Schedule of benefits

Benefits IncomeShield Standard Plan

Ward entitlement Restructured hospital for ward class B1 and below

Inpatient hospital treatment Limits of compensation
Room, board and medical-related services $1,700
(each day)
Intensive care unit (ICU) and medical-related $2,900
services (each day)
Surgical benefit (including day surgery)
Surgical limits table - limits for various categories
of surgery, as classified by the Ministry of Health
in its latest surgical operation fees tables
- Table 1 (less complex procedures) $590
- Table 2 $1,670
- Table 3 $3,290
- Table 4 $4,990
- Table 5 $8,760
- Table 6 $11,670
- Table 7 (more complex procedures) $16,720

Surgical implants (for each admission) $9,800

Gamma knife and novalis radiosurgery $9,600
(for each procedure)
Staying in a community hospital (each day) $650
Inpatient psychiatric treatment (each day, up to $500
35 days for each policy year)

Outpatient hospital treatment Limits of compensation

Stereotactic radiotherapy for cancer (for each $1,800
session)
Radiotherapy for cancer (for each session)
- External or superficial $550
- Brachytherapy with or without external $1,100
Chemotherapy for cancer (each month) $5,200
Renal dialysis (each month) $2,750
Erythropoietin and other drugs approved under $450
MediShield Life for chronic renal failure
(each month)
Cyclosporin or tacrolimus and other drugs $1,200
approved under MediShield Life for organ
transplant (each month)
Benefits IncomeShield Standard Plan
Pro-ration factor Singapore Singapore Foreigner
Citizen Permanent
Resident
Inpatient
- Restructured hospital
- Ward class C, B2 or B2+ Does not apply Does not apply Does not apply
- Ward class B1 Does not apply 90% 80%
- Ward class A 80% 80% 80%
- Private hospital or private medical institution 50% 50% 50%
- Community hospital
- Ward class C, B2 or B2+ Does not apply Does not apply Does not apply
- Ward class B1 Does not apply 90% 80%
- Ward class A 80% 80% 80%
Day surgery or short-stay ward
- Restructured hospital subsidised Does not apply Does not apply Does not apply
- Restructured hospital non-subsidised Does not apply Does not apply Does not apply
- Private hospital or private medical institution 65% 65% 65%
Outpatient hospital treatment
- Restructured hospital subsidised Does not apply Does not apply Does not apply
- Restructured hospital non-subsidised Does not apply Does not apply Does not apply
- Private hospital or private medical institution 65% 65% 65%

Deductible for each policy year for an insured aged 80 years or below next birthday
Inpatient
- Restructured hospital
- Ward class C $1,500
- Ward class B2 or B2+ $2,000
- Ward class B1 $2,500
- Ward class A $2,500
- Private hospital or private medical institution $2,500
- Community hospital
- Ward class C $1,500
- Ward class B2 or B2+ $2,000
- Ward class B1 $2,500
- Ward class A $2,500
Day surgery or short-stay ward
- Subsidised $1,500
- Non-subsidised $2,000
Benefits IncomeShield Standard Plan

Deductible for each policy year for an insured aged over 80 years at next birthday
Inpatient
- Restructured hospital
- Ward class C $2,000
- Ward class B2 or B2+ $3,000
- Ward class B1 $3,000
- Ward class A $3,000
- Private hospital or private medical institution $3,000
- Community hospital
- Ward class C $2,000
- Ward class B2 or B2+ $3,000
- Ward class B1 $3,000
- Ward class A $3,000
Day surgery or short-stay ward
- Subsidised $3,000
- Non-subsidised $3,000

Co-insurance 10%
Limit in each policy year $150,000
Limit in each lifetime Unlimited
Last entry age (age next birthday) Does not apply
Maximum coverage age Lifetime
Conditions for IncomeShield Standard Plan

Your policy 1 What your policy covers

This is your IncomeShield Standard Plan policy. Your policy covers the following benefits.
It contains:
 these conditions; The benefits only pay for reasonable expenses
 the policy certificate; for necessary medical treatment for the
 the schedule of benefits; and insured. This treatment must be provided by a
 the riders and endorsements (if this hospital or a licensed medical centre or clinic,
applies). all of which must be accredited by MOH to
take part in the MediShield Life scheme.
The full agreement between us and you is
made up of these documents and: All benefits are paid as a reimbursement for
 all statements to medical officers; treatment received and paid by the insured
due to illness or injury, and depend on the
 declarations and questionnaires relating
terms, conditions and limits set out in the
to your and the insured’s lifestyle,
schedule of benefits and your policy.
occupational or medical condition which
you or the insured provided to us for our
underwriting purposes; and
 written correspondence we have issued 1.1 Inpatient hospital treatment
relating to your policy and which we
intend to be legally binding between you The inpatient hospital treatment benefit pays
and us. for the types of costs set out below, and
depends on the limits in the schedule of
We refer to them all together as ‘Your policy’. benefits under the heading ‘Inpatient hospital
Please examine them to make sure you have treatment’. These costs must be for treatment
the protection you need. It is important that received by the insured while staying in a
you read them together to avoid hospital.
misunderstanding.
If the insured is in hospital for only part of a
Words defined in the definitions section of day, we will halve the limits of compensation
these conditions have the meanings given to for the room, board and medical-related
them in the definitions section and the same services benefit and the intensive care unit
definitions apply if the defined words are used (ICU) and medical-related services benefit for
in any of the documents in your policy or any that part-day. Whether we class the stay in
correspondence between you and us. hospital as a full day or part of a day will
depend on whether the hospital charges the
IncomeShield is a medical insurance plan room rate for a full day or for half a day, for the
which covers you for costs associated with day in question.
staying in hospital and having surgery. If your
policy is integrated with MediShield Life, it Inpatient hospital treatment benefit is made
adds to the MediShield Life tier operated by up of the following sub-benefits.
the CPF Board and provides extra benefits to
meet the needs of those who would like more a Room, board and medical-related
cover and medical insurance protection. You services
will find details of what we will cover set out in
your policy. Ward charges the insured has to pay for each
day in a hospital including:

