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MyShield & MyShield Plus Summary of Changes

MyShield & MyShield Plus Summary of Changes

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Aviva's my shield & myshield plus   summary of changes (for advisers) - 1... Aviva's my shield & myshield plus summary of changes (for advisers) - 1... Document Transcript

  • Summary of changes to MyShield and MyShield PlusÐ effective 1 March 2013 Current MyShield New MyShield 1 No coverage of Accident & Emergency Treatment under We will cover Accident and Emergency (A&E) Treatment Pre-Hospital Specialist Consultation. given within 24 hours prior to hospitalisation. This benefit will be renamed as ÒPre-Hospital SpecialistÕs Consultation and Accident and Emergency (A&E) Treatment.Ó 2 Cornea is not covered under Surgical Benefits for We will include Cornea into Surgical Benefits for Major Major Organ Transplant Organ Transplant. 3 Inpatient Congenital Anomalies (after waiting period a) Inpatient Congenital Anomalies (after waiting period of 24 months). Benefit is as charged. of 24 months). Benefit is as charged. b) Inpatient Congenital Anomalies excluding Surgical Benefits (first diagnosed within waiting period of 24 months). Surgical fees are not payable. Refer to the table below for benefit. Plan 1 Plan 2 Plan 3 Up to $450 per day or S$900 per day for Intensive Care Unit 4 Inpatient Psychiatric Treatment (after 10 months of a) Inpatient Psychiatric Treatment (after 10 months of continuous coverage) (per policy year). continuous coverage) (per policy year). Benefit is as charged. Benefit is as charged. b) Inpatient Psychiatric Treatment (within 10 months of continuous coverage) (per policy year). Refer to the table below for benefit. Plan 1 Plan 2 Plan 3 Up to $100 per day up to 35 days 5 Pro-ration Factor a) For Plan 2 and 3, we will revise the pro-ration factors for the insured person who is admitted to a ward / MyShield hospital higher than this entitlement under the policy. Pro-ration Factor Plan 1 Plan 2 Plan 3 b) We will also define a list of the private hospitals that Private Hospitals/ will continue to receive the benefits on an Òas chargedÓ Medical institutions and Hospitals outside N.A. 65% 50% basis, and apply a pro-ration factor on other private Singapore hospitals not in the list. Here are the revised pro-ration factors: Restructured Hospitals N.A. N.A. 85% Ð Class A MyShield Pro-ration Factor Plan 1 Plan 2 Plan 3 Unsubsidised wards in Community N.A. N.A. 85% Selected Private Hospitals Hospitals*/ Medical N.A. 50% 35% institutions and Hospitals outside Singapore Aviva Ltd 4 Shenton Way #01-01 SGX Centre 2 Singapore 068807 www.aviva.com.sg Company Reg. No.: 196900499K ¥ GST Reg. No.: MR-8500166-8
  • Summary of changes to MyShield and MyShield PlusÐ effective 1 March 2013 Current MyShield New MyShield 5 Pro-ration Factor (continued) MyShield Pro-ration Factor Plan 1 Plan 2 Plan 3 Restructured Hospitals N.A. N.A. 85% Ð Class A Unsubsidised wards in N.A. N.A. 85% Community Hospitals Other Hospitals in 80% 40% 28% Singapore * Selected Private Hospitals shall mean Parkway East Hospital, Gleneagles Hospital, Mount Alvernia Hospital, Mount Elizabeth Hospital, Raffles Hospital and Thomson Medical Centre. 6 Annual Deductible Changes to Annual Deductible (due to regulation requirements) MyShield MyShield Annual Deductible Annual Deductible for Insured Persons Plan 1 Plan 2 Plan 3 for Insured Persons Plan 1 Plan 2 Plan 3 80 years and below 80 years and below age next birthday. age next birthday. C Class Ward S$1,000 S$1,000 S$1,000 C Class Ward S$1,500 S$1,500 S$1,500 B2 Class Ward S$1,500 S$1,500 S$1,500 B2 Class Ward S$2,000 S$2,000 S$2,000 B1 Class Ward S$2,000 S$2,000 S$2,000 B1 Class Ward S$2,500 S$2,500 S$2,500 A1 Class Ward / S$3,000 S$3,000 S$3,000 A1 Class Ward / S$3,500 S$3,500 S$3,500 Private Hospital and Private Hospital and Hospital outside Hospital outside Singapore Singapore Day Surgery S$3,000 S$3,000 S$2,000 Day Surgery S$3,000 S$3,000 S$2,000 7 Premium age bands are 1-18 and 19-30. Premium age bands will now be 1-20 and 21-30 to be aligned with MediShield. Aviva Ltd 4 Shenton Way #01-01 SGX Centre 2 Singapore 068807 www.aviva.com.sg Company Reg. No.: 196900499K ¥ GST Reg. No.: MR-8500166-8
