SHP Contract

GREAT EASTERN LIFE
SUPREMEHEALTH PLAN
POLICY VERSION 07/09 (AS CHARGED)
In THIS POLICY,"THE COMPANY" is THE GREAT EASTERN LIFE ASSURANCE COMPANY LIMITED and
"THE POLICYHOLDER" is the Policyholder named in Schedule A. "LIFE INSURED" refers to any person named
as the Life Insured in Schedule A or in an endorsement on this Policy.
SCHEDULE A defines the scope of the insurance under this Policy, including the Plan Type for the Life Insured,
and all clauses and conditions must be read in conjunction with this Schedule. Schedule A may be varied by
endorsements on this Policy. From time to time, the Company may issue a fresh Schedule A which consolidates
all variations made since the last Schedule A was issued. Upon issue, the new Schedule A will take effect from
the stated Effective Date and all previous Schedules A will be void from that date.
THIS
(a) Policy;
(b) the written Proposal and Declarations (which form the basis of this Contract);
(c) all subsequent written notices given by the Company to the Policyholder; and
(d) all subsequent written statements given by the Policyholder to the Company,
will make up the whole of the Contract of Insurance between the Company and the Policyholder.
NOW, THIS POLICY confirms that, if at any time during a Period of Insurance, the Life Insured incurs any Eligible
Expenses as described in this Policy as a result of Injury, illness or disease THEN the Company will reimburse
the Hospital (as defined in this Policy), the Policyholder, or the Policyholder's legal personal representative(s), the
benefits as stated in this Policy.
THIS SUPREMEHEALTH PLAN Insurance is subject to the clauses contained in this Policy and in endorsements,
if any, attached to this Policy. No change in or endorsement on this Policy is valid unless approved by a duly
authorised representative of the Company.
DIRECTOR
DIRECTOR
GREAT EASTERN LIFE

SUPREMEHEALTH PLAN
CONTENTS
DESCRIPTION
Schedule A and Endorsements (if any)
PAGE
DESCRIPTION
Attachments
Schedule B
RENEWAL
17
8.1
When No Renewal Allowed
8.2
Renewal Upon Payment of Premium
8.3
Grace Period
8.4
Rate of Premium
8.5
Company May Amend Clauses and
Conditions and Premium Rates
8.6
Upgrading/Downgrading of Plan Type
REINSTATEMENT OF POLICY
9.1 Clauses and Conditions
9.2 Reinstatement Premium Rate
9.3 When No Reinstatement Allowed
Clauses and Conditions

1
POLICY DEFINITIONS
1.1
Special Definitions
1.2
Expenses
1.3
In-hospital Psychiatric Treatment
LIFE INSURED JOINTLY INSURED

UNDER MEDISHIELD
LIMITS ON ELIGIBLE EXPENSES
BENEFITS
9
4.1
Subject to Clauses and Conditions
4.2
Reimbursement of Eligible Expenses
4.3
Benefit Computation
4.4
Benefit Limits
4.5
Indemnity
EXCLUSIONS
5.1
General Exclusions
5.2
Pre-existing Conditions
5.3
Expenses Falling under Exclusion
12
TERRITORIAL FACTORS
6.1
Overseas Emergency Medical
Treatment
6.2
Currency Exchange
15
TERMINATION
7.1
Termination on Renewal Date
7.2
Death of Policyholder or Life Insured
7.3
Cancellation By Policyholder
7.4
Not Citizen or Permanent
Resident : Residence Overseas
7.5
Life Insured Insured under Another
Shield Plan
7.6
No Benefits Payable after
Termination of Insurance
15
PAGE
18
10 CLAIM
10.1 Notification
10.2 Submission and Documentation
10.3 Medical Examiner's Certificate
10.4 Medical Examination
10.5 Expiration of Liability
20
11 POLICY - WHEN VOID

11.1 Misrepresentation or Non-disclosure
of Material Facts
11.2 Refund of Premium
11.3 Fraudulent Claim
11.4 Cheque Dishonoured
20
12 OTHER CONDITIONS
12.1 Form of Notices
12.2 Alteration of Policy
12.3 Errors of Age
12.4 Absolute Owner
12.5 Law of the Republic of Singapore
12.6 Exclusion of the Contracts (Rights of
Third Parties) Act 2001
21
The table of contents, headings and sub-heading in this Policy are inserted merely for convenience of
reference and will be ignored in the interpretation of the clauses and conditions contained in this Policy.
SupremeHealth Plan Policy Version 07/09
GREAT EASTERN LIFE

SUPREMEHEALTH PLAN (SHP)
SCHEDULE B: BENEFIT LIMITS (inclusive of MediShield Basic Limits)
LIMITS ON ELIGIBLE EXPENSES (All Amounts in S$)
Plan Type
P Plus
A Plus
Hospital/Ward Class Entitlement to

As Charged Reimbursement
Private Hospitals
EXPENSE ITEM
AMOUNT LIMIT
B Plus
Restructured Hospitals,
Class A Wards
Class B1 Wards
AMOUNT LIMIT
AMOUNT LIMIT
1. INPATIENT BENEFITS
Room & Board
As Charged
(1)
As Charged
(1)
Intensive Care Unit (ICU)
As Charged
(1)
As Charged
(1)
Miscellaneous Hospital Services
As Charged
(1)
As Charged
(1)
Daily In-Hospital Physicians Visit
As Charged
(1)
As Charged
(1)
As Charged
(1)
As Charged
(1)
As Charged
(1)
As Charged
(1)
As Charged
(1)
As Charged
(1)
Accidental Dental Treatment
As Charged
(1)
As Charged
Surgery
As Charged
(1)
As Charged
As Charged
Pre-Hospital Specialists Consultation

(within 90 days before Hospitalisation)
Examination and Laboratory Tests
(During Hospitalisation and within 90 days before
Hospitalisation)
Post Hospital Follow - up Treatment
(within 90 days from Hospital discharge)
Surgical Implants / Approved Medical

Consumables
Gamma Knife
Confinement in Community Hospital
2. FINAL EXPENSES BENEFIT
As Charged
(1)
As Charged
(1)
As Charged
(1)
As Charged
(1)
As Charged
(1)
As Charged
(1)
As Charged
(1)
(1)
As Charged
(1)
As Charged
(1)
As Charged
(1)
(1)
As Charged
(1)
As Charged
(1)
(1)
As Charged
(1)
As Charged
(1)
$325 per day

$ 7,000
$300 per day

$
6,000
$275 per day

$3,600
3. OUTPATIENT BENEFITS
Erythropoietin
1.
Cyclosporin ; or
2.
Tacrolimus ; or
3.
Other immunosuppressants prescribed for
treatment of organ transplants
Kidney Dialysis
Cancer Treatment:
1.
Radiotherapy
2.
Chemotherapy
3.
Immunotherapy
4.
Stereotactic Radiotherapy
As Charged
(1)
As Charged
(1)
As Charged
(1)
As Charged
(1)
As Charged
(1)
As Charged
(1)
As Charged
(1)
As Charged
(1)
As Charged
(1)
As Charged
(1)
As Charged
(1)
As Charged
(1)
4. OTHER BENEFITS
(1)
(1)
(1)
As Charged
As Charged
As Charged
(But limited to
(But limited to Singapore
(But limited to Singapore
Emergency Medical Treatment outside Singapore
Singapore Private
Hospital charges)
Class A Ward charges)
Class B1 Ward charges)
(1)
As Charged means all Eligible Expenses incurred by the Life Insured in the Hospital and Ward Class of the Life Insureds
entitlement under the Plan Type insured.
PRO-RATION FACTORS
(2)
P Plus
A Plus
B Plus
Pro-ration Factor to apply to Private Hospital