LHO/IncomeShield Standard/201603 Page 1 of 15

 meals; Any surgery not listed in MOH’s surgical
 prescriptions; operation fees table 1 to 7 as at the date of the
 medical consultations; surgery is not covered.
 miscellaneous medical charges;
 specialist consultations; d Surgical implants
 examinations;
 laboratory tests; and Charges the insured has to pay for implants in
 being admitted to a high-dependency their body during surgery. These implants
ward. must stay in the insured’s body after the
surgery. The charges for the following
If the insured is in a short-stay ward, we will approved medical items are also covered.
pay for the ward charges.  Intravascular electrodes used for
electrophysiological procedures
If the insured is in a luxury or deluxe suite or  Percutaneous transluminal coronary
any other special room of a hospital, we will angioplasty (PTCA) balloons
pay only the equivalent of room, board and  Intra-aortic balloons (or balloon catheters)
medical-related services for a standard room
in the hospital. We will also apply the pro- e Gamma knife and novalis radiosurgery
ration factor if the insured is admitted to a
ward or hospital that is higher than their ward Covers gamma knife and novalis radiosurgery
entitlement. carried out on the insured.

b Intensive care unit (ICU) and medical- f Staying in a community hospital

related services
Charges the insured has to pay for each day
Charges the insured has to pay for each day in while staying in a community hospital.
an ICU including:
 meals; To claim the inpatient hospital treatment
 prescriptions; benefit for a stay in a community hospital, the
 medical consultations; following conditions must all be met.
 miscellaneous medical charges;  The insured must have first had inpatient
 specialist consultations; hospital treatment in a restructured
hospital or private hospital.
 examinations; and
 After the insured is discharged from the
 laboratory tests.
restructured hospital or private hospital,
they must be immediately admitted to a
c Surgical benefit
community hospital for a continuous
period of time.
Charges the insured has to pay for surgery
(including day surgery) in a hospital by a  The attending registered medical
surgeon including: practitioner in the restructured hospital
or private hospital must have
 surgeon’s fees;
recommended in writing that the insured
 fees and charges for anaesthesia and
needs to be admitted to a community
oxygen and for them to be administered;
hospital for necessary medical treatment.
and
 The treatment must arise from the same
 using the hospital’s operating theatre and
injury, illness or disease that resulted in
facilities.
the inpatient hospital treatment.
Surgical benefit depends on the surgical limits
table.

LHO/IncomeShield Standard/201603 Page 2 of 15

g Inpatient psychiatric treatment doubt, follow-up consultation fees,
benefit medicines, examinations and tests after
the outpatient hospital treatment are not
Inpatient psychiatric treatment benefit pays covered.
for psychiatric treatment provided to the
insured while in hospital by a registered
medical practitioner qualified to provide that
psychiatric treatment, for each day up to 35 2 Our responsibilities to you
days for each policy year.

1.2 Outpatient hospital treatment We are only responsible to you for the cover
and period shown in your policy certificate or
The outpatient hospital treatment benefit renewal certificate (as the case may be). The
pays for medical treatment of the insured set policy is governed by the terms, conditions and
out below and depends on the limits in the limits of the schedule of benefits and your
schedule of benefits under the heading policy.
‘Outpatient hospital treatment’.

