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Thome Group (Smartcare Entrepreneur). Employee Benefits Insurance Programme 2014. Content. Group Term Life (New Cover) Group Personal Accident Smartcare Entrepreneur with Major Medical rider Group Business Travel Claims Procedures (Smartcare Plans). Period of Insurance
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Thome Group (Smartcare Entrepreneur) Employee Benefits Insurance Programme 2014
Content • Group Term Life (New Cover) • Group Personal Accident • Smartcare Entrepreneur with Major Medical rider • Group Business Travel • Claims Procedures (Smartcare Plans) Period of Insurance 1 July 2014 to 30 June 2015
GROUP TERM LIFE (NEW COVER)
Group Term Life What are the benefits?
Group Term Life Who is covered? All active full-time employees How much are you covered? 36 x basic monthly salary (maximum S$2 million) Age Limit Age 65 (entry age), renewable up to Age 70 Geographical Limit 24 hours, Worldwide basis Insurer AXA Life Insurance
Group Term Life Non-Medical Limit S$470,000 up to age 65 Within Non-Medical Limit: No underwriting required – Cover up to full sum insured. Exceed Non-Medical Limit: Underwriting is required. Details are in the letters that would be given to the affected employees.
Group Personal Accident What are the benefits?
Group Personal Accident Who is covered? All active full-time employees How much are you covered? All Employees – 36 x basic monthly salary Age Limit No age limit. Reduced payout for 80 years and above (insured at 50% of sum assured) Geographical Limit 24 hours, Worldwide basis Insurer AIG
Group Personal Accident Major Exclusions… • Self inflicted injuries • War • Participation in Riot • Participation in competitive racing on wheels TERRORISM IS COVERED
Smartcare Entrepreneur Who is covered? All active full-time employees and eligible dependents Age Limit Age 65 (entry age), renewable up to Age 72 Geographical Limit 24 hours, Worldwide basis Insurer AXA Life Insurance
Smartcare Entrepreneur Major Exclusions.. • Pre-existing conditions will be covered after 12 continuous months, unless you have been advised otherwise by AXA. • Psychological, psychiatric, alcoholism, drug addictions, abortion, birth control, infertility, impotency • Cosmetic, obesity, weight improvement / reduction • Refractive error of the eyes, correction of myopia, lasik surgery, etc • AIDs, VDs, STDs • Rest cures, special nursing care • Items of Non-Medical Nature, e.g. newspaper, GST etc • Self Inflicted or attempted suicide • Circumcision • Disabilities resulting from direct participation in a strike, riot or commotion, insurrection or any act of war • Annual Health Screening
Group Business Travel Coverage Authorised business trip by company including personal deviation before, during and after a business trip Duration Per Trip 183 days Territorial Limit Worldwide Age Limit Age 70 (entry age), renewable up to Age 75 Insurer ACE
Group Business Travel Major Exclusions… • Self inflicted injuries • War • Participation in Riot • Participation in competitive racing on wheels (Please refer to policy for full listing of exclusions) TERRORISM IS COVERED
Claim Process Inpatient Claims (Without LOG) Patient has to sign Medisave Form upon admission and pay all charges when discharged Private/Overseas Hospital Govt Restr Hospital Employee to submit to HR: • Group Hospital & Surgical Claim Form Part 1 • All original final itemised medical bills • Copy of Inpatient Discharge Summary Employee to submit to HR: • Group Hospital & Surgical Claim Form Part 1 • All original final itemised medical bills • Medical Report (to be completed by the attending physician/surgeon) Any medical report fee is to be borne by the Patient HR to endorse on Part E and send all originals to JLT AXA will process claim within 6 working weeks of receiving full documentation AXA will settle claim via cheque and if medisave is used, AXA will settle directly with CPF Board
Claim ProcessInpatient Claims (With LOG) Govt Restr Hospital Private/Overseas Hospital 1. LOG Form - Release of Medical Information Form (ROMIF) - Pre-admission form (completed by the attending doctor) 2. Financial Counselling Form 3. Inpatient Admission Authorisation Form 4. Inpatient Discharge Summary (to be submitted upon discharge) 1. LOG Form - Release of Medical Information Form (ROMIF) - Pre-admission form (completed by the attending doctor) The member can submit the relevant forms to AXA as follows: Email: healthops@axa.com.sg Copy HR Department AXA will verify the policy coverage Yes No Covered? No LOG will be issued. Member will need to bear the full medical expenses upon discharge. AXA will issue the LOG directly to the hospital • Important Note: • Policy Number:80018653 • TAT for issuance of LOG is 5 working days before scheduled surgery
Thank You This presentation is designed solely to provide an overview of the benefit. Please refer to the relevant policy contracts for detailed coverage, terms and conditions.
