AIA Vitality

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Frequently-Asked Questions

AIA HealthShield Gold Max¹ Plan and Riders

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1. How will the latest MediShield Life changes impact the coverage and benefit for my AIA HealthShield Gold Max plan?

In view of upcoming benefit and pro-ration changes for MediShield Life, we’ve reviewed our suite of AIA HealthShield offerings to ensure our IP plans continue to provide you with comprehensive coverage and medical benefits for greater protection.

Key benefit enhancements for AIA HealthShield Gold Max (A, B and B Lite):

Providing a new Inpatient Hospice Palliative Care Benefit, in line with MediShield Life enhancements.
Increasing claims limit for Cell, Tissue & Gene Therapy to reduce out-of-pocket expenses.

Please get in touch with your AIA Financial Services Consultant / Insurance Representative or call our AIA Customer Care Hotline at 1800 248 8000 to learn more about the changes to your policy or if you need further assistance.

2. Why are the changes necessary?

Our latest enhancements are aligned with the recommendations from the Health Insurance Task Force (HITF) to encourage everyone to play a more active role in managing the rising medical care costs, so quality healthcare will remain accessible for generations to come.

3. When will these changes take place?

Policyholders of AIA HealthShield Gold Max Integrated Shield plan(IP) and riders should take note of the following key dates:

For new customers, policy changes will be implemented on / after 1 April 2021.
For current policyholders of AIA HealthShield Gold Max IP and riders, policy changes will take effect in the following manners:
- AIA HealthShield Gold Max: Effective from 1 April 2021;
- All Riders: Effective from their respective policy anniversary dates on/after 1 April 2021.

We will inform you on the changes with a written notification at least 31 days before the change takes effect.

4. Why is AIA raising premiums? What’s the percentage increase policyholders can expect? Are premiums being adjusted in response to the changes under MediShield Life?

Policyholders with the following policies will need to take note of the premium changes, which will take effect from their policy anniversary date on / after 1 April 2021:

AIA HealthShield Gold Max A plan.
AIA Max VitalHealth.
AIA Max Essential A (upon the conversion to AIA Max VitalCare).
AIA Max Essential A Saver (upon the conversion to AIA Max VitalHealth A with Emergency and Outpatient Care Booster).

There won’t be any premium adjustments for policyholders of AIA HealthShield Gold Max B / Max B Lite / Max Standard plans. However, policyholders will see an increase in the MediShield Life premiums as this has been announced by the government.

IP premiums are reviewed regularly to ensure that the portfolios remain financially sustainable over the long-term. In recent years, rising claims costs have necessitated premium revisions amongst all IP insurers. Greater healthcare consumption and increased use of newer and costlier treatments have resulted in an increase in claims for IPs.

AIA Singapore has been an active advocate for collaboration among stakeholders in the industry to manage healthcare costs. We were the first insurer to establish direct relationships with healthcare providers through our AIA Quality Healthcare Partners (AQHP) to encourage policyholders to seek quality, affordable care from our panel doctors. We have also made pre-authorisation available for all private hospital admissions and day surgeries to provide customers with financial assurance that their claim will be paid and help ensure that treatment and charges are in line with norms. We continue to work closely with the Life Insurance Association of Singapore, the Ministry of Health, and professional medical associations to manage healthcare cost inflation.

5. Are you planning to raise premiums again for your IP and riders in the near future?

IP premiums are reviewed regularly to ensure that the portfolios remain financially sustainable over the long-term. In recent years, rising claims costs have necessitated premium revisions amongst IP insurers. Greater healthcare consumption and increased use of newer and costlier treatments which leverage medical technological advancements have resulted in an increase in claims for IPs.

6. With the removal of the 85% Pro-ration Factor, does this mean that there’s no real reason for me to opt for pre-authorisation anymore?

We highly recommend that customers obtain pre-authorisation as it gives you peace of mind when seeking medical care as coverage is confirmed upfront prior to treatment.

Key benefits of Pre-authorisation include:

No bill shock: You get assurance and peace of mind that their procedure will be covered and are informed of the amount AIA will cover – all before the admission or surgery.
Minimal cash outlay: You will not have to make a deposit and cash outlay will be limited to applicable deductible and co-insurance / co-payment. Remaining charges will be directly settled between AIA and the hospital/healthcare provider.
From 1 April 2021, we have also introduced a new benefit when customers of AIA Max VitalHealth and AIA Max VitalCare rider opt for pre-authorisation. If an admission to and / or treatment by non-AIA preferred healthcare providers is pre-authorised, the 5% co-payment that customers are required to pay will be capped at $3,000 per policy year. This feature was previously only provided for admission/treatments at AIA Quality Healthcare Partners (AQHP) specialists or public hospitals.
Ensuring that charges are reasonable and that treatment is in line with norms: Pre-authorisation will allow AIA to ensure that proposed charges are reasonable and customary based on national fee benchmarks and agreed fee schedules with panel doctors (if applicable). It will also allow AIA to ensure that the proposed treatment is in line with norms and advise policyholders if this is not the case.
Continued access to quality healthcare: Pre-authorisation supports our long-term efforts to mitigate health claims inflation so that all IP insurers, including AIA, can continue providing medical coverage to Singapore Residents.