Outpatient hospital treatment covers the 2.1 Claims

following received by the insured from a
hospital or a licensed medical centre or clinic. Depending on the terms, conditions and limits
in the schedule of benefits and your policy,
a Stereotactic radiotherapy, radiotherapy we use the following limits in the following
and chemotherapy for cancer. order on the benefits covered (if it applies).
b Renal dialysis. a Pro-ration factor
c Approved immunosuppressant drugs b The limits of compensation
including erythropoietin for chronic renal c The deductible
failure, cyclosporin and tacrolimus for d Co-insurance
organ transplant (to avoid doubt, this does e The limit in each policy year.
not include stem-cell or bone marrow
transplant) and other drugs approved by As long as you have paid the premium or any
the Health Science Authority of Singapore. amount you owe us under your policy, we will
d Outpatient consultation fees, medicines, pay you the benefits.
examinations and tests ordered by the
attending registered medical practitioner All claims must be made and sent to us
which take place within 30 days before the through the system set up by MOH (electronic
outpatient hospital treatment. The filing) and according to the act and regulations
consultation fees, medicines, within 90 days from the date of billing or the
examinations and tests must be needed as date the insured leaves hospital, whichever is
a result of the same injury, illness or later. We will only accept claims that are
disease that resulted in the outpatient electronically filed and we will pay the hospital
hospital treatment, and the medicines direct. You must give us any other documents,
must be used within 30 days before the authorisations or information we need for
outpatient hospital treatment. We will assessing the claim. You must also pay any
treat these claims as part of the outpatient costs involved.
hospital treatment, and pay benefits
depending on any balance under the limits For claims which are not integrated with
of compensation for the outpatient MediShield Life, you must send the claim to us
hospital treatment that the insured by post or by hand. These claims must be sent
receives within the next 30 days. To avoid to us within 90 days from the date of billing or

LHO/IncomeShield Standard/201603 Page 3 of 15

the date the insured leaves hospital, 2.2 Deductible and co-insurance
whichever is later.
You must pay the deductible and co-insurance
To make a claim for the benefit under clause before we pay any benefit. We will apply the
1.2(d), the claim for outpatient hospital deductible followed by the co-insurance.
treatment under clause 1.2(a), (b) or (c) must
have already been filed and approved. For each period of 12 months or less that the
insured stays in hospital, you must pay the
You, or if you die, your legal representative, deductible for one policy year (even if the stay
must give us all documents, authorisations or in a hospital runs into the next policy year). If
information we need to assess the claim. You the stay is for a continuous period of more
must also pay any costs involved in doing so. If than 12 months but less than 24 months, you
you, your legal representative or the insured must also pay the deductible for the next
fails to co-operate with us in dealing with the policy year. And, for each further period of 12
claim, the assessment of the claim may be months or less that the stay in hospital
delayed or we can reject the claim. extends, you must pay a further deductible for
one extra policy year.
We will pay claims according to your policy or
MediShield Life, whichever is higher. If the insured stays in different hospitals over
a continuous period of time, we will treat the
If your plan is not integrated with MediShield expenses for the stay in each hospital as a
Life, your plan does not cover the MediShield separate claim and apply the deductible and
Life tier operated by the CPF Board. We will co-insurance for each claim.
pay claims according to your policy.

If your claim includes expenses that are not 2.3 Limits of compensation and limit in
reasonable, we will pay only the amount of each policy year
your claim that we believe is reasonable
expenses. We can reduce your claim to reflect If it applies, you must pay any amount over the
what would have been reasonable, based on limits of compensation or the limit in each
the professional opinion of our registered policy year.
medical practitioner or the insured’s
entitlement to benefits under your policy. If For each stay in a hospital of 12 months or less,
there is a difference in opinion between our we will apply the limit in each policy year for
registered medical practitioner and your one policy year (even if the stay in a hospital
registered medical practitioner, the matter runs into the next policy year). If the stay in a
will be referred to an independent person for hospital is for a continuous period of more
adjudication under clause 4.14 of these than 12 months but less than 24 months, the
conditions. limit in each policy year for two policy years
will apply. And, for each further period of 12
months or less that the stay in a hospital
extends for, the limit in each policy year for
one extra policy year will apply.

LHO/IncomeShield Standard/201603 Page 4 of 15

 How we apply the deductible and limit in each policy year
(Figures are for illustration purposes only.)

Example 1

If your policy began on 1 January in year X, the policy year will run from 1 January to 31 December in year X and will
renew from 1 January to 31 December in year X+1. If the insured’s stay in hospital is from 28 December in year X to 1
January in year X+1 (runs into the next policy year but for a continuous period of less than 12 months), we will work out
the claim as follows for an insured who is a Singapore Citizen, covered under IncomeShield Standard Plan staying in
ward class B1 of a restructured hospital.

Expenses Limits of Bill Amount

compensation you can claim

Room, board and medical-related services (5 $8,500

$3,000 $3,000
days) ($1,700 a day x 5 days)

Surgical benefit (table 7) $16,720 $10,000 $10,000

Total $13,000 $13,000

Less deductible $2,500

Less co-insurance: 10% x ($13,000 - $2,500) $1,050

IncomeShield Standard Plan (including
MediShield Life) pays (this depends on the limit $9,450
in each policy year)
Insured pays $3,550

Example 2

If your policy began on 1 January in year X, the policy year will run from 1 January to 31 December in year X and will
renew from 1 January to 31 December in year X+1. If the insured’s stay in hospital is from 28 December in year X to 29
December in year X+1 (runs into the next policy year and for a continuous period of more than 12 months but less than
24 months), we will work out the claim as follows for an insured who is a Singapore Citizen, covered under
IncomeShield Standard Plan staying in a ward class B1 of a restructured hospital.

