(a) If you have the following plans, you will be subjected to the effect of pro-ration if you were to seek treatment from our panel of specialists in private practice.
- Enhanced IncomeShield Advantage
- Enhanced IncomeShield Basic
- Enhanced IncomeShield C
- IncomeShield Standard
The “effect of pro-ration” reduces the amount you can claim for the medical consultation or treatment by our panel of private specialists as the claimable amount is pro-rated.
For example, if you have an Enhanced IncomeShield Advantage plan that caters to hospitalisation and treatments at a Class A ward in public hospitals, you will be subjected to a pro-ration factor of 65% if you were to seek treatment with a private specialist on our Panel and were hospitalised in a private hospital as your plan does not cater to the latter. Although your claimable amount could be $10,000 if you were hospitalised and treated at a Class A ward at a public hospital, the effect of pro-ration would reduce your claim amount to $6,500.
(b) If you have the following plans, you will be subjected to the effect of sub-limits if you were to seek treatment from our panel of specialists in private practice.
- IncomeShield Plan P
- IncomeShield Plan A
- IncomeShield Plan B
- IncomeShield Plan C
- IncomeShield Standard
Sub-limits apply to plans that are not as-charged. They are limits that put a cap on the amount of coverage for various hospital items such as, the daily room charges. This means that you are required to pay for charges that exceed the sub-limits.
For example, if you have an IncomeShield Plan A that caters to hospitalisation and treatments at a Class A ward in public hospitals, you will be subjected to sub-limits if you were to seek treatment with our panel of specialists in private practice and were hospitalised in a private hospital for 1 day. As a result to the plan’s sub-limit amount of $1,200/day for daily room and medical-related charges, although you have incurred $2,600 for daily room & medical-related charges due to treatment by a private specialist on our panel and hospitalisation in a private hospital, you are required to pay for the amount of $1,400 that exceeds the sub-limit on your own.