United World College of South East Asia Group Medical Insurance Handbook
2021 - 2022
Loc
Group Medical Insurance 2021 2022
Contents 1. Introduction: Your Group Insurance Cover……………………..….…………. 3
2. Singapore Network……………………………………………………………………………. 4 2.1 Hospitals Network……………………………………………………………………. 4 2.2 Outpatient GP Clinic Network………………………………………………….. 6
3. Benefits Overview………………………….………………...... 8 3.1 Inpatient Coverage………………………………………………………………….. 9 3.2 Outpatient Coverage…….…………………………………………………………. 12 3.3 Further Benefits…….………………………………………………………………… 14
4. Policy Exclusions…………………………………………..………...... 15
5. Area of Coverage……..…………………………………………..………...... 18
6. Inpatient Direct Billing Services……………..…………………………………………. 19 6.1 Pre-Authorisation……….…………….……………………………...……………… 19 6.2 Prior Approval Treatment…………………………………………………....….. 19 6.3 Scheduled & Emergency Hospital Admission………………………….... 20
7. Outpatient Direct Billing Services.……………..…………….……...... 22 7.1 Outpatient Direct Billing Procedures………………………...... 22 7.2 Outpatient Non-Direct Billing Network………………………….……….... 23 8. Claims Procedure (Pay & Claim)…….…………...………………………….……….….. 23 8.1 Cigna Envoy App Submission……..……………….…….………………………. 23 8.2 Cigna Envoy Online Portal Submission.……….….………………….....….. 24 8.3 Claim Form Submission……………………………………….…………………..... 24
9. Cigna Envoy…………………………………………………………………..……………………. 25 9.1 Registration Process…..………………………………………...... 25 9.2 Cigna Envoy Mobile App…………………………………………………………… 26
10. Cigna Virtual Clinic……………………………………………………..……………………… 27 10.1 Registration Process…..………………………………………...... 28 10.2 Teleconsultation…………………………………………………………………….. 28 10.3 How to View Documents & Purchase Medication…………………… 29
11. Contact Details…………………………………………………………………………………… 31
12. Appendix……………………………………………………………………………………….. 32
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1. Introduction: Your Group Medical Insurance Coverage
This booklet provides the necessary information for your international group medical insurance scheme and benefit entitlement under UWC South East Asia.
This is just a summary and is not meant to replace the actual policy wording and insurance contract.
Policy Period: 01 August 2021 to 31 July 2022
Policy Number: 605500 / 605501
Insurance Provider: Cigna Health Insurance
Insurance Advisor: Pacific Prime Singapore
Eligibility: You are covered under the Global Health Benefits Scheme plan as active and permanent employee of UWC South East Asia.
Insurance Card: Each new joiner or employee will be issued with a Cigna E-Card and will receive a membership pack on the UWC South East Asia registered email address.
Cigna Insurance Card (front) Cigna Insurance Card (back)
NOTE: The content reflected in this handbook is correct at the time of print and are subject to changes as needed.
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2. Singapore Network
2.1 Hospitals network
You are entitled to a standard private room at these hospitals: • Standard private room of following Public Hospitals:
Singapore General Hospital (SGH) – Bukit Merah (Rank 3rd best hospitals in the world 2019, covers all specialisms) Changi General Hospital (CGH) – Tampines (Covers all specialisms) National University Hospital (NUH) – Queenstown (Covers all specialisms) Ng Teng Fong General Hospital – Jurong East (Newest, integrated healthcare initiative in the West) KK Women and Children’s Hospital (KKH) – Bukit Timah (Best for Women & Children) Alexandra Hospital – Queenstown (Best for acute/sub-acute conditions & rehabs) Khoo Teck Puat Hospital – Yishun (Best integrated healthcare initiative in the North) Sengkang General Hospital (SGH) – Sengkang (Best integrated healthcare initiative in the North) Tan Tock Seng Hospital – Novena (Largest multi-disciplinary hospital)
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• Standard private room of following Hospitals under Cigna Links where 10% co- payment applies (Please note members must visit the listed doctor at the listed facility to be classed as ‘in network’, please refer to Appendix A1):
Gleneagles Hospital - Tanglin
Mount Elizabeth Hospital - Orchard
Mount Elizabeth Novena Hospital - Novena
Parkway East Hospital - Eunos
• Standard private room of following Private Hospitals outside of Cigna Links (20% co-payment applies):
Raffles Hospital - Bugis
Thomson Medical Centre - Novena
Farrer Park Hospital - Bendemeer
Mount Alvernia Hospital - Braddell
Concord International Hospital – Tan Kah Kee
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2.2 Outpatient Clinic Network
▪ General Practitioners:
o Public Facilities - 18 Polyclinics across Singapore (strictly on Pay-and-Claim basis)
Map of Singapore Polyclinics Location
o Cigna has aligned with ParkwayHealth (Cigna Links) and Doctor Anywhere to provide seamless medical services, where you can obtain access to an extensive network of local health professionals and facilities through Cigna direct billing (cashless) services. - Parkway facilities strategically located throughout Singapore more than 400 general practitioners
- Doctor Anywhere Clinic (Onsite Campus)
▪ Specialist Practitioners:
o Public Facilities - Out-Patient Specialists in Public Hospitals (strictly on Pay-and- Claim basis)
o Public Facilities - 7 specialised national medical centres (strictly on Pay-and-Claim basis):
- National Heart Centre (specialised in Heart conditions) - Singapore National Eye Centre (specialised in Eye conditions) - National Cancer Centre (specialised in Cancer conditions)
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- National Skin Centre (specialised in Skin conditions) - National Neuroscience Institute (specialised in Neuro conditions) - Communicable Disease Centre (specialised in Infectious Diseases) - Institute of Mental Health and Jurong Medical Centre (specialised in mental conditions)
Map of Singapore Specialised National Medical Centre Location
The list of Singapore Public Facilities available near your location can be found easily on the Health Buddy Mobile App developed by the SingHealth Group.
