AIA Singapore

Ward-class scope

AIA HealthShield Gold Max A

Private hospitals, Class A, Class B1 in restructured hospitals (as implied by plan tier structure; Standard Room defined as the room type covered)

Co-payment & deductible

Panel hospitals & in/out-of-panel rules

The wording references MediSave-accredited institutions and referral centres for planned overseas treatment, and Letter of Guarantee / prior approval mechanics are not explicitly detailed in the extracted text. Eligible Expenses are limited to Reasonable and Customary charges for medical expenses or fees incurred.

Pre-existing conditions

Any Pre-existing Condition that was not covered under the plan in-force prior to the effective date of plan upgrade will continue to be excluded under the upgraded plan. In relation to plan upgrades, claims that arise on or after the effective date of plan upgrade from a pre-existing condition (physical impairment, illness or disease) developed during the period of insurance of the prior plan will be assessed and payable based on the terms and conditions and benefits limits of the plan in-force prior to the effective date of the plan upgrade, unless the Insured makes a declaration of such pre-existing condition in the application for the plan upgrade and such application is specifically accepted by us. For Congenital Abnormalities of Insured: any birth defects that were diagnosed, treated, or for which a Physician or Specialist was consulted at any time prior to the Policy Date or last Reinstatement Date of this Policy (if any), whichever is latest, are not covered.

Cancer treatment

Outpatient cancer drug treatment is covered under Part (J) Outpatient Benefit for cancer drug treatments on the Cancer Drug List (CDL). If the Insured is claiming for more than one cancer drug treatment, we will pay a total amount up to the highest limit among the cancer drug treatments administered in that month, if they are used according to the indications on the Cancer Drug List (CDL). If any cancer treatments received are not in accordance with the indications on the Cancer Drug List (CDL), we will not cover any of the cancer drug treatments used, even if the individual treatments are listed on the Cancer Drug List (CDL). Drug omission or replacement with another drug under Cancer Drug List (CDL) indicated 'for cancer treatment' is allowed for cancer drug treatments listed on the Cancer Drug List (CDL) involving more than one drug, only if they are due to intolerance or contraindications. Cancer Drug Services include consultations, scans, lab investigations, treatment preparation and administration fees, supportive care drugs and blood transfusions that are part of any outpatient cancer drug treatment. It does not cover services incurred before the Insured is diagnosed with cancer and/or after the cancer drug treatment has ended. Radiotherapy for cancer and stereotactic radiotherapy for cancer are also covered under Part (J). Expenses incurred for Proton Beam Therapy and Cell, Tissue and Gene Therapy are expressly excluded from Part (J) Outpatient Benefit and from Part (A) Hospitalisation and Surgical Benefits; they are covered under Part (N) Cell, Tissue and Gene Therapy Benefit and Part (O) Proton Beam Therapy Benefit respectively. In the event of treatment for conditions for which guidelines on fees and medical practice may be published by the Ministry of Health of Singapore or official medical body in Singapore, we will take reference from these when assessing and paying claims. There are specific clinical situations where we may require additional criteria to be met in order for a claim to be admitted (refer to Appendix A).

MediShield Life integration

This Policy is issued under a joint insurance arrangement with the Central Provident Fund (CPF) Board, whereby we provide an enhancement scheme in this Policy. Provided the Insured meets the eligibility conditions as specified in the CPF Act and its regulations, the Insured is jointly also insured under the MediShield Life Scheme operated by the CPF Board. The reimbursement for the Eligible Expenses incurred under this Policy shall be on the basis of the higher of the benefits computed under this Policy and the MediShield Life Scheme. Any mandatory revision of the minimum deductibles, maximum co-insurance or new guidelines and conditions that may be introduced by the Ministry of Health of Singapore, CPF Board or other relevant government authorities on the MediShield Life Scheme or the said joint insurance agreement from time to time, shall be deemed to apply to this Policy (where applicable). Any refund of premiums shall be made to your MediSave account or to you directly, as the case may be.

