Making a Claim

You have to submit the following document

1. Duly completed Accident and Hospitalisation Claim Form
2. Original final hospital/medical bills and receipts.
3. Inpatient Discharge Summary/medical report/diagnostic & laboratory test result
4. If you have submitted a claim to other policies/insurers/your employers/any other third parties who have reimbursed your bills, please submit a copy of the settlement letter

Original final hospital bills are

1. The bill is a final bill, not an estimated or interim bill
2. The bill is an original copy, not a duplicate or a photocopy/scanned copy.
3. There is no outstanding amount due to the medical institution.
4. The amount covered by Medisave is approved and reflected in the bill, if applicable.
5. The amount covered by MediShield / your Private Shield plan is reflected on the bill, if applicable.

Yes, you have to settle you hospitalisation bills and submit the original final bill for reimbursement. You can settle your bills with any of the following methods:

• Medisave account
• Cash or credit card
• Combination of the above: If the hospital bill exceeds the allowed Medisave deduction limit, you will need to pay the excess amount with cash or credit card.

For claim under Income Benefit, you only need to provide copies of the final hospital bills   OR copies of the medical leave certificates.

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.

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 & Hospitalisation with other proof of loss documents as may be determined by us to our satisfaction.

Please refer to the link provided here for further details.

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.

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”.

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.

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.

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.

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. 

The procedure you are claiming for must be eligible based on the terms and conditions as set out by the Ministry of Health.

Guideline for AIA HealthShield Gold Max Policy for Surgical Ptosis Correction

Subject to all applicable contractual terms, pre-existing and qualifying conditions in your policy, AIA considers a) Eyelid ptosis correction; b) Upper blepharoplasty and c) Eyebrow ptosis correction eligible for claims with the following criteria listed below:

1. The policy holder’s doctor diagnoses that the condition which the policy holder has is a functional impairment severe enough to require surgical treatment and is not cosmetic in nature.
2. The treating doctor may also need to include additional information to demonstrate the severity of the policy holder’s condition in order to be eligible for the full claim payout. This may include taking colour photographs of the policy holder’s face and conducting several tests to assess the policy holder’s vision. MOH has published the requirements in a circular which all doctors would have received in November 2018.
   

Once the documents submitted are adequate for assessment, it will generally take 14 days (longer if the case is complex) for a claims office to reply to the claimant on the status of the assessment. For straight-forward case where all the relevant documents are submitted at the same time, you may expect a fast settlement within 5 working days.

The claims office will review the case once further required documents and/or information are provided.

For document which are not issued by the relevant Authority of Singapore, and required to be certified true copies, our Officers at AIA Customer Service Centre or a Singapore lawyer can certify the document required for filing the Death Claim. The original documents have to be produced for certification. 

The claimant will have to get legal advice to apply for a court order that presumes the insured’s death. The court order is to be submitted as part of the claim document. 

Applications for a certified extract from the Registry of Births & Deaths may be made in person or online. 

Original policy contract is not required as part of the basic requirement for claim submission. 

A coroner’s Inquest Report is required for cases:

• Insured died of unnatural causes, or
• An accidental death benefit is payable in addition to the death claim under the policy, or
• Any other cases where we consider further documentary evidence of the circumstances leading to death is essential. 

Estate duty of a deceased person’s estate is payable on the aggregate market value of all Singapore property (immovable and moveable property) and movable property outside Singapore as at the date of death.

The Estate Duty has been removed for deaths on and after Feb 15, 2008. Hence, this is only applicable for policies where death occurred before Feb 15, 2008. 

A person who takes care of the deceased’s estate following his death is a personal representative.

A personal representative appointed by the insured via a Will before his death is an executor. The executor will have to apply for the Grant of Probate via the courts in order to administer the distribution of the deceased’s estate according to the deceased’s directions in the Will.