Alternatively, you can also refer to the Appendix A2 for full listing of Singapore public facilities. We would strongly advise you to download the app since it also provides you with the access to health information and including the ability to make appointments at SingHealth providers.
Do kindly refer to Appendix B for the “MiniGuide on Health Buddy App”.
o Cigna has aligned with ParkwayHealth (Cigna Links) to provide seamless medical services, where you can obtain access to an extensive network of local health professionals and facilities through Cigna direct billing (cashless) services. Parkway facilities strategically located throughout Singapore; - more than 780 Specialist practitioners
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3. Benefits Overview
Insurer: Cigna Health Insurance
Plan Name : Global Health Benefits
Area of Cover : Worldwide excluding the USA
Underwriting Terms : Medical History Disregarded
Overall Plan Limit : SGD 2,250,000
New Co-payment Applies:
Inpatient Outpatient Cigna Out-of- Cigna Out-of- Govt Network Govt Network Network Network Network Network SG Government All other Providers + All other SG Treatment private Cigna Virtual private Government CignaLinks CignaLinks Location providers in SG Clinic + Doctor providers in Providers + Raffles Anywhere SG + Raffles Campus Clinic Co- 0% 10% 20% 0% 20% 20% payment Out of Pocket SGD $5,000 maximum out of pocket per member per year Maximum
Inpatient In Network: All Government Restructured Hospitals, CignaLinks Singapore
Outpatient In Network: All Government Restructured Clinics and Cigna Virtual Clinic, CignaLinks Singapore
For a detailed summary of your benefits under your Cigna plan, please refer to the Table of Benefits available on your Cigna Envoy Online Portal or Mobile App:
www.cignaenvoy.com NOTES:
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• Within CignaLinks members must visit the listed Doctor at the listed facility to be classed as ‘In-Network’.
• Cigna Virtual Clinic refers to general practitioner video consultation, medication prescription and its delivery, as well as treatment at the affiliated physical clinics in Singapore, under Doctor Anywhere (DA) Group upon presenting CIGNA Card or DA Card link to their Cigna membership.
2.1 Inpatient Coverage
In the following sections, some benefits are indicated as paid in full but please note that the total value of claims paid by the insurer cannot exceed the overall plan limit.
Govt In Network: All Government Restructured Hospitals CignaLinks In Network: CignaLinks Hospitals
CignaLinks Govt In-Network Out of Network In-Network Inpatient and Daycare Paid in full 90% Refund 80% Refund treatment (Private Room) (Private Room) (Private Room)
Parental accommodation Paid in full 90% Refund 80% Refund Pre-Hospitalisation (up to 30 days before procedure) Paid in full 90% Refund 80% Refund
Post Hospitalisation (up to 90 days after procedure) includes Rehabilitation as well which is Paid in full 90% Refund 80% Refund subject to maximum of 120 days after procedure
Specialist Physician’ Fee include stays in hospital and Paid in full 90% Refund 80% Refund intensive care as long as is required by medical necessity
Radiotherapy, Chemotherapy, Paid in full 90% Refund 80% Refund Oncology
Radiology and Pathology Paid in full 90% Refund 80% Refund
Physiotherapy where required Paid in full 90% Refund 80% Refund due to medical necessity
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Govt In-Network CignaLinks Out of Network In-Network Home Nursing - If recommended by a specialist immediately, after hospital treatment for as long as is required by medical necessity. Paid in full - On a full time basis for as long as is required by medical necessity for treatment which would normally be provided in hospital. Hospice/Palliative Care requires pre-approval from Paid in full Cigna
Surgical Appliance and/or Paid in full 90% Refund 80% Refund Medical Appliance
Organ Transplant* requires pre-approval from Cigna Paid in full 90% Refund 80% Refund
HIV or AIDS Paid up to SGD $12,500 per policy year (Combined limit with OP)
Hospital Cash Allowance (up to 20 days per policy year) for SGD $300 Not Applicable admission to Singapore per day restructured hospitals only.
