Raffles Health Insurance

Ward-class scope

Raffles Shield Plan A

Class A in Government Restructured Hospitals and Private Hospitals (with Pro-ration Factor applied for Private Hospital admissions under standard plan; Raffles Hospital Option available to increase Pro-ration Factor to 100% for Raffles Hospital)

Raffles Shield Plan B

Class B1 in Government Restructured Hospitals

Raffles Shield Private

Private hospitals

Raffles Shield Standard Plan

Standard ward coverage aligned with MediShield Life, Government Restructured Hospitals

Claim limits (SGD)

Raffles Shield Plan A

Higher Policy Year Limit applies if all Inpatient Episode/Day Surgery episodes treated by Panel Specialists, Extended Panel Specialists or Specialists from GRH; lower Policy Year Limit applies if any episode is treated by non-Panel/non-GRH Specialist — exact amounts in Benefit Schedule

Raffles Shield Plan B

Higher Policy Year Limit applies if all Inpatient Episode/Day Surgery episodes treated by Panel Specialists, Extended Panel Specialists or Specialists from GRH; lower Policy Year Limit applies if any episode is treated by non-Panel/non-GRH Specialist — exact amounts in Benefit Schedule

Raffles Shield Private

Higher Policy Year Limit applies if all Inpatient Episode/Day Surgery episodes treated by Panel Specialists, Extended Panel Specialists or Specialists from GRH; lower Policy Year Limit applies if any episode is treated by non-Panel/non-GRH Specialist — exact amounts in Benefit Schedule

Raffles Shield Standard Plan

Policy Year Limit as stated in Benefit Schedule

Co-payment & deductible

Panel hospitals & in/out-of-panel rules

Panel Specialists are listed at http://www.raffleshealthinsurance.com. A higher Policy Year Limit applies if all Inpatient Episode/Day Surgery episodes are treated by Panel Specialists, Extended Panel Specialists or Specialists from GRH. A lower Policy Year Limit applies as long as there is one Inpatient Episode/Day Surgery episode in which the Attending Physician is not a Panel Specialist, Extended Panel Specialist, or from a GRH. Extended Panel Specialists must obtain prior written approval via pre-authorisation before the Inpatient Episode/Day Surgery episode. A Co-Payment cap of $3,000 per Policy Year (with Raffles Key Rider selected) applies when the Attending Physician is a Panel Specialist or an approved Extended Panel Specialist.

Pre-existing conditions

Any Pre-Existing Illnesses from which the Insured is suffering from prior to the Policy Start Date are excluded, unless they were declared to Us in the proposal and specifically accepted by Us. Additionally, treatment or diagnosis of any serious illness (including ischaemic heart disease, cancer, stroke, renal failure, diabetes with complications, and others listed) for which the Insured received medical treatment during the period of twelve months prior to the Policy Start Date is excluded. Pre-Existing Illness is defined as any Illness the Insured was suffering from, or for which there were signs or symptoms the Insured sought or received treatment, or would be reasonably expected to seek treatment, prior to the Policy Start Date or the last Reinstatement Date, whichever is the later.

Cancer treatment

Outpatient cancer drug treatments are covered only where the drug-indication pairing is found on the Cancer Drug List (CDL) listed on MOH's website. Non-CDL treatments are not covered. For each primary cancer, drug omission or replacement with another CDL drug with indication 'for cancer treatment' is permitted only due to intolerance or contraindications. Where multiple cancer drug treatments are administered in a month, specific rules apply regarding which CDL treatments are claimable depending on the indications of the drugs administered. Higher claim limits for Multiple Primary Cancers are accorded on an application basis. Cancer Drug Services (consultations, scans, lab investigations, treatment preparation and administration fees, supportive care drugs and blood transfusions) are covered only as part of cancer drug treatment on the CDL; Cancer Drug Services incurred before cancer is diagnosed, after remission, or once treatment has ceased are not covered. Radiotherapy for cancer (external/superficial, brachytherapy, hemi-body, stereotactic radiotherapy, Proton Beam Therapy Categories 1, 2 and 3) is covered as outpatient. Proton Beam Therapy Category 4 is covered under radiosurgery benefit for Raffles Shield Standard Plan only. Proton Beam Therapy is only covered if administered for an MOH-approved indication and the Insured meets MediShield Life eligibility criteria. Cell, Tissue and Gene Therapy Treatment is covered for Raffles Shield Private, A and B as inpatient or Day Surgery, if approved by HSA and/or MOH and Medically Necessary. Pre-authorisation requirements and panel oncologist requirements are not explicitly stated beyond the general Panel/Extended Panel/Non-Panel mechanics.

