Aviva's my shield & myshield plus summary of changes (for advisers) - 1...
1. Summary of changes to MyShield and MyShield Plus
Ð effective 1 March 2013
Current MyShield New MyShield
1 No coverage of Accident & Emergency Treatment under We will cover Accident and Emergency (A&E) Treatment
Pre-Hospital Specialist Consultation. given within 24 hours prior to hospitalisation.
This benefit will be renamed as ÒPre-Hospital SpecialistÕs
Consultation and Accident and Emergency (A&E) Treatment.Ó
2 Cornea is not covered under Surgical Benefits for We will include Cornea into Surgical Benefits for Major
Major Organ Transplant Organ Transplant.
3 Inpatient Congenital Anomalies (after waiting period a) Inpatient Congenital Anomalies (after waiting period
of 24 months). Benefit is as charged. of 24 months). Benefit is as charged.
b) Inpatient Congenital Anomalies excluding Surgical
Benefits (first diagnosed within waiting period of
24 months). Surgical fees are not payable.
Refer to the table below for benefit.
Plan 1 Plan 2 Plan 3
Up to $450 per day or S$900 per day
for Intensive Care Unit
4 Inpatient Psychiatric Treatment (after 10 months of a) Inpatient Psychiatric Treatment (after 10 months of
continuous coverage) (per policy year). continuous coverage) (per policy year).
Benefit is as charged. Benefit is as charged.
b) Inpatient Psychiatric Treatment (within 10 months
of continuous coverage) (per policy year).
Refer to the table below for benefit.
Plan 1 Plan 2 Plan 3
Up to $100 per day up to 35 days
5 Pro-ration Factor a) For Plan 2 and 3, we will revise the pro-ration factors
for the insured person who is admitted to a ward /
MyShield hospital higher than this entitlement under the policy.
Pro-ration Factor
Plan 1 Plan 2 Plan 3
b) We will also define a list of the private hospitals that
Private Hospitals/
will continue to receive the benefits on an Òas chargedÓ
Medical institutions
and Hospitals outside N.A. 65% 50% basis, and apply a pro-ration factor on other private
Singapore hospitals not in the list.
Here are the revised pro-ration factors:
Restructured Hospitals N.A. N.A. 85%
Ð Class A MyShield
Pro-ration Factor
Plan 1 Plan 2 Plan 3
Unsubsidised wards
in Community N.A. N.A. 85% Selected Private
Hospitals Hospitals*/ Medical
N.A. 50% 35%
institutions and
Hospitals outside
Singapore
Aviva Ltd 4 Shenton Way #01-01 SGX Centre 2 Singapore 068807 www.aviva.com.sg Company Reg. No.: 196900499K ¥ GST Reg. No.: MR-8500166-8
2. Summary of changes to MyShield and MyShield Plus
Ð effective 1 March 2013
Current MyShield New MyShield
5 Pro-ration Factor (continued)
MyShield
Pro-ration Factor
Plan 1 Plan 2 Plan 3
Restructured Hospitals N.A. N.A. 85%
Ð Class A
Unsubsidised wards in N.A. N.A. 85%
Community Hospitals
Other Hospitals in 80% 40% 28%
Singapore
* Selected Private Hospitals shall mean Parkway East Hospital,
Gleneagles Hospital, Mount Alvernia Hospital, Mount
Elizabeth Hospital, Raffles Hospital and Thomson
Medical Centre.
6 Annual Deductible Changes to Annual Deductible (due to regulation
requirements)
MyShield MyShield
Annual Deductible Annual Deductible
for Insured Persons Plan 1 Plan 2 Plan 3 for Insured Persons Plan 1 Plan 2 Plan 3
80 years and below 80 years and below
age next birthday. age next birthday.
C Class Ward S$1,000 S$1,000 S$1,000 C Class Ward S$1,500 S$1,500 S$1,500
B2 Class Ward S$1,500 S$1,500 S$1,500 B2 Class Ward S$2,000 S$2,000 S$2,000
B1 Class Ward S$2,000 S$2,000 S$2,000 B1 Class Ward S$2,500 S$2,500 S$2,500
A1 Class Ward / S$3,000 S$3,000 S$3,000 A1 Class Ward / S$3,500 S$3,500 S$3,500
Private Hospital and Private Hospital and
Hospital outside Hospital outside
Singapore Singapore
Day Surgery S$3,000 S$3,000 S$2,000 Day Surgery S$3,000 S$3,000 S$2,000
7 Premium age bands are 1-18 and 19-30. Premium age bands will now be 1-20 and 21-30 to be
aligned with MediShield.