Psychiatric and Psychological Care (up to 180 days in any one Paid in full year of insurance)
Private Ambulance Paid in full
Cancer Treatments to include Oncology, Chemotherapy, Radiotherapy and other Paid in full 90% Refund 80% Refund Outpatient treatment and prescribed drugs
Kidney Dialysis Paid in full 90% Refund 80% Refund
Mortal remains Paid in full
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CignaLinks Govt In-Network Out of Network In-Network Emergency Medical Evacuation and Repatriation requires pre- approval from Cigna Paid in full immediately, in no case later than 7 days Hospital Accommodation Costs relating to a new born baby (up to 16 weeks old) to accompany his/her mother (being a Paid in full 90% Refund 80% Refund member) whilst receiving treatment as an inpatient in hospital, following discharge from the original delivery
NOTES:
• Cigna will consider charges made for or in connection with approved organ transplant services, including immunosuppressive medications, organ procurement costs, and donor’s medical costs. The amount payable for donor’s medical costs is reduced by the amount payable for those costs from any other plan or source. Certain transplants will not be covered based on general limitations (i.e. experimental procedures). The employee/dependant must contact Cigna before incurring costs relating to organ donation.
• A 20% co-payment applies to you for the cost of each claim for eligible treatment outside of the plan network.
• A 10% co-payment applies to you for the cost of each claim for eligible treatment within the CignaLinks Network.
• The co-payment is capped up to SGD $5,000 per members across all benefits per policy year.
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2.2 Outpatient Coverage
In the following sections, please note that the total value of claims paid by the insurer cannot exceed the overall plan limit.
Out-Patient Annual Maximum: Up to SGD $10,000 per policy year
In Network In Network (Sgp Govt Restructured Out of Clinics/Hospitals, Cigna (CignaLink Network Virtual Clinics, Doc Clinics) Anywhere Campus Clinic) Consultations with Medical Paid in full 80% refund Practitioners and Specialists
Outpatient Physiotherapy, Paid in full Podiatry, Osteopathic and Chiropractic Treatment Up to SGD $1,875 per policy year
Diagnostic Scans, X-rays, Lab Tests Paid in full and Advanced Radiological Imaging
Outpatient Appliances including insoles when prescribed following Paid in full a referral by a medical practitioner Up to SGD $1,575 per policy year or specialist
Paid in full HIV or AIDS Up to SGD $12,500 per policy year (combined limit with IP)
Hormone Replacement Therapy Paid in full
Minor Surgical Procedures and Paid in full Treatment
Prescribed Medicines, Drugs and Paid in full 80% refund Dressings
Emergency Dental Treatment received within 24 hrs of a dental Paid in full emergency
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In Network In Network (Sgp Govt Restructured Out of Clinics/Hospitals, Cigna (CignaLink Network Virtual Clinics, Doc Clinics) Anywhere Campus Clinic) Well Child Tests includes a maximum of 13 visits per lifetime per dependent child under age of Paid in full 80% refund 7, with annual immunisations for dependent child under age of 19
Psychiatric & Psychological Care paid in respect of psychiatric Paid in full conditions, other mental health Up to SGD $2,000 per policy year disorders or addictive conditions.
NOTES:
• Emergency dental treatment is where a severe pain that is not relieved by painkillers, a dental accident occurs, or facial swelling or uncontrollable bleeding after an extraction, is being suffered and it is either outside the business hours of the employee or dependant’s usual dentist or the employee or dependant is staying at a place which is away from the dental practice they usually visit. The treatment covered in such an instance is to purely stabilise the problem and relieve severe pain.
• List of Well Child Tests immunization covered under the plan;
DPT, MMR, HIB, Polio, Influenza, Hepatitis A, Hepatitis B, HPV (from age 9-26), Meningococcal, Pneumococcal (PCV), Varicella(chickenpox), Poliovirus Vaccines, Typhoid, Japanese Encephalitis, Rabies, Tuberculosis (PPD), BCG, Yellow Fever, Meningitis, Cholera, Rotavirus, Pertussis and Hand-foot-mouth disease vaccine.
• COVID-19 vaccine can be covered under the Well Child test benefit and Vaccinations benefit if it is approved by local government bodies, prescribed and administered by a medical professional.
• Psychiatric & Psychological Care treatments refers to treatments received from the listed professionals whom are registered in the country where they are treating;
Psychiatrist, Clinical psychologist, Psychotherapist, Psychoanalyst, Registered clinical social worker, Registered counsellor only.
• There is an all-exhaustive list of what specific conditions are covered under Psychiatric benefit but a sample list is as follows - Clinical depression, Bipolar disorder, Severe anxiety, Schizophrenia, Addictive disorder (e.g. chronic alcoholism) and so on. Coverage will be subject to terms and benefits of the plan as per usual (e.g. medical necessity, orthodox treatment, etc.).
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• The co-payment is capped up to SGD $5,000 per members across all benefits per policy year.
2.3 Further Benefits In the following sections, please note that the total value of claims paid by the insurer cannot exceed the overall plan limit.
