GROUP MANAGED CARE – SUPREMECARE
Coverage
- Policy provides 24 hours comprehensive medical coverage with an appointed network of General Practitioner, Specialist complementing the Hospitalisation benefits. It provides a full spectrum of medical cover from primary to tertiary care.
- It covers an Insured Employee or Dependant in connection with his or her medical treatment or hospital confinement or surgery which results directly from an illness or injury.
Description of Benefits
Outpatient Cover
Outpatient cover provided by a panel of GP and Specialist clinics
Visit to panel GP clinic for treatment
Member will be provided medical treatment upon presentation of valid SupremeCare card at any panel GP clinics.
Visit to panel Specialist clinic for treatment (if applicable)
Member who is referred by a panel GP clinic will be provided treatment upon presentation of valid SupremeCare card at any panel specialist clinics or be reimbursed for the specialist care subject to the limit of the Specialist Consultation Benefit under the schedule of benefits.
Visit to panel Laboratory and Radiologic facilities
Member who is referred by panel clinic will be provided diagnostic services upon presentation of valid SupremeCare card at any panel facilities.
Visit to Accident and Emergency Department of appointed hospitals
Member will be provided treatment upon presentation of valid SupremeCare card at any designated A&E dept of appointed hospitals or be reimbursed for the visit to A&E department subject to the limit of the Accident and Emergency Benefit under the schedule of benefits.
Hospitalisation cover
Hospitalisation and Surgical cover
Daily Room & Board Benefit
Reimbursement for room and board charges during his hospital confinement, up to a daily maximum amount and number of days as specified in the policy contracts.
Intensive Care Unit
Reimbursement of room and board charges under Intensive Care Unit, up to a daily maximum amount and number of days as specified in the policy contracts.
Hospital Miscellaneous Services
Reimbursement of hospital charges for supplies and services rendered by the hospital during his confinement, subject to the maximum amount shown in the policy contracts.
Surgical Benefit
Reimbursement of surgical fees for operation but shall not exceed the sum obtained by multiplying the appropriate percentage shown for that operation in the Schedule of Surgical Operations by the maximum limit per Any One Disability as specified in the Schedule of Benefit shown in the policy contracts.
For surgical fees below S$500, the Schedule of Surgical Operations shall not apply.
In-Hospital Attending Doctor's Visit
Reimbursement for charges made by the attending doctor during his hospital confinement, subject to the daily maximum amount and number of days as specified in the policy contracts.
Pre & Post-Hospitalisation Specialist Consultation & Diagnostic X-ray and Lab Tests
Reimbursement for charges for pre and post consultations and tests within the 90 days prior to and post hospitalisation, subject to the maximum amount shown in the policy contracts.
Emergency Outpatient Treatment
Reimbursement for charges incurred as a result of an accident and is given emergency outpatient treatment by the hospital/clinic within 24 hours of the occurrence, and subsequent follow up treatment up to 31 days, subject to the maximum amount shown in the policy contracts.
Miscarriage due to Accident
Reimbursement for charges incurred or up to the amount provided under the Schedule of Benefits, which is lower, for an accident resulting in a miscarriage.
Funeral Expense
Lump sum amount provided under Schedule of Benefits shall be paid irrespective of cause of death.
Definitions
- "Any One Disability" shall means all disabilities arising from the same cause, including any or all complications therefrom, except that if the Insured Member returns to active full-time employment for 14 calendar days from the Insured Members latest date of discharge from the hospital, any subsequent period of disability from the same cause, shall be considered a new disability. In the case of the Insured Dependant, if any, the separation period shall be 30 calendar days.
- "Spouse" shall means an Eligible Employee's spouse below 65 age next birthday and not legally separated from the employee.
- "Child" means an Eligible Employee's natural child, step child or legally adopted child (adopted for at least 1 complete year) who has not reached 25 age next birthday, on the start date of any period of insurance.
Exclusions
- Any disability which originated before the effective date of the coverage unless the Insured member has been continuously insured , without any lapse in coverage under the Policyholder's Group Hospital and Surgical Insurances for at least 12 months with the previous Insurer or under this present contract or with both ;
- Injuries or sickness arising directly or indirectly from insurrection, war or act of war (whether declared or undeclared), direct participation in strikes, riots or civil commotion, or full-time service in any of the armed forces including National Service under Section 10 of the Enlistment Act Cap. 93 of the Republic of Singapore except National Service reservist duty or training under Section 14 of the Enlistment Act, Cap. 93 of the Republic of Singapore;
- Intentional self-inflicted injuries, or injuries sustained as a result of a criminal act of the Insured Employee or Dependant or attempted suicide (while sane or insane); nervous and mental conditions, alcoholism or drug addition, rest cures, sanitaria care or special nursing care, venereal disease; Acquired Immunodeficiency Syndrome (AIDS) and AIDS related complications; communicable diseases requiring by law isolation or quarantine in the event of an epidemic;
- Pregnancy including childbirth, caesarean operation, abortion, miscarriage (and all complication therefrom), except miscarriage due to accident, sterilization, infertility; oral contraceptives prescribed for birth control; impotency; congenital anomalies; treatment of obesity, weight reduction and improvement; cosmetic and plastic treatment except due to accident and for medical reasons only; dental surgery care, and extractions except dental treatment/operations resulting from injury due to an accident; eye and vision care (including any laser eye treatment for correction of eye refraction);
- Services and supplies not recommended, medically necessary (for e.g. vitamins and health supplement unless medically required and in the presence of vitamin deficiency), approved and performed by a legally qualified Registered Medical Practitioner or for services which are not necessary for the treatment of an illness or injury, or which are for preventive care or routine physical health check-up or prophylactic purposes. Procurement or use of special braces, any appliances, any equipment, implant or prosthetic devices, hearing aids and non-medical services such as radio, television, and telephone, house or office call performed outside the site of panel clinic.
- Chemotherapy, radiotherapy, immunotherapy and or stem cell support therapy, treatment following brain death, Interferon and other biological response modifiers, Physiotherapy and speech therapy, all treatment including and relating to kidney dialysis and/or organ transplants and or therapy for chronic hepatitis conditions, Computing Tomography, Magnetic Resonance Imaging, Positron Emission Tomography scan services unless these are provided for under the Benefit Schedule.
- Goods & Service Tax (GST) and any other government tax payable on charges made to any Insured Employee or Dependant in connection with his medical treatment.
Please refer to the policy contracts for details.
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