Aviva Ltd 4 Shenton Way #01-01 SGX Centre 2 Singapore 068807 www.aviva.com.sg Company Reg. No.: 196900499K ¥ GST Reg. No.: MR-8500166-8
3. Summary of changes to MyShield and MyShield Plus
Ð effective 1 March 2013
Current MyShield New MyShield
8 Policy provisions
General Conditions
Under ÔRenewalÕ, the clause is currently worded as: For clarity that MyShield is guaranteed renewable, that
Your cover is automatically renewed for a further clause has been changed to:
Period of Insurance by payment of the renewal premium Subject to General Conditions Clause 8, Your cover is
before the Renewal Date. guaranteed renewable for a further Period of Insurance by
payment of the renewal premium before the Renewal Date.
WeÕve also added the following in ÔGeneral ConditionsÕ
section, Ô16. Full DisclosureÕ clause:
If there is a claim made under this Policy before it is void,
the premiums to be refunded shall be calculated from
the first Policy Year immediately following the Policy Year
in which the last claim was made under this Policy.
Section II Ð Limits of Liability
There is no formula to calculate the prorated amount of For clarity, the formula has now been included into the
the total bill if the Insured Person stays in a more expensive policy contract, as follows:
room than the standard room covered under the plan.
Standard room charge
x total bill
Incurred room charge
Section III Ð Covered Benefits
(a) The benefits that are not entitled for Pre- and Post- (a) For clarity, the list has now been defined in the policy
Hospitalisation Benefits are not listed. contract, as follows:
(i) 1(f) Ð Accident Inpatient Dental Treatment;
(ii) 1(l) Ð Inpatient Congenital Anomalies;
(iii) 1(m) Ð Inpatient Pregnancy Complications;
(iv) 1(n) Ð Living Donor Organ Transplant;
(v) 3(b) Ð In-Hospital Psychiatric Treatment; and
(vi) 3(d) Ð Inpatient Medical Complaint outside
Singapore.
(b) Under ÔInpatient Pregnancy ComplicationsÕ, the clause (b) For clarity, the clause has now been reworded to:
is currently worded as: (iv) Miscarriage after 13 weeks of pregnancy (not due
(iv) Miscarriage after first trimester of pregnancy to voluntary or malicious act)
(not due to voluntary or malicious act)
(c) Under ÔOutpatient Kidney DialysisÕ, the clause is (c) For clarity, the clause has now been reworded to:
currently worded as: Charges for treatment of an Insured Person requiring
Charges for treatment of an Insured Person requiring machines or apparatus for providing kidney dialysis at
machines or apparatus for providing kidney dialysis at a legally registered dialysis centre. Cover includes
a legally registered dialysis centre. Cover includes examination and tests ordered by the attending
examination and tests ordered by the attending Physician and conducted on the same day of treatment.
Physician during the course of treatment. It extends Charges for consultation by the attending Physician
to cover Erythropoietin as part of the treatment for are not covered.
Chronic Renal Failure and ambulatory peritoneal dialysis
It extends to cover Erythropoietin as part of the
ordered by a Physician.
treatment for Chronic Renal Failure and ambulatory
peritoneal dialysis ordered by a Physician.
Aviva Ltd 4 Shenton Way #01-01 SGX Centre 2 Singapore 068807 www.aviva.com.sg Company Reg. No.: 196900499K ¥ GST Reg. No.: MR-8500166-8
4. Summary of changes to MyShield and MyShield Plus
Ð effective 1 March 2013
Current MyShield New MyShield
8 Policy provision (continued)
General Exclusions
(a) The following exclusions are currently included in the (a) We removed Clauses 15, 16(a), and 18 from the
policy contract: current policy contract.
15. Additional Fees billed by a referring Physician
for treatment given after the date on which an
Insured Person has been referred to another
Physician or Specialist.
16. (a) active military, police or civil defence training,
duties or operations, including maintenance of
civil order, engagement in hostilities, participation
in war (whether war be declared or not) and
whether or not compensation or reimbursement
of hospitalisation or medical expenses in part or
full has been made by the Government or the
relevant authorities. For the avoidance of doubt,
this shall not include operationally ready national
service duty under Section 14 of the Enlistment
Act Cap 93 of the Republic of Singapore; or
18. Air travel, other than as a fare-paying passenger
on a duly licensed aircraft on a regular scheduled
route operated by a recognised airline.
