Singapore legislation
Regulation 14
Regulation 14
Cross insurance period claim
Subregulation 1
An insured person’s cross insurance period claim may be paid in respect of each relevant insurance period of the cross insurance period claim, instead of only in respect of the initial insurance period of the cross insurance period claim.
Subregulation 2
Subject to paragraph (3), the amount of an insured person’s cross insurance period claim that may be paid in respect of each relevant insurance period of the cross insurance period claim is an amount not exceeding the excess limit for that relevant insurance period determined in accordance with the following formula:A − B,where Ais the insurance period limit specified in regulation 13(1) for the initial insurance period of the cross insurance period claim; andBis the total amount of other claims —
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.
Subregulation 3
If the initial insurance period of an insured person’s cross insurance period claim is the insured person’s first insurance period and regulation 20(1)(a) applies to that first insurance period, the value of A for the purposes of paragraph (2) —
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.
Subregulation 4
For the purposes of regulation 13(3) —
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.
Subregulation 5
In this regulation, in relation to a cross insurance period claim —
Definition
“final insurance period” means the insurance period in which the date of discharge of the claimable medical treatment or services to which the cross insurance period claim relates falls;
Definition
“initial insurance period” means the insurance period in which the admission date of the claimable medical treatment or services to which the cross insurance period claim relates falls;
Definition
“relevant insurance period” means each insurance period from the initial insurance period of the cross insurance period claim to the final insurance period of the cross insurance period claim (both inclusive).
Subregulation 6
This regulation applies subject to regulations 19 and 20.IllustrationAssume a person’s cross insurance period claim spans 3 relevant insurance periods, namely, the initial insurance period, the second relevant insurance period and the final insurance period.Assume the amount of an insured person’s cross insurance period claim, calculated in accordance with regulation 13(3), is $450,000.Assume the excess limits of the person’s cross insurance period claim, calculated in accordance with regulation 14(2), in respect of —
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.