Expenses Limits of Bill Amount

compensation you can claim
$623,900
Room, board and medical-related services
($1,700 a day x 367 $220,200 $220,200
(367 days)
days)
Surgical benefit (table 7) $16,720 $10,000 $10,000

Total $230,200 $230,200

Less deductible: ($2,500 x 2 years) $5,000

Less co-insurance: 10% x ($230,200 - $5,000) $22,520

IncomeShield Standard Plan (including
MediShield Life) pays (this depending on two $202,680
times the limit in each policy year)
Insured pays $27,520

LHO/IncomeShield Standard/201603 Page 5 of 15

2.4 Pro-ration factor insured’s medical expenses which they can
claim under your policy.
a Ward entitlement and pro-ration factor for
inpatient hospital treatment

The ward entitlement means the class of ward 3 Your responsibilities

and medical institution covered by your policy
and depends on the plan. The ward entitlement
is shown in the schedule of benefits. 3.1 Premium

The class of ward covered refers to a standard Your policy certificate or the renewal certificate
room, and does not include luxury suites, luxury (as the case may be) shows the premium which
rooms or any other special room in the hospital. you have to pay to us to receive the benefits.
You must pay the premium every year.
If the insured is admitted into a ward and
medical institution that is the same as or lower We give you 60 days’ grace from the renewal
than their ward entitlement, we pay date to pay the premium for your policy. During
reasonable expenses for the necessary medical this period of grace, your policy will stay in force.
treatment according to the plan. We will pay up You must first pay any premium or other
to the limits of compensation. amounts you owe us before we pay any claim
under your policy.
If the insured is admitted into a ward and
medical institution that is higher than what they If you still have not paid the premium after the
are entitled to, we will only pay the percentage period of grace, your policy will be cancelled.
of the reasonable expenses for necessary This cancellation will apply from the renewal
medical treatment of the insured as shown date.
using the pro-ration factor which applies to the
plan. This is set out in the schedule of benefits. You are responsible for making sure that your
We will work out the benefits we will pay by premium is paid up to date.
multiplying the relevant pro-ration factor by the
insured’s medical expenses which you can claim We may take your premium from your
under your policy. Medisave account according to the act and
regulations.
b Pro-ration factor for outpatient hospital
treatment You will need to pay the premium, or any part
of it, by cash if:
If the insured receives outpatient hospital a the premium you owe is more than the
treatment from a restructured hospital, we pay maximum withdrawal limit set by the CPF
reasonable expenses for their necessary Board;
medical treatment according to the plan. We b there are not enough funds in your
will pay up to the limit of compensation. Medisave account to pay the premium due;
or
If the insured receives outpatient hospital c the premium, or part of it, is not taken from
treatment from a private hospital or private your Medisave account for any reason.
medical institution, we will only pay the
percentage of the reasonable expenses for the
necessary medical treatment of the insured,
depending on the pro-ration factor which
applies to the plan, as set out in the schedule of
benefits. We will work out the benefits we will
pay by multiplying the pro-ration factor by the

LHO/IncomeShield Standard/201603 Page 6 of 15

3.2 Refunding your premium when the new premium is. We will change the premium
policy ends for your policy only if the change applies to all
policies within the same class.
When your policy ends, we will refund the
unused part of the premium (based on our scale
of refund as shown below):
a to your Medisave account (if your premium 4 What you need to be aware of
was paid using deductions from your
Medisave account); or
b in cash (if your premium was paid in cash). 4.1 Other insurance, benefit, incentive or
subsidy scheme
How we use our scale of refund
(Figures are for illustration purposes only.)
We do not pay for claims if the medical expenses
Example have been paid, or you or the insured have
received a refund or similar benefits from other
Policy year : 1 January to
31 December sources, whether under any insurance,
in year X incentive (including discounts) or subsidy
IncomeShield Standard Plan : $100 scheme.
yearly premium
MediShield Life yearly premium : $50 If you or the insured have other medical
(for the relevant age next birthday)
insurance, or medical benefits under any
If the policy ends on 30 November in year X, the number employment contract, which allows you or them
of days unused left for the policy year will be 31 days. to claim a refund for medical expenses, you or
the insured must first claim from these policies
If the policy is integrated with MediShield Life, the or employee benefits before making any claim
refund amount will be:
31 days/365 days x ($100-$50) = $4.25
under your policy. Our obligations to pay under
your policy will only arise after you have fully
If the policy is not integrated with MediShield Life, or if claimed under these policies or employee
the policy ends because you have switched insurer or benefits.
died, the refund amount will be:
31 days/365 days x $100 = $8.49
If we have paid any benefit to you first before a
claim is made under the other medical insurance
If you had paid the premium partly by CPF and
policies or employee benefits, the other medical
partly by cash, we will refund the premium as a
insurers or employer will have to refund us their
percentage to the amount of the premium paid
by CPF or cash. share. You must give us all information and
evidence we need to help us get back any other
Example medical insurer’s or employer’s share of the
claim we have paid. For every claim, the total
If you pay 70% of your premium from your Medisave
account and the other 30% in cash, the refund of reimbursement we will make will not be more
unused premium will be in the same percentage – than the actual expenses paid.
meaning 70% returned to your Medisave account and
30% paid in cash to you.

