Central Provident Fund (Private Medical Insurance Scheme) Regulations

Central Provident Fund Act

(CHAPTER 36, Section 77(1)(ja))

Central Provident Fund (Private Medical
Insurance Scheme) Regulations

Rg 26

G.N. No. S 17/1995

REVISED EDITION 1998

(1st January 1998)

[1st July 1994]

Citation

1. These Regulations may be cited as the Central Provident Fund (Private Medical Insurance Scheme) Regulations.

Definitions

2. In these Regulations, unless the context otherwise requires —

“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;

“Government premium rebate” means —

(a)	the sum of money, equivalent to the amount of premium payable under the MediShield Scheme in Division 2 of Part II of the Central Provident Fund (MediShield Scheme) Regulations (Rg 20); or
(b)	the amount of premium payable after deducting any premium rebate given by the insurer,

whichever is the lower, which may be paid by the Government to a person under the MediShield Scheme for the Elderly;

[S 73/2001 wef 01/01/2001]

“insurer” means any insurer which is registered under the Insurance Act (Cap. 142);

“MediShield Scheme” means the MediShield Scheme established and maintained by the Board under section 53 of the Act;

“member” includes a member who is an undischarged bankrupt;

“policy year” means a period of 12 months from the date of the commencement of an insured person’s insurance cover under the Scheme;

[S 347/2000 wef 01/08/2000]

“premium” means any premium payable under a private medical insurance policy and includes any goods and services tax thereon;

“private medical insurance policy” means a private medical insurance policy which is approved by the Minister for Health for the purposes of these Regulations;

“Scheme” means the Private Medical Insurance Scheme established and maintained by the Board for the purposes of these Regulations.

Application of these Regulations

2A. These Regulations shall apply to persons in respect of whom an application under regulation 3 is approved by the Board.

[S 73/2001 wef 01/01/2001]

Application to withdraw moneys for purchase of private medical insurance policy

3.—(1) A member who wishes to use the whole or part of the available amount in his medisave account to purchase a private medical insurance policy for himself or his dependant under the Scheme may apply to the Board for the withdrawal of the amount.

[S 347/2000 wef 01/08/2000]

(2) Subject to paragraph (3), the amount that may be withdrawn under paragraph (1) shall not exceed a sum of $660 per year per person insured.

[S 73/2001 wef 01/01/2001]

(3) Where the private medical insurance policy referred to in paragraph (1) is the Managed Healthcare System, provided by NTUC Income Insurance Co-operative Limited, the amount that may be withdrawn per person insured shall not exceed —

(a)	in the case of a person aged 30 years and below, a sum of $90 per year;
(b)	in the case of a person aged 31 to 40 years, a sum of $135 per year;
(c)	in the case of a person aged 41 to 50 years, a sum of $270 per year;
(d)	in the case of a person aged 51 to 60 years, a sum of $450 per year;
(e)	in the case of a person aged 61 years and above, a sum of $660 per year;
(f)	80% of the amount of premium payable by the member for himself or his dependant, as the case may be, under the policy; or
(g)	the total credit balance in the member’s medisave account,

whichever is the lowest applicable amount.

[S 73/2001 wef 01/01/2001]

(4) For the purpose of computing the amount that the Board may deduct under paragraph (1), the sum of $660 referred to in paragraphs (2) and (3) shall include any Government premium rebate which the member may be entitled to receive.

[S 73/2001 wef 01/01/2001]

4. [Deleted by S 73/2001 wef 01/01/2001]

Further conditions of application

5.—(1) The amount withdrawn from the member’s medisave account pursuant to an application made by him under regulation 3 shall be forwarded by the Board to the insurer in payment of the premiums payable by the member or his dependant under the private medical insurance policy.

[S 73/2001 wef 01/01/2001]

(2) Every application under regulation 3 shall be —

(a)	made in such form and in accordance with such procedure as the Board may require; and
(b)	supported by such documents or evidence as the Board may require. [S 73/2001 wef 01/01/2001]

(3) The Board may approve the application subject to such terms and conditions as the Board may think fit to impose.

(4) No member or his dependant shall be insured —

(a)	under more than one private medical insurance policy under the Scheme; or
(b)	concurrently under the MediShield Scheme and a private medical insurance policy under these Regulations.

Payment of premiums

6.—(1) Any premium payable by a member or his dependant under the private medical insurance policy taken out under the Scheme, after discounting any Government premium rebate which the member or his dependant may be entitled to receive, shall be paid from the moneys standing to the credit of the member in the Fund in his medisave account at the time when the insurer notifies the Board that the payment of such premium is due.

[S 73/2001 wef 01/01/2001]

(2) If the amount standing to the member’s credit in his medisave account is insufficient to pay the premium which he or his dependant is liable to pay under the private medical insurance policy taken out under the Scheme, after discounting any Government premium rebate which the member or his dependant may be entitled to receive, the insurer shall determine whether the member or his dependant, as the case may be, may continue to be insured under the policy, but the continuance of the insurance shall be subject to such terms and conditions as the Board may impose.

