Medi Shield Life Scheme Regulations 2015

if the day on which a person was born cannot be ascertained but the month of the person’s birth can be ascertained, the person is taken to be born on the first day of the month in which the person was born;

if the month in which the person was born cannot be ascertained, the person is taken to be born in January.(3) For the purposes of paragraphs 19 and 20 of the Third Schedule —

“at-risk traveller” means an insured person who —

makes a relevant journey; and

begins to show symptoms consistent with COVID‑19 infection before the end of the at‑risk traveller’s possible incubation period in relation to that relevant journey;

“COVID-19” means the infectious disease known as Coronavirus Disease 2019;

“possible incubation period”, in relation to each relevant journey of an at‑risk traveller, means a period starting upon the arrival in Singapore of the at‑risk traveller at the end of that relevant journey and ending on and including the 14th day after that day of arrival in Singapore;

subject to sub-paragraph (e), an insured person makes a relevant journey if —

the insured person leaves Singapore on or after 27 March 2020; and

that insured person’s journey is against any travel advisory concerning the risk of COVID‑19 infection, issued by the Ministry of Health and published on the website of that Ministry, that is applicable to that journey; and

an insured person does not make a relevant journey if that insured person satisfies the Minister that the insured person had a compelling reason for undertaking the journey mentioned in sub‑paragraph (d) despite the travel advisory.(4) In these Regulations, in relation to admissions before 1 October 2022, “radiosurgery treatment” means the gamma knife treatment or the Novalis shaped beam treatment of neurosurgical or neurological disorders.(5) For the purposes of these Regulations, a patient is taken to have been transferred —

from any approved permanent premises of an approved restructured hospital to receiving MIC@Home treatment provided by that approved restructured hospital;

from receiving MIC@Home treatment provided by an approved restructured hospital to any approved permanent premises of that approved restructured hospital (except where the patient is treated by the emergency department of the approved restructured hospital immediately after the patient ceases to receive MIC@Home treatment); or

between an approved permanent premises of an approved restructured hospital and an approved permanent premises of an approved community hospital,if the medical treatment or services at the approved permanent premises of the approved restructured hospital and the MIC@Home treatment, or at the different approved permanent premises of the approved restructured hospital and approved community hospital respectively, are provided consecutively (in any order) and without any break in treatment, and the transfer is not taken to be a new admission.

on 1 November 2015, if the person is a citizen or permanent resident of Singapore on that date and was not insured under the MediShield Scheme immediately before that date;

on the date of birth of the person, if the person is born on or after 1 November 2015 and is a citizen of Singapore by birth or descent; or

on the date the person becomes a citizen or permanent resident of Singapore after 1 November 2015, if the person is not already insured under the Scheme.

the person becomes a citizen or permanent resident of Singapore; and

the person’s parent or guardian applies to the Board, in the form and manner specified by the Board, for the person’s MediShield Life cover to commence on the person’s date of birth.

the person dies before the premium for the first insurance period of that person’s MediShield Life cover has been paid, or the Board is notified of the person’s death after the premium for the first insurance period has been paid; and

no claim has been made under the person’s MediShield Life cover.

ceases to be a citizen of Singapore and does not immediately become a permanent resident of Singapore; or

ceases to be a permanent resident of Singapore and does not immediately become a citizen of Singapore.

immediately after the person ceases to be a citizen or permanent resident of Singapore, as the case may be; or

on a later date (before or immediately after the end of the insurance period in which the person ceases to be a citizen or permanent resident of Singapore, as the case may be) specified by the Board.

unless sub-paragraph (b) applies, for the first 10 insurance periods of the insured person’s MediShield Life cover; or

if the insured person’s MediShield Life cover replaced the insured person’s pre-existing MediShield cover under regulation 20(1)(a), for 10 consecutive insurance periods starting with the insurance period that commences immediately after the end of the first insurance period of the person’s MediShield Life cover.

premium loading is payable as premium for the next 10 insurance periods starting on or after the date when the Board made that discovery; or

if the Board approves an application by the insured person to apply premium loading to the insurance periods under paragraph (1)(a) or (b) (as the case may be) instead, premium loading is payable in accordance with paragraph (4).