4.2 Declaring the insured’s age

3.3 Change in premium The premium is based on the age of the insured
on his or her next birthday. If the age or date of
The premium that you pay for this policy can birth of the insured is shown wrongly in the
change from time to time. If we change the application form, we will adjust the premium
premium for your policy, we will write to you at you must pay. We will refund any extra
your last known address, at least 30 days before premium paid or ask for any shortfall in
the change is to take place, to tell you what your premium you need to pay.

LHO/IncomeShield Standard/201603 Page 7 of 15

4.3 Guaranteed renewal to be insured under MediShield Life as long as
you are eligible under the act and regulations.
We will renew your policy automatically every
year. We guarantee to do this for life as long as: If you are not the insured, as long as you have
a the premium is paid at the current rate paid all the premiums and your policy is not
which applies; and cancelled or ended, if you die, it will not affect
b the cover for the insured under your policy the cover of the insured under your policy.
has not been ended.

4.7 Reinstating the policy

4.4 Cancelling the policy
If your policy is cancelled because you have not
You may cancel your policy by giving us at least paid the premiums, you may apply to reinstate
30 days’ notice in writing. We will tell you the your policy.
date it will end.
You can do this if we agree and you meet all of
the following conditions.
4.5 Not enforcing a condition a You must pay all premiums you owe before
we will reinstate your policy.
If we do not enforce any of the conditions of b We will not pay for any expenses which
your policy at any time, it does not mean we happen between the date the policy ends
cannot enforce it in the future. and the date immediately before the
reinstatement date of your policy.
c If there is any change in the insured’s
4.6 Ending the policy medical or physical condition, we may add
exclusions or charge an extra premium from
All benefits will end when one of the following the reinstatement date.
events happens, and we will not be legally
responsible for any further payment under your To avoid doubt, if we accept any premium after
policy. your policy has ended, it does not mean we will
a You cancel your policy under clause 4.4. not enforce our rights under your policy or
b We do not receive your premium after the create any liability for us in terms of any claim.
period of grace. Our responsibility to pay will only arise after we
c The insured dies. have reinstated your policy.
d You fail or refuse to pay or refund any
amount you owe us.
e Fraud as shown in clause 4.12. 4.8 Change of citizenship and residency
f Not revealing relevant information or status
misrepresentation as shown in clause 4.11.
g If another Medisave-approved Integrated You must tell us, as soon as possible, when the
Shield Plan is taken out to cover the insured. insured’s citizenship or residency status
changes in any way.
We or the CPF Board (as the case may be) will
decide on what date your policy will end.
4.9 Changing policy terms or conditions
When the policy ends, you have no further
claims or rights against us under your policy. We may change the premiums, benefits or
cover or these conditions at any time. However,
Ending your policy will not affect your insurance we will write to you at your last-known address
cover under MediShield Life. You will continue at least 30 days before doing so. We will apply

LHO/IncomeShield Standard/201603 Page 8 of 15

the changes only if the changes apply to all 4.13 Currency
policies within the same class.
All premium and benefits will be paid in
Singapore dollars.
4.10 Changing the plan

You may write and ask to change the plan if we 4.14 Dealing with disputes
approve. If we do approve your request, we will
tell you when the change in plan will take place. Any dispute or matter arising under, out of or in
connection with your policy must be referred to
the Financial Industry Disputes Resolution
4.11 Giving us all information Centre Ltd (FIDReC) to be dealt with. (This
applies if it is a dispute that can be brought
You and the insured must give us all significant before FIDReC.)
information about the insured, up to the start
date of your policy, or the last reinstatement If the dispute cannot be referred to or dealt with
date of your policy (if any), whichever is later, by FIDReC, the dispute must be referred to and
that may influence our decision whether to decided using arbitration in Singapore in line
provide cover or to impose any terms under with the Arbitration Rules of the Singapore
your policy. International Arbitration Centre which apply at
that point of time. We will not be legally
If you fail to give us this information or responsible under your policy unless you have
misrepresent any information, we may: first received an award under arbitration.
a declare your policy as ‘void’ from the start
date, or end the cover for the insured and
we will not pay any benefits; or 4.15 Excluding the rights of others
b add extra or change the terms and
conditions for your cover. A person who is not directly involved in your
policy will have no right, under the Contracts
(Rights of Third Parties) Act (Cap 53B), to
4.12 Fraud enforce any of its terms.