Govt In Network: All Government Restructured Hospitals CignaLinks In Network: CignaLinks Hospitals
CignaLinks Govt In Network Out of Network In Network Maternity Complicated Inpatient includes non- Paid in full 90% Refund 80% Refund elective caesarean sections Maternity Complicated Outpatient Paid in full Routine Adult Physical Exams for employees or dependants age 18 years old and above Annual Pap Smear Annual Prostate Cancer Paid in full Screening Annual Mammograms for Up to a combined limit of SGD $500 per policy year Breast Cancer Screening Adult Vaccinations for employees or dependants age 18 years old and above
Offers an online expert second opinion as well as a Health & Well-being assessment to assess, improve and monitor Cigna Care + your health (register via Cigna Envoy to be entitled to such services) 24/7 counselling sessions and access up to 6 free sessions ‘per issue’, either face to face or via skype/phone. Helps International Employee with issues that matters to you and your family from Assistance Program* topics such as for a short period of time;
• Improving family communication • Harmony between work and home life and so on Telemedicine (Refer to Section 10 for more Cigna Virtual Clinic run by Doctor Anywhere details)
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NOTES:
• The Employee Assistance Program (EAP), is a wellness program to help insured members with their mental wellbeing provided by WPO counsellors. Please note this service is only for support of short-term counselling issues.
• An initial clinical assessment will take place during the 1st call by a clinical professional, to understand the needs and suitability of short term counselling
• You are able to access the feature via Cigna Envoy Online Portal or contact the respective EAP team at 1800 6922 775/ [email protected]
• Members are required to pay out of their own pocket if they have exceeded the 6 free counselling sessions per topic/issue.
4. Policy Exclusion
Your plan does not cover claims for, arising from or connected to the exclusions in this section unless shown otherwise in your Benefits Schedule or we have agreed separately in writing, and we will seek to recover from you any payments we have made if we determine an exclusion applies to a claim we have already paid.
1. Treatment that arises from or is in any way connected with attempted suicide or any injury or illness that the employee or dependant inflicts upon himself which exceeds an upper lifetime limit of SGD $150,000 per patient.
2. Treatment for or in connection with speech therapy that is not restorative in nature, or if such therapy is • used to improve speech skills that have not fully developed; • can be considered custodial or educational; or • is intended to maintain speech communication.
3. Dental or orthodontic treatment unless benefit is specifically provided in the list of benefits.
4. Private prescriptions or dressings for use as an out-patient unless the out-patient list of benefits has been chosen.
5. Expenses which are not reasonable and customary.
6. Charges for out-patient treatment, except charges for cancer treatment, unless the out- patient list of benefits has been chosen.
7. Nutritional and dietary supplements including, but not limited to, vitamins (except for prenatal vitamins if maternity cover is elected), minerals, herbs, meal supplements, sports nutrition products, natural food supplements, and other related products used to boost the nutritional content of the diet.
8. Treatment in nature cure clinics, health spas and nursing homes.
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9. Charges for residential stays in a hospital which are arranged wholly or partly for domestic reasons or where treatment is not required or where the hospital has effectively become the place of domicile or permanent abode.
10. Charges for hospital accommodation which are greater than those of a standard private room at the same hospital. Deluxe, executive rooms or VIP suites are not covered.
11. Pregnancy or childbirth, including any complications, unless benefit is specifically provided in the list of benefits.
12. Treatment needed because of or relating to male or female birth control, except for treatment received in Singapore within the agreed Parkway Health provider network.
13. Treatment needed because of or relating to infertility or any type of fertility treatment, including complications arising out of such treatment, with the exception of the investigation of infertility to the point of diagnosis.
14. Treatment by way of the intentional termination of pregnancy, unless two medical practitioners certify in writing that the pregnancy were to endanger the life or mental stability of the mother.
15. Treatment by way of nursery care for a dependant in a hospital following childbirth, unless due to medical necessity during treatment that is otherwise covered by this policy.
16. Travel and accommodation expenses in connection with treatment for kidney dialysis.
17. Treatment to change the refraction of one or both eyes, including refractive keratotomy (RK) and photorefractive keratectomy (PRK), unless Cigna agrees in writing.
18. Injury or disability directly or indirectly caused or contributed to whilst engaging in or taking part in war, invasion, act of terrorist activities, rebellion (whether war be declared or not), civil war, commotion, military or usurped power, martial law, riot or the act of any lawfully constituted authority, or while the employee or dependants are carrying out army, naval or air services operations, whether or not war has been declared.
19. Treatment outside the selected area of coverage if one of the reasons the patient travelled was for that treatment, except if the medical assistance service has arranged emergency evacuation or medical repatriation.
20. Any form of non-emergency travel costs.
21. Any expenses for international services which were not approved in advance by the medical assistance service.
22. International services expenses for emergency evacuation, medical repatriation and transportation costs for third parties where the treatment needed is not covered under the plan.
23. Any expenses for ship-to-shore evacuations.
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24. Gender reassignment operations or any treatment needed to prepare for or recover from these operations (for example, psychological counselling) including complications arising out of such treatment.
25. Treatment that arises from or is any way connected with injury, sickness or disablement as a result of • taking part in a sporting activity on a professional basis; or • solo scuba-diving or scuba diving at depths below 30 metres unless the diver is PADI qualified (or equivalent) for that depth.