An administrator is the personal representative if an insured died without a Will. The administrator will have to apply for the Grant of Letters of Administration via the courts in order to administer the deceased’s estate. 

A Grant of Probate is a court order issued by the Court of Singapore given to the executor appointed by the deceased in his Will.  You need to apply for the Grant of Probate with the help of a lawyer licenced to practice in Singapore.  We can only accept a copy of the Grant of Probate issued by the Court of Singapore for the release of claim payment.

Where the insured died without a Will, the court of Singapore will issue the Grant of Letters of Administration to the administrator(s).  You need to apply for the Grant of Letters of Administration with the help of a lawyer licensed to practice in Singapore, or at the Subordinate Court of Singapore personally.  We can only accept a copy of the Grant of Letters of Administration issued by the Court of Singapore for the release of claim payment.

The Grant of Probate or Grant of Letters of Administration can be applied through a lawyer. The approval from the court may take any time from 1 to 6 months (longer if more complex). 

Section 61 of the Insurance Act provides that the insurer may (i.e. at its sole discretion) to pay up to S$150,000.00 to a ‘proper claimant’ without the production of the Grant of Probate or Grant of Letters of Administration any person falls within the ‘proper claimant’ class (i.e. spouse, parent , child, sibling, nephew or niece).

The remaining amount is payable only on production of the Grant of Probate or Grant of Letters of Administration issued by the Court of Singapore. 

LIA has issued the industry’s approach to Beneficiary Nominations – a copy of the FAQ can be obtained from www.lia.org.sg website. 

Payout of the claim proceeds will be made in accordance with the NOB framework if the Deceased Insured make a nomination under the NOB framework from Sep 1, 2009.

More information on nomination of beneficiaries (NOB) can be obtained from www.lia.org.sg website.

ILOE benefit provides coverage for loss of Full-time Employment due to Redundancy or Retrenchment and ceased to make regular contribution to the benefit of the covered owner/insured.  The covered owner/insured at the same time is not receiving any income from other sources.

ILOE arising out of disability or injury due to any Accident or sickness has been specifically excluded from the coverage.  Please refer to the contract Exclusion Clauses for complete terms of the coverage.

As long as the covered owner/insured is able to produce a documented proof of loss of Full-time Employment due to Redundancy or Retrenchment and covered owner/insured ceased to receive any income, the covered owner/insured may file in the claim after the stipulated Waiting Period.

“Redundancy” shall mean the termination of the Full-time Employment caused by any one of the following occurrences:

a. The employer re-structures, re-organises, or closes the business in which the covered owner/insured is under Full-time Employment; or

b. The employer relocates the business in which the covered owner/insured is under Full-time Employment to another country.

“Retrenchment” shall mean the employment of employee is terminated on the grounds of redundancy.

The covered owner/insured has to remain continuously unemployed for three (3) months before claim can be submitted for review.

The Company shall only waive and refund the monthly premium received on the basis of a full month.  If the period in which the Insured is eligible for payment of the ILOE benefit is less than a full month, then the received premium will not be refunded for that period.

The waiver of premium due to ILOE shall cease when an aggregate of twelve (12) monthly premiums has been waived in total under Waiver of Premium due to ILOE.

Please refer to the respective policy contract for the complete terms and provisions of the coverage.

ILOE benefit provides coverage for loss of Full-time Employment due to Redundancy or Retrenchment and ceased to make regular contribution to the benefit of the covered owner/insured.  The covered owner/insured at the same time is not receiving any income from other sources.

Premium received during the ILOE period will be refunded upon proof of ILOE and loss of any forms of income.

The Company shall only waive and refund the received monthly premium on the basis of a full month.  If the period in which the covered owner/insured is eligible for payment of the ILOE benefit is less than a full month, then no premium will be refunded for that period.

The waiver of premium due to ILOE shall cease when the covered owner/insured is under any kind of employment again and receiving income.