If a claim or any part of a claim is false or

fraudulent, or if you use fraudulent methods or 4.16 Integration with MediShield Life
devices to gain any benefit, we can do any or all
of the following. The MediShield Life scheme is run by the CPF
 We may declare your policy invalid and you Board under the act and regulations.
will lose all benefits under this policy. You
will have to repay to us all amounts we have Your policy is integrated with MediShield Life if
paid out under the policy and we will refund the insured meets the eligibility conditions
all premiums to you. shown in the act and regulations.
 We may end your policy.
 We may refuse to renew your policy. If your policy is integrated with MediShield Life
 We may add extra terms and conditions. If to form a Medisave-approved Integrated Shield
you disagree with the addition of extra Plan, the following will apply.
terms and conditions, you can write to us to a The insured will enjoy all benefits under
cancel this policy. You will have to repay to MediShield Life provided in the act and
us all amounts we have paid out under the regulations.
policy and we will refund all premiums to b If the cover for the insured under this policy
you. ends, the cover for the insured under
MediShield Life will continue as long as the

LHO/IncomeShield Standard/201603 Page 9 of 15

 insured meets the eligibility conditions MediShield Life at the time the claim is
shown in the act and regulations. made under your policy.
c If the MediShield Life cover ends or is not c Cosmetic surgery (unless this is covered
renewed, this policy will continue without under cosmetic surgery due to accident or
any integration with MediShield Life. breast reconstruction after mastectomy) or
any medical treatment claimed to generally
prevent illness, promote health or improve
4.17 Notice of communication bodily function or appearance.
d General outpatient medical expenses or
We will assume any notice or communication retail items or treatment before or after the
under this policy has been given and received if inpatient hospital treatment or outpatient
sent: hospital treatment, even when the
a personally – on the day it is delivered; treatment arises from the same injury,
b by prepaid mail – within seven days after the illness or disease that resulted in the
mail is sent; inpatient or outpatient hospital treatment
c by fax – immediately, as long as a (unless this is covered under outpatient
transmission report is produced by the hospital treatment).
machine from which the fax was sent which e Treatment for birth defects, including
shows that the fax was sent to the fax hereditary conditions and disorders and
number of the recipient; or congenital sickness or abnormalities.
d by email, SMS or other electronic means – f Overseas medical treatment.
as soon as it is sent. g Psychological disorders, personality
disorders, mental conditions or behavioural
disorders, including any addiction or
4.18 Exclusions dependence arising from these disorders
such as gambling or gaming addiction
The following treatment items, procedures, (unless we cover it under inpatient
conditions, activities and their related psychiatric treatment benefit).
complications are not covered under your policy. h Pregnancy, childbirth, miscarriage, abortion
a A stay in hospital if the insured was or termination of pregnancy, or any form of
admitted to the hospital before the start related stay in hospital or treatment.
date or, if it applies, between the date the i Infertility, sub-fertility, assisted conception,
policy ends and the date immediately erectile dysfunction, impotence or any
before the reinstatement date of your contraceptive treatment.
policy. j Treatment of sexually-transmitted diseases.
b Any pre-existing illness, disease or k Acquired immunodeficiency syndrome
condition from which the insured was (AIDS), AIDS-related complex or infection by
suffering, unless declared in the application human immunodeficiency virus (HIV)
form and we accepted the application (except HIV due to blood transfusion and
without any exclusions. However, any pre- occupationally acquired HIV).
existing illness, disease or condition which l Treatment for self-inflicted injuries or
falls under any other exclusion under this injuries or illnesses resulting from suicide or
clause 4.18 is not covered under your policy, attempted suicide, whether the insured is
whether a declaration was made in the sane or insane.
application form or not. To avoid doubt, any m Drug or alcohol abuse or misuse, or any
pre-existing illness, disease or condition injury, illness or disease caused directly or
(including birth defects and congenital indirectly by the abuse or misuse of alcohol,
sickness or abnormalities) will be covered drugs or substance.
under MediShield Life according to the act n Expenses of getting an organ or body part
and regulations, as long as the insured for a transplant from a living donor for the
satisfies the eligibility criteria for

