Contract

Your Policy Contract
AIA HealthShield Gold Max

(For Foreigners)
aia.com.sg
AIA HEALTHSHIELD GOLD MAX FOR FOREIGNERS PROTECTION 1
Table of Contents
General Provisions .................................................................................................................................. 2

Benefits Provisions .................................................................................................................................. 6
General Exclusions ............................................................................................................................... 27
Premium Provisions .............................................................................................................................. 30
Claims Procedures ................................................................................................................................ 31
Definitions.............................................................................................................................................. 33
Schedule of Benefits ............................................................................................................................. 38
Appendix A ............................................................................................................................................ 42
Appendix B ............................................................................................................................................ 43
202004
2 PROTECTION AIA HEALTHSHIELD GOLD MAX FOR FOREIGNERS
GENERAL PROVISIONS
Notwithstanding any other provision to the contrary, any mandatory revision of the minimum
deductibles, minimum co-insurance or new guidelines and conditions that may be introduced
by the Ministry of Health of Singapore, CPF Board or other relevant government authorities on
Medisave-approved medical insurance plans, shall apply to this Policy, provided that such
mandatory revisions or new guidelines and conditions are determined by us to be relevant to
this Policy.
OUR AGREEMENT
Your Policy is a legally enforceable agreement between you and us. We agree to pay the benefits set
out in your Policy in exchange for the premiums paid by you.
We shall rely on the information you and the Insured gave us in your application in deciding whether
or not to accept your application. All statements made in your application are, in the absence of fraud,
regarded as representations and not warranties. In other words, both you and the Insured must
answer all the questions in your application accurately and reveal all the facts both of you know, or
ought to know. Otherwise, we can void your Policy, deny a claim under your Policy or impose
additional terms and conditions on your Policy.
Your Policy is governed by and interpreted according to the laws of the Republic of Singapore.
MODIFICATIONS
Your Policy’s provisions cannot be changed or varied by any of our employees, independent
contractors or agents unless such change is contained in an endorsement signed by our duly
authorised officer.
The clauses in your policy are subject to the provisions of the Insurance Act (Cap. 142) and other
relevant laws, including subsequent changes or replacements of such provisions from time to time. In
response to regulatory requirements or changes beyond our control required by law, we may amend
the terms and conditions of your Policy by informing you of the relevant changes and such changes
will become effective from a date specified.
NON-ADMISSION
Neither the Insured nor you shall make any admission, offer promise or payment to any third party
without our prior written consent. We may at our discretion take over and conduct in the Insured’s or
your name the defence of any claim or commence any claim for indemnity or damages against any
third party, and shall have full discretion in the conduct of any proceeding in the settlement of any
claim and both the Insured and you shall give all such information and assistance as we may require.
SUBROGATION
If we shall make any payment or otherwise make good any loss applying under this Policy, we shall
be subrogated to all of the Insured’s and your rights of recovery against any other person or persons
and you shall complete, sign and deliver any document necessary to secure such rights. Both the
Insured and you shall not take any action following a loss to prejudice such rights of subrogation.
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OWN INSURER
If at the time of any loss or damage, the policy limit of any benefit is less than the total amount of
claim, you and/or the Insured shall be considered his own insurer for the difference.
AGE
If the age of the Insured indicated on your application is incorrectly stated, we shall, subject to the
satisfaction of our terms and conditions, adjust the premiums payable according to the correct age.
We shall accept the correct age if we are satisfied with the evidence produced.
If the adjusted premiums are higher, you shall be required to pay the underpaid premiums. If the
adjusted premiums are lower, we shall refund the overpaid premiums without interest. Any refund
shall be made to your Medisave account or to you directly, as the case may be.
If at the correct age, the Insured would not have been eligible for coverage under this Policy, no
benefits shall be payable and your Policy shall be cancelled.
We may require proof of age at the time of processing any claim under your Policy.
CURRENCY OF PAYMENT
The amounts to be paid by us or to us shall be in the currency shown on the Policy Schedule.
FREE-LOOK PERIOD
We shall give you 21 days from the date of receipt of the Policy to decide whether you want to
continue with your Policy. If you do not want to continue, you may cancel this Policy in writing to us