Mental health cover

Part (I)(i) – In-Hospital Psychiatric Treatment: Eligible Expenses incurred for medical or surgical treatment including room and board charges for a Standard Room, meals, prescriptions, professional charges, investigations and miscellaneous medical charges incurred per day during the period the Insured is Confined in a Hospital to receive psychiatric treatment provided by a Psychiatrist. Such hospitalisation and psychiatric treatment must be advised in writing for the Insured by a Psychiatrist and administered to the Insured under the direct supervision of a Psychiatrist. Part (I)(ii) – Post-Hospitalisation Psychiatric Treatment: Eligible Expenses incurred for post-hospitalisation psychiatric treatments and tests that the Insured is required to undergo, within the period specified in the Schedule of Benefits following the day such Confinement ends. All Eligible Expenses incurred in respect of and in connection with Part (I)(i) and Part (I)(ii) are accumulated towards its respective Limit of Compensation under Psychiatric Treatment Benefits as stated in the Schedule of Benefits. Specific SGD sublimits are stated in the Schedule of Benefits (not fully reproduced in the extracted text).

Maternity

Part (E) Pregnancy Complications Benefit: Eligible Expenses incurred if the Insured requires Confinement in a Hospital to undergo medical or surgical treatment due to listed pregnancy complications. These pregnancy complications must have been first Diagnosed after the Insured has been insured under this Policy for a continuous period of 10 months from the Policy Date, the last Reinstatement Date (if any) or the effective date of plan upgrade (if any) of this Policy, whichever is latest. Covered complications include: ectopic pregnancy, pre-eclampsia or eclampsia, disseminated intravascular coagulation, miscarriage (after 13 weeks), acute fatty liver pregnancy, choriocarcinoma and hydatidiform mole, postpartum haemorrhage requiring hysterectomy, still birth (after 22 weeks), cervical incompetency, accreta placenta, placental abruption, placenta praevia, antepartum/intrapartum/postpartum haemorrhage, placental insufficiency and intrauterine growth restriction, gestational diabetes mellitus, obstetric cholestasis, twin to twin transfusion syndrome, infection of amniotic sac and membranes, amniotic fluid embolism, fourth degree perineal laceration, uterine rupture, postpartum inversion of uterus, obstetric injury or damage to pelvic organs, complications resulting in a caesarean hysterectomy, retained placenta and membranes, abscess of breast, medically necessary abortion, and maternal death. Part (F)(i) – Congenital Abnormalities of Insured's Biological Child from Birth: Eligible Expenses incurred by the Insured's biological child if required to be Confined to undergo medical or surgical treatment due to birth defects, including hereditary conditions and congenital sickness or abnormalities during the first 24 months from date of birth. Applies only if the Insured is female. These conditions must be first Diagnosed after the Insured has been insured for a continuous period of 10 months from the Policy Date, last Reinstatement Date (if any) or effective date of plan upgrade (if any), whichever is latest.