7. What are the main changes between the old full rider and the new co-pay rider?

From 1 April 2021, all new and existing AIA IP riders will have 5% co-payment. For existing customers, the switch to AIA Max VitalHealth or AIA Max VitalCare will take effect from their policy renewal on/after 1 April 2021. This is in accordance with the MOH guidelines.

The co-payment is capped at $3,000 per policy year, if the insured receives treatment from an AIA Quality Healthcare Partners specialist or a public hospital, or if the treatment is pre-authorised.

¹ Please refer to your policy contract for specific details of your AIA HealthShield Gold Max policies.

AIA Max Essential rider / AIA Max VitalHealth rider / AIA Max VitalCare rider

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1. I currently have the AIA Max Essential rider. Will my plan automatically convert to the new AIA Max VitalCare rider or AIA Max VitalHealth rider plan? How will I know about the transition?

From 1 April 2021, all existing policyholders of AIA Max Essential rider will automatically be converted to the following plans, effective from their policy renewal on / after 1 April 2021*. All AIA IP riders will include the 5% co-payment features moving forward.

Current name	New name from 1 April 2021
AIA Max Essential A	AIA Max VitalCare
AIA Max Essential A Saver	AIA Max VitalHealth A (with Emergency and Outpatient Care Booster)
AIA Max Essential B / B Lite	AIA Max VitalHealth B / B Lite
AIA Max Essential C	Will continue to be referred to as AIA Max Essential C

We will inform you of the changes with a written notification at least 31 days before the change takes effect.

*For policies with changes requested by you, where the effective dates of such changes being later than the cut-off dates of the respective written notification mail-drops (i.e. approximately 2 months prior to the policy renewal dates), the above-mentioned conversion shall take place only from the next policy renewal, i.e. from April 2022 onwards.

2. Deductible and co-insurance / co-payment – how do they work?

A deductible is the amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself.

After you pay the deductible, you usually will need to pay the co-insurance / co-payment for covered services before your insurance starts to pay. The amount covered by the insurance plan, is subject to the co-insurance / co-payment percentage.

Both deductibles and co-insurance / co-payment features help keep premiums affordable.

3. Co-payment and co-payment cap features – how do they work?

On co-payment

After paying the applicable deductible, you will need to pay minimum of 5% the remaining covered amount, out-of-pocket. This means that IP plan and rider will no longer cover 100% of medical bills.

Expenses that are not covered by AIA are not subject to the 5% co-payment as the full amount is already paid out-of-pocket by the policyholder.

On co-payment cap

The co-payment is capped at $3,000 per policy year, if the insured receives treatment from an AIA Quality Healthcare Partners specialist or a public hospital, or if the treatment is pre-authorised.

The aim of the co-payment cap feature is to protect you against large bills by limiting the out-of-pocket amount you have to pay per policy year. The minimum co-payment cap insurers can apply is $3,000.

4. How does Deductible Waiver Pass under AIA Max VitalHealth A work?

The Deductible Waiver Pass under AIA Max VitalHealth A allows you to enjoy zero deductible on the first Private Hospital Claim under the rider regardless of doctor, subject to 5% co-payment. The deductible waiver will reset if there are no Private Hospital Claims over 3 consecutive policy years.

Private Hospital Claims without the Deductible Waiver Pass will be subject to a $2,000 deductible in a policy year.

Below is an example to illustrate how the Deductible Waiver Pass works:

Policy Year 1: From 01 February 2022 to 31 January 2023 (with Deductible Waiver Pass)

No deductible will be applicable on your Private Hospital Claim in this policy year as the $2,000 deductible will be waived

Policy Year 2 to 4: From 01 February 2023 to 31 January 2026 (without Deductible Waiver Pass)

During this period, if you need hospital treatment, a $2,000 deductible will be applicable if you go to a private hospital (whether through our AIA Quality Healthcare Partners (AQHP) or non-AQHP)
No deductible will be applicable if you seek treatment from Public/Restructured Hospital

Policy Year 5: From 01 February 2026 to 31 January 2027

If you have no Private Hospital claims over 3 consecutive policy years, no deductible will be applicable on your Private Hospital claims in this policy year.

5. How will I know if my Deductible Waiver Pass benefit has been refreshed? Will this be available on my correspondences or My AIA SG application?

You will have no deductible on your first AIA Max VitalHealth A claim, whether it is for treatment at a private or public hospital. The deductible waiver will reset if there are no private hospital claims over 3 consecutive policy years. You may refer to My AIA SG to find out the Deductible Waiver Pass status at any time.

6. How does switching across riders work?

You may request to switch to other riders by making a request for change. Please note that your request may be subject to underwriting.

