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ElderShield Claims (FAQ)

General
What is the definition of disability?
Disability shall mean the inability of the Policyholder to perform at least 3 out of the 6 Activities of Daily Living (ADL), even with the aid of special equipment and always require the physical assistance of another person throughout the entire activity.

Cases whereby substantial assistance is needed to do the ADL will also be considered.

What are the 6 Activities of Daily Living?
The 6 Activities of Daily Living are washing, dressing, feeding, toileting, mobility and transferring.

Does ElderShield cover worldwide?
Yes.

What if I become disabled during the offer period?
The cover for ElderShield only commences from 30 September 2002. Hence, there will be no coverage under ElderShield if the disability occurs before 30 September 2002.

However, you may be covered under IDAPE should the disability definition is fulfilled and you meet the income criteria.

Can I claim after I reach age 65 since I will no longer be paying premiums?
The premium payment term of the policy is up to age 65. However, the policy provides lifetime coverage. Hence, you will still be eligible to claim under the policy after you have stopped your premium payment at age 65.

Should I recover from my disability after a period of time, will I have to continue paying the premiums?
Should you recover from your disability, benefit payments will cease and you have to resume paying the premiums to continue the coverage.

However, if you are pass the premium paying age, no more premium payments will be required but you will continue to be covered under the policy.

My parent is insured under ElderShield and he/she has passed away, is there any claim payable or will there be any refund of premiums?
The ElderShield policy covers disability. Hence, no claim will be payable should death occurs. There will also be no refund of premiums. The policy is automatically terminated on the death of the policyholder.


Benefit
How much is the monthly benefit?
The monthly benefit shall be S$300.

For how long will I receive the monthly benefit?
The benefit shall be payable up to a maximum of 60 months per lifetime. It shall cease immediately on the earliest of the following dates:

a. the date of recovery from Disability;
  b. the date of death of the Policyholder, or
  c. after 60 benefit payments have been made.

How will the monthly payments be made to me?
For your convenience, the payments can be directly credited into your bank account specified in the Personal Statement of the claim form. Alternatively, cheque payments can be arranged.

Can the payments be made to my caregiver?
All payments will be made to the policyholder. However, we will consider your request on a case- by-case basis.

I am going overseas for my treatment, can you send the monthly benefit to my overseas address?
Arrangement for bank drafts to be sent to your overseas address or telegraphic transmission to your overseas account can be made. However, any charges involved will be deducted from the benefit payments.

Do I need to be confined to an institution before I am entitled to the monthly benefit?
ElderShield payouts will be made in the form of cash benefit and not tied to the reimbursement of institutional care. Thus, it is not a requirement for you to be confined to an institution for a benefit to be paid out.

With the treatment received, I can now perform the ADLs, which I was unable to do, must I inform your company?
Yes, since the benefit is only payable when you are not able to perform at least 3 ADLs, we will have to review your case when there is an improvement in your condition.

Procedure
Can I stop my premium payment once I file for a claim?
You are required to continue paying the premiums to keep the policy in force till the admission of the claim. Subsequently, any premiums paid after the date of our panel doctors assessment will be refunded.

I am disabled but I do not stay in Singapore and am unable to go back. How should I file my claim?
You would be required to obtain the Personal Statement (claim form) from the insurers' website, or contact the insurers' Customer Service Centre to request for a copy to be mailed to you.

You will then submit the completed Statement, together with any available medical reports (from registered practitioners in western medicine), and provide the name, address and clinic of the doctor certifying your medical condition.

Upon receipt of the information, the insurer will send the Assessor's Statement to the doctor, who will assess the severity of your disability and send the completed Statement back to the insurer.

The insurer will assess the claim and where necessary, request your disability to be assessed by a specialist, appointed by the insurer, in your country of residence.

For claims made from overseas, the insurer shall make every reasonable effort to assess the disability and make claim payments. Under these circumstances, the insurer may commute the benefit payments to a single payment reflecting the present value of future benefit payments.

Medical Assessment
I am a housebound patient and cannot go to your panel assessor for the medical assessment, can the assessor come to my house or institution?
You may make arrangement with the panel assessor located nearest to your house or institution for a house call.

Who is the panel assessor nearest to my house/institution?
The list is provided in the website under Panel Assessor. The list is also attached to the claim form for your easy reference.

Should I recover from my disability and subsequently become disabled again, would I need to go for another medical assessment?
Yes, you would need to go for another medical assessment.

Periodic Review
Will there be any reviews of my disability?
Yes, you may be required to go to our panel assessor for periodic examination. We shall keep you informed when such requirements arise.

Will there be any charges for the reviews? Who will bear the charge?
Yes, there will be charges for reviews. However, the insurer shall bear the charges for the reviews.

Appeal
What should I do if you repudiate my claim and I am not satisfied with your assessment?
You would have to write in an appeal for a review of your case. On receipt of your appeal, we may require you to make an appointment for your condition to be re-assessed by our panel specialist.

Will there be any charges for the medical assessment with your specialist? Who will bear the charges?
The charges for the specialist's assessment is S$75 and an additional of S$75 for a house call. You will have to first bear the charges for the assessment. Should your appeal be successful, and we decide to admit your claim, we will reimburse you the charges incurred.

Arbitration
Who can I go to if my appeal is unsuccessful and I am still not satisfied with the outcome?
You would have to write to us to request for a review by the Arbitration Panel appointed by the Ministry of Health. We shall forward your request and records to the Arbitration Panel for their consideration.

Subsequently, the Arbitration Panel may require you to go for another medical assessment with a specialist appointed by the panel. The charges for the assessment shall firstly be borne by you and reimbursed by the insurer only if your appeal is successful.

The decision made by the Arbitration Panel shall be final and binds both parties.

 
 
 
   
LIG

Thursday, 17 Apr 2014 (SGT)
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