PART I | 1. These Regulations may be cited as the Central Provident Fund (MediShield Scheme) Regulations. |
2. In these Regulations, unless the context otherwise requires —| “approved community hospital” means any premises which, in the opinion of the Minister for Health, provides an intermediate level of care for out-patients and in-patients who have simple ailments that do not require specialist medical and nursing care and which is approved by that Minister for the purposes of these Regulations; |
| “approved hospital” means any hospital, clinic or centre which provides medical treatment and which is approved by the Minister for Health for the purposes of these Regulations; |
| “approved medical practitioner” means any medical practitioner who is approved by the Minister for Health or such other person as he may appoint for the purposes of these Regulations; |
| “approved private hospital” means any private hospital approved by the Minister for Health for the purposes of these Regulations; |
| “approved restructured hospital” means any restructured hospital approved by the Minister for Health for the purposes of these Regulations; |
“assured amount” —| (a) | in relation to each item of medical treatment received by a person insured under the Scheme in Division 2 of Part II, means the amount specified in the second column of the Third Schedule in respect of that item of medical treatment; | | (b) | in relation to each item of medical treatment received before 1st October 2005 by a person insured under Plan A of the Scheme in Division 3 of Part II, means the amount specified in the third column of the Third Schedule in respect of that item of medical treatment; | | (c) | in relation to each item of medical treatment received before 1st October 2005 by a person insured under Plan B of the Scheme in Division 3 of Part II, means the amount specified in the fourth column of the Third Schedule in respect of that item of medical treatment; |
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| “claim limit”, in relation to each item of medical treatment, means the charge levied by the approved hospital for that item of medical treatment or the assured amount for that item of medical treatment, whichever is the lower; |
| “day surgical treatment” means any surgical treatment (including any radiosurgery treatment) received by a person who is admitted and discharged on the same day, and includes any ancillary medical treatment received by that person between such admission and discharge, but shall not include any excluded medical treatment; |
“dependant”, in relation to a member, means —| (a) | a member’s spouse, child, parent or grandparent; or | | (b) | any other person who is dependent on the member and whom the Board may approve for the purpose of these Regulations; |
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| “excluded medical treatment” means any medical treatment specified in the First Schedule; |
| “gamma knife treatment” means the treatment of neurosurgical and neurological disorders by way of radiotherapeutic procedure as specified in the Central Provident Fund (Medisave Account Withdrawals) Regulations (Rg 17) in force immediately before 1st May 2007; |
| “Government premium rebate” means the sum of money, equivalent to the amount of premium payable under the Scheme in Division 2 of Part II after deducting any premium rebate in regulation 17, which may be paid by the Government to a person under the MediShield Scheme for the Elderly; |
| “incapacitated” has the same meaning as in section 28 of the Act; |
| “insured’s contribution”, in relation to any claim by an insured person, means the amount specified in the Fourth Schedule for which the insured person is responsible under the Scheme in respect of any one or more claims in a policy year; |
“insured out-patient medical treatment” means any of the following medical treatment as an out-patient of any approved hospital: | (a) | renal dialysis; | | (b) | treatment of neoplasms by chemotherapy; | | (c) | radiotherapy treatment for cancer; | | (d) | administration of immunosuppressants for organ transplant; | | (e) | administration of erythropoietin for dialysis and chronic renal failure; |
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| “insurer” means any insurer which is registered under the Insurance Act (Cap. 142); |
“integrated medical insurance plan” means any plan under which a person is insured —| (a) | under a medical insurance policy which is approved by the Minister for Health for the purposes of regulation 4(1)(b) of the Central Provident Fund (Private Medical Insurance Scheme) Regulations (Rg 26); and | | (b) | where applicable, under the Scheme in Division 2 of Part II; |
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| “lifetime claim limit” means the total amount that may be claimed by an insured person under the Scheme in his lifetime; |