AIA Max VitalCare policyholders may switch to:

AIA Max VitalHealth A - No underwriting is required if the request was submitted between 01 April 2021 to 30 September 2022. Thereafter, the request will be subject to underwriting.
AIA Max VitalHealth B or AIA Max VitalHealth B Lite – No underwriting is required.

AIA Max VitalHealth A policyholders may switch to:

AIA Max VitalCare - No underwriting is required if the request was submitted between 01 April 2021 to 30 September 2022. Thereafter, the request will be subject to underwriting.
AIA Max VitalHealth B or AIA Max VitalHealth B Lite – No underwriting is required.

AIA Max VitalHealth B policyholders may switch to:

AIA Max VitalCare or AIA Max VitalHealth A - Underwriting is required.
AIA Max VitalHealth B Lite – No underwriting is required.

AIA Max VitalHealth B Lite policyholders may switch to:

AIA Max VitalCare, AIA Max VitalHealth A or AIA Max VitalHealth B - Underwriting is required.

AIA Max Essential C policyholders may switch to:

AIA Max VitalCare, AIA Max VitalHealth A, AIA Max VitalHealth B or AIA Max VitalHealth B Lite - Underwriting is required.

When contemplating switching, please do consider factors like age, pre-existing conditions, appropriate healthcare for your needs and affordability of future premiums. It is important to understand the risk of switching plans, as this could lead to an exclusion of pre-existing conditions or an increase in premiums (loading). Speak with your AIA Financial Services Consultant / Insurance Representative and he / she will be able to advise further based on your existing portfolio and health insurance needs.

7. If my AIA Max Essential policy had been converted to AIA Max VitalCare / Max VitalHealth, can I request to change back to AIA Max Essential?

No, you can’t as AIA Max Essential will no longer be available from 1 April 2021.

On Claim-based Pricing

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1. What is claim-based pricing?

Claim-based pricing is a fairer pricing approach to empower our policyholders with more control over their future renewal premiums by managing their claim experience. Customers who make less claims will be rewarded with lower premiums.

It is applicable for AIA Max VitalCare only.

2. How does it work?

There are five premium levels in the claim-based pricing for AIA Max VitalCare.

With claim-based pricing, all policyholders will start off at the Standard Level premium, the lowest premium level of your age band. During each policy renewal, the renewal premium level will be determined by the previous claim made during the premium evaluation period. As long as you stay healthy, with no claims made during the premium evaluation period while your AIA Max VitalCare is at Standard Level, you will continue to enjoy the No Claim Discount on your Standard Level premium at your next policy renewal.

Find out how the different premium levels will affect you.

3. Why is there a need for claim-based pricing?

Claim-based pricing rewards you for actively managing your health and being prudent in your use of medical services.

4. How does the No Claim Discount work?

When no claims are made during the premium evaluation period, and if the AIA Max VitalCare is at Standard Level Premium, policyholders will get to enjoy a specified discount rate. The No Claim Discount applies only to the AIA Max VitalCare premium, and will increase based on the number of years without claim as shown in the table below.

AIA Max Essential A policyholders who have not made any claims in the policy year prior to conversion to AIA Max VitalCare will immediately enjoy a 10% discount at the point of conversion.

5. What should I do if I do not want to be subject to claim-based pricing?

AIA Max VitalCare is the only AIA IP rider which is subject to claim-based pricing.

If you do not want to be subject to claim-based pricing, you may consider switching your rider to AIA Max VitalHealth. Please click here for further details on switching of riders.

6. Which AIA plans offer claim-based pricing currently? Why is this not offered to all IP plans/riders?

Currently, only AIA Max VitalCare is subject to claim-based pricing. AIA Max VitalCare is a rider that is only attachable to the AIA HealthShield Gold Max A plan.

7. Will claim-based pricing be extended to more AIA plans moving forward?

In implementing claim cost containment initiatives, we have always prioritised initiatives that will truly be effective without affecting the adequacy of the protection we provide. We will monitor and review the new claim-based pricing approach closely to ensure that we continue to strengthen our comprehensive healthcare proposition in a meaningful way.

As a leading insurer in the healthcare space, AIA Singapore is committed to journeying with our customers through their lives as well as continuously providing them with innovative solutions that truly meet their needs.

8. What is Premium Evaluation Period?

Your premium level may move up or down depending on the source of claim and the claim amount paid from your AIA Max VitalCare during each policy year. This is assessed and determined during the Premium Evaluation Period.

For the very first renewal of AIA Max VitalCare, the Premium Evaluation Period will cover the first 10 months from the issue date or renewal date of AIA Max VitalCare.

For subsequent renewals of AIA Max VitalCare, the Premium Evaluation Period will be a period of 12 months commencing from the date immediately following the previous Premium Evaluation Period.

For example, if the previous Premium Evaluation Period ended on 8 November 2020, the subsequent Premium Evaluation Period shall be from 9 November 2020 to 8 November 2021.

