Student Group Hospitalisation & Surgical (GHS) Insurance Who is covered?

Student Group Hospitalisation & Surgical (GHS) Insurance
Need to stay in a hospital or have surgery?
Apply for Letter of Guarantee (LOG).
1.
Student should inform MYCG at least 5 working days (whenever possible)
before the scheduled admission/surgery by submitting an online LOG Request
Form at www.mycg.com.sg/sit. Please also upload the following documents:
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Who is covered?
Registered full-time students of Singapore Institute of Technology (SIT) who have paid
the insurance premium.
For emergency admission, please contact MYCG as soon as possible.
2.
If approved by the insurer, MYCG will issue the LOG and fax it to the hospital. A
copy will be emailed to the student, copied to SIT.
3.
With the LOG, the hospital will waive the deposit and payment of the hospital
bill, up to the limits of the insurance and subject to the policy terms and
conditions. The hospital will bill the insurer directly.
4.
Student should submit to MYCG the documents required (refer to below section
on “How to make a claim”) to process the claim as soon as possible but within
30 days after discharge from the hospital.
What is covered?
Coverage
Overall Maximum Limit any one policy period and in total of
any one claim or event, subject to the sub-limits as stated
below
Hospital
Annual Limit
S$30,000
Singapore
Government/
Restructured
Room and Board
B1 Ward
Hospital & Related Services (HRS)
S$30,000
1
In-Hospital treatment, facilities & services including
accommodation up to B1 ward in a Singapore Government/
Restructured Hospital including ICU, HDU and implants
2
Day Care Surgery
3
Pre-Hospital Specialist Consultation and Diagnostic
Services
 within 90 days of hospital admission
 Specialist must be referred by a GP/A&E
4
Post-Hospital Follow-up Treatment
 up to 90 days after discharge
5
Casualty Ward Accident & Emergency Services including
Dental (for bodily injury due to accident only)
 treatment must be sought within 24 hours of the accident
 follow-up treatment covered up to 31 days from the date
of accident
6
Outpatient Kidney Dialysis
7
Outpatient Cancer Treatment
8
Ambulance Fee
9
Medical Report Fee (if required by the insurer)
10
Treatment in a Accident & Emergency (A&E) Department of
a Government/Restructured Hospital for emergency
treatment of illnesses (within Singapore only)
As Charged
Claims should be submitted as soon as possible but within 30 days of the date
medical treatment. If more time is required, please submit the “Claim Notification”
online form at www.mycg.com.sg/sit.
1. Prepare/obtain the following documents:
S$70
per visit
(a)
(b)
Outpatient treatment for Mental Illness in Singapore only
(with referral from a Physician or School
Counsellor/Appointed Psychologist)
 treatment in a Government/Restructured hospital/clinic or
private Psychologist appointed by SIT
S$500
13
Outpatient Extension for UOM students
 Covers consultation, outpatient laboratory tests
(including vaccinations and check up) and medicine
recommended by a Specialist/A&E in a Singapore
Government/ Restructured Hospital due to accidental
injury or illness contracted in the course of work or
research (e.g. needle prick, blood/urine splash)
 Does not cover flu injections, which may or may not be
required due to a flu outbreak, Hepatitis B injections and
other similar preventive treatment
 Other illnesses and accidents are not covered under this
extension
S$750
S$10,000
(c)
(d)
(e)
(f)
(g)
(h)
Original Completed Reimbursement Request Form (Claim Form) - download
from www.mycg.com.sg/sit
Original Final Hospital Bill (the hospital will send this to the patient within 2 to 3
weeks after discharge)
Original Pre and Post Hospitalisation/Surgery Bills
Copy of Inpatient Discharge Summary)
Copy of Test Reports, if any
Original Completed Letter of Indemnity (if LOG is issued)
Copy of Police Report (for traffic accidents)
Original Medical Report (for emergency hospitalisation overseas)
2. The student should keep a photocopy for his/her own records.
3. Please send the documents by post to “MYCG, 3 Church Street, #25-00 Samsung
Hub, Singapore 049483” for processing.
