Claim payable under a hospital bill

When you submit a claim under a hospital bill, the insurance company will apply the following deductions on the amount that you have spent for medical treatment:

a) Pre-existing illness. You are usually not covered for medical conditions that exist before you purchase the insurance, including congential conditions.

b) Exclusion. Certain medical conditions are specifically excluded, e.g. HIV, self-inflicted injuries.

c) Sub-limit. You are allowed to claim up to a liit for each item, such as daily room and board, hospital expenses and surgery. Any expense above the sub-limit will not be claimable

d) Pro-ration. If you are insured for a lower class of ward, and you are treated in a higher class of ward, a pro-rated formula may apply. Only this pro-rated portion of the expenses will be counted.

e) Deductible. This is the amount that you have to bear first, before you can make a claim for the excess of the eligible bill.

f) Co-insurance. You have to pay a percentage of the eligible bill in excess of the deductible.

When you submit your hospital bill, the insurance company will apply the sub-limits, exclusions and pro-ration to get the eligible amount. It will then apply the deductible and co-insurance to determine the final amount that is payable.

Before you incur a large bill, it is advisable to get an estimate of the hospital bill from your doctor and to check with your insurance company on what proportion of the bill is payable under the insurance policy.

Tan Kin Lian

Signs and messages

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Low payout for medical claim

Hi Mr Tan,
I saw this article on the forum last week but till now I have not seen any reply from Income on it (Normally companies will be quick to respond to letters in the ST forum).


Can you comment on why an expected payout of $3,600 can end up to be only $240?
Maybe you can even share this in your blog.

Puzzled by insurer's payout for medical claim

RECENTLY, my wife was hospitalised at Mount Alvernia Hospital for four days. Her medical bill came up to $7,995.15.

She is insured under Income's IncomeShield Plan MA, but the total payout by Income was a shocking $240.
I called Income to find out how it arrived at that sum and was told that technically the $7,995.15 was classified as "room and board", hence limiting the claim.

The $7,995.15 included a renal screen, bed charges, clinical consumables and supply, diagnostic imaging services, equipment use, laboratory services, outside hospital services, pharmacy cost, resident medical officer fees, treatment fee and doctor attendance fee.

Given a deductible of $4,000 per policy year and 10 per cent co-insurance, any man in the street would expect an insurance payout of $3,595.63. But this is not the case.

My wife has faithfully paid her premium for the past 15 years without a single claim and this is what she gets in return. I am writing this so the public is made aware of such pitfalls in their medical insurance.

For big insurance companies to cite a technicality as an excuse not to make a decent payout is in no way fair. I urge the Consumers Association of Singapore and leaders in the insurance industry to look into this loose definition of "room and board".
In my opinion, given my wife's good record, Income should honour the $3,595.63 payout as a goodwill gesture.

Lastly, I would like to ask the Central Provident Fund Board why only $450 a day can be used from Medisave for hospitalisation.

Ong Kok Lam

The uninsured cannot afford health care

This article explains the problem of the uninsured in America. Medical care is very costly. Those who are employed can get health insurance, paid by their employer. The employer pays a group rate which is one third of the cost of individual insurance.

In Singapore, citizens can get treated in subsidized wards and enjoy a subsidy of up to 75%. They have to pay only 25% of the full cost. The cost in restructured hospital is lower than in private hospitals. The elderly, which are likely to need health care more, will be able to benefit from the subsidized wards.

Those who are well off or have insurance can go for the non-subsidized or private care.