NA
70%
50%
charges
Pro-ration Factor to apply to Restructured
NA
NA
80%
Hospital, Class A Ward charges
(2)
Please refer to Clause 4.2.2.1 and Clause 4.2.2.2
Does not apply to the Expenses incurred in a Restructured Hospital for the following treatment provided to the Life Insured on an
outpatient basis: Kidney Dialysis Treatment, Cancer Treatment, Erythropoietin or Cyclosporin/Tacrolimus or other immunosuppressants
prescribed for treatment of organ transplant.
(3)
P Plus
A Plus
B Plus
Per Period of Insurance (Up to age 85 years next

birthday on Renewal Date)
Ward:
C: $1,000
B2: $1,500
B1: $2,000
A: $3,000
Private Hospital (all ward
types) and Hospitals
outside Singapore:
$3,000
Day Surgery: $3,000
Ward:
C: $1,000
B2: $1,500
B1: $2,000
A: $3,000
outside Singapore:
$3,000
Day Surgery: $3,000
Ward:
C: $1,000
B2: $1,500
B1: $2,000
A: $3,000
outside Singapore:
$3,000
Day Surgery: $2,000
Per Period of Insurance (above age 85 years next

birthday on Renewal Date)
Ward:
C: $1,500
B2: $2,250
B1: $3,000
A: $4,000
outside Singapore:
$4,000
Day Surgery: $4,000
Ward:
C: $1,500
B2: $2,250
B1: $3,000
A: $4,000
outside Singapore:
$4,000
Day Surgery: $4,000
Ward:
C: $1,500
B2: $2,250
B1: $3,000
A: $4,000
outside Singapore:
$4,000
Day Surgery: $3,000
DEDUCTIBLE
(3)
Does not apply to the Expenses incurred for the following: Kidney Dialysis Treatment, Cancer Treatment, Erythropoietin or
Cyclosporin/Tacrolimus or other immunosuppressants prescribed for treatment of organ transplant.
CO-INSURANCE
LIMITS ON BENEFITS PAYABLE
P Plus
A Plus
B Plus
10%
10%
10%
P Plus
A Plus
$6,000 per
$5,000 per
Period of Insurance
Period of Insurance
(4)
Living Organ Donor Transplant (Kidney / Liver)
$50,000 per Transplant
Annual Benefit Limit
$500,000
$350,000
Lifetime Benefit Limit
Unlimited
Unlimited
(4)
The recipient must be a family member (parents, siblings, children or spouse) of the Life Insured.
B Plus
$2,000 per
Period of Insurance
$200,000
Unlimited
GREAT EASTERN LIFE

SUPREMEHEALTH PLAN
1.
POLICY DEFINITIONS
The following clauses are defined as stated below and apply wherever they appear in this Policy:
1.1
Special Definitions
1.1.1
Physician
Any physician qualified by degree in Western medicine and legally licensed and authorised to
practise medicine and surgery in the geographical area of his practice, other than the
Policyholder, the Life Insured or a family member of either.
1.1.2
Hospital
An establishment constituted and registered as a hospital for the care and treatment of sick and
injured persons as bed-paying patients and which:
(a)
Has facilities for diagnosis and major surgery, provides 24 hours a day nursing services
by registered graduate nurses and is under the constant supervision of a Physician; or
(b)
Is a Government / restructured specialist medical centre.
However, the term Hospital does not refer to a clinic, an alcoholic or drug rehabilitation centre,
a nursing, rest or convalescent home, a spa or a hydroclinic, a Community Hospital or similar
establishment.
1.1.3
Hospitalisation
Confinement of the Life Insured in a Hospital:
(a)
for 12 consecutive hours or longer; or
(b)
for which a room and board charge is made in connection with such confinement; or
(c)
is required because of a surgical procedure.
1.1.4
Accident
An event involving the Life Insured which is caused solely and directly by accidental, violent,
external and visible means and independently of all other causes.
1.1.5
Injury
Bodily injury of the Life Insured caused solely and directly by an Accident.
1.1.6
Emergency
A serious Injury or illness or the onset of a serious medical condition which, in the opinion of the
Company, requires urgent remedial treatment to avoid death or serious impairment to the Life
Insureds immediate or long-term health.
1.1.7
Period of Insurance
The Period of Insurance stated in Schedule A or any subsequent Period of Insurance as
effected in accordance with Clauses 8.2.1 and 9.1.2.
1.1.8
Effective Date of Cancellation

The date of cancellation advised in the notice of cancellation or date of receipt of the notice of
cancellation by the Company, whichever is later.
1.1.9
Renewal Date
The date immediately following the last day of any Period of Insurance.
1.1.10 Commencement Date of Insurance of the Life Insured

The date (this date) on which this SupremeHealth Plan insurance on the Life Insured first
began, whether under this Policy or any policy for which insurance under this Policy is a
4
subsequent renewal or reinstatement. This date shall be the first day of the month of successful
deduction from the Policyholders Medisave account and/or during which the full premium is
paid by the Policyholder, or such date as determined and advised by the Company.
1.1.11 Eligible Expenses
Eligible Expenses are Expenses (as defined under Clause 1.2) incurred for medically necessary
treatment provided to the Life Insured for Injury, illness or disease during the Period of
Insurance.
1.1.12
Aggregate Eligible Expenses

The Aggregate Eligible Expenses for the Life Insured is the sum of all Eligible Expenses
incurred by the Life Insured during the Period of Insurance, subject to the limits as stated in
Clause 3 of this Policy. On the Commencement Date of Insurance of the Life Insured and on
each subsequent Renewal Date of this Policy, the Aggregate Eligible Expenses for the Period of
Insurance which follows that date is nil.
1.1.13 Deductible
The amount of the Aggregate Eligible Expenses (other than Eligible Expenses for Kidney
Dialysis, Cancer Treatment, Erythropoietin and Cyclosporin/Tacrolimus or other
immunosuppressants prescribed for treatment of organ transplants) incurred during the Period
of Insurance which will be borne by the Policyholder before any benefit becomes payable under
this Policy.
1.1.14 Co-insurance
The share of the Aggregate Eligible Expenses incurred during the Period of Insurance in excess
of the Deductible which is borne by the Policyholder.
1.1.15 Country of Issue
The Country in which this Policy is issued as stated in Schedule A.
1.1.16
The Act refers to the Central Provident Fund Act (Chapter 36).
1.1.17 The Regulations refer to the Central Provident Fund (MediShield Scheme) Regulations 2005
and any other revised future edition of the Regulations.
1.1.18
MediShield refers to the plan operated by the Central Provident Fund (CPF) Board, which is
governed by the Act and the Regulations.
1.1.19 Policyholders Medisave Account refers to the Policyholders Central Provident Fund (CPF)
Medisave account.
1.1.20
Community Hospital
Any approved community hospital defined in regulation 2 of the Regulations.
1.1.21 Reasonable & Customary Charges

Charges applicable for similar or comparable treatment or services provided in the Class of
Ward in accordance with the Plan Type insured for the Life Insured to individuals of the same
sex and comparable age for similar illness, disease, disability or injury.
1.1.22 Government
The government of the Republic of Singapore.
1.1.23 Restructured Hospital
A Hospital that is run as a private company and is wholly-owned by the Government through the
Ministry of Health, Singapore, and that receives a government subsidy for the provision of
subsidised medical services to its patients.
1.1.24
1.2
Foreigner
A person who is not a citizen nor a permanent resident of Singapore.
Expenses
The Expenses incurred by the Life Insured in respect of the following items are defined as Expenses:
1.2.1
Daily Room & Board