| “medical practitioner” means any medical practitioner registered under the Medical Registration Act (Cap. 174) or any dentist registered under the Dental Registration Act (Cap. 76); |
| “medical treatment” means any medical treatment, surgical treatment, radiotherapy treatment, treatment of neoplasms by chemotherapy, renal dialysis treatment or radiosurgery treatment and includes investigations, medicines, curative materials and surgical implants, and where such treatment has been received by a person as an in-patient in an approved hospital, includes the maintenance of that person in the hospital, but shall not include any excluded medical treatment; |
| “member” includes a member who is an undischarged bankrupt; |
“national school” means —| (a) | a school which is organised and conducted directly by the Government; | | (b) | a school which is in receipt of grant-in-aid under the Education (Grant-in-Aid) Regulations (Cap. 87, Rg 3); or | | (c) | a school which is named in any order made under section 3(1) of the School Boards (Incorporation) Act (Cap. 284A); |
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“organ procurement costs” means any costs arising in relation or incidental to the procurement of any organ from a non-living organ donor for organ transplant and includes the costs of —| (a) | the donor’s extended stay, before his death, in a hospital as necessitated by the donation of his organ; | | (b) | any surgical operation to remove the organ from the donor’s body; | | (c) | any pre-harvesting laboratory test and investigation; | | (d) | any counselling provided to the donor’s family in connection with the donation of his organ; | | (e) | the storage and transport of the organ; and | | (f) | such other procedure as may be approved by the Minister for Health; |
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| “Plan” means Plan A or Plan B, as the case may be, of the Scheme in Division 3 of Part II; |
| “policy year” means a period of 12 months from the date of the commencement or renewal of an insured person’s insurance cover under the Scheme; |
| “policy year limit” means the total amount that may be claimed by an insured person under the Scheme in a policy year; |
| “premium” means the premium payable by an insured person or by a member whose dependant is an insured person in each policy year under the Scheme; |
| “premium rebate” means the premium rebate specified in regulation 17; |
| “private medical insurance plan” means any medical insurance policy which is approved by the Minister for Health for the purposes of regulation 4(1)(a) of the Central Provident Fund (Private Medical Insurance Scheme) Regulations (Rg 26); |
| “pro-rating factor” means a pro-rating factor specified in the Sixth Schedule for medical treatment received by a person insured under the Scheme in Division 2 of Part II; |
| “radiosurgery treatment” has the same meaning as in the Central Provident Fund (Medisave Account Withdrawals) Regulations (Rg 17) and shall not include any excluded medical treatment; |
| “Scheme” means the MediShield Scheme in Division 2 or 3, as the case may be, of Part II; |
| “subsidised”, when used to describe any medical treatment received by a person, means that the person received a subsidy from the Government for that medical treatment; |
| “treatment of neoplasms by chemotherapy” means the administration of tested and approved chemotherapeutic agents by the usual and known routes in the treatment of malignant neoplasms, certain benign neoplasms and neoplasms of uncertain behaviour as approved by the Minister for Health for the purposes of these Regulations; |
| “unsubsidised”, when used to describe any medical treatment received by a person, means that the person did not receive any subsidy from the Government for that medical treatment. |
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| Persons not covered under Scheme |
3.—(1) Except as expressly provided otherwise in these Regulations, these Regulations shall not apply to —| (a) | any person who has attained the age of 85 years; | | (b) | any person who is neither a citizen nor a permanent resident of Singapore; | | (c) | any person who is physically or mentally incapacitated from ever continuing in any employment; | | (d) | any person who is of unsound mind; | | (e) | any person who is suffering from a terminal illness or disease; and | | (f) | any person or class of persons whom the Minister may, by notification in the Gazette, specify. |
| (2) Notwithstanding anything in paragraph (1)(a), these Regulations shall apply to an insured person whose policy year under the Scheme had commenced within the 12-month period immediately preceding his attaining 85 years of age, until the end of that policy year. |
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