[S 73/2001 wef 01/01/2001]

Period of insurance cover

6A. Notwithstanding anything in these Regulations, any member or his dependant shall, on payment of the premium payable under the private medical insurance policy taken out under the Scheme, be insured under that policy for a period of 12 months from the first day of the month in which the premium was paid.

[S 347/2000 wef 01/08/2000]

Automatic termination of existing insurance cover

7.—(1) A person who is already insured under the MediShield Scheme shall cease to be insured under that Scheme once he is insured under a private medical insurance policy under these Regulations, and the provisions of the Central Provident Fund (MediShield Scheme) Regulations (Rg 20) as are applicable to a person whose policy under the MediShield Scheme has been terminated under regulation 22 or 23 of those Regulations.

[S 73/2001 wef 01/01/2001]

(2) A person who is already insured under the Scheme cease to be insured under that Scheme as from the date he is insured under the MediShield Scheme and regulation 7B shall apply accordingly.

[S 347/2000 wef 01/08/2000]

[S 73/2001 wef 01/01/2001]

(3) A person who is already insured under a private medical insurance policy under the Scheme cease to be insured under that policy as from the date he is insured under another private medical insurance policy under the Scheme and regulation 7B shall apply accordingly.

[S 347/2000 wef 01/08/2000]

[S 73/2001 wef 01/01/2001]

Termination of existing insurance cover by member

7A.—(1) An insured person —

(a)	who is a member; or
(b)	who is insured as a dependant of a member and has attained the age of 16 years,

may terminate his insurance cover under the Scheme by giving notice in writing to the insurer with whom his private medical insurance policy is taken out that he no longer wishes to be insured under the Scheme.

(2) Where an insured person is insured as a dependant of a member and —

(a)	has not attained the age of 16 years; or
(b)	is, in the opinion of the insurer, unable by reason of his disability to make the decision to terminate his insurance cover by himself,

the member who took out the private medical insurance policy for the insured person may terminate the insured person’s insurance cover by giving notice in writing to the insurer with whom the policy is taken out that he no longer wishes the insured person to be insured under the Scheme.

(3) An insured person in respect of whom a written notice to terminate his insurance cover has been given under paragraph (1) or (2), as the case may be, shall cease to be insured under the Scheme with effect from either of the following dates, whichever is the later:

(a)	the date on which the notice is received by the Board; or
(b)	the date specified in the notice as the effective date of termination of the insured person’s insurance cover under the Scheme. [S 347/2000 wef 01/08/2000] [S 73/2001 wef 01/01/2001]

Refund of premium

7B.—(1) If a person insured under the Scheme ceases, under regulation 7 or 7A, to be insured under the Scheme within 2 months from the date of the commencement of his existing insurance cover, the insurer with whom the existing private medical insurance policy is taken out shall refund, in the manner set out in paragraph (3), the full amount of the premium paid by the member for that policy year.

(2) If a person insured under the Scheme —

(a)	ceases, under regulation 7 or 7A, to be insured under the Scheme at any time after the second month of the commencement of the existing insurance cover; and
(b)	has not, before the effective date of termination of his insurance cover, made any claim under the existing private medical insurance policy,

the insurer with whom the existing policy is taken out shall refund, in the manner set out in paragraph (3), a pro-rated amount of the premium in respect of the unexpired period of the insured person’s insurance cover under the Scheme.

(3) The refund of the full amount of the premium referred to in paragraph (1), and the refund of the pro-rated amount of the premium in respect of the unexpired period of the insurance cover referred to in paragraph (2), shall be paid in the following manner:

(a)

where the premium for the policy year was deducted entirely from the member’s medisave account, the refund shall be paid into the member’s medisave account;

(b)

where the premium for the policy year was paid entirely using the Government premium rebate, the refund shall be paid to the Government in cash; and

(c)

where the premium for the policy year was paid using the Government premium rebate, by deducting from the member’s medisave account, or by cash, or by any combination of these, such amount of the refund, as represents the proportionate amount of the Government premium rebate paid, if any, shall be paid to the Government in cash, and —

(i)	where the balance remaining, after refund of the proportionate amount of the Government premium rebate, is less than the amount of premium paid in cash, such balance shall be paid to the member in cash; and
(ii)	where the balance remaining, after refund of the proportionate amount of the Government premium rebate, is more than the amount of premium paid in cash, such balance shall be paid to the member in cash in respect of any amount of premium paid in cash, and any amount remaining thereafter shall be paid to his medisave account. [S 73/2001 wef 01/01/2001]

Breach of Regulations

8. If a member who has taken out a private medical insurance policy under the Scheme is in breach of any of these Regulations or if for any purpose connected with these Regulations he makes a false representation to the Board or furnishes the Board with any false information, the Board may require the member to refund to his medisave account all moneys withdrawn by him therefrom under these Regulations together with interest that would have accrued thereto if the withdrawal had not been made.

[G.N. Nos. S 17/95; S 354/95; S 298/97]

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