Accommodation in a Hospital including meals and general nursing during confinement as a bedpaying patient. This excludes deluxe rooms, luxury suites or other special rooms that are
available in the Hospital.
1.2.2
Intensive Care
Confinement in the intensive care ward of a Hospital.
1.2.3
Miscellaneous Hospital Services

Drugs and medicines, dressings, splints and plaster casts, intravenous infusions and blood
transfusions, anaesthetics (other than that required for surgery) and oxygen and their
administration.
1.2.4
Surgery
Surgical operations in a Hospital (regardless of whether the Life Insured is Hospitalised or not)
and performed by a duly qualified Physician and involving local or general anaesthesia. Surgery
Expenses include the fees and charges for anaesthetics and oxygen and their administration
and use of operating theatre and facilities. Surgery excludes Accidental Dental Treatment as
defined in Clause 1.2.9
1.2.5
Daily In-Hospital Physicians Visit

Consultation by a Physician during confinement in a Hospital.
1.2.6
Pre-Hospital Specialists Consultation

Consultation by a specialist Physician (such consultation) upon recommendation by a nonspecialist Physician (general practitioner) and in connection with a medical condition which
results in:
(a)
(b)
(c)
(d)
Hospitalisation; or
Surgery; or
Kidney Dialysis Treatment; or
Cancer Treatment,
within 90 days of such consultation, which includes the day on which such consultation took
place. Such consultation must take place in a Hospital or in a medical clinic where the specialist
Physician customarily provides such consultations. However, such consultation would exclude
consultations while the Life Insured is Hospitalised or which is provided after discharge from a
Hospital.
1.2.7
Examination & Laboratory Tests

Examinations using instruments and laboratory tests (such examinations) ordered by a
Physician and performed:
(a)
during the period of Hospitalisation; or
(b)
in the course of diagnosis of a condition resulting in Hospitalisation, Surgery, Kidney

Dialysis Treatment or Cancer Treatment within 90 days of such examinations including the
day on which such examinations took place.
6
1.2.8
Post Hospital Follow-Up Treatment

Medical treatment received after discharge from a Hospital (post Hospital treatment) provided
the treatment is prescribed by a Physician and resulted directly from the condition for which
Hospitalisation was required and includes:
(a)
(b)
(c)
General Outpatient services provided by a non-specialist Physician (general practitioner);

or
Specialist Outpatient services provided by a specialist Physician; or
Instrument Examinations and Laboratory Tests ordered by a Physician,
in a Hospital or in a medical clinic where the Physician customarily provides such services or in
a duly licensed medical laboratory where such instrument examinations and laboratory tests are
conducted. The post Hospital treatment must take place within 90 days of the discharge from a
Hospital including the day of the discharge. Post Hospital Follow-up Treatment excludes Kidney
Dialysis Treatment and Cancer Treatment as defined in Clauses 1.2.10 and 1.2.11 respectively
below.
Administration
of
Erythropoietin
and
Cyclosporin/Tacrolimus
or
other
immunosuppressants prescribed for treatment of organ transplants are also excluded.
1.2.9
Accidental Dental Treatment

Dental procedures performed by a duly qualified dental surgeon necessary to restore or replace
sound natural teeth lost or damaged during an Accident. Such dental procedures must take
place during Hospitalisation of the Life Insured.
1.2.10 Kidney Dialysis Treatment

In-hospital and outpatient kidney dialysis performed in a Hospital or a legally registered dialysis
centre including examinations and tests ordered by a Physician during the course of the
treatment.
1.2.11 Cancer Treatment
Chemotherapy, radiotherapy, immunotherapy and/or stereotactic radiotherapy provided by a
Hospital or a legally registered cancer treatment centre, including examinations and tests
ordered by a Physician during the course of the treatment.
1.2.12
Surgical Implant/Approved Medical Consumables

Surgical Implant refers to an implant inserted into the body of the Life Insured during surgery
and remains in the body of the Life Insured on completion of the surgery. Approved Medical
Consumables includes any of the following:
(a) intravascular electrodes used for electrophysiological procedures;
(b) Percutaneous Transluminal Coronary Angioplasty (PTCA); or
(c) inter-aortic balloons (or balloon catheters).
1.2.13
Human Immunodeficiency Virus (HIV) Due to Blood Transfusion and Occupationally Acquired
HIV
1.2.13.1
Infection with the HIV through a blood transfusion, provided that all of the
following conditions are met:
(a)
(b)
(c)
The blood transfusion was medically necessary or given as part of a

medical treatment;
The blood transfusion was received in Singapore after the
Commencement Date of Insurance or the last Date of Reinstatement of
the policy or the last effective date of upgrading, whichever is the latest
date;
The source of the infection is established to be from the Hospital that
provided the blood transfusion and the Hospital is able to trace the origin
of the HIV tainted blood; and
(d)
1.2.13.2
The Life Insured does not suffer from Thalassaemia Major or

Haemophilia.
Infection with HIV which resulted from an Accident occurring after the
Commencement Date of Insurance or the last Date of Reinstatement of the policy
or the last effective date of upgrading, whichever is the latest date, whilst the Life
Insured was carrying out the normal professional duties of his or her own
occupation in Singapore, provided that all of the following are proven to the
Companys satisfaction:
(a)
(b)
(c)
(d)
Proof of the Accident giving rise to the infection must be reported to the
Company within 30 days of the accident taking place;
Proof that the Accident involved a definite source of the HIV infected
fluids;
Proof of sero-conversion from HIV negative to HIV positive occurring
during the 180 days after the documented Accident. This proof must
include a negative HIV antibody test conducted within 5 days of the
Accident; and
Proof that the Life Insured is a medical practitioner, a houseman in a
Hospital, medical student, registered nurse, medical laboratory
technician, dental surgeon, dental nurse or paramedical worker, working
in a medical centre or medical clinic in Singapore.
1.2.14 Pregnancy Complications

Complications arising from pregnancy or childbirth after 10 months from the Commencement
Date of Insurance or the last Date of Reinstatement of the policy or the last effective date of
upgrading, whichever is the latest date, even if it results in Caesarean section, vacuum extraction
or forceps delivery.
1.2.15 Congenital Abnormalities
Treatment relating to birth defects, including hereditary conditions, and congenital sickness or
abnormalities first diagnosed after 2 years from the Commencement Date of Insurance or the last
Date of Reinstatement of the policy or the last effective date of upgrading, whichever is the latest
date.
1.2.16 Living Organ Donor Transplant (Kidney / Liver)
All Expenses incurred by the Life Insured arising from transplanting his kidney or liver where the
recipient of the kidney or liver is the Life Insureds family member, and where the recipients
kidney or liver failure is only first diagnosed after 2 years from the Commencement Date of
Insurance or the last Date of Reinstatement of the policy or the last effective date of upgrading,
whichever is the latest date. For the purposes of this Expense only, the Life Insureds family
members are deemed to be his parents, siblings, children and spouse.
1.2.17 Stem Cell Transplant
All Expenses incurred by the Life Insured arising from the treatment of an illness or a medical
condition. Outpatient therapy such as an injection or extraction where there is no Surgery or
Hospitalisation involved will not be covered. Related costs including costs of harvesting, storage,
transportation and cell culture will also not be covered.
1.2.18 Final Expenses Benefit
In the event of the Life Insureds death during Hospitalisation or after discharge from Hospital,
the Deductible and Co-insurance which applies to the Eligible Expenses (or proportionately
reduced Eligible Expenses under Clause 4.2.2) will be waived and Eligible Expenses (or
proportionately reduced Eligible Expenses) incurred during the Period of Insurance in which
death occurs which will otherwise not have been reimbursed due to the application of the
Deductible and Co-Insurance provisions will be reimbursed up to the limits stated in Schedule B
for the Plan Type insured, except if the Life Insured dies as a result of self-inflicted injuries,
suicide or attempted suicide, whether sane or insane.
1.3