9. How will I be notified of my Premium Level during the Premium Evaluation Period?

Please be assured that you will be notified of the premium level in your next renewal through the yearly Premium Notification Letter, and you can also access the information through My AIA SG.

10. Will the Standard Level Premium rates still be subject to revision when my future renewal premium is subject to my claim experiences?

Yes. The Standard Level Premium rates are not guaranteed and are expected to be adjusted from time to time to allow for ongoing reviews of claims experience, medical inflation, and general cost of treatments, supplies or medical services in Singapore.

11. How will the renewal premium for AIA Max VitalCare be determined if I made claims on both private hospital and restructured hospital during the relevant premium evaluation period?

When there were claims made for both private hospital and restructured hospital treatment during the premium evaluation period, only private hospital claims made will be used to ascertain the next renewal premium level for AIA Max VitalCare.

12. Will the claim-based pricing be imposed on all AIA Max Essential A policyholders upon their renewal into the AIA Max VitalCare?

All AIA Max Essential A policyholders will automatically be converted to AIA Max VitalCare at Standard Level premium on/from April 2021. Those who have not made a claim in the policy year prior to conversion will receive a 10% No Claim Discount on their Standard Level Premium.

Customers who do not wish to remain on AIA Max VitalCare (with claim-based pricing) can choose to switch to AIA Max VitalHealth (no claim-based pricing). Please click here for further details on switching of riders.

13. How would I know when is the lock-in-date for claim-based pricing premium movement, for the premium of my AIA Max VitalCare?

With claim-based pricing, you will start off at the Standard Level premium, the lowest premium level of the relevant age band. During each policy renewal, the renewal premium level will be determined by the previous claims made during the premium evaluation period. Any changes to your premium level will be implemented on your next policy renewal.

The lock in date for AIA Max VitalCare’s renewal premium level is T – 2 calendar months, where T is the next policy anniversary date.

14. If my AIA Max Essential policy had been converted to AIA Max VitalCare / Max VitalHealth, can I request to change back to AIA Max Essential?

No, you can’t as AIA Max Essential will no longer be available from 1 April 2021.

AIA QUALITY HEALTHCARE PARTNERS (AQHP)

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1. What is AIA Quality Healthcare Partners (AQHP)?

AIA Quality Healthcare Partners or AQHP, is our panel of private specialist doctors exclusively curated for AIA HealthShield Gold Max customers. Each of them has at least 5 years of specialist experience and a clean professional track record.

2. Why was AIA Quality Healthcare Partners (AQHP) introduced?

Forming AQHP is one of the measures that the Company has put in place to manage rising healthcare costs. The formation of such preferred provider panels was one of the recommendations of the Health Insurance Task Force to ensure that health insurance premiums remain sustainable in the long run.

3. How can the introduction of AQHP help in managing the rising healthcare costs?

We have negotiated fee agreements with AQHP, which was set with reference to MOH published fee benchmarks, to help ensure treatment and charges are in line with what is reasonable and customary. This will ultimately benefit consumers as it will help moderate the rate of premium increases in the long run.

4. How do the AQHP fees compare to the Fee Benchmarks published by MOH?

AQHP fees take reference from MOH’s Fee Benchmarks. They are generally set at the midpoint between the upper and lower bounds, but there may be some deviations from this based on our negotiations with our panel. We set a fixed fee instead of a range so that there is more clarity for doctors and policyholders as to the expected charges.

5. What are the benefits of choosing AQHP specialists over other specialists?

With AQHP, we have made it easy for you to gain access to more than 380 specialists. It is also convenient for you to request for an appointment with your preferred AQHP specialist using the following methods:

On AIA Healthcare mobile app
Submit your request via our website
Call our medical concierge at 1800 248 8000

Upon submission of your request, we will contact you via SMS/call on the status of your appointment within 1 hour*. You will also get to enjoy pre-negotiated outpatient consultation fees with our AQHP specialist as an AIA HealthShield customer.

(*For requests submitted on Mondays to Fridays, between 8.45am to 5.30pm. Excludes Public Holidays)

Notes:

We will try our best to arrange an appointment with your preferred specialist within 3 working days. However, there may be times when this is only possible with an alternative specialist in the same field.
Consultation or treatment with any AQHP specialists does not mean that the bills will be claimable. Claims eligibility will be subjected to the terms and conditions of the AIA HealthShield Gold Max policy.

6. Who can have access to AQHP?

All existing and new AIA HealthShield Gold Max customers will enjoy exclusive access to services provided by AQHP.

7. How does AIA select the medical specialists to partner with as an AQHP specialist?

Our AQHP specialists are carefully selected based on their professional track record and a minimum 5 years of specialist experience. We also ensure that we have a healthy mix of medical fields when selecting our AQHP specialists to cater to your medical needs.

8. Where can I get more information on the list of AQHP specialists?

You can access our AQHP specialists’ profiles here.

