PRODUCT SUMMARY FOR PREFERREDCARE PLUS POLICY - (Enhanced Group Hospital & Surgical Insurance)

Transcription

1 PRODUCT SUMMARY FOR PREFERREDCARE PLUS POLICY - (Enhanced Group Hospital & Surgical Insurance) SINGAPORE UNIVERSIY OF SOCIAL SCIENCES POLICY NO PRODUCT INFORMATION Welcome to AVIVA Managed Care Plan - PreferredCare PLUS (PCP). This is a comprehensive medical programme designed to take care of your healthcare needs. It covers you from your General Practitioner visits to your hospitalization. This programme works with a panel of medical providers to ensure that you are provided with high quality care services. BENEFITS & PREMIUM TABLE (Please refer to Schedule of Benefits attached). PreferredCare PLUS is a comprehensive managed care programme which provide you with cost effective treatments without compromising on healthcare services. AVIVA has selected a range of medical providers consisting of General Practitioners and Specialists from a wide spectrum of medical disciplines. The programme offers the following benefits 1) Primary Care Benefits 2) Hospital Confinement Benefits You will be issued with a PreferredCare Plus (PCP) membership card. Please remember to present your card together with your identity card, birth certificate or passport when seeking medical care. Always identify yourself with the PCP card at all the panel clinics you visit to ensure a cash-free consultation. It is very important to remember that your membership card is non-transferable and must be returned to your Human Resource (HR) / Personnel dept when you leave your company. An administrative fee of S$10.00 is charged for each replacement of a lost or misplaced card. 1. Primary Care and Specialist Care Benefits A. Primary Care Benefit Expenses incurred in respect of consultation with and medication prescribed by a Preferred General Practitioner on an outpatient basis shall be payable, subjected to co-insurance or co-payment (if applicable), as specified in the Benefit Schedule. 1

2 B. Standard Diagnostic X-ray & Laboratory Test Expenses incurred in respect of basic and standard diagnostic X-ray or ultrasound examination or laboratory tests which is recommended by a Preferred General Practitioner or Preferred Specialist for the purpose of diagnosis of a covered illness shall be payable C. Emergency Outpatient Treatment Benefit for Illness Should you need emergency outpatient A&E treatment in Singapore for illness only, Aviva shall reimburse you the eligible expenses up to the maximum limit and subject to co-insurance or copayment (if applicable) as specified in the Benefit Schedule. D. Overseas Emergency Outpatient Treatment For outpatient treatment whilst overseas, expenses incurred in respect of consultation and medication including the costs of all other diagnostic tests for an emergency outpatient rendered by a Registered Medical Practitioner outside Singapore shall be reimbursed up to a maximum limit and subject to co-insurance or co-payment (if applicable ) as specified in the Benefit schedule 2. Hospital Confinement Benefits A. Daily Room and Board Benefit The daily room and board charges incurred by an Insured Person while in Hospital Confinement shall be payable up to the maximum amount and for a maximum no. of days per Disability specified in the Benefit Schedule. 2

3 B. Intensive Care Unit Benefit In the event that an Insured Person is confined to the Intensive Care Unit of the Hospital, the scheme will reimburse up to a maximum amount per Disability specified in the benefit schedule. C. Hospital Miscellaneous Services Reimbursement will be made for expenses such as the use of operating room, drugs and medicine, laboratory examination, anaesthesia and oxygen and their administration, ambulance service and other eligible miscellaneous expenses. D. Surgical Benefit A surgical benefit equal to the sum actually charged for any operation performed by one or more Registered Medical Practitioners shall be payable, provided that the maximum benefit for all surgical operations performed per Disability shall not exceed the aggregate amount obtained by multiplying the respective percentages shown for the operations listed in the Surgical Schedule of Fees by the maximum Surgical Benefit shown in the Benefit Schedule. E. In-Hospital Doctor Consultation Fees charged by the Registered Medical Practitioner for consultation while an Insured Person is in Hospital Confinement shall be payable up to the maximum daily limit shown in the Benefit Schedule. If a surgery has been performed, the consultation fee shall be payable under the Surgical Benefit instead. F. Post-Hospital Confinement / Surgery Follow-up Treatment Upon discharge, expenses incurred for follow-up treatment by the same Registered Medical Practitioner will be reimbursed up to a maximum no. of days specified in the Benefit Schedule. Co-Insurance (if applicable) If an Insured Person is in Hospital Confinement or receive emergency treatment of bodily injury caused by Accident on an outpatient basis, the eligible expenses reimbursable under the above benefits 2A, 2B, 2C, 2D, 2E, 2F, 3 and 4 shall be subjected to the co-insurance (if applicable) as specified in the Benefit Schedule. 3. Emergency Outpatient Treatment Benefit (Bodily Injury Caused by Accident) Reimbursement will be made for emergency outpatient treatment of bodily injuries arising from an accident and not by sickness, disease or gradual physical or mental deterioration received within 24 hours of the accident. 3