LHO/IncomeShield Standard/201603 Page 10 of 15

 insured and all expenses the living donor y Rest cures, hospice care, home or
has to pay. outpatient nursing, home visits or
o Dental treatment (unless this is covered treatments, home rehabilitation or
under accident inpatient dental treatment). palliative care, convalescent care in
p Transport-related services including convalescent or nursing homes,
ambulance fees, emergency evacuation, sanatoriums or similar establishments,
sending home a body or ashes. outpatient rehabilitation services such as
q Sex-change operations. counselling and physical rehabilitation.
r Buying or renting the following, including z Alternative or complementary treatments,
parts attached to them, for use at home or including traditional Chinese medicine
as an outpatient. (TCM), chiropractic, osteopathy or a stay in
 Braces any health-care establishment for social or
 Prostheses non-medical reasons.
 Medical appliances including storage, aa Treatment for illness or injury resulting from
transport and associated administrative the insured taking part in any dangerous
costs of those appliances and which are activities or sports, when they are
not necessary to complete a surgical performed in a professional capacity or
operation. when income could or would be earned
 Medical equipment or machines from those activities or sports.
 Corrective devices ab Treatment for obesity, losing weight,
 Wheelchairs increasing weight, or any procedures
 Walking aids relating to managing weight.
 Home aids ac Staying in a hospital mainly for general
 Renal-dialysis machines physical or medical check-ups or screenings.
ad Non-medical items such as parking fees,
 Iron lungs
hospital administration and registration
 Oxygen machines
fees, laundry, television rental, newspaper
 Hospital beds
or medical report (including test results)
 Replacement organs
fees.
 Any other hospital-type equipment ae Genetic testing and preventive treatment or
s Optional items which are outside the scope procedures.
of treatment or prostheses.
t Experimental or pioneering medical or Some of the exclusions shown above may be
surgical techniques and medical devices not covered under MediShield Life.
approved by the Institutional Review Board
and the Centre of Medical Device Regulation
and medical trials for medicinal products
whether or not these trials have a clinical
trial certificate issued by the Health Sciences 5 Definitions
Authority of Singapore.
u Private nursing charges and nursing home
services. Accident means an unexpected incident that
v Vaccinations. happens on or after the start date of your policy,
w Treatment of injuries arising from being or the last reinstatement date, whichever is
directly or indirectly involved in civil later, that results in an injury. The injury must be
commotion, riot, strike or terrorist activities, caused entirely by being hit by an external
breaking or attempting to break the law, object that produces a bruise or wound; except
resisting arrest or any imprisonment. for injury caused specifically by drowning, food
x The consequences arising, whether directly poisoning, choking on food, or suffocation by
or indirectly, from nuclear fallout, smoke, fumes, or gas.
radioactivity, any nuclear fuel, material or
waste, war and related risks.

LHO/IncomeShield Standard/201603 Page 11 of 15

Accident inpatient dental treatment means performed during a stay in hospital within 365
inpatient treatment to remove, restore or days of the accident.
replace sound natural teeth which have been
lost or damaged in an accident. CPF Board means the Central Provident Fund
Board of Singapore.
Act means the Central Provident Fund Act (Cap.
36) and the MediShield Life Scheme Act (Act No. Deductible means the part of the benefit you
4 of 2015), as amended, extended or re-enacted are claiming that the insured must pay before
from time to time. we will pay any benefit. The deductible is shown
in the schedule of benefits. The deductible does
Application form means the application to not apply to claims for outpatient hospital
cover the insured under this policy you make to treatment covered by your policy.
us.
Expiry date means the date the insurance cover
Benefits means the benefits set out in the under your policy ends and is shown in the
schedule of benefits and your policy. policy certificate or renewal certificate (as the
case may be).
Breast reconstruction after mastectomy means
reconstructive surgery of the breast on which a HIV due to blood transfusion means infection
mastectomy has been performed as a result of with the human immunodeficiency virus (HIV) as
breast cancer. The breast reconstruction must a result of a blood transfusion as long as all of
be performed by a registered medical the following conditions are met.
practitioner during a stay in hospital within 365  The blood transfusion is necessary medical
days from the date the insured leaves the treatment.
hospital when the mastectomy was done. The  The blood transfusion was received in
breast cancer must be first diagnosed on or after Singapore on or after the start date or last
the start date of your policy, or the last reinstatement date (if any), whichever is
reinstatement date, whichever is later. Any later.
surgery or reconstruction of the other breast to  The source of infection is from the hospital
produce a symmetrical appearance will not be that gave the blood transfusion.
covered.  The cause of HIV is the blood provided by
the hospital that gave the blood transfusion.
Co-insurance means the amount that you need  The insured does not suffer from
to pay after the deductible. The co-insurance thalassaemia major or haemophilia.
percentages for the benefits are shown in the We do not cover HIV infection resulting from
schedule of benefits. Co-insurance applies to all any other means, including sexual activity and
claims made under your policy. using intravenous drugs.

Community hospital means any approved Hospital means:

community hospital under the act and  a restructured hospital;
regulations that provides an intermediate level  a private hospital;
of care for individuals who have simple illnesses  a community hospital; or
which do not need specialist medical treatment  any other hospital we accept.
and nursing care.
Insured means the person named as the insured
Cosmetic surgery due to accident means a in the policy certificate or renewal certificate
necessary medical treatment done to repair (as the case may be).
damage for the injury caused only by an
accident. This surgery must be recommended Intensive care unit (ICU) means the intensive
by the registered medical practitioner who care unit of a hospital.
treated the insured for the injury and must be

LHO/IncomeShield Standard/201603 Page 12 of 15

Limit in each lifetime means the maximum  The incident happened while the insured
amount (if any) shown in the schedule of was carrying out their normal professional
benefits which we will pay under your policy duties in Singapore as a medical practitioner,
during the lifetime of the insured. houseman, medical student, state
registered nurse, medical laboratory
Limit in each policy year means the maximum technician, dentist, dental surgeon, dental
amount set out in the schedule of benefits nurse or paramedical worker working in a
which we will pay under your policy for the hospital or in a licensed medical centre or
relevant policy year. clinic in Singapore.
We will not cover HIV infection resulting from
Limits of compensation means the limits of any other means, including sexual activity and
compensation set out in the schedule of using intravenous drugs.
benefits and is the most we will pay in benefits.
Period of grace means the period shown in
MOH means the Ministry of Health, Singapore. clause 3.1.