For easy access on the go, you can also access the list on the AIA Healthcare mobile app, which is available for download from the Apple App Store and Google Play Store.

APPOINTMENT REQUESTS

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1. How can I request for an appointment with an AQHP specialist?

You can request for an appointment with your preferred AQHP specialist using the following methods:

Via our AIA Healthcare mobile app
Submit your request via our website
Call our medical concierge at 1800 248 8000

Alternatively, you may also contact your AIA Financial Services Consultant or Insurance Representative for assistance.

2. Can I request for an appointment on behalf of another person, who is an insured under AIA HealthShield Gold Max plan?

Yes, you may request for an appointment on behalf of another insured. Please submit your request here.

3. How do I know if my request for an appointment has been processed and confirmed?

Upon submission of your request, we will contact you via SMS/call on the status of your appointment within 1 hour*.

(*For requests submitted on Mondays – Fridays, 8.45am to 5.30pm, excluding Public Holidays.)

4. What is the earliest appointment date that I can request for an appointment with the AIA Quality Healthcare Partners?

If your appointment request is submitted:

Before 1 pm, the earliest appointment date you may request for is on the next working day.
After 1 pm, the earliest appointment date that may be requested for will be the day after the next working day.

Please note that the confirmed appointment date will be subject to the specialist's availability.

Example:

Appointment request submitted	Earliest possible appointment
Monday, before 1:00pm	Next working day, Tuesday
Monday, after 1:00pm	Day after next working day, Wednesday
Friday, before 1:00pm	Next working day, Monday
Friday, after 1:00pm	Day after next working day, Tuesday

Working days exclude Saturdays, Sundays, Public Holidays and eve of selected Public Holidays.

5. Why I can’t request for an appointment with an AQHP specialist on Saturdays, Sundays and Public Holidays?

Most of the specialist clinics have short consultation hours on Saturdays, hence their appointment timeslots are usually full. They also do not operate on Sundays and Public Holidays.

6. Can I change or cancel my appointment request or for a confirmed appointment?

You may call our medical concierge at 1800 248 8000 to make changes to your appointment or contact the clinic directly to make the changes.

7. What do I need to bring on the day of my appointment?

Please bring along the following items:

Your NRIC, Birth Certificate, Work Permit or Passport (where applicable)
Any medication you are currently taking or the names of the medication
Relevant medical reports, x-rays or scans

The availability of the items will help the specialist to better understand your current medical condition.

8. How do I request for an appointment for my follow-up visit?

You can arrange for follow-up appointments directly at the clinic after your consultation. You do not need to go through us again to make the follow-up appointment.

9. Can I contact the AQHP specialist clinics directly to make an appointment?

We do encourage you to let us help connect you with an AQHP specialist to make an appointment as we strive to provide you with the best experience possible.

10. How can I request for an appointment in the event of emergency?

In the event of an emergency, please proceed directly to the Accident & Emergency department of a hospital nearest to you.

TELEMEDICINE

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1. What is Telemedicine?

Telemedicine is the remote diagnosis and treatment of patients using telecommunications devices i.e. a smartphone with camera.

2. Why introduce WhiteCoat Telemedicine service for AIA HealthShield Gold Max customers?

Along with the rest of our healthcare solutions, such as AIA Quality Healthcare Partners (AQHP) and Medix, Whitecoat telemedicine allows us to provide primary care that is accessible and yet affordable to our customers. AQHP and Medix supports our healthcare solution with hospitalisation and post-hospitalisation services, forming a holistic healthcare solution for AIA HealthShield Gold Max customers.

3. When should I use WhiteCoat’s telemedicine services?

Telemedicine is suitable for everyone who is seeking (i) treatment for non-emergency medical issues*; (ii) chronic conditions like hypertension, hyperlipidaemia and diabetes; or (iii) advice or a second opinion on a pre-existing condition.

*List of conditions as follows:
a. flu, cough, cold or sore throat;
b. fever, or headache;
c. diarrhea, constipation or vomiting;
d. rash, or cold sores;
e. conjunctivitis;
f. urinary tract infection;
g. dermatological conditions; and
h. other non-emergent medical issues

4. Do I need to launch the WhiteCoat App via the AIA Healthcare App to enjoy the consultation fee of S$12?

Simply download and login to WhiteCoat App to enjoy the consultation fee of S$12 as an AIA HealthShield Gold Max customer.

5. What are the other costs other than consultation fee?

There are other costs like GST, medication cost and delivery cost.

6. Do I need to call the AIA Quality Healthcare Partners Hotline to make an appointment for a telemedicine consultation with WhiteCoat?

No, you do not need to request for an appointment with WhiteCoat. WhiteCoat’s teleconsultation services are on-demand, with an average waiting time of less than 5 minutes.

