PART 1 | Citation and commencement |
| 1. These Regulations may be cited as the MediShield Life Scheme Regulations 2015 and come into operation on 1 November 2015. |
2.—(1) In these Regulations, unless the context otherwise requires —| “additional private insurance coverage” means any private insurance cover provided under an integrated shield plan that is additional to the insurance cover provided by the MediShield Life Component of that integrated shield plan; |
| “admission date”, in relation to a claim for any approved medical treatment or services, means the admission date assigned to the approved medical treatment or services claimed in accordance with guidelines issued by the Minister, and “admission” and “admitted” have corresponding meanings; |
| “approved cancer drug” means any active ingredient (or combination of active ingredients) in the dosage form and strength listed in the CDL and administered for the corresponding clinical indication listed in the CDL; [S 711/2022 wef 01/09/2022] |
| “approved community hospital” means an approved medical institution which, in the opinion of the Minister, provides an intermediate level of care for outpatients and in-patients who have simple ailments that do not require specialist medical and nursing care; |
“approved day surgery centre” —| (a) | means an approved medical institution that provides day surgical treatment; but | | (b) | does not include an approved medical institution which is a private hospital or restructured hospital; [S 403/2023 wef 26/06/2023] |
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“approved dental treatment” means dental work or dental treatment —| (a) | owing to accidental injuries; | | (b) | certified in writing, by an approved medical practitioner, to be necessary in relation to a separate surgical treatment (excluding any surgical treatment specified in the Third Schedule); or | | (c) | certified in writing, by an approved medical practitioner, to be necessary in relation to any approved medical treatment or services (excluding any medical treatment or services specified in the Third Schedule), and assessed by the Council to be appropriate; |
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“approved in-patient palliative care” means any of the following approved medical treatment or services received as an in-patient of any approved in-patient palliative care institution: | (a) | general palliative care; | | (b) | specialised palliative care; [S 224/2020 wef 01/04/2020] |
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“approved in-patient palliative care institution” means any approved medical institution that is —| (a) | an approved community hospital, or a hospice or nursing home; and | | (b) | approved by the Minister for the purposes of these Regulations; [S 224/2020 wef 01/04/2020] |
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| “Approved Indications for PBT” means Approved Indications for Use of Proton Beam Therapy in Treatment published on the website of the Ministry of Health at https://www.moh.gov.sg; [S 769/2022 wef 01/10/2022] |
| “approved medical practitioner” means a medical practitioner who is approved by the Minister for the purposes of these Regulations; |
| “approved OS”, “OS application”, “OS scheme” and “relevant amount” have the meanings given by the MediShield Life Scheme (Scheme for Overseas Singapore Citizens) Regulations 2016 (G.N. No. S 535/2016); [S 300/2018 wef 14/05/2018] |
“approved outpatient treatment” means any of the following approved medical treatment or services received as an outpatient of any approved medical institution:| (a) | renal dialysis; | | (b) | cancer drug treatment; [S 711/2022 wef 01/09/2022] | | (c) | radiotherapy treatment; [S 731/2018 wef 01/11/2018] | | (d) | administration of immunosuppressants for organ transplant; | | (e) | administration of erythropoietin for dialysis and chronic renal failure; | | (f) | long term parenteral nutrition provided on or after 1 November 2018; [S 731/2018 wef 01/11/2018] |
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| “approved private hospital” means an approved medical institution which is a private hospital; [S 135/2021 wef 01/03/2021] |
| “approved proton beam therapy” means any radiotherapy treatment or radiosurgery treatment using proton beam therapy for a clinical indication listed in the Approved Indications for PBT; [S 769/2022 wef 01/10/2022] |
| “approved public healthcare institution” means an approved medical institution which is a restructured hospital, a public specialist outpatient clinic or a national specialty centre; [S 135/2021 wef 01/03/2021] |
| “approved restructured hospital” means an approved medical institution which is a restructured hospital; |
| “cancer drug” means any drug, including any approved cancer drug, used for the treatment of neoplasms; [S 711/2022 wef 01/09/2022] |
“cancer drug treatment” means —| (a) | the administration of any cancer drug for the treatment of neoplasms; or | | (b) | any other medical treatment or services ancillary to the administration of any cancer drug for the treatment of neoplasms; [S 711/2022 wef 01/09/2022] |
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| “CDL” means the Cancer Drug List published on the website of the Ministry of Health at https://www.moh.gov.sg; [S 711/2022 wef 01/09/2022] |
“claim bar date”, in relation to an insured person who is an in‑patient in an approved medical institution, means the 7th calendar day after the earliest day when the insured person is both —| (a) | certified, by a medical practitioner treating the insured person at the approved medical institution, to be medically fit for discharge from in‑patient treatment at that approved medical institution; and | | (b) | assessed by that medical practitioner to have a feasible discharge option; [S 465/2018 wef 15/07/2018] [S 224/2020 wef 01/04/2020] |