the amount of premium loading for that insurance period is due and payable to the Board at such times and in such manner as the Board may require; and

the Board may, in accordance with regulation 10, deduct the whole or part of that amount from the medisave account of the CPF member who paid the insured person’s premium for that insurance period.

the insured person was suffering from a pre‑existing medical condition;

where the insured person’s MediShield Life cover commences on the person’s date of birth under regulation 4(1A), the insured person would have been regarded as having a pre-existing medical condition had the MediShield Life cover instead commenced on the date the insured person became a citizen or permanent resident of Singapore.

the insured person’s medisave account; or

a CPF member’s medisave account if —

the insured person is a dependant of the CPF member; and

the Board has approved an application by the CPF member for payment of that premium from the CPF member’s medisave account.

a previous insurance period of an insured person; or

a policy year of an insured person’s pre-existing MediShield cover which was replaced, under these Regulations or the MediShield Life Scheme (Private Medical Insurance Scheme) Regulations 2015, by the insured person’s MediShield Life cover,was deducted from the medisave account of a CPF member who is not the insured person, the Board may continue to deduct the premium for each subsequent insurance period of the insured person’s MediShield Life cover from that CPF member’s medisave account.

cease to deduct the premium for that insurance period and any subsequent insurance period from the medisave account of a CPF member under paragraph (2); or

if the CPF member authorises the Board in writing, continue to deduct the premium from the CPF member’s medisave account.

the insured person had not attained 21 years of age at the beginning of the insurance period for which the premium is payable; and

the amount standing to the insured person’s credit in the insured person’s medisave account is insufficient to pay the premium for that insurance period.

from the medisave account of the insured person’s male parent; or

from the medisave account of the insured person’s female parent, if the amount standing to the insured person’s male parent’s credit in that parent’s medisave account is insufficient to pay the premium payable or that parent has died.

the medisave account of any one of the insured person’s parents; or

the medisave accounts of more than one of the insured person’s parents, in such proportion as the Board may determine.

the spouse of the insured person who, when the payment is to be deducted, has attained 16 years of age;

a CPF member from whose medisave account payment has been deducted —

for the whole or part of the insured person’s premium under any insurance policy;

under the Central Provident Fund (Medisave Account Withdrawals) Regulations (Rg 17) for any medical treatment or services received, or to be received, by the insured person; or

under section 16B of the Central Provident Fund Act 1953 for any long‑term care required by the insured person.

the approved OS;

any CPF member who made the OS application, on behalf of the approved OS, pursuant to which the collection of the relevant amount was suspended.

a CPF member may not withdraw under paragraph (9) from paying any premium payable by the CPF member under section 4(1)(c) of the Act;

a CPF member, who has applied to the Board for an insured person’s outstanding premium to be paid by a lump sum deduction from that CPF member’s medisave account, may not withdraw under paragraph (9) from paying that outstanding premium; and

an approved OS or a CPF member, mentioned in paragraph (8), may not withdraw under paragraph (9) from paying the relevant amount mentioned in paragraph (8).

subject to such conditions as the Board may impose; and

only if the Board is satisfied that there are exceptional reasons to allow the withdrawal from making the payment.

deduct from the CPF member’s medisave account, under this regulation, an amount not exceeding the amount standing to the credit of the CPF member in the medisave account to pay the whole or part of the premium; and

permit any deficiency to be paid in such manner as the Board thinks fit, subject to such terms and conditions as the Board may impose.

the deduction from the CPF member’s medisave account breaches these Regulations or the MediShield Life Scheme (Private Medical Insurance Scheme) Regulations 2015; or

the insured person or the CPF member made a false representation to the Board, or furnished the Board with any false information, in connection with the application for payment of a premium for the MediShield Life cover of an insured person to be deducted from a CPF member’s medisave account.

the CPF member must, if required by the Board, refund to the CPF member’s medisave account the amount of moneys withdrawn from that account, which could not have been withdrawn if the cancelled approval had not been given (called the affected moneys); or

the Board may —

refund from the Fund to the CPF member’s medisave account the affected moneys paid as premiums for the insured person’s MediShield Life cover; and

require payment of the resulting shortfall in the premiums under section 6 of the Act or in accordance with the other provisions of this regulation.

the insurer must transfer the moneys to the Board; and

the Board must refund the moneys, transferred in sub‑paragraph (a), to the CPF member’s medisave account.