Psychiatric treatment provided by a Physician duly qualified in psychiatry during full-time confinement in
a Hospital.
LIFE INSURED JOINTLY INSURED UNDER MEDISHIELD

The Life Insured is also jointly insured under MediShield operated by the Central Provident Fund Board which
is governed by the Act and the Regulations, provided the Life Insured meets the eligibility conditions as
specified in the Act and the Regulations. The Life Insured, if insured under MediShield, shall enjoy all benefits
of MediShield as provided under the Act and the Regulations.
LIMITS ON ELIGIBLE EXPENSES

Eligible Expenses are:
(a)
limited to the Reasonable and Customary Charges for such Expenses; and
(b)
subject to the limits as stated in Schedule B of this Policy in accordance with the Plan Type insured
at the time such Expenses are incurred.
BENEFITS
4.1
4.2
Subject to Clauses and Conditions

4.1.1
Subject to the clauses and conditions of this Policy, the Company will pay benefits under this
Policy for any Eligible Expenses incurred by the Life Insured during the Period of Insurance. If the
benefits payable under MediShield are higher than the benefits payable for the Eligible Expenses
according to Clause 4.2 to 4.5 below, the Company will pay the benefits under MediShield.
4.1.2
Subject to the clauses and conditions of this Policy, any claim for Eligible Expenses incurred after
the Commencement Date of Insurance of the Life Insured shall only be paid after the Company
receives the full payment of the premium for the Period of Insurance during which the Eligible
Expenses are incurred.
Reimbursement of Eligible Expenses

4.2.1
The Company will pay benefits under this Policy by way of reimbursement of Eligible Expenses
incurred subject to the limits as stated in Clause 3 above.
4.2.2
Pro-ration Factor
4.2.2.1
A Plus
Subject to clause 4.2.2.4, if the Life Insured is insured under A Plus as indicated
in Schedule A of this Policy and incurs Eligible Expenses while warded in:
(a)
a private Hospital; or
(b)
any Class or type of Ward of a Restructured Hospital (X Hospital) for

which X Hospital does not receive any subsidy from the Government for
the provision of medical services to the Life Insured while confined in that
Class or type of Ward (other than the Class A Ward of X Hospital), which
the Company may at its discretion include under this Clause 4.2.2.1 from
time to time,
all such Eligible Expenses will first be proportionately reduced by multiplying the
Pro-ration Factor shown for A Plus in Schedule B with the original amounts of
such Expenses. The proportionately reduced Expenses will then be subject to the
Deductibles, Co-insurance and Limits stated in Schedule B.
For the avoidance of doubt, all Expenses in excess of the proportionately reduced
Expenses will not be reimbursed by the Company.
4.2.2.2
B Plus
Subject to clause 4.2.2.4, if the Life Insured is insured under B Plus as indicated
in Schedule A of this Policy and incurs Eligible Expenses in:
(a)
a private Hospital; or
(b)
a Class A Ward of a Restructured Hospital; or
(c)
any Class or type of Ward of a Restructured Hospital (Y Hospital) for

which Y Hospital does not receive any subsidy from the Government for
the provision of medical services to the Life Insured while confined in that
Class or type of Ward, which the Company may at its discretion include
under this Clause 4.2.2.2 from time to time; or
(d)
any Class or type of Ward of a Restructured Hospital (Z Hospital) for

which Z Hospital receives a lower subsidy from the Government for the
provision of medical services to the Life Insured while confined in that
Class or type of Ward than the subsidy Z Hospital receives for the
provision of the same services for a patient confined in a Class B1 Ward
of Z Hospital, and which the Company may at its discretion include under
this Clause from time to time,
any such Eligible Expenses will first be proportionately reduced by multiplying the
Pro-ration Factor shown for B Plus in Schedule B with the original amounts of
such Expenses. The proportionately reduced Expenses will then be subject to the
4.2.2.3
Subject to clause 4.2.2.2 and clause 4.2.2.4, if the Life Insured:

(a)
is insured under B-Plus as indicated in Schedule A of this Policy; and
(b)
incurs Eligible Expenses in a class B1 ward or lower ward in a

Restructured Hospital; and
(c)
the Life Insured is a Singaporean Permanent Resident or Foreigner when

such Eligible Expenses were incurred,
any such Eligible Expenses will first be proportionately reduced by multiplying the
Pro-ration Factor shown in the table below applicable to his citizenship status
when such Eligible Expenses were incurred, with the original amounts of such
Expenses. The proportionately reduced Expenses will then be subject to the
Singapore Permanent Resident
Pro-ration Factor
Foreigner
Pro-ration Factor
90%
80%
10
4.2.2.4
4.2.2.5
Expenses incurred in a Restructured Hospital for any of the following treatments

provided to the Life Insured on an outpatient basis will not be pro-rated in
accordance with Clauses 4.2.2.1, 4.2.2.2 and 4.2.2.3:
(a)
Kidney Dialysis Treatment; or
(b)
Cancer Treatment; or
(c)
Erythropoietin; or
(d)
Cyclosporin/Tacrolimus; or other immunosuppressants prescribed for

treatment of Organ Transplant.
If the Life Insured undergoes Hospitalisation in a Restructured Hospital but, during

the Hospitalisation, transfers from a Class or type of Ward to another Class or
type of Ward for which the Restructured Hospital receives a higher or lower or no
subsidy from the Government for the provision of medical services to the Life
Insured, the Pro-ration Factor which applies to the Expenses incurred during the
whole period of Hospitalisation will be that applicable to the Class or type of Ward
for which the Restructured Hospital receives the lowest subsidy from the
Government, in accordance with Clauses 4.2.2.1 or 4.2.2.2.
4.2.3
For any benefits payable under this Policy, the Company will make payment to the Hospital with
which it has a payment arrangement. Otherwise, the Company will make payment directly to the
Policyholder.
4.2.4
If the Life Insured has undergone Hospitalisation in a Hospital (that Hospital) and:
(a)
is discharged from that Hospital; and
(b)
a Physician in that Hospital has recommended in writing that the Life Insured is to be
confined as an in-patient in a Community Hospital for further medical treatment arising
from the same Injury, illness or disease that resulted in the Life Insureds Hospitalisation in
that Hospital,
the Company will reimburse Eligible Expenses incurred arising from the Life Insureds
confinement in the Community Hospital including expenses for accommodation, meals and
general nursing during the Life Insureds confinement as a bed-paying patient in the Community
Hospital subject to the limits as stated in Schedule B of this Policy in accordance with the Plan
Type insured at the time such Eligible Expenses were incurred.
4.3
Benefit Computation
4.3.1
The Company will not pay benefits in respect of the Life Insured unless the Aggregate Eligible
Expenses (other than Eligible Expenses for Kidney Dialysis Treatment, Cancer Treatment,
Erythropoietin or Cyclosporin/Tacrolimus or other immunosuppressants prescribed for treatment
of organ transplant) incurred during any Period of Insurance exceeds the Deductible effective
during that Period of Insurance. If there are two or more Deductibles that can be applied, the
Company will apply the highest Deductible.
4.3.2
If the Aggregate Eligible Expenses (other than the Eligible Expenses for Kidney Dialysis
Treatment, Cancer Treatment, Erythropoietin or Cyclosporin/Tacrolimus or other
immunosuppressants prescribed for treatment of organ transplants) exceeds the Deductible, the
benefit payable shall be the reimbursement of the Aggregate Eligible Expenses in excess of the
Deductible, less the Co-insurance applicable to that Period of Insurance.
4.3.3
The Company will pay benefits in respect of the Eligible Expenses incurred for Kidney Dialysis
Treatment,
Cancer
Treatment,
Erythropoietin,
Cyclosporin/Tacrolimus
or
other
11
immunosuppressants prescribed for treatment of organ transplants, without deducting the