MediShield Life integration

This Policy is an Integrated Shield Plan. MediShield Life coverage is provided as a component of the Policy. For the MediShield Life coverage component, a minimum of 8 consecutive hours applies for an Inpatient Episode. For the private insurance coverage component, a minimum of 12 consecutive hours applies. The Base Premium excludes any amount payable to the CPF Board for MediShield Life coverage. Some charges excluded under the private insurance component may be covered under MediShield Life, subject to MediShield Life terms, conditions and applicable Benefit Limits. MediSave may be used to pay premiums as referenced by the CPF Act and CPF Board references throughout the Policy.

Mental health cover

Inpatient Psychiatric Treatment: We will pay for charges for Psychiatric Treatment provided by a psychiatrist to the Insured while admitted to Hospital, capped at benefit limit for Raffles Shield Private, Plan A and Plan B. For Raffles Shield Standard Plan only, this Benefit is capped at 60 days per policy year. Post-Hospitalisation Psychiatric Treatment: covered up to 90 days after discharge from Hospital; charges form part of the same Benefit Limit as Inpatient Psychiatric Treatment (Raffles Shield Private, A and B only). Treatment for mental, emotional, personality, nervous, physical, psychological, learning, educational, behavioral and psychiatric problems, disorders and developments is excluded except where covered under clauses 3.2.7 and 3.4.3. Suicide, attempted suicide or intentional self-injury exclusion does not apply to Raffles Shield Standard Plans with admission date on or after 1 April 2023.

Maternity

Pregnancy complications must have been first diagnosed after the Insured has been insured under the Policy for a continuous period of 10 months from the Policy Start Date or last Reinstatement Date, whichever is the later. For Raffles Shield Private, A and B: We will pay for hospitalisation charges for specific serious pregnancy complications including choriocarcinoma and hydatidiform mole, disseminated intravascular coagulation, ectopic pregnancy, miscarriage (after 13 weeks), pre-eclampsia or eclampsia, and postpartum haemorrhage requiring hysterectomy. For Raffles Shield Standard Plan only: We will pay for inpatient treatment relating to a list of serious pregnancy and delivery-related complications per MOH website; this does not cover delivery charges except in the event of a Caesarean Section with Hysterectomy. General pregnancy, childbirth, abortion, miscarriage complications, fertility treatments, sterilisation, infertility and assisted reproduction are otherwise excluded.