credit the whole or such part, as the Board may determine, of any refunded premium, interest or penalty into the medisave account of the person who paid the premium, interest or penalty (as the case may be), regardless of how the premium, interest or penalty was paid; and

where the refunded premium, interest or penalty mentioned in sub‑paragraph (a) was paid by deduction from the same medisave account, also pay into that medisave account, the whole or such part, as the Board may determine, of the interest that would have been payable on the amount credited into that medisave account under sub‑paragraph (a) if that amount had not been deducted from that medisave account.

a Government grant is used (without first being credited to a person’s medisave account) to pay the whole or any part of any premium, interest or penalty; and

the premium, interest or penalty is to be refunded, in whole or in part,the Board may pay to the Government from the refund, an amount not more than the amount of the Government grant.

from an approved medical practitioner employed or engaged by an approved medical institution; and

during the period when the insured person is insured under the Scheme.

for any treatment, service or item specified in the Third Schedule; or

for any treatment, service or item assessed, by the Council or a committee appointed under section 8(4) of the Act, to be inappropriate in the circumstances of a particular case.

$100,000, if the insured person was admitted before 1 March 2021; (b)$150,000, if the insured person was admitted on or after 1 March 2021 but before 1 April 2025; or

$200,000, if the insured person was admitted on or after 1 April 2025.

an amount determined in accordance with the following formula:T × P × 0.9,where Pis the pro-ration factor specified in the Fourth Schedule applicable to the insured person in relation to the type of approved outpatient treatment received by the insured person; andTis the total amount of the charges payable for the approved outpatient treatment received by the insured person; (b)the total of the assured amounts for approved outpatient treatment received by the insured person.

if A is not more than $5,000, the formula is —[(A − B) × 0.9] − C;

if A is more than $5,000 but not more than $10,000, the formula is —[($5,000 − B) × 0.9] + [(A − $5,000) × 0.95] − C;

if A is more than $10,000, the formula is —[($5,000 − B) × 0.9] + ($5,000 × 0.95) + [(A − $10,000) × 0.97] – C,where Ais the sum of —

the relevant amount for the approved medical treatment or services to which the current claim relates; and

the relevant amount for all other approved medical treatment or services —

with an admission date during the same insurance period as the approved medical treatment or services to which the current claim relates; and

in respect of which a claim was received by the Board before the current claim was received;Bis the lower of the following:

A;

the insured person’s contribution for the approved medical treatment or services to which the current claim relates; andCis the sum of all claims paid for all other approved medical treatment or services referred to in sub‑paragraph (b) of the definition of A.

an insured person is only entitled to claim for 2 courses of repetitive transcranial magnetic stimulation treatment in the insured person’s lifetime;

an insured person is only entitled to claim up to the following number of treatment sessions of repetitive transcranial magnetic stimulation for the first course of treatment:

where the insured person has received 24 or more treatment sessions for the first course of treatment before 1 June 2026 — 24 treatment sessions;

where the insured person has not received more than 23 treatment sessions for the first course of treatment before 1 June 2026 — 30 treatment sessions;

an insured person is only entitled to claim for a second course of repetitive transcranial magnetic stimulation treatment if the second course of treatment starts at least 120 days after the last treatment session of the first course of treatment;

an insured person is only entitled to claim up to the following number of treatment sessions of repetitive transcranial magnetic stimulation for the second course of treatment:

where the claim is made before 1 June 2026 — 15 treatment sessions;

where the claim is made on or after 1 June 2026 — 30 treatment sessions.

the insured person has received claimable medical treatment or services as an in-patient of an approved medical institution and, on the insured person’s discharge from in-patient treatment provided by the institution, an approved medical practitioner of that institution certifies in writing that the insured person requires the community hospital treatment; (aa)a medical practitioner treating or assessing the insured person at the emergency department of an approved restructured hospital certifies in writing that the insured person requires the community hospital treatment; (ab)the insured person has received MIC@Home treatment provided by an approved medical institution, and an approved medical practitioner of that institution certifies in writing that the insured person requires the community hospital treatment; or

the Minister approves the person’s claim for the community hospital treatment.

is admitted to any approved permanent premises of an approved medical institution as an in-patient for any claimable medical treatment or services; or

receives any day surgical treatment in the approved medical institution,the insured person is entitled to claim under the Scheme, as part of the charges incurred for such treatment, the amount of any organ transplantation costs that the insured person has incurred in connection with the organ transplant.