26. Any form of treatment (or procedure) that is deemed by the medical team to be experimental, investigative, or unproven, or does not amount to orthodox treatment or does not adhere to the commonly accepted, customary or traditional practice of medicine in the location where the treatment is given at the time of the commencement of the procedure or treatment.
27. Expenses relating to: • any form of sterilisation or contraception including vasectomy, • any form of plastic, cosmetic or reconstructive surgery or treatment, even for psychological reasons, unless it is of medical necessity as a direct result of the patient having an accident or because of other surgery, which itself would have been covered under the plan; • appliances (including spectacles, unless benefit is specifically provided under the list of benefits and hearing aids) which do not fall within Cigna’s definition of surgical appliance and/or medical appliance; • hearing tests, except for one hearing test per year of insurance for a dependent child under the age of 15 years, if benefit is specifically provided in the list of benefits; • eye tests except for one eye test per year of insurance for a dependent child under the age of 15 years, if benefit is specifically provided in the list of benefits; • incidental costs including newspapers, taxi fares, telephone calls, guests’ meals and hotel accommodation; • routine examinations or tests including health screens and medical examinations except for Well Child Tests for a dependent child, and those specifically included under the list of benefits. (if Adult Wellness benefit has been selected, this will be detailed in the benefit schedule, and coverage for Adult Wellness benefits will be included); • marriage, parent/child issue and other relationship counselling (covered under EAP with WPO); • treatment for educational purpose. For eg; Speech therapy, learning difficulties • costs or fees for filling in a claim form or other administration charges.
28. Costs that have been or can be paid by another insurance company, person, organisation or public programme. If the employee or dependant are covered by other insurance, Cigna will only pay its part of the benefit. If another person, organisation or public programme is responsible for paying the costs of treatment, Cigna may claim back any of these costs it has paid.
29. Cigna’s products and services may not be available in all jurisdictions and are expressly excluded from this policy where prohibited by applicable law, including but not limited to, anti-corruption laws and economic sanctions programs administered by the U.S. Treasury
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Department’s Office of Foreign Assets Control.
30. Over-the-counter drugs non medicated drugs and medicated drugs without prescription.
31. Orthoses and orthotic devices unless medically necessary on a short-term basis due to an acute injury or surgery.
5. Area of Coverage
Your policy area of cover is Worldwide excluding USA. Within your area of cover standard benefits, direct billing and claim process apply.
Emergency Coverage Outside Area of Cover:
• In the USA: Cover up to SGD 2,250,000 per policy year for emergency medical treatment only will remain available, where an emergency is a risk of death or imminent serious damage to bodily function, for a period of 30 days per trip whether you are travelling for business or pleasure. All outpatient treatments including wellness will remain excluded.
o Example 1: Food poisoning or broken ankle following an accident (requiring inpatient or outpatient treatments) while travelling for business trip in USA: Acute condition & unplanned > covered.
o Example 2: A member would like to plan a treatment (e.g. hospitalization, outpatient follow up treatments) in USA: Planned treatment > not covered.
o Example 3: While travelling in USA a member has forgotten his medication for high blood pressure and arranges an appointment with a doctor to get a new prescription: Non-acute > not covered.
NOTE:
• ‘Emergency Treatment’ is defined as treatment which is medically necessary for a medical condition which manifests itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy; serious impairment to bodily functions; or serious dysfunction of any body organ or part. Only medical treatment through a physician, medical practitioner or specialist and hospitalisation that commences within 24 hours of the emergency event will be covered.
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6. Inpatient Direct Billing Services
For inpatient treatment, Cigna can arrange direct billing with proper notification and documentation provided and subject to the hospital’s agreement. If you would like Cigna to arrange direct billing for inpatient services, this is possible by requesting for a Pre- Authorisation with your insurer which can be found in the later part, Section 6.3.
6.1 Pre-Authorisation
Pre-authorisation ensures that prior to incurring liability for major medical treatment, you are covered by the policy and will be reimbursed up to the applicable limit. Once your hospitalisation/day surgery request is assessed and approved, Cigna will issue a Guarantee of Payment (GOP) to the treating hospital to facilitate cashless service. You may be required to pay for the following scenarios:
• Expenses incurred not covered under Cigna’s plan • 10% co-payment if admit to CignaLinks In-Network • 20% co-payment if admit to outside network hospital in Singapore • Plan limit has been exceeded
If for any reason a Guarantee of Payment (GOP) cannot be issued on time, you will be required to make payment upon discharge and submit the claim to Cigna for evaluation. If due to any complications during surgery/procedure, additional costs are incurred beyond the GOP obtained, the hospital or you can contact Cigna for the additional cost to be approved beyond the already know estimated costs.
6.2 Prior Approval Treatments
Prior approval from Cigna is required before receiving any of the treatments below:
• Inpatient treatment (overnight or • Outpatient surgery day-case) • Maternity complications • Organ Transplant • International Emergency • Hospice and Palliative Care Services
• Planned high cost out-patient treatment (e.g. MRI, Cancer treatments)
NOTE: • Outpatient General Practitioner, Specialist, Outpatient Physiotherapy, Wellness & Vaccination is not required for Pre-Authorisation.