Exclusions

• Expenses associated with hospitalisation or Day Surgery where the Insured was admitted or surgery started before the Policy Start Date
• Any Pre-Existing Illnesses from which the Insured is suffering from prior to the Policy Start Date, unless declared and specifically accepted by Us
• Treatment or diagnosis of any serious illness for which the Insured received medical treatment during the period of twelve months prior to the Policy Start Date (including ischaemic heart disease/coronary heart disease, heart valves disorders or arrhythmia, cancer, stroke/cerebrovascular disorders/tumour of the brain/AVM, renal failure or renal dialysis, diabetes with complications, chronic liver disorders/cirrhosis/hepatic encephalopathy/liver failure, AIDS/HIV infection, dementia/Alzheimer's Disease, severe psychiatric or mental illness, motor neuron disease, muscular dystrophy, paralysis, chronic lung disease, rheumatoid arthritis with complications, multiple sclerosis or any other degenerative disease, systemic lupus erythematosus, Parkinson's disease with complications, pulmonary hypertension, aplastic anaemia/thalassaemia major/severe blood disorders, and any other serious, life-threatening or terminal illness)
• Cosmetic or Plastic Surgery, except for breast reconstruction after mastectomy due to breast cancer and cosmetic/plastic surgery due to an accident resulting in permanent debilitating scarring or loss of functional use
• Treatment for birth defects, hereditary conditions and congenital sickness or abnormalities, except as covered under clause 3.4.10
• Consultation or treatment for developmental conditions, including developmental delay and/or learning disabilities in children
• Costs incurred from acquisition of an organ from a living donor and expenses incurred by the living donor, except as covered under clauses 3.4.4 and 3.4.6
• Dental treatment or surgery, except as covered under clause 3.2.8
• Correction for refractive errors of the eye including Lasik treatments, as well as routine eye and ear examinations, including costs of spectacles, contact lenses and hearing aids
• Overseas medical treatment or hospitalisation, except as covered under clause 3.4.9
• Treatment for mental, emotional, personality, nervous, physical, psychological, learning, educational, behavioral and psychiatric problems, disorders and developments, except where covered under clauses 3.2.7 and 3.4.3
• Treatment arising from pregnancy, childbirth, abortion or miscarriage and any complications therefrom; investigations and treatment relating to birth control, assisted reproduction, sterilisation (or its reversal), infertility and erectile dysfunction; consultation, treatment or surgical procedures done at fertility/reproductive clinics (except where covered under clause 3.4.7)
• Consultation or treatment for natural/physiological menopause and/or medical conditions arising directly from it (such as osteoporosis) except where menopause was induced by surgical removal of both ovaries deemed Medically Necessary
• Any investigation, test or treatment arising directly or indirectly from STDs, AIDS, any AIDS-related condition or infection by HIV, except as covered under clauses 3.4.11.1 and 3.4.11.2; investigations and treatment of sexually transmitted diseases resulting from Human Papilloma Virus are specifically excluded
• Sex reassignment surgery
• Purchase or rental of items for outpatient/home use (braces, prostheses, corrective devices, durable medical equipment/machines, hospital beds, iron lungs, kidney dialysis machines, oxygen machines, walking or home aids, wheelchairs, special/medical appliances and other hospital-type equipment), unless as part of MIC@Home and We agree to cover these charges
• Ambulatory care services, rest cures, outpatient nursing or palliative care, convalescent care, stays in healthcare establishments for health, social or non-medical reasons, spa, hydroclinic, sanatorium or long-term care facility that is not a Hospital
• Private nursing charges and nursing home services, other than palliative care services, unless as part of MIC@Home and We agree to cover these charges
• Occupational and speech therapy resulting from congenital medical conditions; speech therapy only covered for post-stroke rehabilitation for speech and swallowing; occupational therapy only covered for rehabilitation post hand surgeries
• Alternative or complementary treatments including Traditional Chinese Medicine, chiropractor, acupuncturist, podiatrist, reflexologist, naturopath, homeopath, osteopath, dietitian/nutritional therapy or stay in any health-care establishment for social or non-medical reasons
• Treatment for obesity, weight reduction or weight improvement; all bariatric surgeries/surgeries to achieve weight loss
• Experimental or pioneering medical or surgical techniques and medical devices not approved by the Institutional Review Board and the Centre of Medical Device Regulation; medical trials for medicinal products whether or not these trials have a clinical trial certificate issued by HSA
• Drugs or medicines not registered with HSA or MOH, except drugs on the CDL; drugs registered with HSA or MOH but used for purposes other than those approved by HSA or included in the CDL
• Treatment for injuries or disablement directly or indirectly resulting from addiction to any controlled drug listed under the Misuse of Drugs Act or the Insured being under the influence of any controlled drug
• Suicide, attempted suicide or intentional self-injury by the Insured (exclusion does not apply to Raffles Shield Standard Plans with admission date on or after 1 April 2023)
• Treatment for injuries or disablement directly or indirectly related to drug addiction or alcoholism or the Insured being under the influence of drugs or alcohol (exclusion does not apply to Raffles Shield Standard Plans with admission date on or after 1 April 2023)
• Treatment for which the Insured received reimbursement by workmen's compensation and other forms of insurance coverage and compensation
• Cost of any outpatient cancer drug treatment that is not on the CDL, unless otherwise stated in this Policy
• All medications, investigations or treatment requested by the Insured and not Medically Necessary, as well as optional items outside the scope of treatment or normal standards of practice
• Vaccination(s)

Available riders