What Happens During Hospitalisation for Integrated Shield Plan Holders

It is commonly understood by residents in Singapore that Integrated Shield Plan is an essential hospitalisation insurance for Singapore Citizens and Singapore Permanent Residents. It covers most hospitalisation expenses for the insured in Singapore. However, when hospitalisation really happens, what need to be taken note in the actual practice? Here are answers to the frequently asked questions by my clients.

1. Which hospital should I go to?

This question is the most common when accident or illness suddenly happens. When we apply our Integrated Shield Plan, the first thing that we have to remember is whether the package covers expenses in private hospitals. If the package covers expenses in private hospitals, we can go to both private hospitals and public hospitals. If the package only covers expenses in public hospitals, we can only go to public hospitals. Here is an up-to-date list of public hospitals in each area of Singapore (hospitals not in this list are private hospitals):

South Area：Singapore General Hospital, KK Women’s and Children’s Hospital
Centre Area：Tan Tock Seng Hospital
West Area：National University Hospital, Alexandra Hospital, Ng Teng Fong General Hospital
East Area：Changi General Hospital, Sengkang General Hospital
North Area：Khoo Teck Puat Hospital

If the patient loses consciousness and passers-by help to call emergency ambulance, the ambulance will by default send the patient to the nearest public hospital.

2. Are the expenses in Accident and Emergency (A&E) Department covered? 

When a patient enters a hospital under emergency, usually the Accident and Emergency (A&E) Department is the first place to go. A&E Department is an outpatient clinic in a hospital. Integrated Shield Plan generally doesn’t cover outpatient expenses. But if after emergency treatment, the patient is admitted to the hospital, the expenses in A&E Department will be categorized under pre-hospitalisation expenses. This category of expenses is covered under Integrated Shield Plan. One more thing to take note is that there are temporary wards in some of the A&E Departments. Staying in such temporary wards is not considered an admission to hospital.

3. Do I need to pay a deposit when admitted to hospital?

During hospital admission, the insured of Integrated Shield Plan can let the hospital retrieve the plan information in their system by providing his or her NRIC number. Once the information is retrieved, public hospitals and private hospitals have different ways of handling deposit:

Public hospitals usually waive the deposit for insureds of Integrated Shield Plan. But some insurance companies place restrictions on the waiver of deposit. For example, one common restriction is that admission to hospital due to non-acute illness within 6 months from the commencement date of the insurance coverage is not eligible for waiver of deposit.

Private hospitals usually don’t waive deposit for insureds of Integrated Shield Plan. One exception is that if the patient obtained pre-authorization for the specific hospitalisation with the insurance company before the admission, the hospital will waive the deposit.

4. Do I need to pay the bill when discharged from hospital?

Integrated Shield Plan is a plan on reimbursement basis. The principle is that the insured pays the bill to the hospital first, and then the insurance company assess the claim. Once the claim is approved by the insurance company, eligible expenses will be reimbursed to the insured. When a patient is discharged from hospital, he or she has to remind the hospital to “e-file” the hospitalisation bill to the insurance company. “E-filing” is a compulsory procedure for any claims under Integrated Shield Plan. Insurance Companies do not accept manual submitted bills by the insured for Integrated Shield Plan. The next step, public hospitals and private hospitals have different ways of handling:

Public hospitals usually don’t worry about the bill payment. So they usually don’t request the patient to pay the bill immediately upon discharged. Only when the insurance company decline the claim after assessment, the hospital will contact the patient for bill payment.

Private hospitals usually request the patient to pay the bill immediately upon discharged. One exception is that if before being discharged, the patient obtained pre-authorization for the specific hospitalisation bill payment with the insurance company, the patient will not need to pay the bill upon discharged.

5. Once the insurance company approve the hospitalisation claim, how do I get back my money?

Once the insurance company approve the hospitalisation claim, they will reimburse the bill amount to the hospital, then the hospital will reimburse the patient. If the hospital did not request the patient to pay the bill upon discharged, the step of reimbursing to the patient will be skipped.

6. If my employer purchased group hospitalisation plan for me, do I need to inform my Integrated Shield Plan provider?

When a hospitalisation claim is approved under Integrated Shield Plan coverage, the Integrated Shield Plan provider (insurance company) will mail a form to the insured to request information about other hospitalisation insurance coverage (if there is any). If the insured returns the group insurance information to the Integrated Shield Plan provider, the provider will then claim the hospitalisation expenses from the group hospitalisation insurance. While returning this form is not compulsory, it will be good for the long-term control of the Integrated Shield Plan premiums. Although an Integrated Shield Plan provider do not increase the premium for a specific insured due to his or her individual hospitalisation claims, the provider will adjust the premiums of the plan according to the overall claim statistics of the portfolio of insureds under the same Integrated Shield Plan coverage.

If you have any other questions regarding the practical issues about Integrated Shield Plan, do feel free to contact me for a discussion.