Exclusions

• Expenses incurred for Proton Beam Therapy and Cell, Tissue and Gene Therapy are expressly excluded from Part (A) Hospitalisation and Surgical Benefits (covered separately under Part (N) and Part (O))
• Expenses incurred for Proton Beam Therapy and Cell, Tissue and Gene Therapy are expressly excluded from Part (J) Outpatient Benefit
• Any surgical procedure not listed in the 'Table of Surgical Procedures' under the MediSave Scheme operated by the Ministry of Health of Singapore (Table 1 to Table 7) is not covered
• Dentures and all related expenses are expressly excluded from Accidental Inpatient Dental Treatment Benefit
• Organ or bone marrow transplant: we shall not pay for any cost if the organ or bone marrow transplant is illegal or arises from any illegal transaction or practice
• Living Donor Organ Transplant: we shall not pay for any cost related to the surgery to remove the organ from a living donor if the organ transplant is illegal or arises from any illegal transaction or practice
• Immunosuppressant drugs: we shall not reimburse the immunosuppressant drugs if the organ transplant is illegal or arises from any illegal transaction or practice
• Stem cell transplants (outpatient therapies such as injection or extraction where the Insured does not require Confinement in a Hospital shall not be covered under Stem Cell Transplant Benefit)
• Other stem cell transplants are excluded (under Major Organ / Bone Marrow Transplantation critical illness definition)
• Pre-existing Condition: any birth defects that were diagnosed, treated, or for which a Physician or Specialist was consulted at any time prior to the Policy Date or last Reinstatement Date of this Policy (if any), whichever is latest, are not covered under Congenital Abnormalities of Insured
• No benefit payable for any expense incurred before the Policy Date or occurring after the termination or cancellation of the Policy
• No payment under Post-Hospitalisation Benefit for any routine medical check-up which is not part of the post-hospitalisation medical treatment as recommended by the Physician or Specialist and is not related to the Confinement
• No payment for treatments, medical services, supplies and/or medication purchased within the post-hospitalisation period which are not utilised within the same period
• Counselling provided by medical social workers to the Insured's family in connection with organ donation shall not be covered under Part (G)(i)
• Under Part (G)(ii): charges for any pre-hospitalisation treatment or test incurred by the living donor; charges for any post-hospitalisation treatment or test incurred by the living donor including any post-transplant complication; charges for any counselling provided by medical social workers to the living donor's family
• Organ or bone marrow recovery costs: all other costs not listed in items (a) to (e) arising from or in relation to or incidental to the recovery of any organ or bone marrow from a cadaveric donor are expressly excluded
• Cancer drug treatments: if any cancer treatments received are not in accordance with the indications on the Cancer Drug List (CDL), we will not cover any of the cancer drug treatments used, even if the individual treatments are listed on the CDL
• Cancer Drug Services do not cover services incurred before the Insured is diagnosed with cancer and/or after the cancer drug treatment has ended
• Long-term parenteral nutrition: the Insured must fulfill all the clinical criteria for long-term parenteral nutrition under the MediShield Life Scheme
• HIV Due to Blood Transfusion and Occupationally Acquired HIV: HIV infection resulting from any other means including sexual activity and the use of intravenous drugs is excluded
• HIV benefit will not apply where a cure has become available prior to the infection
• Stroke exclusions: transient ischaemic attacks; brain damage due to accident or injury, infection, vasculitis, and inflammatory disease; vascular disease affecting the eye or optic nerve; ischaemic disorders of the vestibular system
• Coronary Artery By-pass Surgery exclusion: angioplasty and all other intra-arterial, catheter based techniques, 'keyhole' or laser procedures
• Angioplasty exclusion: diagnostic angiography
• Major Cancers exclusions: pre-malignant, non-invasive, carcinoma-in-situ, borderline malignancy, suspicious malignancy, neoplasm of uncertain or unknown behavior, cervical dysplasia CIN-1/CIN-2/CIN-3; non-melanoma skin carcinoma without metastases; malignant melanoma not beyond epidermis; prostate cancers T1N0M0 or below; thyroid cancers T1N0M0 or below; urinary bladder tumours T1N0M0 or below; gastro-intestinal stromal tumours T1N0M0 or below with mitotic count ≤5/50 HPFs; chronic lymphocytic leukaemia less than RAI stage 3; all tumours in the presence of HIV infection
• Heart Attack exclusions: angina; heart attack of indeterminate age; rise in cardiac biomarkers following intra-arterial cardiac procedure
• Coma: coma resulting directly from alcohol or drug abuse is excluded
• Loss of Speech: all psychiatric related causes are excluded
• Paralysis: self-inflicted injuries are excluded
• Alzheimer's Disease / Severe Dementia exclusions: non-organic diseases such as neurosis and psychiatric illnesses; alcohol related brain damage

Available riders