7. From 1 April 2021, AIA will be covering up to S$50 medication, consultation and delivery fees, with only S$5 co-payment required by AIA HealthShield Gold Max (HSG) customers, for the first 10,000 video consultations. How much do I need to pay for my video consultation when utilising this benefit?

Depending on the total cost of your video consultation, the amount that you will need to pay will be different. Please refer to the below illustrations:

	Total bill less than $50	Total bill equals to $50	Total bill more than $50
Total cost of video consultation	$40	$50	$60
Co-payment by AIA HSG customer	$5	$5	$5
Amount covered by AIA	$35	$45	$45
Excess payable by AIA HSG customer	$0	$0	$10
*Total cost payable by AIA HSG customer*	$5	$5	*$15*

MEDIX

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1. Why is AIA offering Personal Medical Case Management Services (PMCM) to our customers?

We understand that customers who have serious medical conditions often feel uncertain about the best course of action and face a lot of stress along the care journey. Through this service, we would like to help our customers get accurate diagnosis and select the best course of treatment, by providing them access to independent global expert medical advice, as well as on-going support throughout their medical journey.

2. How does PMCM differ from a second opinion?

Most second opinion services review medical reports and information to provide an independent diagnosis and recommended treatment plan. Following the second opinion, a patient is often left with questions, as well as the need to find the best doctor and hospital to administer the treatment.

With PMCM, the customer is never alone. This 24/7 service accompanies the customer at all times, throughout the journey of diagnosis, treatment, monitoring the treatment progress until recovery.

3. Who can have access to PMCM service?

This service is exclusively available for our insured customers with AIA Max VitalHealth A, AIA Max VitalCare, AIA Max Essential A/A Saver, AIA Power Critical Cover and AIA Beyond Critical Care plans.

4. Is the PMCM service free?

This optional service is complimentary for our insured customers with AIA Max VitalHealth A, AIA Max VitalCare, AIA Max Essential A/A Saver, AIA Power Critical Cover and AIA Beyond Critical Care plans.

Tests, treatments, procedures, devices or medication recommended by Medix may be subject to additional charges that are not covered by your plan. Please consult your AIA Financial Services Consultant for more details.

5. What are the serious medical conditions that qualify for PMCM service?

Please click here for the list of eligible medical conditions.

6. How does Medix obtain my medical information and reports?

When you choose to use the Medix service, you will be required to sign the service acceptance form and confidentiality waiver form, as well as submit all relevant medical information and reports at hand. This approval will also allow Medix to obtain any missing medical reports from various sources.

AIA and Medix recognise the importance and sensitivity of such personal data and will only share information that is required to accurately analyse the customer’s condition and enable appropriate recommendations to be made.

7. Will Medix refer me for treatment abroad?

Medix’s assessment of treatment is based on medical necessity. As Singapore has a highly developed healthcare system, Medix does not expect that there will be a need to refer patients abroad. However, Medix will consider recommending consultation or treatment abroad in the rare instances where there is a lack of local expertise in relevant fields.

Please note that the AIA HealthShield Gold Max A with AIA Max VitalHealth A, AIA Max VitalCare and AIA Max Essential A/A Saver plans only cover emergency treatments abroad, subject to the overall benefit limits of the policies. Scheduled overseas treatment expenses will not be claimable.

8. How does Medix complement AIA Quality Healthcare Partners (AQHP)?

AQHP specialists are selected based on their qualifications and experience to deliver quality affordable healthcare.

This partnership with Medix complements the AQHP, by providing patients with additional access to local and global expertise and ongoing support. Medix does not directly treat patients but works in collaboration with the treating doctor to ensure that the best possible care is delivered. This enhances the ability of our panel to deliver quality care.

9. What if the treating doctor disagrees with Medix’s recommendation?

In such a situation, with the patient’s permission, Medix will discuss the case with the treating doctor and collectively agree upon the best course of action for the patient. At the end of the day, the decision on how to proceed with the suggested treatment plan is the patient’s.

10. What happens in the case of a wrong medical recommendation?

The decision of treatment is always taken jointly with the patient’s treating doctor, together with the patient’s consent. It is important to note that Medix does not treat patients directly, nor prescribe medications, nor execute treatments or procedures. Hence, Medix would not be able to take on the responsibility of the treating doctor. However, Medix does have Professional Medical Liability Insurance and takes full responsibility for its medical recommendations.

Since Medix’s establishment in 2006, Medix is proud to share that there have been no cases in which an incorrect recommendation was made.

AIA Singapore is not involved in the recommendations that Medix provides as the intent is for Medix to provide independent medical advice.

AIA HEALTHSHIELD PRE-AUTHORISATION

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1. What is AIA HealthShield Pre-authorisation service?

It is a service where AIA approves coverage for a hospital admission and/or day surgery based on your policy coverage, benefit entitlement and medical information provided by your doctor prior to the actual event. This provides customers with peace of mind knowing that their planned procedure or admission will be reimbursed.