  • Summary of changes to MyShield and MyShield PlusÐ effective 1 March 2013 Current MyShield New MyShield 8 Policy provisions General Conditions Under ÔRenewalÕ, the clause is currently worded as: For clarity that MyShield is guaranteed renewable, that Your cover is automatically renewed for a further clause has been changed to: Period of Insurance by payment of the renewal premium Subject to General Conditions Clause 8, Your cover is before the Renewal Date. guaranteed renewable for a further Period of Insurance by payment of the renewal premium before the Renewal Date. WeÕve also added the following in ÔGeneral ConditionsÕ section, Ô16. Full DisclosureÕ clause: If there is a claim made under this Policy before it is void, the premiums to be refunded shall be calculated from the first Policy Year immediately following the Policy Year in which the last claim was made under this Policy. Section II Ð Limits of Liability There is no formula to calculate the prorated amount of For clarity, the formula has now been included into the the total bill if the Insured Person stays in a more expensive policy contract, as follows: room than the standard room covered under the plan. Standard room charge x total bill Incurred room charge Section III Ð Covered Benefits (a) The benefits that are not entitled for Pre- and Post- (a) For clarity, the list has now been defined in the policy Hospitalisation Benefits are not listed. contract, as follows: (i) 1(f) Ð Accident Inpatient Dental Treatment; (ii) 1(l) Ð Inpatient Congenital Anomalies; (iii) 1(m) Ð Inpatient Pregnancy Complications; (iv) 1(n) Ð Living Donor Organ Transplant; (v) 3(b) Ð In-Hospital Psychiatric Treatment; and (vi) 3(d) Ð Inpatient Medical Complaint outside Singapore. (b) Under ÔInpatient Pregnancy ComplicationsÕ, the clause (b) For clarity, the clause has now been reworded to: is currently worded as: (iv) Miscarriage after 13 weeks of pregnancy (not due (iv) Miscarriage after first trimester of pregnancy to voluntary or malicious act) (not due to voluntary or malicious act) (c) Under ÔOutpatient Kidney DialysisÕ, the clause is (c) For clarity, the clause has now been reworded to: currently worded as: Charges for treatment of an Insured Person requiring Charges for treatment of an Insured Person requiring machines or apparatus for providing kidney dialysis at machines or apparatus for providing kidney dialysis at a legally registered dialysis centre. Cover includes a legally registered dialysis centre. Cover includes examination and tests ordered by the attending examination and tests ordered by the attending Physician and conducted on the same day of treatment. Physician during the course of treatment. It extends Charges for consultation by the attending Physician to cover Erythropoietin as part of the treatment for are not covered. Chronic Renal Failure and ambulatory peritoneal dialysis It extends to cover Erythropoietin as part of the ordered by a Physician. treatment for Chronic Renal Failure and ambulatory peritoneal dialysis ordered by a Physician. Aviva Ltd 4 Shenton Way #01-01 SGX Centre 2 Singapore 068807 www.aviva.com.sg Company Reg. No.: 196900499K ¥ GST Reg. No.: MR-8500166-8
  • Summary of changes to MyShield and MyShield PlusÐ effective 1 March 2013 Current MyShield New MyShield 8 Policy provision (continued) General Exclusions (a) The following exclusions are currently included in the (a) We removed Clauses 15, 16(a), and 18 from the policy contract: current policy contract. 15. Additional Fees billed by a referring Physician for treatment given after the date on which an Insured Person has been referred to another Physician or Specialist. 16. (a) active military, police or civil defence training, duties or operations, including maintenance of civil order, engagement in hostilities, participation in war (whether war be declared or not) and whether or not compensation or reimbursement of hospitalisation or medical expenses in part or full has been made by the Government or the relevant authorities. For the avoidance of doubt, this shall not include operationally ready national service duty under Section 14 of the Enlistment Act Cap 93 of the Republic of Singapore; or 18. Air travel, other than as a fare-paying passenger on a duly licensed aircraft on a regular scheduled route operated by a recognised airline. (b) The following exclusions are currently worded in (b) For clarity, we have rephrased them to: this manner: 7. Elective cosmetic treatments and plastic surgery; 7. Elective cosmetic treatments and plastic surgery; all dental treatment or oral surgery related to teeth any treatment to prevent illness, promote health other than those Inpatient treatment due to or improve bodily function or appearance; all Accident; rest cures and services or treatment in dental treatment or oral surgery related to teeth any home, spa, hydro-clinic, sanatorium or long- other than those Inpatient treatment due to term care facility that is not a Hospital as defined. Accident; rest cures and services or treatment in any home, spa, hydro-clinic, sanatorium or long- term care facility that is not a Hospital as defined. 