4 WHO ARE ELIGIBLE? All students of Singapore University of Social Sciences and based in Singapore only. KEY PRODUCT PROVISIONS 1) EXCLUSIONS The following are some key provisions found in the policy contract of this plan. This is only a brief summary and you are advised to refer to the actual terms and conditions in the policy contract. Please consult your financial advisor or insurance intermediary should you require further explanation. (i) Pre-existing conditions which have existed at any time prior to the commencement of insurance coverage, unless the Insured Person has already been insured continuously for 12 months under this policy or under any GHS issued in Singapore immediately prior to the commencement of his insurance coverage under this policy. (ii) Congenital anomalies or genetic defects. (iii) Non-medical expenses. (iv) Treatments which are not medically necessary (eg. cosmetic, fertility related etc.), routine medical check-ups. (v) Childbirth including abortion, birth control, infertility, impotency. (vi) Implants, dental treatments, HIV and all other sexually transmitted diseases. (vii) Treatment of mental illness, self-inflicted injury, suicide, abuse of alcohol, drug addiction. (viii) Disabilities resulting from direct participation in a strike, riot or civil commotion, insurrection, or any act of war (whether declared or undeclared). (ix) When an Insured Person is entitled to benefits payable under any employees compensation legislation, government or public programme of medical benefits, or other group or individual insurance, the benefits payable under this Policy shall be limited to the balance of expenses not covered by benefits payable under such legislation, programme or other insurances, or that computed in accordance with the Benefit Schedule of this Policy, whichever is lesser. (You are advised to read the policy contract for the full list of exclusions) 2) NON GUARANTEED PREMIUM Premiums payable for this plan are not guaranteed and may be increased at Policy Renewal Date at the full discretion of the Company. 3) TERMS OF RENEWAL Coverage may be renewed on the Policy Anniversary Date by payment of the annual premium, we can vary the premium and any other terms, conditions or exclusions in this policy by giving you written notice of such change, if you continue to pay premiums after we give such notice, it means you accept the change. 4) CANCELLATION CLAUSE We may terminate this Policy on any Renewal Date by giving you at least 30 days prior written notice of termination. Whenever such cancellation occurs, the Company shall return the unearned portion of premiums paid. The termination of coverage shall be without prejudice to payment of claims arising prior to the date of termination. 5) WAITING PERIOD Not applicable. 4

5 6) MISSTATEMENT A. If the age or date of birth or other relevant facts relating to any Insured Person is misstated and this affects the scale of benefits or other terms and conditions of this Policy, then we will use the true age and facts to determine whether insurance coverage is in force and the benefits payable under this Policy and if, in our opinion is necessary, an equitable adjustment of premiums will be made and notice of the adjustment will be given to you. B. Where a misstatement of age or other relevant facts has caused a person to be insured under this Policy when he is otherwise ineligible for any insurance, or where such statement has caused a person to remain insured when he would otherwise be disqualified in accordance with the provisions of this Policy, his entire insurance coverage shall be void and there shall be a refund of premiums paid. However, if there is a fraud on the part of the Insured Person, premiums paid shall not be refunded. 7) FREE LOOK PERIOD Not applicable. IMPORTANT NOTICE This is only product information provided by us and is designed to serve as a guide only. In the event of clarification or dispute, the prevailing terms and conditions of the Group Insurance contract with your employer shall apply. 5

6 PLAN (MAXIMUM PER DISABILITY UNLESS SPECIFIED) 1. PRIMARY CARE & SPECIALIST CARE BENEFITS A. PRIMARY CARE BENEFITS (PER VISIT) (i) Visit to Preferred General Practitioner B. Standard Diagnostic X-ray & Laboratory Test (Per Visit) C. Emergency Outpatient A & E Treatment in Singapore for Illness only (per visit) D. Overseas Emergency Outpatient Treatment (per visit) 70 A S$ as charged as charged 70 PLAN (MAXIMUM PER DISABILITY UNLESS SPECIFIED) 2. HOSPITAL CONFINEMENT BENEFITS A. Daily Room and Board Benefit (Maximum 120 days, inclusive of ICU) B. Intensive Care Unit Benefit (ICU) C. Hospital Miscellaneous Services (Including Implant) D. Surgical Benefit (subject to Surgical Schedule of Fees) E. In-Hospital Doctor Consultation F. Pre-Hospital Confinement/Surgery } (i) Diagnostic X-Ray and Laboratory Test } (ii) Specialist Consultation } G. Post Hospital Confinement/Surgery } Follow-Up Treatment (within 90 days of discharge) } If admitted to Singapore Government Hospital or Singapore Government Restructured Hospital, benefits 2C to 2F/G will be reimbursed as charged by the Hospital subject to maximum lump sum limit Per Disability as stipulated (includes NUH) 3. EMERGENCY OUTPATIENT TREATMENT BENEFIT (Accidental Injury including emergency dental treatment) incurred within 31 days of accident provided treatment is sought within 24 hours of accident A S$ B2 ward Govt / restr 10, , N.A