2. Who can request for an AIA HealthShield Pre-authorisation?

All AIA HealthShield Gold Max customers can submit an AIA HealthShield Pre-authorisation request for non-emergency hospital or surgical bill (including day surgery), before admission or surgery.

3. Which hospitals and/or clinics does AIA HealthShield Pre-authorisation apply to?

AIA HealthShield Pre-authorisation is applicable for non-emergency hospital admissions and day surgeries in all private hospitals and ambulatory centres.

4. How many days in advance do I need to apply for AIA HealthShield Pre-authorisation prior to my admission/ surgery?

You will have to send in your request for pre-authorisation and ensure that your doctor completes and submits the e-form at least 3 working days prior to the planned surgeries or hospital admissions.

5. What can I expect after AIA approves the pre-authorisation request?

Once the AIA HealthShield Pre-authorisation request has been approved, we will issue you a Certificate of Pre-authorisation stating the approved amount for the specified medical diagnosis, treatment date and procedures. A copy of the Certificate of Pre-authorisation will also be provided to the admitting hospital.

6. What happens if my AIA HealthShield Pre-authorisation request is declined?

We will call you if your pre-authorisation request is declined or partially approved and provide the reasons for rejection. We will also offer alternative solutions and assist you on your care journey.

7. Is the AIA HealthShield Pre-authorisation service applicable for hospital surgeries or admission due to an emergency?

AIA HealthShield Pre-authorisation is not applicable for emergency cases admitted through the hospital’s A&E department.

8. Do I need to apply for Letter of Guarantee (eLOG) for deposit waiver after my pre-authorisation request is approved?

There is no need to apply for eLOG as the Certificate of Pre-authorisation also includes waiver of deposit at the point of admission. The hospital will only need to collect the deductible and co-insurance (if applicable) at the point of discharge and we will settle the rest of your medical directly with the hospital.

Note: Subject to acceptance of the Certificate of Pre-authorisation by the hospital.

Home Palliative Benefit

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1. What is the Home Palliative benefit?

Home Palliative care refers to the provision of palliative services in the patient’s home. Common palliative services include changing of wound dressings, feeding tubes, stoma care, urinary tube changes, provision of supportive medicines and nutritional feeds.

Home Palliative care provides patients with greater sense of independent living and comfort in familiarity for terminally ill cancer patients. The Home Palliative care benefit provides coverage for eligible items up to $15,000 per month with maximum lifetime limit of $45,000.

2. How do I know if I am eligible for Home Palliative benefit?

From 1 April 2021, Home Palliative benefit under AIA Max VitalHealth A rider will be available to insureds who are diagnosed with terminal cancer with expected survival period of 12 months or less.

For customers with existing AIA HealthShield riders, coverage for Home Palliative benefit will start on the first policy anniversary date after 1 April 2021.

Note: The existing AIA HealthShield riders are: AIA Max VitalHealth A, AIA Max Essential A (which will be known as AIA Max VitalCare), and AIA Max Essential A Saver (which will be known as AIA Max VitalHealth A with Emergency & Outpatient Care Booster).

3. How can I apply for the Home Palliative benefit?

To apply for the service, you need a referral letter* from your oncologist to the AIA Appointed Home Palliative Care Provider(s).

Step 1: Insured requires home palliative care service
Step 2: Insured / referring oncologist contacts AIA Appointed Home Palliative Care Provider to submit referral letter*
Step 3: AIA Appointed Home Palliative Care Provider contacts the insured.

*Note: The referral letter must include a declaration that the insured is diagnosed with Terminal Cancer with an expected survival period not exceeding 12 months

4. Who are the AIA Appointed Home Palliative Care Providers?

Please see below table for the Appointed Provider(s) for this service.

List of AIA Appointed Home Palliative Care Provider(s)
Centre Name	Email Address	Contact Number	Operating Hours
Vickycares Pte Ltd	support@vickycares.sg	+65 8668 8360	Mondays to Fridays, excluding Public Holidays 8.30am - 5.30pm

List of AIA Appointed Home Palliative Care Provider(s)
Centre Name	Vickycares Pte Ltd
Email Address	support@vickycares.sg
Contact Number	+65 8668 8360
Operating Hours	Mondays to Fridays, excluding Public Holidays 8.30am - 5.30pm

Note: This list of Appointed Provider(s) is correct as of 01 April 2021 and may be subject to change.

5. What are the eligible items covered under Home Palliative benefit?

The Home Palliative benefit covers eligible items - doctor’s attendance fee, nurse’s attendance fee, prescription drugs and/or supportive medicine (e.g. pain relief medications, total parenteral nutrition), medical consumables (e.g. wound dressings) and procedures (e.g. feeding tube changes, stoma wound care). If other items are required, AIA reserves the right to determine whether they are considered as Reasonable and Customary.