(b) The following exclusions are currently worded in (b) For clarity, we have rephrased them to:
this manner:
7. Elective cosmetic treatments and plastic surgery; 7. Elective cosmetic treatments and plastic surgery;
all dental treatment or oral surgery related to teeth any treatment to prevent illness, promote health
other than those Inpatient treatment due to or improve bodily function or appearance; all
Accident; rest cures and services or treatment in dental treatment or oral surgery related to teeth
any home, spa, hydro-clinic, sanatorium or long- other than those Inpatient treatment due to
term care facility that is not a Hospital as defined. Accident; rest cures and services or treatment in
any home, spa, hydro-clinic, sanatorium or long-
term care facility that is not a Hospital as defined.
10. Prosthesis, corrective devices and medical appliances 10. Prosthesis, corrective devices and medical
which are not surgically required; all treatment appliances which are not surgically required; all
that is not scientifically recognised by western treatment that is not scientifically recognised by
European or North American standards. western European or North American standards,
such as alternative and complementary treatment.
13. Experimental or pioneering medical, surgical 13. Experimental or pioneering medical, surgical
techniques or clinical trial for drugs or medical techniques or clinical trial for drugs or medical
device not commonly available or not approved device not approved by Ministry of Health which
by Ministry of Health which the Insured Person the Insured Person chooses to receive even though
chooses to receive even though treatment usually treatment usually and customarily provided for
and customarily provided for the medical condition the medical condition concerned is available.
concerned is available.
Aviva Ltd 4 Shenton Way #01-01 SGX Centre 2 Singapore 068807 www.aviva.com.sg Company Reg. No.: 196900499K ¥ GST Reg. No.: MR-8500166-8
5. Summary of changes to MyShield and MyShield Plus
Ð effective 1 March 2013
Current MyShield New MyShield
8 Policy provision (continued)
17. Rock climbing, mountaineering, pot-holing, 16. Injury and/or Illness arising directly or indirectly
skydiving, parachuting, hang-gliding, para-sailing, out of or in connection with engagement/
ballooning, all diving; racing of any kind other involvement in any sports in a professional or
than on foot and all professional or inherently competitive pursuit on a full-time, part-time,
dangerous sports. contractual and/or ad hoc basis other than those
undertaken in leisure or as a hobby.
For full details, please refer to the policy contract, which can be downloaded from
www.aviva.com.sg/pdf/MyShield_PolicyContract.pdf .
Aviva Ltd 4 Shenton Way #01-01 SGX Centre 2 Singapore 068807 www.aviva.com.sg Company Reg. No.: 196900499K ¥ GST Reg. No.: MR-8500166-8
6. Summary of changes to MyShield and MyShield Plus
Ð effective 1 March 2013
Current MyShield Plus New MyShield Plus
1 For children enjoying Free Child Cover, they are covered For children enjoying Free Child Cover, they will now be
under 5 Critical Illnesses. covered for 30 Critical Illnesses.
2 Hospital-related Benefits (e.g. daily cash from the Hospital Hospital-related Benefits will now be payable as long as
Cash Benefit, reimbursement for ambulance fees, etc) there is a payout from either MyShield or MyShield Plus
are not payable if there is no payout from MyShield. Option B.
3 No Accidental Coverage for Child Benefit. MyShield Plus Option A will now offer a cash payout in
the event of a fracture for children under 19 years old
(Accidental Coverage for Child Benefit).
4 No Advanced Benefit. MyShield Plus Option A will now offer a new Advanced
Benefit for MyShield to enhance your coverage:
Accidental Inpatient Coverage will be extended
Dental Coverage from 14 days to 31 days.
Post Hospitalisation Coverage will be extended
Follow-up Treatment from 90 days to 120 days
after discharge.
Confinement in Coverage will be extended
Community Hospital from 45 days to 60 days.
Inpatient Congenital Waiting period will be reduced
Anomalies from 24 to 12 months.
5 Customers are required to inform us of any material This clause has been removed and customers no longer
changes relating to occupation, business or sporting need to inform Aviva of any material changes once the
activity, in line with the ÔGeneral ConditionsÕ section, policy is in force.
Ô6. Material ChangesÕ clause in the policy contract.
6 Only one age band for 1-30 years old. This age band will be split into two separate age bands,
1-20 and 21-30 years old, to be in line with MediShield.
For full details, please refer to the policy contract, which can be downloaded from
www.aviva.com.sg/pdf/MyShieldPlus_PolicyContract.pdf .
Aviva Ltd 4 Shenton Way #01-01 SGX Centre 2 Singapore 068807 www.aviva.com.sg Company Reg. No.: 196900499K ¥ GST Reg. No.: MR-8500166-8