• Procedure to File Health Insurance Claim

    Health insurance companies normally have a dedicated claims team having first-hand knowledge of business practices, risks, regulatory and legal issues. They also employ examiners who handle each claim with appropriate expertise, based on the complexity of the illness or disability. Administrative tasks related to claims are handled by different teams. Hence, examiners get more time to work with you proactively to settle bigger and more intricate claims, and provide faster service on straightforward claims.

    There are many health insurance companies that do business overseas. Such insurers will be able to resolve your claim faster should an illness or disability occur in a foreign country. They will work across borders with teams in several nations, working with local laws, languages and regulations together with those in Singapore.

    Most health insurance companies in Singapore have a fairly transparent procedure of filing health insurance claims. However, the procedure of filing the claim is different for different scenarios. Let us take a detailed look at each of them:

    • Hospitalisation claim
    • If you have an insurance policy that provides coverage for your hospitalisation expenses that include medical bills, hospital stay and treatment, you must take the following steps:

      1. Before getting hospitalised, read through your policy document and check the type of hospitals, treatment and wards that are covered by your policy.
      2. Pay all your hospital and medical bills through your Medisave account or a combination of your credit card, cash and Medisave account, if the bills exceed the allowed Medisave deduction limit.
      3. Submit all relevant documents:
        • Original medical and hospitalisation receipts and bills.
        • Medical reports, if there are any.
        • In case you have submitted a claim to third parties who have refunded your bills, provide copies of payslips that show medical expense deduction, discharge voucher and reimbursement letter.
        • A copy of your NRIC.
        • Hospital discharge summary.
      4. Fill-up and print all relevant claims forms that include hospital cash benefit, hospital benefit rider, annuity hospital & surgical forms.
      5. The final step is the submission of your claim form and documents.
    • Outpatient claim
    • You may not be covered for medical expenses other than hospitalisation if you do not have a plan meant solely for outpatient expenses. Here are the steps that you must take to file a claim:

      1. Before you go to a clinic or hospital for your treatment make sure of the following:
        • Refer to your policy document and verify if your policy covers the outpatient treatment.
        • Bring your referral letter during your first visit to a specialist at government/restructured hospitals or panel private specialists.
        • Submit your identity card when you visit specialists at government/restructured hospitals or panel private specialists.
      2. You must be prepared and ready with all the necessary documents that include:
        • Copy of physician’s prescription if you are claiming for drugs.
        • Medical reports.
        • Copy of referral letter in case of a specialist visit.
        • Original receipts and medical bills.
      3. Download and fill up the claim form.
      4. The last step is the submission of your documents and claim form.
    • Accident claim
    • If you have an accident benefit rider with your health insurance policy, you can file a claim if you meet with an accident. Here are the steps that you need to take:

      1. You need to finish the whole process of claim submission within 30 days of the accident.
      2. Be ready with the following necessary documents:
        • Police report
        • Accident reports
        • Medical reports
        • Medical certificates
        • Hospital discharge summary
        • Copy of all the hospital bills and receipts
        • NRIC
      3. Download and fill-up the claim form and take a print out.
      4. The last step is the submission of your documents and claim form.
    • Critical illness claim
    • If you are suffering from a critical illness or just recovered from one, you must take the following steps to file a critical illness claim under individual health or life insurance plans:

      1. Claims must be submitted within six months from the date of diagnosis of the critical illness.
      2. Prepare the following necessary documents before you submit your claim:
        • Hospital discharge summary, lab reports, investigation reports and medical reports, identification documents and NRIC.
        • Fill-up the Attending Medical Practitioner's Statement or AMPS together with your attending doctor for general illness.
        • There are specific AMPS forms for severe illnesses such as stroke, kidney failure, heart attack, major cancers, brain tumour and more.
      3. Download and fill-up the claim form and take a print out.
      4. The last step is the submission of your documents and claim form.
    • Disability claim (Total and Permanent Disability/Permanent and Partial Disability)
    • If you are disabled either by an accident or a disease, you must take the following steps to file a disability claim under individual health or life insurance plans:

      1. Claims must be submitted within six months from the date of the disease or injury that led to the disability.
      2. Prepare the following necessary documents before you submit your claim:
        • Relevant identification documents or NRIC.
        • Relevant newspaper clipping and accident report.
        • Medical reports, lab reports, investigation reports and hospital discharge summary.
        • Medically boarded out letter.
        • Attending Medical Practitioner’s Statement that should be completed by the petitioner and the attending doctor.
      3. Download and fill-up the claim form and take a print out.
      4. The last step is the submission of your documents and claim form.
    • Disability claim
    • Under a plan where you become disabled because of advanced age, you are eligible to file a claim if you are unable to do basic activities that include:

      • Washing (taking bath)
      • Dressing (put on or take off your clothes)
      • Toileting (use the lavatory)
      • Feeding (feed yourself)
      • Mobility (move indoors)

      Before you make a claim, make sure that you meet at least three of the above criteria, and have the means to pay a subsidised fee for your medical assessment. After filling up the claims form, take a printout of the complete form, book an appointment with an authorised assessor for your medical assessment and attend the assessment.

      Most of the above claims will be settled within 14 working days after submission of all the necessary documents. There may be claims that will require additional clarification and may take time to process.

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