6. What else do I need to take note of if I want to claim for Home Palliative benefits

To submit a claim, the following criteria must be fulfilled:

Service is provided by AIA Appointed Home Palliative Care Provider;
Claim is accompanied by an oncologist’s referral letter with declaration that the patient has Terminal Cancer with an expected survival period not exceeding 12 months;
Claim is linked to a main claim episode for which the claim has been approved. This main claim episode may be an inpatient admission or an outpatient chemotherapy episode within the last six (6) months (Note: This is determined based on the date of the first Home Palliative claim);
Claim is admissible only for eligible items required for the delivery of Home Palliative. Refer to question 5 for eligible items; and
All claims submitted for Home Palliative benefit should be within 12 consecutive months from date of the first Home Palliative benefit claim, subject to the Limit of Compensation stated in the Schedule of Benefits.

7. Who can I reach out to if I need more information on Home Palliative benefit?

Please contact AIA HealthShield Hotline at 1800 248 8000 if you need further assistance.

AIA HEALTHSHIELD CLAIMS

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1. How do I file my claim?

Claims are to be submitted to us by the Medical Institutions through the system set up by the Ministry of Health of Singapore in accordance with the terms and conditions under the CPF Act and the MediShield Life Scheme Act 2015 (where applicable), as amended from time to time. Once you have given the medical institution the authorisation to submit your claim for you, the medical institution will submit a claim to the insurer on your behalf.

This will not be applicable to claims under Pre-Hospitalisation Benefit, Post-Hospitalisation Benefits, Congenital Abnormalities of Insured’s Biological Child from Birth (for female Insured), Non-insured Donating an Organ to Insured, Emergency Overseas (outside Singapore) Medical Treatment Benefit and Post-Hositalisation Psychiatric Treatment under the Benefits Provisions of this Policy. Claims must be notified through the submission of a completed Accident and Hospitalisation Claim with other proof of loss documents as may be determined by us to our satisfaction.

2. Which medical treatments would require additional criteria to be met before the full claim can be paid?

Please refer to the link provided here for further details.

3. How do the deductible and co-insurance work?

The deductible is the portion of costs the policyholder is liable for before any benefits are payable and is applied to the claimable amount, not the total bill amount. The claimable amount is calculated based on the schedule of benefit limits.

The deductible is applied on a policy year basis. Once the total claimable amount for claims arising within the same policy year exceed the deductible, the deductible will not apply to further claims arising within the same policy year. No deductible is applied for out-patient claim.

Co-insurance is the fixed percentage the policyholder is liable for in excess of the deductible and is applied to both in-patient and out-patient claims.

4. What is the definition of “pre-existing illnesses” in AIA HealthShield Gold Max Policy?

It is defined as “any pre-existing illnesses, disease or impairment from which the insured is suffering prior to the Policy Date, other than those defined in Serious Illness, unless declared in the Application form and specifically accepted by the Company”.

5. The policyholder will be posted overseas for a few years. Does his HealthShield Gold Max policy cover him whilst he is overseas?

Except in the case of an “Emergency”, overseas medical treatments are not covered. “Emergency” means a serious illness or injury or the onset of a serious condition, which in our opinion requires urgent remedial treatment to avoid death or serious impairment to the Insured’s immediate or long-term health.

6. AIA only reimbursed part of the policyholder’s hospital expenses. He wants to claim the balance from his company insurer. How should he proceed?

He needs to submit the original final hospital bill to his company insurer and a copy of our settlement letter to claim the balance of the hospital bill not covered under the integrated plan.

7. Does the Policy covers all charges for medications prescribed by my doctors?

All medically necessary medications prescribed by the attending physician related to the hospitalisation is claimable, subject to the terms and conditions of the Policy. This does not include supplement, experimental drugs etc.

8. How do I apply for approval for use of high-cost technologies? High-cost technologies refer to CAR T-cell therapy and Proton beam therapy.

These technologies are currently not approved locally and under review by MOH. Thus, we are unable to review the request for such treatment as it is falls under the general exclusion. We will provide more information on the application process once they are approved for use locally.

9. How does deductible, co-insurance and co-payment work on my AIA HealthShield Gold Max policy?

AIA Healthshield Gold Max covers the majority of your medical bill. Here is an example to illustrate:

John, who is covered under AIA HealthShield Gold Max A, was hospitalised in a private hospital. His total bill was $100K.

With AIA Healthshield Gold Max A

John pays deductible: $3,500
John pays co-insurance: $9,650 [10% x ($100,000 - $3,500)]
HSG Max A (including Medishield Life) pays: $86,850

John pays deductible:
$3,500

John pays
co-insurance: $9,650

[10% x ($100,000 - $3,500)]

HSG Max A (including
Medishield Life) pays: $86,850

10. How does deductible, co-insurance and co-payment work on my AIA HealthShield Gold Max with AIA Max VitalHealth A if I have activated pre-authorisation before treatment and my policy has a Deductible Waiver Pass?

AIA Healthshield Gold Max covers the majority of your medical bill while AIA Max VitalHealth A covers deductibles and co-insurance, subject to 5% co-payment.