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6.3 Scheduled & Emergency Hospital Admission
For Scheduled Hospital admission(s), you must request for a Pre-Authorisation, which guarantees the admission up to the annual limit of the policy coverage if the treatment is eligible. 1. Contact Cigna’s Care Team at 800 188 6017 (Toll-free) or email to [email protected]/[email protected] at least 5 working days prior to your procedure with the following medical information provided. Copy Pacific Prime if you need assistance.
• Member’s name and member number • Member’s policy number • Date of admission • Length of Stay • Doctor’s diagnosis of the condition or purpose of admission • Type of treatment required • Name and contact details of the doctor performing the treatment • Name and contact details of the hospital providing the treatment
2. Upon approval, a Guarantee of Payment (GOP) will be issued up to the estimated treatment cost within the plan's annual limit and this would facilitate direct-billing between insurer and medical provider as per your policy terms.
NOTES:
• If Cigna does not receive the Pre-Authorisation request within the stipulated time frame, you may be required to settle your incurred medical expenses and submit a claim for evaluation.
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• Additional documents may be requested for further assessment on a case-by-case basis. This includes but is not limited to a Referral Letter, Diagnostic test/report and/or other relevant documents such as Hospital Financial Counselling/Admission Forms.
For emergency hospital admission(s), 1. Received your treatment as per advice from your doctor.
2. Notify Cigna immediately by contacting Cigna’s 24-hour Global Hotline on 800 188 6017 (Toll-free) or +86 (21) 6086 3109 (Overseas) by providing below information:
• Patient’s name and member number • Date of admission • Name of hospital or facility • Admitting symptoms or medical diagnosis if known • Treatment received so far or planned treatment(s) • Any other relevant information
3. If your medical condition does not permit you to make the call, your family member or hospital staff can make the call on your behalf. Alternatively, you may reach out to Pacific Prime (your insurance advisor) at [email protected] to request for a pre-authorization on your behalf.
If the GOP is not arranged prior to discharge, you will be required to settle the incurred hospital expenses and submit a claim to your insurer Cigna for evaluation on a Pay-and- Claim basis.
For cases wherein the GOP is ineligible/not approved, the insurer would claw back the relevant amount from you directly. If pre-authorisation is given for a particular service, that pre-authorisation applies only to that service and further pre-authorisation must be obtained for other services even if related to the same disability. If the final medical service/procedure received does not match the initial approval granted for, the insurer will have the right to reject the claim and/or claw back the relevant amount from you directly.
NOTES:
• Do take note that the approved GOP is a form of credit facility* and not an admission of claim liability*.
Credit facility refers to an approved GOP which assures direct billing between the insurer and provider when the provider accepts the issued GOP by Cigna. If the provider doesn’t accept the issued GOP (this would be very rare in Singapore), then it can only be done on a pay-and-claim basis which is outside of Cigna area of control since the provider rejects it. The approved GOP assures the coverage for the specific treatment(s) which was pre- authorised.
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Not an admission of claim liability defines the provider still has to submit the claim docs to Cigna to review further subject to the policy terms, especially if there was a change in the treatment provided.
• Pre-authorization must be received for eligible benefits (non-emergency).
• Pre-authorisation may be revised or withdrawn if Cigna determines later that the service is not covered or is not medically necessary.
7. Outpatient Direct Billing Services
Under the Cigna Direct Billing services, you are eligible for the ‘cashless treatment’ at the following listed facilities for inpatient and/or outpatient treatment:
• CignaLinks Network (please refer to Appendix A1) • Onsite Campus Clinic – Doctor Anywhere • Cigna Virtual Clinic (only applicable to outpatient treatment) • Singapore Government Restructured Hospitals/Clinics (only applicable to inpatient treatment)
The list of panel GP and SP clinics available near your location can be found easily on the Cigna Envoy Portal or Mobile App which is updated monthly. Alternatively, you can also refer to the Appendix A1 for full listing (as of the time of print). Please take note that the network is subject to periodic reviews and may change from time to time.
NOTE: • Standard policy co-payment applies under direct billing
7.1 Outpatient Direct Billing Procedures
Direct billing for specific outpatient treatment (excluding physiotherapy, chiropractic and dental) is only available within the listed panel facilities. Please ensure that you have your Medical Card that you need to show to the clinic. This can be downloaded from the Cigna Envoy portal or mobile app.
1. Please present CIGNA Card at point of registration and before the consultation.
2. Receive your treatment.
3. In some instances, the clinic may ask you to pay a portion of the bill such as in the event where the treating doctor prescribed you with items not covered under the policy like vitamins and supplements or other personal items. Else, when the charges
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exceed the annual limit.
NOTE:
• Though DB claims are via direct settlement, it will still be assessed as per the policy terms by Cigna. Any ineligible incurred expenses would be clawed back from the member.