4. For follow-up claims, please send the original bills to MYCG with a note attached
that states “Follow-up Claim”, “SIT” and the ”Student’s Full Name”.
5. Generally, medical expense claims will be processed within 30 days of receipt of
complete claim documents and information.
S$5,000
 Territorial Limit – 24 hours worldwide for emergency treatment for accident or acute
illness while overseas where immediate medical attention is required (does not
cover non-emergency, elective and/or intentionally booked treatment overseas)
 Medical expenses incurred in an overseas hospital will be limited to similar
treatment in a B1 ward at Singapore General Hospital
Extensions
Pre-existing conditions are covered from inception
Mental Illness as stated in the table above
Occupationally Acquired HIV (applicable to UOM students only)
Prosthesis
Covers all programs, activities and events organised by SIT and/or its Clubs or in
which the student participates as a representative of SIT. This includes academic
programs, work study programs, study trips, site visits, exchange programs,
attachment, internship programs (including attachment or internship arranged
personally by the students where SIT’s approval is not required), extra-curricular
activities and all sports including competitions held locally or overseas.
© MYCG 01042014
Please note that issuance of a LOG does not mean that the claim is approved.
The LOG is a service extended for the convenience of the student during
admission to the hospital. It is based on preliminary information available before
the treatment. The insurer reserves the right to decline the claim after review of
the complete claim documents if there should be difference in the actual
information and subject to the policy terms and conditions.
How to make a claim?
Inpatient treatment for Mental Illness
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(a) If based on the information provided it is not clear if the claim is admissible, the
insurer may decline to issue the LOG and the student would have to pay the
medical bill first. The student can still submit the claim after the treatment for the
insurer to review.
(c)
12
Special Grant/Death Benefit
Note:
(b) Patient will have to sign the Medisave Authorisation Form on admission to the
hospital, if the patient has a medisave account. When the claim is processed, the
medisave account will be reimbursed according to the benefits payable under the
insurance.
11
14
Copy of Completed Notification Form (Claim Form)
Copy of Completed Letter of Indemnity
Copy of Referral Letter, if any
Copy of Financial Counselling Form/Day Surgery Authorisation Form (for
admission to a Government/Restructured hospital) – the hospital will give
these documents to the patient when the admission date is confirmed – the
documents will contain an estimated bill, diagnosis and treatment information
6. Students will be notified of the claim result by email. For approved medical expense
claims, the reimbursement will be credited into the student’s bank account.
What is not covered? (Main Exceptions)
 Birth defects, congenital conditions
 Routine medical examination
 Higher risk/dangerous, professional sports
 War & Terrorism
Please refer to the complete list at the end of this brochure.
When does the cover end?
 When the student ceases to be a full-time student of SIT
 When the student goes on leave of absence (if the student goes on leave of
absence due to medical reasons, he/she will be covered up to the end of the
academic year for which premium and tuition fee has been paid)
 When the benefit limit has been reached
 If the policy has expired
 When the student attains the age of 65
 If the student did not pay the insurance premium
by your undertaking to indemnify the insurer and must settle all outstanding bills
within 30 days of the request made for such payment.
Student Group Hospitalisation & Surgical (GHS) Insurance
14.
What should I do if I need to be admitted to the hospital
urgently/immediately and it is after normal business hours?
Please call MYCG at our 24hr emergency hotline 9336 0159 and provide us with
your personal and admission details. We will try to arrange the LOG to the
hospital.
15.
How long does it take for the LOG to be issued and faxed to the hospital?
Please inform MYCG at least 5 working days (whenever possible) before the
scheduled admission/surgery, or as soon as possible for emergency admission.
16.
How do I make a claim?
What do I need to do after I am discharged from the hospital?
I have paid the medical costs. How can I be reimbursed?
Please visit the Claims section of www.mycg.com.sg/sit for the claim procedure
and download the required forms.
17.
When do I need to submit the claim?