Deductible but after deducting the Co-insurance applicable to that Period of Insurance.
4.4
4.5
Benefit Limits
4.4.1
The Company will pay benefits in respect of Eligible Expenses incurred for treatment provided
to the Life Insured during the Period of Insurance up to the Annual Benefit Limit as stated in
Schedule B, in accordance with the Plan Type insured for the Life Insured at the time such
Expenses are incurred.
4.4.2
The Annual Benefit Limit in Schedule B on benefits payable for In-hospital Psychiatric Treatment
will apply to the total of all Eligible Expenses incurred in respect of and in connection with such
Treatment.
4.4.3
The Benefit Limit per Transplant in Schedule B on Expenses of Living Organ Donor Transplant
(Kidney / Liver) will apply to the total of all Expenses incurred in respect of and in connection
with such Living Organ Donor Transplant (Kidney / Liver).
Indemnity
Benefits payable under this Policy, together with reimbursement of Expenses paid or payable from other
sources, other insurance policies and employment benefit provisions, will not exceed the Expenses
actually incurred in respect of any claim made under this Policy.
4.5.1
Co-ordination
If the Policyholder is entitled to reimbursement from other sources of the Expenses incurred in
respect of any claim and if the total reimbursement from all sources including benefits payable
under this Policy when taken independently exceeds the Expenses so incurred, the Company
reserves the right to reduce the benefits payable under this Policy having regard to the other
sources such that the total actual reimbursement does not exceed the total of the Expenses
actually incurred.
4.5.2
Contribution
When the Policyholder is entitled to reimbursement from group or individual insurance
policy(ies) or under any legislation (these other sources) of the Eligible Expenses incurred by
the Life Insured, the Company will pay the lower of :
(a)
(b)
the benefits under this Policy; or

the balance of the benefits not reimbursed by these other sources.
EXCLUSIONS
5.1
General Exclusions
Under this Policy, the Company will not pay any benefit in reimbursement of Expenses incurred for, or
for the consequences of, the following:
(a)
Pregnancy and childbirth (including Caesarean section, vacuum extraction or forceps delivery
and the consequences thereof) except for Pregnancy Complications defined under clause
1.2.14.
(b)
Elective abortion, spontaneous miscarriage occuring within first trimester of pregnancy, birth
control*, sterilization*, infertility*, sub-fertility* or impotence treatment.
* for male or female
(c)
Routine physical or any other examinations not related to the treatment or diagnosis of an Injury,
illness or disease.
12
(d)
Instrument examinations and laboratory tests not ordered by a Physician or not resulting in a
diagnosis of a condition leading to Hospitalisation, Surgery, Kidney Dialysis Treatment, Cancer
Treatment or Accidental Dental Treatment.
(e)
All Dental Treatment not defined as Accidental Dental Treatment.
(f)
Elective cosmetic or plastic surgery performed during the Period of Insurance unless for Injury
sustained as a result of an Accident which occurs at any time after the Commencement Date of
Insurance of the Life Insured (or after the last Date of Reinstatement of insurance of the Life
Insured, if the insurance had ended and was subsequently reinstated).
(g)
Treatment of psychiatric, emotional, personality, mental and nervous disorders including

depression (except for In-hospital Psychiatric Treatment if covered under this Policy as indicated
in Schedule B).
(h)
Treatment of alcoholism or drug abuse.
(i)
Treatment provided to the Life Insured by the Policyholder, or a family member of the Life
Insured or the Policyholder, or self-treatment by the Life Insured, including the prescription of
drugs.
(j)
Transport for trips made for the purpose of obtaining medical treatment.
(k)
Purchase and rental of prostheses, corrective devices and medical appliances unless the
prostheses, corrective device or medical appliance satisfies the definition of a Surgical Implant
or of Approved Medical Consumables. Medical appliances include but are not limited to kidney
dialysis machines, iron lung, and durable medical equipment (e.g. wheelchairs and hospital
beds) used at home.
(l)
Acquisition of the organ itself for an organ transplant, (except for the procurement costs incurred
directly by the Hospital for the procurement of the organ for transplantation into the Life Insured
where the donor of the organ is already dead at the time of the removal of any of the organs in
the Country of Issue or outside the Country of Issue).
(m)
All Expenses incurred by the donor for an organ transplant except for Living Organ Donor
Transplant (Kidney / Liver) defined under clause 1.2.16.
(n)
Self-inflicted injuries or suicide or attempted suicide, whether sane or insane.
(o)
Treatment relating to birth defects, including hereditary conditions, and congenital sickness or
abnormalities first diagnosed before or within 2 years after the Commencement Date of
Insurance or the last Date of Reinstatement of the policy or the last effective date of upgrading,
whichever is the latest date.
(p)
AIDS and all illnesses or diseases caused by or related to the Human Immuno-deficiency Virus
(HIV) except for Human Immunodeficiency Virus (HIV) Due to Blood Transfusion and
Occupationally Acquired HIV defined under clause 1.2.13.
(q)
Sexually-transmitted diseases.
(r)
Violation or attempted violation of law and resistance to lawful arrest or any resultant
imprisonment.
(s)
War (whether declared or not), invasion, terrorist activities, rebellion, revolution, civil war or any
warlike operations.
(t)
Being in or on an aircraft of any type, or boarding or descending from any aircraft, except as a
fare-paying passenger or crew member on an aircraft on a regular scheduled route operated by
a recognised airline.
(u)
The Life Insured engaging in any sport in a professional capacity or where the Life Insured
would or could earn income or remuneration or win monetary rewards from engaging in such
sport.
13
(v)
5.2
Medical treatment, Hospitalisation, Surgery and consultation provided to and investigation of the
Life Insured commencing:
(i)
Before the Commencement Date of Insurance of the Life Insured for any condition;
(ii)
On or after the Commencement Date of Insurance of the Life Insured which are follow-up
medical treatment(s), consultation(s) or further investigation(s) of the Life Insured for that
condition for which he received medical treatment, consultation or investigation before the
Commencement Date of Insurance.
(w)
Any treatment provided to the Life Insured after the Renewal Date of this Policy unless the
insurance has been renewed on or before that date in accordance with Clause 8 of this Policy.
(x)
Private nursing charges and nursing home services.
(y)
Medical or surgical treatment outside Singapore except in the case of an Emergency.
(z)
Treatment for obesity, weight reduction or weight improvement regardless of whether it is

medically necessary or otherwise.
(aa)
Ambulance fee.
(bb)
Vaccination.
(cc)
Correction for refractive errors of the eye, routine eye and eye examinations, costs of
spectacles, costs of contact lenses and costs of hearing aids.
(dd)
Mountaineering, diving, bungee jumping, racing other than racing on foot, wakeboarding, hanggliding, rock climbing, parachuting, ballooning, handling of explosives or firearms and all
activities which are potentially life-threatening or where there is a risk of bodily injury to the Life
Insured.
(ee)
Ionizing radiation or contamination by radioactivity from any nuclear fuel or nuclear waste from
process of nuclear fission or from any nuclear weapons material.
Pre-existing Conditions
5.2.1
Any pre-existing illnesses, diseases or impairments (Pre-existing Conditions) from which the
Life Insured is suffering prior to the Commencement Date of Insurance of the Life Insured are
excluded, unless declared in the proposal for (or in the application for reinstatement of)
insurance of the Life Insured and expressly accepted by the Company.
5.2.2
Subject to Clause 5.2.3 below, any Pre-existing Condition which qualifies under any exclusions
under Clause 5.1 above is automatically excluded regardless of whether a declaration has
been made of that condition in the proposal for, or in the application for the reinstatement of, the
insurance under this Policy and accepted by the Company.
5.2.3
However, Pre-existing Conditions which had been covered under MediShield immediately
before the Commencement Date of Insurance of the Life Insured will continue to be covered
under MediShield provided that :
(a) the Life Insured was insured under :
(i) MediShield; or
(ii) any policy included in the Integrated Private Medical Insurance Scheme (IPMIS) under
which the Life Insured was jointly insured under MediShield,
immediately before the Commencement Date of Insurance of the Life Insured; and
14
(b)
5.3
Expenses Falling under Exclusion