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“commencement date” —| (a) | in relation to an insured person’s MediShield Life cover, means the date determined under regulation 4 from which the insured person’s MediShield Life cover has been continuously in force; or | | (b) | in relation to an insured person’s pre-existing MediShield cover, means the date from which the insured person’s pre-existing MediShield cover has been continuously in force; |
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| “CPF member” includes a CPF member who is an undischarged bankrupt; |
“cross implementation claim” means a claim under an insured person’s pre-existing MediShield cover, in respect of approved medical treatment or services received by an insured person as an in-patient, with —| (a) | an admission date before 1 November 2015; and | | (b) | a date of discharge on or after 1 November 2015; |
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| “cross insurance period claim” means a claim under an insured person’s MediShield Life cover, in respect of approved medical treatment or services received by the insured person as an in-patient (other than a day treatment patient) in an approved medical institution, with an admission date and a date of discharge in different insurance periods; [S 286/2019 wef 01/04/2019] |
| “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; |
“day treatment patient” means a patient who —| (a) | receives any approved medical treatment or service specified in the Eleventh Schedule in an approved medical institution; but | | (b) | is not required to be hospitalised for the purpose of receiving that treatment or service; [S 286/2019 wef 01/04/2019] |
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“dependant”, in relation to a CPF member, means —| (a) | a CPF member’s spouse, child, parent, grandparent or sibling; or [S 933/2020 wef 03/11/2020] | | (b) | any other person whom the Board approves as a dependant for the purpose of these Regulations; |
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“in-patient” means —| (a) | a patient who —| (i) | is hospitalised, for any treatment other than day surgical treatment, for a period of not less than 8 hours; or | | (ii) | has died within 8 hours after being hospitalised for any treatment other than day surgical treatment; or |
| | (b) | a day treatment patient; [S 286/2019 wef 01/04/2019] |
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“insured person” —| (a) | in relation to an insurance cover under the MediShield Scheme or an integrated medical insurance plan, means a person who was insured under the MediShield Scheme or integrated medical insurance plan, as the case may be, before 1 November 2015; or | | (b) | in relation to an integrated shield plan or a medisave-approved plan, means a person who is insured under the integrated shield plan or medisave-approved plan, as the case may be; |
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| “insurer” means an insurer which is licensed under the Insurance Act 1966; [S 403/2023 wef 31/12/2021] |
| “integrated medical insurance plan” means any plan, under which a person was insured before 1 November 2015, under a medical insurance policy approved by the Minister for the purposes of regulation 4(1)(b) of the revoked PMIS Regulations, with or without a MediShield Component; |
| “integrated shield plan” means a medisave-approved plan that comprises a MediShield Life Component and additional private insurance coverage; |
| “living donor organ transplant” has the same meaning as in the Human Organ Transplant Act 1987; [S 403/2023 wef 31/12/2021] |
| “long term parenteral nutrition” means parenteral nutrition provided by an approved medical institution to a patient with a condition specified by the Minister on the website at https://www.moh.gov.sg; [S 731/2018 wef 01/11/2018] |
| [Deleted by S 403/2023 wef 26/06/2023] |
| “medical practitioner” means a medical practitioner registered under the Medical Registration Act 1997 or a dentist registered under the Dental Registration Act 1999; [S 403/2023 wef 31/12/2021] |
“medical treatment” includes —| (a) | any surgical treatment, radiotherapy treatment, cancer drug treatment, renal dialysis treatment or radiosurgery treatment; [S 711/2022 wef 01/09/2022] | | (b) | any service, investigation, medicine, curative material, medical consumable, surgical implant or other item necessary for the medical treatment; and | | (c) | where any medical treatment has been received by a person as an in-patient in an approved medical institution, the maintenance of that person in that institution; |
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| “medisave-approved plan” has the same meaning as in the MediShield Life Scheme (Private Medical Insurance Scheme) Regulations 2015 (G.N. No. S 623/2015); |
| “MediShield Component”, in relation to a person insured under an integrated medical insurance plan, means the person’s insurance cover under the MediShield Scheme which formed part of the person’s integrated medical insurance plan; |
| “MediShield Life Component” means insurance cover provided by the Scheme which forms part of an integrated shield plan; |
| “MediShield Life cover” means insurance cover under the Scheme; |
“multiple neoplasms” means 2 or more neoplasms that —| (a) | arise from different sites; | | (b) | are of a different histology or morphology group; or | | (c) | arise from different sites and are of a different histology or morphology group; [S 772/2023 wef 01/12/2023] |
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“organ transplantation costs” means —| (a) | any costs arising in relation or incidental to the removal of any organ from a non-living organ donor for organ transplant and includes the costs of —| (i) | the donor’s extended stay, before the donor’s death, in a hospital as necessitated by the donation of the organ; | | (ii) | any surgical operation to remove the organ from the donor’s body; | | (iii) | any pre-harvesting laboratory test and investigation; | | (iv) | any counselling provided to the donor’s family in connection with the donation of the organ; | | (v) | the storage and transport of the organ; and | | (vi) | such other procedures as the Minister may approve; or |
