What is Group Hospitalisation & Surgical Insurance (GHS)?
Group Hospitalisation and Surgical Insurance (GHS) is a crucial component of employee benefits in Singapore, providing coverage for medical expenses incurred from hospitalisation and surgical procedures. This type of insurance is often provided by employers and covers a range of medical services, offering peace of mind and financial protection.
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What do I need to look out for in my GHS Insurance coverage?
- Type of Limit
Before discussing GHS coverage, it is important to understand Per Disability Limit and Annual Limit. Per Disability Limit is the maximum amount paid for each individual disability. For example, if the limit is $50,000 and a disability costs $60,000, the insurer covers up to $50,000 for that disability. Multiple disabilities within the policy period are each covered up to this limit. Annual Limit is the maximum payout over a policy year. If the annual limit is $100,000, total coverage for all claims combined will not exceed $100,000. Choosing between these limits depends on your group’s insurance needs, budget, and administrative capacity.
- Hospital Type
Government Restructured Hospitals, like Singapore General Hospital, receive government subsidies to provide more affordable medical services. GHS plans will mostly cover your stay and treatment in government hospitals, especially in lower room categories such as B1 or B2 wards. In contrast, Private Hospitals like Gleneagles Hospital offer more personalized services and shorter wait times, but they tend to be more expensive. Hence, your treatment and stay in these hospitals may not be fully covered.
- Letter of Guarantee Facility
Having a Letter of Guarantee (LOG) Facility is an important consideration when purchasing GHS insurance. A LOG is a document issued by an insurance provider that guarantees payment for part of a hospitalisation bill, simplifying the billing process by eliminating the need for a cash deposit. It is important to check the coverage limits and conditions for issuing a LOG, as it does not guarantee claim approval, which remains subject to further review by the insurer.
Key Coverages of GHS Insurance
Kidney Dialysis & Cancer Treatment:
Most GHS insurance plans cover Outpatient Kidney Dialysis and Cancer Treatment, as recommended by a Registered Medical Practitioner. This coverage ensures that members can receive regular and necessary treatments without significant financial burden.
Pre & Post Hospitalisation charges:
Pre-Hospitalisation charges for medical treatment is usually covered. Depending on the coverage, this may include specialist consultations (including medications) and X-Ray tests, as long as the insured is hospitalised or undergoes surgery afterwards, up to 120 days*. Similarly, Post-Hospitalisation covers medical treatment after discharge from the hospitalisation or surgery, up to 120 days* after discharge.
Surgical Procedures:
GHS typically covers a range of surgical procedures, from minor operations to major surgeries. This includes pre-surgery consultations, the surgery itself, and post-operative care.
ICU:
ICU coverage is essential because it provides critical, specialized care for severe life-threatening conditions, which often require advanced technology and continuous monitoring. The costs of ICU care are significantly higher than standard hospitalisation care, and insurance helps mitigate these expenses.
Emergency Medical Services:
Emergency medical services, including ambulance fees and emergency room visits, are usually covered. This is essential for urgent medical situations where timely intervention is crucial.
Common Exclusions of GHS Insurance
Pre-existing conditions unless member has been continuously insured with the company policy for more than 12 months
Treatments relating to congenital anomalies or genetic defects
All treatments resulting from pregnancy, miscarriage, childbirth, infertility and sex & growth hormone replacement therapies
All treatments for sexually transmitted diseases and HIV
Self-inflicted injuries, or injuries sustained as a result of a criminal act or attempted suicide, nervous and mental conditions, alcoholism or drug addiction
Health screening, and vision care
All treatments for scar, acne, vitamins and health supplement
Sleep apnea including sleep study
Obesity and weight reduction
Frequently Asked Questions
About Employee Benefits Insurance In Singapore
- If the insured member is admitted into a higher class of ward or hospital type, they will need to pay the difference in cost. For example, a member may be admitted into a private hospital when his GHS plan only covers government hospitals. This additional amount will be determined by the pro-ration factor, which will vary across different insurance providers. It is advisable to check the policy details regarding the allowed room categories and the financial implications of choosing a different type of hospital or class of ward.
- If an insured has dependants that fulfil the necessary criteria, they can be included in the coverage of the policy. They must be:
- The legal spouse of an insured within the age range specified in the policy (e.g. below 65/75 years old)
- The child of an insured within the age range specified in the policy (typically between 15 days and Age 25), who is unmarried and unemployed, including full-time National Service
- Day Surgery is usually covered in Group Hospitalisation and Surgical insurance plans. If day surgery is an important consideration for your members, it is important to check and review the specific policy details to ensure that this benefit is included.
- This will depend on whether overseas treatment/hospitalisation is included in the policy coverage. If overseas treatment is a key concern, it would be advisable to get a GHS plan which offers this benefit.
- To file an Inpatient claim, you will need to provide the following documents where applicable:
- Final Hospitalisation/Day Surgery Tax Invoice
- Day Surgery Authorization form
- Scope/Surgery Report
- Discharge Summary
- Medical Report (if any)
- Referral Letter
- Inpatient claim form
- Hospital Registration No. if Medisave was utilized
- Shield Settlement Letter (if shield plan is activated)
- It is important to note that if your group size does not meet the new insurance provider’s requirements, you may not fulfil the takeover conditions for pre-existing conditions. Under this scenario, the new insurance provider may exclude pre-existing conditions of the existing members for the first 12 months of coverage.
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