Expenses incurred for medical treatment and consultation provided to and investigation of the Life
Insured under any of the exclusions as listed in Clauses 5.1 and 5.2 above will not be part of Eligible
Expenses, and will not be added to the Aggregate Eligible Expenses, if no benefit payment is made in
respect of these Expenses.
TERRITORIAL FACTORS
6.1
6.2
the Life Insured is now jointly insured under MediShield in accordance to Clause 2 above.
Overseas Emergency Medical Treatment

If the Life Insured requires medical or surgical treatment as a result of an Emergency while outside
Singapore, the Company shall reimburse the Expenses incurred up to the Limits stated in Schedule B
subject to the following conditions:
(a)
If the Life Insured is insured under P Plus at the time such Expenses were incurred, the Company
will reimburse the Expenses incurred or the Reasonable and Customary Charges which would
have been incurred for similar medical or surgical treatment in any private Hospital in Singapore,
whichever is lower.
(b)
If the Life Insured is insured under A Plus at the time such Expenses were incurred, the Company
have been incurred for similar medical or surgical treatment in any Class A Ward of a Restructured
Hospital in Singapore, whichever is lower.
(c)
If the Life Insured is insured under B Plus at the time such Expenses were incurred, the Company
have been incurred for similar medical or surgical treatment in any Class B1 Ward of a
Restructured Hospital in Singapore, whichever is lower.
Currency Exchange
Expenses incurred as a result of an Emergency while outside Singapore in any currency other than the
Singapore Dollar will be converted to Singapore currency at the prevailing exchange rate as determined
by the Company to be in effect on the date the Expenses were incurred.
TERMINATION
7.1
Termination on Renewal Date

On any Renewal Date of this Policy, insurance on the Life Insured under this Policy will end unless the
insurance has been renewed in accordance with Clause 8 below.
7.2
Death of Policyholder or Life Insured

7.2.1
If the Policyholder dies and the Policyholder is not the Life Insured, this Policy will continue for
the Life Insured until the Renewal Date of this Policy following the date of the death. On the
Renewal Date, the Company will insure the Life Insured under a new Policy for the same Plan
Type insured for the Life Insured effective on the day before the Renewal Date without requiring
fresh evidence of insurability, subject to the following conditions:
(a)
A party must submit a fresh proposal before the Renewal Date and;
(i)
that party must be allowed to deduct premiums for the Life Insured from that partys
Medisave account with the Central Provident Fund (CPF) Board (that partys
Medisave account) if the premium for the new policy is to be paid entirely or
partially from that partys Medisave account; or
(ii)
if the premium for the new policy is to be paid entirely in cash, that party must have
valid insurable interest on the Life Insured;
15
7.2.2
7.3
(b)
The new policy issued in accordance with Clause 7.2.1 will be issued on the clauses and
conditions of the Policy Version existing as at the Renewal Date; and
(c)
Any endorsement on or variation to this Policy authorised by the Company will also apply
to the new policy issued unless otherwise agreed by the Company.
Insurance on the Life Insured will end upon the death of the Life Insured. The Policyholder [or
the Policyholder's legal personal representative(s)] is entitled to a pro-rated refund of premium
(if paid) in respect of the insurance on the deceased Life Insured for the period remaining up to
the Renewal Date, after the date of death.
Cancellation By Policyholder
7.3.1
The Policyholder may cancel this Policy by submitting a notice of cancellation to the Company
upon which this Policy will be treated as ended on the Effective Date of Cancellation.
7.3.2
The insurance on the Life Insured will end on the Effective Date of Cancellation.
7.3.3
Upon termination of this Policy by cancellation, the Policyholder is entitled to a full refund of
premium, if the Effective Date of Cancellation falls within the first two calendar months after the
Commencement Date of Insurance of the Life Insured.
7.3.4
If the Effective Date of Cancellation falls outside the first two calendar months as mentioned
in clause 7.3.3 above, the premium will be refunded on a pro-rated basis allowing for the actual
number of days this Policy was in force from the:
(a) Commencement Date of Insurance of the Life Insured; or
(b) Renewal Date,
preceding the Effective Date of Cancellation, where applicable, except for a pro-rated
amount of the corresponding premium for MediShield for the Life Insured under the Act and the
Regulations. After the Effective Date of Cancellation, the Life Insured will be covered under
MediShield provided the Life Insured meets the eligibility conditions as specified in the Act and
the Regulations.
7.3.5
7.4
7.5
If no Effective Date of Cancellation is specified in the notice of cancellation, the Company will
assume the Effective Date of Cancellation to be the date of receipt of the notice of cancellation
by the Company.
Not Citizen or Permanent Resident : Residence Overseas

Insurance for the Life Insured will end on the Renewal Date (that Renewal Date) of this Policy and will
not be renewed if, on that date, the Life Insured:
(a)
Is not a citizen or permanent resident of the Country of Issue; and
(b)
Has resided outside the Country of Issue for more than 180 days, whether continuously or
otherwise during the Period of Insurance immediately prior to that Renewal Date; and
(c)
Is still residing outside the Country of Issue.
Life Insured Insured Under Another Shield Plan

The insurance under this Policy will terminate immediately, when the Life Insured is subsequently
insured under a similar plan issued under the Regulations by another insurance company.
7.6
No Benefits Payable after Termination of Insurance

7.6.1 The Company will not pay any benefit in reimbursement of any Expenses incurred by the Life
Insured whose insurance has ended in accordance with Clauses 7.3, 7.4 or 7.5 above for
treatment provided to the Life Insured on or after the effective date of such termination.
16
7.6.2
The Company will not pay any benefit for any Expenses incurred by the Life Insured for
treatment provided to the Life Insured on or after a Renewal Date of this Policy unless insurance
for the Life Insured was renewed in accordance with Clause 8 below.
RENEWAL
8.1
When No Renewal Allowed

The Company will not renew insurance under this Policy for the Life Insured whose insurance has ended
in accordance with Clauses 7.3, 7.4 or 7.5 above.
8.2
Renewal upon Payment of Premium