the claimable medical treatment or services as received by the insured person; and

the claimable medical treatment or services as received by the living organ donor.

an amount determined in accordance with the formula T × P, where —

P is the following pro-ration factor applicable to the insured person:

where the approved medical treatment or services are received by the insured person as an approved outpatient treatment — the pro-ration factor specified in the Fourth Schedule applicable to the insured person in relation to the type of approved outpatient treatment received by the insured person;

where the approved medical treatment or services are received by the insured person as an in-patient, under the MIC@Home programme, or as day surgical treatment — the pro-ration factor specified in the Fifth Schedule applicable to the insured person in relation to the type of approved medical treatment or services received by the insured person; and

T is the total amount of the charges payable for the approved medical treatment or services received by the insured person;

the total of the assured amounts for such approved medical treatment or services.

an amount determined in accordance with the formula T × P × 0.9, where —

P is the pro-ration factor specified in the Fourth Schedule applicable to the insured person; and

T is the total amount of the charges payable for the approved CTGTP received by the insured person;

the total of the assured amounts for the approved CTGTP received by the insured person.

an amount determined in accordance with the formula T × P × 0.9, where —

P is the pro-ration factor specified in the Fourth Schedule applicable to the insured person; and

T is the total amount of the charges payable for the approved high-cost drug received by the insured person;

the total of the assured amounts for the approved high-cost drug received by the insured person.

received before the Board received the cross insurance period claim; and

paid under the person’s MediShield Life cover in respect of the relevant insurance period to which the excess limit relates.

for the initial insurance period of the cross insurance period claim, is the insurance period limit specified in paragraph 3(3) of the Ninth Schedule; and

for any subsequent relevant insurance period of the cross implementation claim, is $100,000.

an insured person’s cross insurance period claim is to be treated as a single current claim for claimable medical treatment or services with an admission date during the initial insurance period of the cross insurance period claim; and

the calculation under regulation 13(3) —

is to be applied to the whole of the insured person’s cross insurance period claim only once; and

is not to be repeated in calculating the amount of the cross insurance period claim to be paid in respect of any relevant insurance period of the cross insurance period claim after the initial insurance period of the cross insurance period claim.

the initial insurance period is $40,000; (b) the second insurance period is $200,000; and (c) the final insurance period is $200,000.The total amount of the cross insurance period claim paid is $440,000, leaving only $10,000 of the cross insurance period claim unpaid.

an insured person’s claim under the Scheme in respect of any approved medical treatment or services received by the insured person has been paid from the Fund; and

another person, who is under an obligation (contractual or otherwise) to pay or reimburse the insured person for charges incurred in respect of the approved medical treatment or services, has made the payment or reimbursement,an amount computed in accordance with the following formula becomes due and payable to the Fund by the insured person on the date such payment or reimbursement is made by that other person:X + Y – Z,where Xis the total amount of the payment or reimbursement made by that other person;Yis the total amount of the claim paid from the Fund under the Scheme; andZis the total amount of the charges incurred by the insured person.

are withdrawn under paragraph (2);

transferred to the Board under regulation 6(2) of the MediShield Life Scheme (Private Medical Insurance Scheme) Regulations 2015; or

otherwise received by the Board.

the CPF member must, if required by the Board, refund to the CPF member’s medisave account the amount of moneys withdrawn from that account, which could not have been withdrawn if the cancelled approval had not been given (called the affected moneys); or

the Board may —

refund from the Fund to the CPF member’s medisave account the affected moneys paid as premiums for the insured person’s MediShield Life cover; and

require payment of the resulting shortfall in the premiums under section 6 of the Act or in accordance with the other provisions of this regulation.

the insurer must transfer the moneys to the Board; and

the Board must refund the moneys, transferred in sub‑paragraph (a), to the CPF member’s medisave account.

the insured person’s MediShield Life cover provided by the MediShield Life Component of the insured person’s earlier plan (called the earlier MediShield Life cover) continues as the MediShield Life Component of the later plan, with an insurance period of 12 months commencing on the same date as the later plan; and

the Board is to refund, to the person who paid the premium for the last insurance period of the insured person’s earlier plan, the pro-rated amount specified in paragraph (4).