Once the documents submitted are adequate for assessment, it will generally take 14 working days (longer if the case is complex) for a claims officer to reply to the insured on the status of the assessment. The claims officer will review the case again once further required documents and/or information are provided. 

The policyholder should continue to pay the premiums for that policy until the disability claim is admitted. 

Original policy contract is not required as part of the basic requirement for claim submission.

The disability must be total and permanent and such that there is neither then nor at any time thereafter, any work, occupation, or profession that the Insured can ever be capable of doing or following to earn or obtain any wages, compensation or profit.

The occurrence of any of the following shall also be considered as total & permanent disability:

• total and irrecoverable loss of the sight of both eyes; or
• loss by severance of two limbs at or above wrist or ankle; or
• total and irrecoverable loss of the sight of one eye and loss by severance of one limb at or above wrist or ankle.

Please refer to the policy contract for the definition of total & permanent disability as different contracts may have different definition.

Written notification of claims should be submitted within 6 months from the date of the commencement of such disability, unless it can be shown not to have been reasonable possible to give such notice and that notice was given as soon as reasonably possible.

An Insured will have to be totally and permanently disabled for a specific period. This period can range from 6 to 12 months (depending on the contract wordings). It is advisable that the disability claim is submitted after expiry of the applicable disability period. 

Once the Insured is determined to be totally and permanently disabled, we will pay the TPD Benefit in 10, 5 or 2 annual installments or 1 lump sum after deducting all outstanding loans or indebtedness on the policy.

If the policy terms and conditions state that the admitted TPD claim will be paid on installment basis, the first annual payment will be made on the policy anniversary subsequent to the date of commencement of the disability and subsequent payments will be made annually from the policy anniversary if the Insured remains totally disabled after the stipulated disability period in the policy contract.

Please refer to the policy contract for the number of instalment payments as different contracts have different terms and conditions.

No, it can be by any physician (qualified in western medicine) but AIA reserves the right for examination by an independent examiner, if required. 

The Insured is responsible for the cost of examination and provision of evidence as proof of his disability leading to his inability to work.

Before every total & permanent disability instalment is paid, medical evidence is required to prove that the Insured continues to be totally and permanently disabled during the TPD benefit period.

Under the contract for TPD benefit, if the Insured is no longer suffering from the disability, we will discontinue future TPD benefits payments and the policy shall continue under such terms and conditions in accordance with the contract provisions.

If there is any remaining insured amount, we will advise the Insured of the amount of premiums payable. 

Under the contract for total & permanent disability benefit, if the Insured is no longer suffering from the disability, we will discontinue future total & permanent disability benefits payments and the policy shall continue under such terms and conditions in accordance with the contract provisions.

If there is any remaining insured amount, we will advise the Insured of the amount of premiums payable.

The unpaid total & permanent disability instalments will be paid in one lump sum to a person who can give us proper discharge for the moneys.

We will pay to the policyholder the balance of the total & permanent disability instalments in one lump sum on the maturity due date.

If the Insured is disabled while he was not working, this plan will pay out the monthly benefit after the deferment period, for up to 24 months if he is unable to perform* 1 out of 5 ADLs (transferring, mobility, dressing, washing and feeding). Thereafter, he is still eligible to receive the monthly benefit up to age 65 or until he recovers from his disability, whichever is earlier if he is unable to perform* 2 out of 6 ADLs (as listed above and includes toileting).

*even with the aid of special equipment and always requiring the physical assistance of another person throughout the entire activity. 

We have to approve the rehabilitation programme and expenses before the Insured undertakes the programme. The Insured is required to submit the bills in respect of the expenses incurred for speech therapy treatment. These expenses incurred would be reimbursed back to the policyholder accordingly up to the benefit limit. 