Claims should be submitted as soon as possible but within 30 days of the date
medical treatment. If more time is required, please submit the “Claim Notification”
form online.
18.
I have submitted my claim earlier. I wish to submit follow-up treatment
bills. What should I do?
Please send the original bills to MYCG with a note attached that states “Followup Claim”, “SIT” and the ”Student’s Full Name”.
19.
I am not sure if my claim falls under the Group Hospitalisation & Surgical
(GHS) or Group Personal Accident (GPA) Insurance Scheme. How should I
submit my claim?
Please rest assured that we will help to review the claim documents to ensure
that they are prepared correctly. If more documents or information are required,
we will inform you by email.
20.
How long does it usually take to process my claim?
Upon receipt of all required documents and information, approved claims will
generally be settled within 30 days.
21.
How will I be notified of the result of my claim?
You will be notified by email. Reimbursement for approved claims will be
deposited into your bank account.
22.
When will my insurance end?
The insurance will end when one of the following occurs, whichever occurs first:
 When the student ceases to be a full-time student of SIT
 When the student goes on leave of absence (if the student goes on leave of
absence due to medical reasons, he/she will be covered up to the end of the
academic year for which premium and tuition fee has been paid)
 When the benefit limit has been reached
 If the policy has expired
 When the student attains the age of 65
 If the student did not pay the insurance premium
23.
If I have questions or need assistance, who should I contact?
Please contact MYCG at [email protected] or call 6476 3829 / 9762
2062. For emergencies only after business hours, please call 9336 0159 (24hr
Emergency Hotline).
FAQ
1.
Who is covered?
All registered full-time students of SIT who have paid the premium.
2.
When does my coverage start?
Your coverage will start on the date advised by SIT.
3.
What does the insurance cover?
The insurance covers mainly (a) medical expenses incurred for hospitalisation
&/or surgery due to accident or illness, including mental illness and (b) medical
expenses incurred for outpatient treatment of mental illness.
4.
Are outpatient services for illnesses covered?
Emergency treatment at the Accident & Emergency (A&E) Department of a
Government/Restructured Hospital is covered up to $70 per visit. Other
outpatient services provided by a GP or Specialist for illnesses (e.g. for common
cold or fever) are not covered.
5.
Is dental treatment covered?
Dental treatment is not covered except for treatment required to restore sound
natural teeth lost or damaged in an accident.
6.
Will I be covered during my overseas Exchange Program/Industrial
Attachment?
Yes, you are covered for emergency treatment for accident or acute illness while
overseas where immediate medical attention is required. The insurance does not
cover non-emergency, elective and/or intentionally booked treatment overseas.
Medical expenses incurred in an overseas hospital will be capped to B1 ward
charges in Singapore General Hospital
7.
Will I be covered if I travel overseas or return
vacation?
Yes, please refer to answer for Q6. You are
consecutive days while overseas. If you wish to
country, please contact MYCG to obtain approval
country for treatment.
to my home country during
covered up to maximum 90
seek treatment in your home
before returning to your home
8.
Are pre-existing conditions covered?
Yes, pre-existing conditions are covered.
9.
Do I have to pay the medical costs at the time of treatment?
For hospitalisation and/or surgery, please visit www.mycg.com.sg/sit and submit
an online request for a Letter of Guarantee (LOG). For outpatient treatment,
please pay first and submit the claim for reimbursement.
10.
What should I do if I need to stay in the hospital or have surgery?
Please inform MYCG at least 5 working days (whenever possible) before the
scheduled admission/surgery by submitting an online LOG Request Form at
www.mycg.com.sg/sit. You will also need to upload the following documents:
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11.
12.
13.
Copy of Completed Reimbursement Request Form (Claim Form)
Copy of Completed Letter of Indemnity
Copy of Referral Letter, if any
Copy of Financial Counselling Form/Day Surgery Authorisation Form (for
admission to a Government/Restructured hospital) – the hospital will give
these documents to the patient when the admission date is confirmed – the
documents will contain an estimated bill, diagnosis and treatment information
If a LOG is issued, does this mean that the medical expenses are covered?