10. Prosthesis, corrective devices and medical appliances 10. Prosthesis, corrective devices and medical which are not surgically required; all treatment appliances which are not surgically required; all that is not scientifically recognised by western treatment that is not scientifically recognised by European or North American standards. western European or North American standards, such as alternative and complementary treatment. 13. Experimental or pioneering medical, surgical 13. Experimental or pioneering medical, surgical techniques or clinical trial for drugs or medical techniques or clinical trial for drugs or medical device not commonly available or not approved device not approved by Ministry of Health which by Ministry of Health which the Insured Person the Insured Person chooses to receive even though chooses to receive even though treatment usually treatment usually and customarily provided for and customarily provided for the medical condition the medical condition concerned is available. concerned is available. Aviva Ltd 4 Shenton Way #01-01 SGX Centre 2 Singapore 068807 www.aviva.com.sg Company Reg. No.: 196900499K ¥ GST Reg. No.: MR-8500166-8
  • Summary of changes to MyShield and MyShield PlusÐ effective 1 March 2013 Current MyShield New MyShield 8 Policy provision (continued) 17. Rock climbing, mountaineering, pot-holing, 16. Injury and/or Illness arising directly or indirectly skydiving, parachuting, hang-gliding, para-sailing, out of or in connection with engagement/ ballooning, all diving; racing of any kind other involvement in any sports in a professional or than on foot and all professional or inherently competitive pursuit on a full-time, part-time, dangerous sports. contractual and/or ad hoc basis other than those undertaken in leisure or as a hobby.For full details, please refer to the policy contract, which can be downloaded fromwww.aviva.com.sg/pdf/MyShield_PolicyContract.pdf . Aviva Ltd 4 Shenton Way #01-01 SGX Centre 2 Singapore 068807 www.aviva.com.sg Company Reg. No.: 196900499K ¥ GST Reg. No.: MR-8500166-8
  • Summary of changes to MyShield and MyShield PlusÐ effective 1 March 2013 Current MyShield Plus New MyShield Plus 1 For children enjoying Free Child Cover, they are covered For children enjoying Free Child Cover, they will now be under 5 Critical Illnesses. covered for 30 Critical Illnesses. 2 Hospital-related Benefits (e.g. daily cash from the Hospital Hospital-related Benefits will now be payable as long as Cash Benefit, reimbursement for ambulance fees, etc) there is a payout from either MyShield or MyShield Plus are not payable if there is no payout from MyShield. Option B. 3 No Accidental Coverage for Child Benefit. MyShield Plus Option A will now offer a cash payout in the event of a fracture for children under 19 years old (Accidental Coverage for Child Benefit). 4 No Advanced Benefit. MyShield Plus Option A will now offer a new Advanced Benefit for MyShield to enhance your coverage: Accidental Inpatient Coverage will be extended Dental Coverage from 14 days to 31 days. Post Hospitalisation Coverage will be extended Follow-up Treatment from 90 days to 120 days after discharge. Confinement in Coverage will be extended Community Hospital from 45 days to 60 days. Inpatient Congenital Waiting period will be reduced Anomalies from 24 to 12 months. 5 Customers are required to inform us of any material This clause has been removed and customers no longer changes relating to occupation, business or sporting need to inform Aviva of any material changes once the activity, in line with the ÔGeneral ConditionsÕ section, policy is in force. Ô6. Material ChangesÕ clause in the policy contract. 6 Only one age band for 1-30 years old. This age band will be split into two separate age bands, 1-20 and 21-30 years old, to be in line with MediShield.For full details, please refer to the policy contract, which can be downloaded fromwww.aviva.com.sg/pdf/MyShieldPlus_PolicyContract.pdf . Aviva Ltd 4 Shenton Way #01-01 SGX Centre 2 Singapore 068807 www.aviva.com.sg Company Reg. No.: 196900499K ¥ GST Reg. No.: MR-8500166-8