MediShield Life means the basic tier of Plan means the type of plan that you have
insurance protection scheme run by the CPF chosen under your policy and which is shown in
Board and governed by the act and regulations. the policy certificate or the renewal certificate
(as the case may be).
Necessary medical treatment means treatment
which, in the professional opinion of a Policy certificate means the policy certificate
registered medical practitioner or a specialist in which we issue to you.
the relevant field of medicine, is appropriate
and consistent with the symptoms, findings, Policy year means one year starting from:
diagnosis and other relevant clinical  the start date; or
circumstances of the illness or injury and  if your policy is renewed, the renewal date.
reduces the negative effect of the illness or
injury on the insured’s health. The treatment Pre-existing illness, disease or condition means
must be provided in line with generally accepted any illness, disease or condition:
medical practice in Singapore.  for which the insured asked for or received
treatment, medication, advice or diagnosis
Occupationally acquired HIV means infection (or which they ought to have asked for or
with the human immunodeficiency virus (HIV) received) before the start date or the last
which resulted from an incident which reinstatement date (if any), whichever is
happened on or after the start date or the last later;
reinstatement date (if any), whichever is later,  which was known to exist before the start
while the insured was carrying out their job. date or the last reinstatement date (if any),
However, you must give us satisfactory proof of whichever is later, whether or not the
all of the following. insured asked for treatment, medication,
 You must report the incident giving rise to advice or diagnosis; or
the HIV infection to us within 30 days of the  the conditions or symptoms of which
incident. existed before the start date or the last
 We need proof that the incident was the reinstatement date (if any), whichever is
cause of the HIV infection. later, and would have led a reasonable and
 We also need proof that the insured has sensible person to get medical advice or
changed from HIV negative to HIV positive treatment.
during the 180 days after the reported
incident. This proof must include a negative Premium means the premium as shown in
HIV antibody test carried out within five clause 3.1.
days of the incident.

LHO/IncomeShield Standard/201603 Page 13 of 15

Private hospital means any licensed private  is governed by broad policy guidance from
hospital in Singapore that is not a restructured the Singapore Government through MOH;
hospital. and
 receives a yearly government subsidy to
Private medical institution means any licensed provide subsidised medical services to its
private clinic or medical centre in Singapore. patients.

Pro-ration factor means the pro-ration factor as Schedule of benefits means the schedule of
shown in clause 2.4. benefits attached to these conditions (or any
revised schedule of benefits which we may issue
Reasonable expenses means expenses paid for in an endorsement to your policy, or when
medical services or treatment which are renewing your policy).
appropriate and consistent with the diagnosis
and according to accepted medical standards, Short-stay ward means a ward in the
and which could not have reasonably been emergency department of a hospital for
avoided without negatively affecting the patients who need a short period of inpatient
insured’s medical condition. These expenses monitoring and treatment.
must not be more than the general level of
charges made by other medical service suppliers Specialist means a registered medical
of similar standing in Singapore for the services practitioner who has the extra qualifications
and supplies. and expertise needed to practise as a recognised
specialist of diagnostic techniques, treatment
Registered medical practitioner means a doctor and prevention, in a particular field of medicine,
qualified in western medicine who is licensed like psychiatry, neurology, paediatrics,
and authorised in the geographical area they are endocrinology, obstetrics, gynaecology,
practising in to provide medical or surgical dermatology and physiotherapy.
services. This cannot be you, the insured or your
or the insured’s parent, brother or sister, Start date means the date your policy starts and
husband or wife, child or relative. is shown in the policy certificate.

Regulations mean any subsidiary legislation Staying in a community hospital is defined in

made under the act and, as amended, extended line with the conditions in clause 1.1(f).
or re-enacted from time to time.
Staying in a hospital means a continuous period
Reinstatement date means the date when we of time, during which the insured is admitted to
approve your application for reinstatement or and stays in a hospital for necessary medical
when we receive the reinstatement premium, treatment, in line with the terms of your policy
whichever is later. and where room and board charges are made.
This includes day surgery for which no overnight
Renewal certificate means (in cases where your stay is needed (as long as the surgery is listed in
policy is renewed) the renewal certificate issued the surgical limits table).
for your policy.
Surgical limits table means the latest surgical
Renewal date means the start date of the operation fee tables 1 to 7 set by MOH from
relevant renewed policy year covered by your time to time.
policy and shown in the renewal certificate.
Ward entitlement means the ward entitlement
Restructured hospital means a hospital in shown in clause 2.4(a).
Singapore that:
 is run as a private company owned by the We, us or our means NTUC Income Insurance
Singapore Government; Co-operative Limited.

LHO/IncomeShield Standard/201603 Page 14 of 15

You or your means the person named in the
policy certificate as the policyholder.

Policy owners’ protection scheme

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 NTUC Income or visit the
GIA/LIA or SDIC websites (www.gia.org.sg or www.lia.org.sg or www.sdic.org.sg).

LHO/IncomeShield Standard/201603 Page 15 of 15