How To Make A Hospitalisation / Surgery Claim

If you have an Integrated Shield Plan (IP), or any other hospitalisation and surgery policies, you may be able to make a claim for inpatient medical treatment, surgery, or selected outpatient cancer treatments and kidney dialysis.

Integrated Shield Plan – If you are a Singapore Citizen or Singapore Permanent Resident

During the admission, the clinic / hospital will be able to check if you have an Integrated Shield Plan. If you do, they will be able to do an e-File for you. With this process, the claim will be sent directly to the insurance company after the patient is discharged. The claim will also be sent to CPF for their assessment as this policy is integrated with MediShield Life.

As this policy is on reimbursement basis, you may be required to pay the deposit and/or bill in full upon discharge. Once the claim is approved, the insurance company will pay the hospital, and the hospital will then refund you in cash and/or Medisave, accordingly.

It is necessary to do the e-File if you are claiming from this policy. Should this not be done during admission, you will be required to return to the hospital to request for e-File. This usually incurs additional charges (if done after discharge), that are not claimable by your insurance.

Integrated Shield Plan – If you are a Foreigner

For foreigners under the Integrated Shield Plan, e-File is not available. As such, foreigners are required to pay the bill in full before claims can be processed and reimbursed.

Claim submission will be manual and medical reports, claimant and doctor’s statement, discharge summary, final itemized bill, and any other relevant documents, are required for the claim assessment. The fees to retrieve these documents are not claimable from insurance companies and will be borne by you. As such, do remember to request these documents when you are in the hospital. Otherwise, additional charges may be imposed when a request is made after discharge. Retrieval will also take longer (usually 6 to 8 weeks) when requested at a later date.

Group Insurance or Other Global Health Plans

There are many other hospitalisation and surgical plans that are available. Some of these are 100% claimable, while some have a restriction on the hospital, ward and claim limit. Should you have Company Group insurance that covers you for hospitalisation and surgery, and if you have an Integrated Shield Plan as well, unless your Company’s insurance has full cover, otherwise, do e-File and claim from your IP first. Once your IP claim is approved, you can then submit the settlement letter together with your bills, and claim from your Company Group Insurance. Your Group Insurance will assess the eligible amount payable and pay you back for the co-payment that is not claimable under your IP, and the balance will be paid to your IP insurer. This will lower your claim amount as some insurance companies’ premium is based on claims-adjusted pricing.