8.2.1
Subject to clause 8.1, if the required premium for renewal is paid on or before a Renewal Date,
the Company will guarantee the renewal of this Policy for a further Period of Insurance. The
further Period of Insurance will begin on the Renewal Date.
8.3
8.4
8.2.2
Where the premium is to be paid from the Policyholders Medisave account, the Company shall
request for deduction of the premium from the Policyholders Medisave account, subject to the
limits under the Central Provident Fund (Private Medical Insurance Scheme) Regulations
(PMIS regulations) effective at the time of request.
8.2.3
The excess of the premium for the Life Insured over the PMIS regulations limit, and any shortfall
in the deduction of premium resulting from the Policyholders CPF Medisave account being
inadequate, must be paid by the Policyholder before the end of the Grace Period described in
Clause 8.3.1 below.
8.2.4
All endorsements on or variations to this Policy authorised by the Company and any premium
loading imposed will also apply to the insurance granted on this Policys renewal unless
otherwise agreed in writing by the Company.
Grace Period
8.3.1
The Policyholder has a period of 60 days (the Grace Period) from the Renewal Date including
the Renewal Date, to pay the required renewal premium. If the full renewal premium is not paid
on or before the last day of the Grace Period, insurance under this Policy will be treated as
ended on the Renewal Date and may only be reinstated with the consent of the Company.
8.3.2
If the Life Insured receives treatment for which Eligible Expenses are incurred during the Grace
Period and a claim is submitted and there is still an amount of renewal premium to be paid (the
balance unpaid premium) or the renewal premium (outstanding renewal premium) has not
been paid yet, the Company will not pay any benefits for any claim submitted until the balance
unpaid premium or the outstanding renewal premium is paid before the end of the Grace Period.
8.3.3
If during the Grace Period, insurance on the Life Insured begins under any policy of insurance
with the Company which also provides benefits payable as defined in this Policy, then Clause
8.3.2 will immediately be void on the date of commencement of such other insurance.
8.3.4
Clauses 8.3.1 and 8.3.2 will not apply to the Life Insured if insurance on the Life Insured will not
be renewed in accordance with Clause 8.1 above.
Rate of Premium
The required renewal premium for the Life Insured whose insurance is renewed will be calculated at the
rate of premium applicable on the Renewal Date to:
(a) the Plan Type insured for the Life Insured and effective on the day before the Renewal Date (or for
any other Plan Type subject to the agreement of the Company); and
(b) the age next birthday of the Life Insured on the Renewal Date,
unless otherwise agreed in writing by the Company.
8.5
Company May Amend Clauses and Conditions and Premium Rates
17
8.6
8.5.1
The Company may amend the clauses and conditions of the insurance at renewal provided that
the amendments apply to all policies of this class of insurance and the Policyholder has been
informed of the amendments at least 30 days before the Renewal Date at which time the
amendments will apply.
8.5.2
The Company may amend the rates of premium at renewal provided that the amended rates
apply to all policies of this class of insurance and the Policyholder has been informed of the
amended rates at least 30 days before the Renewal Date at which time the amended rates will
apply.
Upgrading/Downgrading of Plan Type

8.6.1
The Policyholder may apply to:
(a)
upgrade the insurance under this Policy to a Plan Type with higher limits on Eligible
Expenses and Benefits on renewal of this Policy, subject to receipt of evidence of
insurability on the Life Insured acceptable to the Company;
(b)
downgrade the insurance under this Policy to a Plan Type with lower limits on Eligible
Expenses and Benefits on renewal of this Policy.
The Policyholder must submit the application for upgrading or downgrading at least 30 days
before the Renewal Date. The Company may refuse such an application.
8.6.2
If the Company accepts the Policyholders application, any endorsement on or variation to this
Policy authorised by the Company and any premium loading imposed will also apply to the
insurance granted upon the renewal and upgrading/downgrading, unless otherwise agreed in
writing by the Company.
8.6.3
For medical treatment, Hospitalisation, Surgery and consultation provided to and investigation of
the Life Insured commencing :
(a) before the effective date of upgrading or downgrading ("upgrading/downgrading date") of
benefits for any condition; and
(b) on or after the upgrading/downgrading date which were follow-up medical treatment(s),
consultation(s) or further investigation(s) of that Life Insured for the same condition for which
he
received
medical
treatment,
consultation
or
investigation
before
the
upgrading/downgrading date,
benefits will be payable in accordance with the Limits of the Plan Type insured under this Policy
immediately prior to the upgrading/downgrading date.
9.
REINSTATEMENT OF POLICY
9.1
Clauses and Conditions

9.1.1
If insurance under this Policy ends on the Renewal Date in accordance with Clause 7.1 above
and is not renewed in accordance with Clause 8 above, the Policyholder may apply for the
insurance to be reinstated by submitting evidence of insurability acceptable to the Company
within 15 days of the last date of the Grace Period (excluding the last date of the Grace Period)
described in Clause 8.3.1 above. The Company may refuse such an application.
9.1.2
If the Company accepts the Policyholder's application to reinstate the insurance under this
Policy, such insurance will be reinstated only if the required premium for reinstatement (the
reinstatement premium) is paid in accordance with one of the following applicable modes:
(a)
If the reinstatement premium is paid entirely in cash, the reinstatement premium must be
paid to the Company within 15 days of the last date of the Grace Period (excluding the last
18
date of the Grace Period) described in Clause 8.3.1 above. The date of reinstatement
(Date of Reinstatement) is the date when the application of reinstatement is approved or
when the reinstatement premium is received by the Company, whichever is the later date;
or
(b)
If the reinstatement premium is paid entirely from the Policyholders Medisave account, the
reinstatement premium must be successfully deducted from the Policyholders Medisave
account. The date of reinstatement (Date of Reinstatement) is the date on which the
premium was successfully deducted from the Policyholders Medisave account; or
(c)
If the reinstatement premium is paid partly in cash and partly from the Policyholders
Medisave account (the CPF portion), the:
(i)
CPF portion of the reinstatement premium must be successfully deducted from the
Policyholders Medisave account; and
(ii)
cash portion of the reinstatement premium must be paid by the date of the
successful deduction of the CPF portion, and
the date of reinstatement (Date of Reinstatement) is the date on which the premium was
successfully deducted from the Policyholders Medisave account.
The Period of Insurance upon reinstatement will begin on the Renewal Date on which the
insurance had ended in accordance with Clause 7.1.
9.1.3
Insurance granted upon reinstatement excludes medical treatment, Hospitalisation, Surgery and
consultation provided to and investigation of the Life Insured commencing :
(a) Before the Date of Reinstatement for any condition;
(b) On or after the Date of Reinstatement which are follow-up medical treatment(s),
consultation(s) or further investigation(s) of the Life Insured for that condition for which he
received medical treatment or consultation or investigation before the Date of
Reinstatement.
9.1.4
9.2
All endorsements on and variations to this Policy authorised by the Company and any premium
loading imposed will also apply to the insurance granted upon the reinstatement unless
otherwise agreed in writing by the Company.
Reinstatement Premium Rate

The required reinstatement premium for the Life Insured whose insurance is to be reinstated will:
(a)
Be calculated at the rate of premium applicable on the Date of Reinstatement according to the:
(i)
(ii)
(b)
Plan Type of the insurance granted on reinstatement; and

Age next birthday reached by the Life Insured on the Renewal Date of this Policy
described in Clause 9.1.2; and
Include any extra premium loading imposed on this Policy,
unless otherwise agreed in writing by the Company.

9.3
10
When No Reinstatement Allowed

The Company will not allow reinstatement of insurance for the Life Insured whose insurance had ended
in accordance with Clauses 7.2.2, 7.3, 7.4 or 7.5 above.
CLAIM
10.1
Notification
19
10.1.1 The Policyholder must, within 90 days after the happening of any event likely to give rise to a
claim, notify the Company and give written proof of such claim except where there is an
electronic filing submission of a claim under this Policy made on behalf of the Policyholder by a
Hospital or medical clinic or other medical establishment using the electronic submission system.
10.1.2 However, a claim will still be valid if it was not reasonably possible for the Policyholder to give
such proof within this period.
11
10.2
Submission and Documentation

The Policyholder must (at the Policyholders own expense) give to the Company all certificates and
forms, bills and receipts and information and evidence required by the Company and submit only original
bills, receipts and other documents required to support a claim, unless otherwise agreed in writing by the
Company except where such certificates, forms, bills and receipts, information and evidence required by
the Company are electronically submitted on behalf of the Policyholder by a Hospital or medical clinic or
other medical establishment using the electronic submission system.
10.3
Medical Examiner's Certificate