No, the issuance of the LOG does not mean that the insurer has approved the
claim. The LOG is a service extended for the convenience of the student during
admission to the hospital. It is based on preliminary information available before
the treatment. The insurer reserves the right to decline the claim after review of
the complete claim documents if there should be difference in the actual
information and subject to the policy terms and conditions. After you have been
discharged from the hospital, please submit the documents required to the
insurer to process the claim. If the claim is payable, the insurer will pay directly to
the hospital. If the claim is not admissible, you will have to reimburse the insurer
or pay to the hospital.
Will a LOG be issued for medical treatment that is not covered?
No. For such cases, students will have to make payment directly to the hospital.
Thus, they should ensure that they have the financial means before admission
into the hospital.
What is a Letter of Indemnity?
If a LOG is issued, you will have to sign the Letter of Indemnity to indemnify the
insurer in the event that:
 total medical cost exceeds the maximum limit of the coverage, or
 the treatment cost/medical condition is excluded under the policy, or
 there is interest charged by the hospital due to delay in settlement to the
hospital caused by your delay in submitting the claim documents.
In the event that the above situation should arise, the insurer will instruct you to
settle the bill directly with the hospital or recover from you if payment has already
been made by the insurer to the hospital. Your benefits under this insurance will
be suspended pending settlement. Reinstatement will be granted as soon as full
payment has been received by the insurer or the hospital. You are legally bound
© MYCG 01042014
For all enquiries, please contact
MYCG Pte Ltd
Co. Reg. No. 200313024E
Phone
Fax
Email
Web
:
:
:
:
Address :
+65 6476 3829 / +65 9762 2062
+65 6474 0089
[email protected]
www.mycg.com.sg/sit
3 Church Street, #25-00 Samsung Hub,
Singapore 049483
24-hr Emergency Hotline
+65 9336 0159 (for emergencies only after business hours)
Underwritten by
MSIG Insurance (Singapore) Pte. Ltd.
Co. Reg. No. 200412212G
This policy is protected under the Policy Owners' Protection Scheme which is
administered by the Singapore Deposit Insurance Corporation (SDIC). Coverage for
your policy is automatic and no further action is required from you. For more
information on the types of benefits that are covered under the scheme as well as the
limits of coverage, where applicable, please contact your insurer or visit the GIA / LIA
or SDIC websites (www.gia.org.sg or www.lia.org.sg or www.sdic.org.sg).
The information contained in this brochure is a summary only and is subject to the
terms conditions and exceptions of MSIG’s policy. Any discrepancy between the
information in this brochure and the policy is unintentional.
Student Group Hospitalisation & Surgical (GHS) Insurance
26. Hotel or non-Hospital accommodation costs except as provided for in the Policy.
27. Cost of medical reports unless agreed by the Company.
What is not covered?
GENERAL EXCEPTIONS
(which apply to the whole Policy)
The following tests, investigations, treatments, items, conditions, activities and their related or
consequential expenses are excluded from the Policy and the Company shall not be liable for:
1.
Pre-Existing Conditions as defined, including any treatment and complication arising from
the Pre-existing Conditions. For the avoidance of any doubt, the Pre-Existing Conditions
exclusion, including any treatment and complication arising from the Pre-Existing
Conditions, shall always apply unless specifically waived or limited by the Company in
writing in the Schedule or official endorsement thereto.
2.
Routine medical examinations or check-ups; routine eye or ear examinations; or any form
where there is no objective indication of impairment of normal health or any treatment or
investigation of a preventive nature; or any treatment which is not medically necessary;
vaccinations; cosmetic surgery or plastic surgery; treatment for obesity or weight
reduction (including liposuction); weight improvement programs; alopecia; breast
reduction or enlargement (regardless whether it is medically necessary or not); treatment
for all forms of acne; 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.
3.
Infertility; contraception; sterilization (or its reversal); impotence; erectile dysfunction;
sexual dysfunction; treatment relating to sex change; sexually transmitted diseases;
Human Immunodeficiency Virus (HIV), including Acquired Immune Deficiency Syndrome
(AIDS) or any HIV/AIDS related conditions or diseases.