The intention of the rehabilitation benefit is to help the Insured recover from his disability and return to work. As such, there is no restriction to the scope of the treatment (ie can be alternative programs or treatments such as those provided by legally registered Traditional Chinese Medicine* and chiropractors) as long as it is justifiable that such programs help the Insured recover from his disability and return to work; and the program and cost are approved by us before they are incurred. However, medications related to cancer treatment, renal failure or any other conditions are not covered. *currently available on the MOH website

The Insured is required to notify us in writing within 30 days from the date he recovers from his disability.

We will also assess the Insured’s disability from time to time to determine any payment or continued payment of the disability benefit.

Based on the necessary information gathered, eg. the medical information furnished by Insured’s attending Physician’s for the assessment of the claim, AIA will assess the Insured’s ability to return to work. In the event of a dispute, we can require the examination or re-examination of the Insured by an independent expert as selected by us should we deem that such examination or re-examination is required. The opinion of such expert shall be binding on the Insured and AIA, and the cost and fees of such independent expert shall be borne by the Insured. 

No, it can be by any physician (qualified in western medicine) but AIA reserves the right for examination by an independent examiner, if required. 

The Insured is responsible for the cost of examination and provision of evidence as proof of his disability leading to his inability to work. 

The amount of benefit payable is based on the amount purchased at the point of application, and should there be any present earnings, it will be deducted off from the monthly benefit payout. Any non-disclosure of existing disability income covers leading to over-insurance will be considered and will affect the benefit payout. 

No, we would not. 

We reserve the right to cease the benefit payment and terminate the policy. 

No, this is not considered as earned income or income from his active employment.

If he is able to work in his own occupation in the first 24 months after a deferment period of 60 days, a claim under the Disability Benefit will not be payable. However, he is able to claim the lump sum Catastrophic Disability Benefit if fulfills the Catastrophic Disability definition. 

It will be treated as a continuation of the disability and the definition for the first claim trigger applies.

Two examples:

(a) An Insured with stroke, meets working disability definition and gets the benefit payout. He then recovers, but remains unemployed and the monthly benefit ceases. Subsequently, there is a relapse; we use working disability definition to assess whether to continue the monthly payout.

(b) An Insured with stroke, meets non-working disability definition and gets the benefit payout. He then recovers and goes to work in an occupation, hence the monthly benefit ceases. Subsequently, there is a relapse; we use non-working disability definition to assess whether to continue the monthly payout. 

We would not be able to pay a claim, in view we regard his ability to perform duties of a GP to provide medical consultation as his ability to perform a suited occupation; and hence he would not have satisfied the working disability definition. 

We will assess the claim based on the Insured’s employment status at the point of disability. Hence, while the Insured is on sabbatical leave or medical leave, he remains employed and we will assess the claim based on working disability definition.

You have to submit the following document

1. Duly completed AIA Assist/Around the World Claim Form
2. Original final hospital/medical bills and receipts, for medical claim.
3. Inpatient Discharge Summary/medical report/diagnostic & laboratory test result, for medical claim
4. Document supporting your travel claim such as
    

• Copy of E-ticket/travel itinerary/boarding pass/passport with stamp date showing date of departure from Singapore/Home Country;
• Proof of payment for accommodation / travel fare which are not refundable
• Property irregularity report (PIR);
• Letter of acknowledgement from common carrier for actual date and time baggage delivered to owner/Copy of compensation letter from common carrier or accommodation management (if loss while under their care)
• Copy of police report for theft and must be lodged to the police having jurisdiction at place of the damage within 24hours
• Proof of purchase / ownership for the damaged items

Exclusions common to many travel insurance plans also apply to AIA Around the World Plus, including:

• Any pre-existing conditions;
• Any/all illegal or unlawful act(s) by the Insured or confiscation, detention, destruction by customs or other authorities
• Any participation in Extreme Sports and Sporting Activities

For the full list of exclusions, please refer to the Policy Document.

Single Trip plan provides overseas trip coverage for up to 182 consecutive days. While the Annual Multiple Trip plan covers up to 90 consecutive days for each overseas trip