.
For the list of hospitals and clinics that are Medishield Life Accredited, please refer to CPF Board link HERE.
There were complains on why people are unable to make a claim from their shield plan providers. A large number of these complains have to do with the clinics which are not Medishield Life accredited by MOH. See example: IncomeShield claims - why they have to be e-filed.
The question is why there is such large number of clinics who refused to get themselves accredited?
The second reason is because some private doctors’ target market are foreigners. Since Medishield Life and Medisave are not applicable for foreigners, it is not necessary for these clinics to be Medishield Life accredited.
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