7.2 Outpatient Non-Direct Billing Network
▪ Private Clinics Outside of Network o Private GP and SP clinics (other than CignaLinks and Raffles Medical) are covered on a Pay and Claim basis.
▪ Public Facilities o Polyclinics, Govt Hospitals and Clinics are strictly on a Pay and Claim basis. ▪ Outpatient Physiotherapy, Psychological/Psychiatric, Podiatry, Chiropractic & Wellness o These treatments will always be covered on a Pay and Claim basis.
8. Claims Procedure (Pay & Claim)
Pay & Claim will be required:
• For outpatient private GP and SP visits (other than Cigna Network & Cigna Virtual Clinic) and Public Facilities
• For certain procedures such as outpatient physiotherapy, Psychological/Psychiatric, Podiatry, Chiropractic and Wellness are always on a Pay and Claim basis (within or outside the network)
• When pre-authorisation is required but wasn’t sought and guarantee of payment wasn’t issued
For cases where you are required to pay for the medical services received, you can submit the claims to Cigna for reimbursement via 3 options/method available.
8.1 Cigna Envoy App Submission (Strongly Recommended)
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1. Click on the “New Claim” icon. See attached Appendix C for Cigna Envoy Mobile App Guide.
2. Do kindly complete all the sections in the E-Claim submission.
3. Take a picture of all your necessary documents (Invoices, Doctor’s memo, medical report etc.) through the app. 4. Claim submission is completed upon receipt of an E-Claim reference number.
8.2 Cigna Online Portal Submission
1. To file a claim, you can do so via e-claim submission on the Cigna Online Portal website – https://public.cignaenvoy.com. See attached Appendix D for step-by-step instructions on Envoy Registration Guide.
2. Click on “My Claims” and then “Submit New Claim”.
3. Complete all the required details in patient section, Claim section and Payment section.
4. Thereafter, upload the necessary documents (Invoices, Doctor’s memo, medical report etc.) through the portal.
5. Click submit and claim submission is completed once you receive an e-claim submission reference number.
8.3 Claim Form Submission 1. Complete one (1) Claim Form per medical condition. See attached Appendix E for Cigna Medical Claim Form.
2. Do kindly complete all the sections in the Claim Form and sign on the declaration section.
3. If claiming for a hospitalisation admission where a Letter of Guarantee (LOG) has not been sought, please submit a copy of the discharge summary.
4. Submit to Pacific Prime together with the invoice or receipts including the discharge summary and scan/email to [email protected]. You may also keep Pacific Prime at
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[email protected] in copy to help monitor your claim status when necessary.
NOTES
• Please submit claims within 90 days from treatment date but ‘sooner the better’.
• When submitting a hospital bill, ensure the document is the “Final Bill”. Interim Bill is not acceptable.
• Outpatient Appliances Insoles has to be prescribed following a referral letter by a medical practitioner or specialist.
• Cigna aim to finalize your claim within 10 working days subject to submission of complete claim documents.
• Reimbursements can be done via bank transfer. For international transfers to a foreign bank, note that your bank may charge you fees for each transaction which will be your responsibility to bear.
9. Cigna Envoy Online Portal
Cigna Insurance has an Online Portal - Cigna Envoy for their members, which is a secure member website that gives you easy access to a world of useful tools.
9.1 Registration Process
You can now start using the Cigna Envoy Online Portal by following the below steps: 1. You should receive an electronic Membership Pack titled “International Healthcare Plan with Cigna” (via secure mail) from Cigna Insurance with your Member ID indicated.
2. Go to https://public.cignaenvoy.com to register (one-time set up). See attached Appendix D for step-by-step instructions on Cigna Envoy Registration Guide.
3. You are required to key in your personal details together with the policyholder details - use the information exactly as you find it within the below text box in your individual Membership Pack.
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4. Once you have successfully registered onto the portal, a secure PIN will be automatic generated and this shall be your password upon your first login.
5. Click on “Continue to Login”, enter your Cigna Member ID number (#) and the secure PIN.
6. Choose your security questions and enter your answers, then click 'Continue'.
7. You will be asked to create your own password* once you have successfully login onto the portal for the very first time.
Dependents Registration 1. Dependents, who are covered with Cigna, will be tagged to the main employee. One account per family.
NOTES: • If you have not received the Membership Pack, do kindly check your spam folder and if you cannot find it, please reach out to [email protected] to request a new welcome email be sent to you.
• You are required to register an account first via Cigna Envoy Online Portal (on desktop) before being able to utilise the Mobile App.
• Only 1 registration per family is required.
• The password has to contain the following requirements; o Must at least have 8 characters in length o Must include one upper and one lower case letters o Must include at least one numeral
• Please note the password created are case sensitive.