4.
Birth defects, congenital Illness.
5.
Pregnancy or childbirth except as defined under the Maternity Benefit when this Benefit is
stated on the Schedule as being covered by the Policy.
6.
Circumcision operations unless medically necessary.
7.
All types of Sleep Disorders including Sleep Apnoea unless this leads to treatment
through surgery.
8.
Behavioural or Developmental Delay and/or learning disabilities.
9.
Prosthesis; corrective devices; medical appliances which are not surgically required; or
any other that is not scientifically recognised by Western European or North American
Standards.
10. All costs relating to cornea, muscular, skeletal, human organ or tissue transplant from a
donor to a recipient and all expenses directly or indirectly related to organ transplantation
(except as defined under the Organ Transplantation Benefit but only when this Benefit is
stated on the Schedule as being covered by the Policy).
11. Mental illness; self-inflicted injury; misuse or over dosage or excessive use of
drugs/medicine; alcoholism; abuse of alcohol; drug abuse; drug addiction; suicide or
attempted suicide.
28. Expenses, administrative or other charges of a non-medical nature in connection with the
provision and/or performance of medical supplies and/or services.
29. Non-prescription drugs, medicines and other items.
30. Diving unless the person concerned has been duly qualified and certified as a diver by an
internationally recognised diving organisation or unless such person is at the time of the
happening of the event giving rise to a claim actually receiving diving instruction from a
duly qualified and certified diving instructor, Rock climbing Caving, Pot-holing,
Mountaineering, Skydiving, Parachuting, Hang-gliding, Para-sailing, Bungee Jumping,
racing of any kind other than on foot, or any other type of competitive sports other than
those in which the Insured Person participates purely as an amateur, all professional or
inherently dangerous sports unless declared to and accepted by the Company in writing
prior to the event giving rise to a claim.
31. Any Flying Activity or Air Travel other than as a fare-paying passenger in a commercially
licensed passenger carrying aircraft.
32. Costs or treatment after an annual renewal date (Due Date) arising from Injury, Illness or
death occurring during the previous Period of Insurance.
33. Costs or benefits payable under the Work Injury Compensation Act or similar or
subsequent Act or legislation, or corresponding insurance cover relating to occupational
death, Injury, Illness or disease.
34. Costs arising under any legislation which seeks to increase the cost of medical treatment
and services actually received above charge levels which would be considered
Reasonable and Customary in the absence of such legislation or action for compensation
under this Policy brought in any jurisdiction outside Singapore.
35. Any treatment or expense in respect of persons less than 15 (fifteen) days old or more
than 70 (seventy) years old for Employee or 65 (sixty-five) years old for Dependant at the
date of the onset of the event giving rise to a claim, unless agreed otherwise by the
Company prior to the inception of the Policy.
36. The cost of transporting an Insured Person by means of his employer's owned or leased
watercraft or aircraft or the cost of medical treatment rendered by the employer's
personnel or at the employer-provided medical facilities unless agreed otherwise in
writing by the Company prior to the inception of the Policy. This exclusion shall also apply
to transportation and medical treatment which an Insured Person is entitled to receive by
virtue of a contract between his employer.
37. Costs arising out of any litigation or dispute between the Insured Person and any medical
person or establishment from whom treatment has been sought or given, or any other
costs not specifically related to the payment of the medical expenses covered by the
Policy.
Additionally, the following apply:
38.
Institute Radioactive Contamination, Chemical,
Electromagnetic Weapons Exclusion Clause
(a)
13. Refractive defects of the eye, such as nearsightedness and astigmatism.
(b)
14. Spectacles; monocles or contact lenses, Lasik, hearing aids.
(c)
15. All dental treatment or oral surgery related to teeth (unless within the terms of the
Accident Dental Benefit).
(d)
16. Robotic Surgery; Use of Stem Cell Transplants; Cryopreservation; implantation or reimplantation of living cells or living tissue, whether authologous or provided by a donor.