The Policyholder must (at the Policyholders own expense) submit a certificate signed by a Physician
who attended to the Life Insured for whom the claim is submitted. Otherwise, the Company will not pay
any benefit under this Policy. The medical certificate must be in a form prescribed by the Company.
10.4
Medical Examination
The Life Insured, for whom a claim has been submitted, must whenever reasonably required to do so (at
the Companys expense) submit to medical examinations by a Physician or Physicians appointed by the
Company.
10.5
Expiration of Liability
If the Company denies liability to the Policyholder for any claim, the Company will not be responsible for
that claim after 12 months have passed from the date of the disclaimer unless the claim is the subject of
pending mediation before a mediation authority or body.
POLICY - WHEN VOID

11.1
Misrepresentation or Non-disclosure of Material Facts

11.1.1 The Company may declare this Policy void if the Proposal and Declarations made by the
Policyholder or any written statement given by the Policyholder or the Life Insured on proposal
for (or application for reinstatement of) insurance is untrue in any respect, or if any material fact
affecting the risk is incorrectly stated or represented in or is omitted from these documents.
11.1.2 This Policy is treated as void:
(a)
(b)
11.2
On the Commencement Date of Insurance of the Life Insured if the misrepresentation,

omission or fraudulent statement was made to the Company on a proposal for insurance;
or
On the applicable Renewal Date described in Clause 9.1.2, if the misrepresentation,
omission or fraudulent statement was made to the Company on an application for
reinstatement of insurance.
Refund of Premium
Except in the case of fraud, when this Policy is treated as void under Clause 11.1 above:
(a)
If there are no claims made under this Policy, all premiums paid for insurance which became
effective on or after the date on which this Policy is treated as void will be refunded.
(b)
If there were claims made under this Policy, only the premiums paid for the Periods of Insurance
following the Period of Insurance in which the last claim was made will be refunded.
20
12
11.3
Fraudulent Claim
The Company may declare this Policy void if the Policyholder makes any claim which is fraudulent or
exaggerated or if the Policyholder makes any false declaration or statements in support of any claim. In
this case, this Policy will be void immediately and there will be no refund of premiums.
11.4
Cheque Dishonoured
This Policy will be void if the cheque issued for the payment of the premium due on this Policy is
dishonoured. The Company reserves the right not to grant or reinstate insurance unless evidence of
insurability acceptable to the Company is given.
OTHER CONDITIONS
12.1
Form of Notices
12.1.1 Any request, notice, instruction or correspondence required under this Policy whether to the
Company or the Policyholder has to be in writing and will be delivered personally or sent by
courier, or by post, or facsimile transmission or electronic mail addressed to the addressee or by
any other means as may be approved or adopted or accepted by the Company. For the
Policyholder, the mailing address is that stated in the proposal or any other address that the
Policyholder has informed the Company in writing.
12.1.2 The Companys notice, request, instruction or communication is presumed to be received:
(a)
In case of a letter, on the 7th day after posting if posted locally, and on the 14th day after
posting, if posted overseas;
(b)
In the case of personal delivery or delivery by courier, on the day of delivery;
(c)
In the case of a facsimile transmission or electronic mail, on the business day
immediately following the day of despatch; or
(d)
In the case of other means as approved, adopted or accepted by the Company, as when
the Company decides when it is reasonable to be received.
12.2
Alteration of Policy
No alteration in the clauses of this Policy or any endorsement will be valid unless the alteration or
endorsement is signed or initialled by an authorised representative of the Company.
12.3
Errors of Age
If the age of the Life Insured has been stated wrongly in the proposal for this Policy, the premium shall
be adjusted based on the correct age of the Life Insured. Any excess premium paid shall be refunded
and any shortfall in premium made up.
If at the correct age, the Life Insured would not have been eligible for insurance under this Policy, no
benefits will be payable, and all premiums paid will be refunded in full.
12.4
Absolute Owner
12.4.1 The Company is entitled to treat the Policyholder as the absolute owner of this Policy.
12.4.2 The Company will not recognise any equitable or other claim to or interest in this Policy.
12.4.3 The receipt by the:
(a)
(b)
(c)
Policyholder;
Policyholders legal personal representative(s); or
Hospital in which Eligible Expenses were incurred by the Life Insured,
of any payment made will be a full and final discharge.

12.5
Law of the Republic of Singapore

12.5.1 This Policy will be construed according to and governed by the laws of the Republic of
Singapore.
21
12.5.2 The laws of the Republic of Singapore will apply in the event of any conflict or dispute with
regard to this Policy and the parties to the conflict or dispute agree to submit themselves to the
exclusive venue and jurisdiction of the courts of the Republic of Singapore for the resolution of
any conflict or dispute.
12.6 Exclusion of the Contracts (Rights of Third Parties) Act 2001
A person who is not a party to this Policy shall have no right under the Contracts (Rights of Third Parties)
Act 2001 to enforce any of its terms.
22

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GREAT EASTERN LIFE

GREAT EASTERN LIFE

Clauses and Conditions

LIFE INSURED JOINTLY INSURED

LIMITS ON ELIGIBLE EXPENSES

11 POLICY - WHEN VOID

SupremeHealth Plan Policy Version 07/09

GREAT EASTERN LIFE

Hospital/Ward Class Entitlement to

Intensive Care Unit (ICU)

Miscellaneous Hospital Services

Daily In-Hospital Physicians Visit

Accidental Dental Treatment

Pre-Hospital Specialists Consultation

Surgical Implants / Approved Medical

$325 per day

$300 per day

$275 per day

SupremeHealth Plan Policy Version 07/09

Pro-ration Factor to apply to Private Hospital

Per Period of Insurance (Up to age 85 years next

Per Period of Insurance (above age 85 years next

LIMITS ON BENEFITS PAYABLE

SupremeHealth Plan Policy Version 07/09

GREAT EASTERN LIFE

Effective Date of Cancellation

1.1.10 Commencement Date of Insurance of the Life Insured

SupremeHealth Plan Policy Version 07/09

Aggregate Eligible Expenses

1.1.21 Reasonable & Customary Charges

SupremeHealth Plan Policy Version 07/09

Daily Room & Board

Miscellaneous Hospital Services

Daily In-Hospital Physicians Visit

Pre-Hospital Specialists Consultation

Examination & Laboratory Tests

during the period of Hospitalisation; or

in the course of diagnosis of a condition resulting in Hospitalisation, Surgery, Kidney

SupremeHealth Plan Policy Version 07/09

Post Hospital Follow-Up Treatment

General Outpatient services provided by a non-specialist Physician (general practitioner);

Accidental Dental Treatment

1.2.10 Kidney Dialysis Treatment

Surgical Implant/Approved Medical Consumables

The blood transfusion was medically necessary or given as part of a

SupremeHealth Plan Policy Version 07/09

The Life Insured does not suffer from Thalassaemia Major or

1.2.14 Pregnancy Complications

SupremeHealth Plan Policy Version 07/09

In-hospital Psychiatric Treatment

LIFE INSURED JOINTLY INSURED UNDER MEDISHIELD

LIMITS ON ELIGIBLE EXPENSES

Subject to Clauses and Conditions

Reimbursement of Eligible Expenses

any Class or type of Ward of a Restructured Hospital (X Hospital) for

SupremeHealth Plan Policy Version 07/09

a Class A Ward of a Restructured Hospital; or

any Class or type of Ward of a Restructured Hospital (Y Hospital) for

any Class or type of Ward of a Restructured Hospital (Z Hospital) for

Subject to clause 4.2.2.2 and clause 4.2.2.4, if the Life Insured:

is insured under B-Plus as indicated in Schedule A of this Policy; and

incurs Eligible Expenses in a class B1 ward or lower ward in a

the Life Insured is a Singaporean Permanent Resident or Foreigner when