9.2 Cigna Envoy Mobile App
Cigna Envoy Mobile App is a mobile application that enables you to: • Locate CignaLinks Health Care facilities • View your Cigna Membership card • Check claims status/history • Submission of Claims
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You can now start using the Cigna Envoy Mobile App by following the below steps:
1. Download the Cigna Envoy Mobile App through the Apple Store/Google Play store.
2. Please ensure that you have successfully registered an account with Cigna Envoy Online Portal, before attempting to use the features via Cigna Envoy Mobile app. If you have not done so, please do register an account through Cigna Envoy Online Portal at https://public.cignaenvoy.com. 3. To login to your own account on Cigna Envoy Mobile App, please do so by using your Cigna Envoy Online Portal login credentials as both the platform shares the same Cigna Member ID number and Password. See attached Appendix C for step-by-step instructions on Cigna Envoy Mobile App User Guide.
NOTES:
• No registration is required for Cigna Envoy Mobile App once you have successfully created an account with Cigna Envoy Online Portal.
• The main employee (you) has the main account access to both platforms and each family has only one account.
• All of your dependent(s) are tagged to your (main employee) account.
10. Cigna Virtual Clinic
Cigna Insurance has a Virtual Clinic available for all their members, where you can access a GP consultation through a video call for selected conditions from your place of work or at home. This is run by Doctor Anywhere (DA), which also has 8 physical locations in Singapore.
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10.1 Registration Process
You can now start using the Cigna Virtual Clinic by following the below steps:
1. Please visit https://doctoranywhere.com/signup/cigna
2. Submit your full name, Cigna Member ID number (found in your Cigna Card) as well as your UWC email address registered with Cigna. 3. Download the Doctor Anywhere (DA) App through the Apple Store/Google Play store. See attached Appendix F for step-by-step instructions on Cigna Virtual Clinic Doctor Anywhere.
4. Once you have successfully registered, login via the app using the details submitted and created during the registration process.
A more detailed guide of Cigna’s Virtual Clinic and the capabilities of Doctor Anywhere can be found in the Appendix F.
NOTES:
• A separate account has to be created for your dependents who are eligible members using their personal email address.
• If your dependent does not have a personal email address, you can create an additional email address using your account for him/her to sign up on the Doctor Anywhere app.
• Emails sent to your dependent accounts will still be delivered to your main account registered email address.
10.2 Teleconsultation
Steps for Tele-Consultation: 1. Log in to your account on the Doctor Anywhere app. See attached Appendix F for step-by-step instructions on Cigna Virtual Clinic Doctor Anywhere.
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2. Click on the "Video Consultation" button, select "General Practitioner (GP)". Then, click on “See the Next Available GP Now”.
Should you have a preferred language, do click on “Search for a GP” instead. Select your preferred GP, language, date and time slot to arrange for an appointment online.
3. There will be a Pre-Consultation Survey to be done, a total of 3 short questions before DA connects you to a doctor on the platform.
4. Subsequently, click “Continue” and an assigned DA doctor will pick up your video call. You are required to present your Identification Card/Passport for verification purposes.
NOTES:
• Operating Hours: 24/7 teleconsultation service.
• Doctor Anywhere is only for benign, visible medical conditions and NOT for emergencies.
• Only General Practitioner (GP) visits are covered cashless through Cigna Corporate Programme. • For dependents below 16 years of age, a parent/guardian has to be around during the teleconsultation.
• For medical conditions which are deemed not suitable for teleconsultation by the DA doctors, you will be recommended to go for a physical consultation.
• If you missed your appointment timing, do kindly reach out to DA immediately at +65 6591 8668 or [email protected]. The respective DA Team will assist you in cancelling or rescheduling your appointment.
10.3 How to View Documents & Purchase Medication
Steps for Viewing Documents & Purchasing your medications: 1. If the doctor has prescribed medications during your consultation, you can click on;
• View Documents - To view all your documents like MCs, Referral letters, receipts and prescribed medications or,
• Buy Medication - To view and order your prescribed medications
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2. Select “Next” to instruct on the delivery address and timing. Changing your delivery address is applicable if required.
3. There will be a Pre-Consultation Survey to be done, a total of 3 short questions before DA connects you to a clinic assistant on the platform.
4. Subsequently, click “Continue” and your medications would be delivered to the designated mailing address furnished on DA within 3 hours upon confirmation.
NOTES:
• Operating Hours: 24/7 medication purchase service available.
• Medication delivery is available from 8am to 11pm daily. Last order is at 8pm for same day delivery
• You can select or de-select the medications you’d like to order.
• DA rider would contact you before delivery and provide the Verification Code sent to you to the rider. You are expected to be available during medication delivery and to receive the medication.
• For dependents below 16 years of age, a parent/guardian has to be around during the medication delivery.
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11. Contact Details
UWC General Enquiries
Email: [email protected]
Jas Yap Raquelle Lee Tel: +65 6713 5874 Tel: +65 6346 3781 (Extn 103) Fax: +65 6722 8610
Cross Street Exchange #14-05 18 Cross Street Singapore 048423
Account Management
Nick Law Email: [email protected] DID: +65 6713 9957 Tel: +65 6346 3781 (957)
Cigna Claims & Pre-authorization Team
Email: [email protected] Tel: 800 188 6017 (Local) +86 (21) 6086 3109 (Overseas)
Website: http://www.cigna.com.sg
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Appendix
To view the attachments, do kindly click on the link here.
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