18. Experimental or pioneering medical and surgical techniques not commonly available and
elected by the Insured Person to be received elsewhere in the world in lieu of t treatment
usually and customarily provided for the medical condition.
19. Second Opinions in respect of medical conditions which have already been diagnosed
and/or treated at the date such Second Opinions are obtained unless considered by the
Company's medical advisers to be reasonable and necessary having regard to the
medical facts and circumstances.
(e)
39.
death, disability, loss, damage, destruction, any legal liabilities, cost or expense
including consequential loss of whatsoever nature, directly or indirectly caused by,
resulting from or in connection with any of the following regardless of any other cause or
event contributing concurrently or in any other sequence to the loss;
(a)
war, invasion, acts of foreign enemies, hostilities or warlike operations (whether
war be declared or not), civil war, rebellion, revolution, insurrection, civil
commotion assuming the proportions of or amounting to an uprising, military or
usurped power; or
(b)
any act of terrorism including but not limited to
i.
the use or threat of force, violence and/or
ii.
(ii) harm or damage to life or to property (or the threat of such harm or
damage) including, but not limited to, nuclear radiation and/or
contamination by chemical and/or biological agents,
by any person(s) or group(s) of persons, committed for political, religious,
ideological or similar purposes, express or otherwise, and/or to put the public or
any section of the public in fear; or
(c)
any action taken in controlling, preventing, suppressing or in any way relating to
(a) or (b) above
22. Injury or Illness while serving as a full-time member of a police or military unit and
treatment resulting from participation in war, riot, civil commotion or any illegal act
including resistance to lawful arrest or resultant imprisonment.
25. Travel costs in respect of trips made specifically for the purpose of obtaining medical
treatment unless in the course of an approved Overseas Emergency Medical Evacuation,
and all Overseas Emergency Medical Evacuation and Repatriation costs not approved in
advance by the Company or MSIG Assist.
© MYCG 01042014
ionising radiations from or contamination by radioactivity from any nuclear fuel or
from any nuclear waste from the combustion of nuclear fuel
the radioactive, toxic, explosive or other hazardous or contaminating properties
of any nuclear installation, reactor or other nuclear assembly or nuclear
component thereof
any weapon or device employing atomic or nuclear fission and/or fusion or other
like reaction or radioactive force or matter
the radioactive, toxic, explosive or other hazardous or contaminating properties
of any radioactive matter. The exclusion in this subclause does not extend to
radioactive isotopes, other than nuclear fuel, when such isotopes are being
prepared, carried, stored, or used for commercial, agricultural, medical, scientific,
or other similar peaceful purposes
any chemical, biological, bio-chemical, or electromagnetic weapon.
The insurance by this policy excludes:
21. Continuance of fees from a referring Doctor after the date on which an Insured Person
has been referred to another Doctor or Specialist.
24. Hospital Inpatient treatment for conditions which can be properly treated as an outpatient.
and
War and Terrorism Exclusion
20. Costs of treatment rendered and drugs or medicine prescribed by a Doctor or Specialist
which are not related to the treatment provided to the Insured Person in respect of a
condition that is covered under this Policy.
23. Outpatient Services except as defined under the Outpatient Services Benefit and then
only to the extent such Benefits are stated on the Schedule as being covered by the
Policy.
Biochemical
In no case shall this insurance cover loss damage liability or expense directly or
indirectly caused by or contributed to by or arising from
12. Elective overseas treatment for non-emergency or chronic medical conditions where
covered treatment can reasonably be postponed until the Insured Person returns to the
Usual Country of Residence.
17. Treatment provided to an Insured Person by the Insured or Insured Person or a family
member of the Insured or Insured Person, self treatment by the Insured Person, including
the dispensation of medication and/or any medical tests/procedures carried out.
Biological,
If the Company says that any loss, damage, cost or expense is not covered by this
insurance by reason of any of these General Exceptions,
then the burden of proving the contrary shall be upon the Insured and/or the Insured
Person.