| | (b) | any costs that are reasonably or directly attributable to the removal of any specified organ from a living organ donor for organ transplant and includes the costs of —| (i) | the donor’s stay in a hospital as necessitated by the donation of the specified organ until the donor is discharged; | | (ii) | any surgical operation to remove the specified organ from the donor’s body; | | (iii) | the storage and transport of the specified organ; and | | (iv) | such other procedures as the Minister may approve, |
| (A) | any costs arising in relation or incidental to complications suffered by the donor due to the donation of the specified organ after the donor’s discharge from the hospital under sub‑paragraph (i); | | (B) | any pre-harvesting laboratory test and investigation; and | | (C) | any counselling provided to the donor’s family in connection with the donation of the specified organ; |
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“outpatient” means a patient other than —| (a) | an in-patient; or | | (b) | a patient receiving day surgical treatment; |
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“policy year” means —| (a) | in relation to any insurance cover under the MediShield Scheme in Division 2 of Part II of the revoked MediShield Regulations for a period referred to in regulation 9(1)(ca)(i), (2)(a) or (3)(a) of those Regulations, that period; | | (b) | in relation to any other insurance cover under the MediShield Scheme, a period of 12 months from the date of the commencement or renewal of that insurance cover; or | | (c) | in relation to a person’s integrated medical insurance plan (including any MediShield Component of that plan), a period of 12 months from the date of the commencement or renewal of that plan; |
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| “pre-existing MediShield cover” means insurance cover under the MediShield Scheme in force immediately before 1 November 2015 which is replaced by MediShield Life cover under regulation 19(1); |
| “premium payable” excludes any Government subsidies paid towards the amount of premium determined under regulation 8; |
“radiosurgery treatment” means the treatment of neurosurgical or neurological disorders using any of the following:| (a) | gamma knife technology; | | (b) | linear accelerator technology; | | (c) | proton beam therapy for a Category 4 clinical indication listed in the Approved Indications for PBT; | | (d) | externally generated ionising radiation delivered using —| (i) | a rigidly attached stereotactic guiding device or other immobilisation technology; or | | (ii) | a stereotactic image-guidance system, |
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| but excludes stereotactic radiotherapy; |
[S 769/2022 wef 01/10/2022] |
| “radiotherapy treatment” means the treatment of any malignant disease or certain benign conditions with ionising radiation delivered externally or internally by sealed or unsealed radionuclides and irradiating apparatus; [S 731/2018 wef 01/11/2018] |
| “revoked MediShield Regulations” means the Central Provident Fund (MediShield Scheme) Regulations (Cap. 36, Rg 20) as in force immediately before 1 November 2015; |
| “revoked PMIS Regulations” means the Central Provident Fund (Private Medical Insurance Scheme) Regulations (Cap. 36, Rg 26) as in force immediately before 1 November 2015; |
| “specified organ” has the same meaning as in the Human Organ Transplant Act 1987; [S 403/2023 wef 31/12/2021] |
| [Deleted by S 711/2022 wef 01/09/2022] |
| “treatment of neoplasms” means the treatment of malignant neoplasms, certain benign neoplasms and neoplasms of uncertain behaviour. [S 711/2022 wef 01/09/2022] |
(2) For the purposes of these Regulations —| (a) | if the day of the month on which a person was born cannot be ascertained, the person is taken to be born on the first day of the month in which the person was born; | | (b) | if the month in which the person was born cannot be ascertained, the person is taken to be born in January. |
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(3) For the purposes of paragraphs 19 and 20 of the Third Schedule —| (a) | “at-risk traveller” means an insured person who —| (i) | makes a relevant journey; and | | (ii) | begins to show symptoms consistent with COVID-19 infection before the end of the at-risk traveller’s possible incubation period in relation to that relevant journey; |
| | (b) | “COVID-19” means the infectious disease known as Coronavirus Disease 2019; | | (c) | “possible incubation period”, in relation to each relevant journey of an at-risk traveller, means a period starting upon the arrival in Singapore of the at-risk traveller at the end of that relevant journey and ending on and including the 14th day after that day of arrival in Singapore; | | (d) | subject to sub-paragraph (e), an insured person makes a relevant journey if —| (i) | the insured person leaves Singapore on or after 27 March 2020; and | | (ii) | that insured person’s journey is against any travel advisory concerning the risk of COVID-19 infection, issued by the Ministry of Health and published on the website of that Ministry, that is applicable to that journey; and |
| | (e) | an insured person does not make a relevant journey if that insured person satisfies the Minister that the insured person had a compelling reason for undertaking the journey mentioned in sub-paragraph (d) despite the travel advisory. [S 192/2020 wef 27/03/2020] |
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| (4) In these Regulations, in relation to admissions before 1 October 2022, “radiosurgery treatment” means the gamma knife treatment or the Novalis shaped beam treatment of neurosurgical or neurological disorders. [S 769/2022 wef 01/10/2022] |
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| 3. An application made or a notice given to the Board under these Regulations must be made or given in such form and supported by such evidence as the Board may require. |
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