AIA Singapore extends medical claims pre-authorisation to give clients peace of mind

| 23 Mar 2020

(Source: AIA Singapore)

AIA Singapore has announced enhancements for AIA HealthShield Gold Max plans, including the extension of claims pre-authorisation to cover all non-emergency admissions and day surgeries at all private hospitals and healthcare providers across Singapore.

Pre-authorisation is already available for policyholders seeking treatment with AIA Quality Healthcare Partners, a curated panel of private specialist doctors. This makes the insurer the first to provide policyholders Pre-authorisation of medical claims at all private hospitals and healthcare providers nationwide, said the company statement.

This extended service will be provided to all AIA HealthShield Gold Max policyholders – representing approximately 1 in 5 Singapore Residents – effective 15 April 2020.

The initiative is aligned with the recommendations of the 2016 Health Insurance Task Force’s report on managing the cost of health insurance in Singapore.

Obtaining a Certificate of Pre-authorisation

Pre-authorisation is not required for emergency treatments including COVID-19 cases, as eligible claims will be accepted automatically.

Policyholders will be able to obtain a Certificate of Pre-authorisation prior to admission or day surgery at any private hospital and/or healthcare provider. Requests for pre-authorisation should be submitted at least 3 working days prior to the intended date of admission. Policyholders will be notified via SMS and/or email once the request has been approved.

Key benefits of Pre-authorisation include:

No bill shock: Policyholders get assurance and peace of mind that their procedure will be covered and are informed of the amount AIA will cover – all before the admission or surgery.

Minimal cash outlay: Policyholders will not have to make a deposit and cash outlay will be limited to applicable deductible and co-insurance. Remaining charges will be directly settled between AIA and the hospital/healthcare provider

Ensuring that charges are reasonable and that treatment is in line with norms: Pre-authorisation will allow AIA to ensure that proposed charges are reasonable and customary based on national fee benchmarks and agreed fee schedules with panel doctors (if applicable). It will also allow AIA to ensure that the proposed treatment is in line with norms and advise policyholders if this is not the case.

Continued access to quality healthcare: Policyholders, by going through the pre-authorisation process, are supporting long-term efforts to mitigate health claims inflation so that all IP insurers, including AIA, can continue providing medical coverage to Singapore Residents.

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Dr Alan Ong, Medical Director, AIA Singapore, said there is a need to manage the longer-term challenge of rising healthcare costs. “Pre-authorisation was a key recommendation put forth by the Health Insurance Task Force and complements AIA’s other efforts such as our panel of AIA Quality Healthcare Partners, and AIA Vitality – our comprehensive health and wellness programme. As an industry leader, we need to help moderate healthcare inflation, and ensure that people have assurance regarding the coverage of their medical costs.”

Singapore’s medical inflation was 10% in 2018, more than 20 times the nation’s average inflation rate of 0.44%. In a recent survey conducted by AIA Singapore, 90% of respondents were concerned about the cost of healthcare, and more than 80% highlighted concerns about being charged more than necessary for their medical treatment. In addition, 87% were concerned about being fully reimbursed for their medical bills.

The expansion of pre-authorisation to cover all other private providers will help address these pain points so that policyholders can focus on recovery.


Pre-authorisation process for policyholders

Going forward, AIA HealthShield Gold Max policyholders will be able to easily activate pre-authorisation in 3 simple steps, accessible via multiple channels. These include the My AIA SG mobile app and the AIA Singapore website. AIA will also be setting up a dedicated 24/7 AIA HealthShield Gold Max hotline – 1800-248-8000, which would be available from 15 April 20209, to provide round-the-clock assistance to policyholders regarding pre-authorisation and other aspects of their AIA HealthShield Gold Max policies.


Requirement for pre-authorisation – applicable only to non-emergency treatments

Policyholders should activate Pre-authorisation for any non-emergency admission or day surgery in order to ensure full insurance coverage. Pre-authorisation is not required for emergency treatment.

For treatment at public hospitals / institutions, policyholders do not need to activate pre-authorisation. AIA Singapore is working towards enabling automatic pre-authorisation in public hospitals for AIA policyholders, and will announce further information on this in due course.

For treatment by AIA Quality Healthcare Partners, policyholders are only required to activate a pre-authorisation request, and where necessary, AIA Singapore will work directly with the healthcare provider to ensure submission of the required information to AIA. Once approved, policyholders will be notified and receive a Certificate of Pre-authorisation.

For treatment by other private healthcare providers, policyholders will need to activate the request and follow up with the doctor to ensure that the doctor submits the required information. A Certificate of Pre-authorisation will be issued for approved requests. Treatment which is not pre-authorised may be subject to pro-ration, where policyholders will need to bear a percentage of the bill.

For a smooth transition when claims pre-authorisation service is extended, and in view of the ongoing COVID-19 situation, a grace period will be provided until 30 June 2020 before pro-ration comes into effect for non-panel AIA HealthShield Gold Max A cases without pre-authorisation. The application of pro-ration factor will be based on the date of admission / day surgery. AIA Singapore will continue to monitor the COVID-19 situation as it unfolds and may extend this grace period for pro-ration as required.

For all AIA HealthShield Gold Max claims related to the COVID-19, AIA Singapore will continue to monitor the evolving COVID-19 situation and will provide updates in accordance with the latest guidelines from the relevant authorities.

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