and we shall refund the premiums paid for this Policy without interest. Any refund shall be made to
your Medisave account or to you directly, as the case may be.
If you opted for an electronic copy of your Policy, the 21-day free-look period will start when you
receive our SMS or email notification, informing you that the policy contract documents are available
for your viewing on our customer portal (My AIA SG or such other name as we may choose for our
customer portal from time to time).
If we have posted the Policy to you, the 21-day free-look period shall start seven (7) days after we
have posted the Policy to you.
CANCELLATION
You may cancel your Policy by giving us 30 days’ notice after the Free-Look Period. Cancellation
shall be without prejudice to any claim arising prior to the effective date of cancellation.
We shall refund to you the portion of the premiums paid in respect of the period from the effective
date of cancellation up to the next policy anniversary. After such refund of premiums, we shall not be
liable for any reimbursement of any claim incurred for the remaining period of the Policy Year
immediately following the effective date of cancellation.
RIGHTS OF THIRD PARTIES
The Contracts (Rights of Third Parties) Act (Cap. 53B) and any subsequent changes or replacement
of its provisions shall not apply to your Policy.
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NON-PARTICIPATING
This Policy shall be Non-Participating.
AVOIDANCE OF POLICY
Your Policy shall be void if any declaration or any written statement provided to us is untrue in any
respect or if any material fact affecting the risk is incorrectly represented, stated or if you or the
Insured have omitted such written statement.
Your Policy is treated as void:
(a) on the Policy Date if the misrepresentation, omission, or fraudulent statement was made to us on
a proposal of insurance; or
(b) on the last reinstatement date (if any) or the effective date of change of plan (if any) if the
misrepresentation, omission, or fraudulent statement was made to us on an application for
reinstatement of insurance or change of plan.
Except in the case of fraud, when this Policy is treated as void pursuant to the above:
(a) If there are no claims made under this Policy, all premiums paid for insurance which became
effective on or after the date on which this Policy is treated as void will be refunded.
(b) If there were claims made under this Policy, only the premiums paid for the Policy Year(s)
following the Policy Year in which the last claim was made will be refunded.
Your Policy shall be void if any claim is fraudulent or exaggerated or if any false declaration or
statement in support of any such claim is made. In this case, the Policy will be void immediately and
there will be no refund of premiums. We reserve the right to recover such fraudulent or exaggerated
claims that we have paid under this Policy.
CHANGE OF POLICY TERMS AND CONDITIONS
We may vary the premiums, benefits and/or cover or amend any privilege, term or condition of this
Policy by giving you 31 days prior written notice, provided that such changes apply to all policies
within the same class of insurance.
CHANGE OF CITIZENSHIP/ RESIDENCY/ VALID PASS STATUS
You must inform us in writing immediately of any change in the citizenship or residency status of the
Insured or when he ceases to hold a Valid Pass.
If the Insured is a Foreigner and does not have a Valid Pass for a continuous period of more than 60
days after his pass is expired or terminated, the Policy shall be terminated by us in accordance with
the Termination Clause of this Policy. If the expiry or the termination of the pass is due to the Insured
becoming a Singapore Citizen or Singapore Permanent Resident, upon receipt of notification of the
change, we reserve the right to convert the Policy to a Medisave-approved integrated medical
insurance plan that is jointly insured by the CPF Board for the MediShield Life Scheme component
and us for the medical enhancement scheme covering the Insured, subject to the availability of such
plan.
For conversion of plan, any claim for expenses incurred before the effective date of the conversion of
plan shall be payable in accordance with the benefit limits of the plan in-force prior to the conversion
of plan.
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CHANGE OF PLAN
You may request for a change of plan which includes plan upgrade, plan downgrade or plan
conversion in accordance with our terms and conditions for a change of plan by writing to us.
Any change of plan is subject to our approval and if approved, shall take effect on such date as
notified by us to you.
For change of plan, any claim for expenses incurred before the effective date of the change of plan
shall be payable in accordance with the benefit limits of the plan in-force prior to the change of plan.
In relation to a plan upgrade, claims that arise on or after the effective date of plan upgrade from
a pre-existing condition (physical impairment, illness or disease) developed during the period of
insurance of the prior plan will be assessed and payable based on the terms and conditions and
benefits limits of the plan in-force prior to the effective date of the plan upgrade, unless the Insured
makes a declaration of such pre-existing condition in the application for the plan upgrade and such
application is specifically accepted by us. For the avoidance of doubt, any Pre-existing Condition
that was not covered under the plan in-force prior to the effective date of plan upgrade will continue to
be excluded under the upgraded plan.
TERMINATION
Your Policy shall automatically terminate on the earliest occurrence of the following:
(a) if any premium of your Policy remains unpaid at the end of the Grace Period;
(b) on the commencement date of another medical insurance plan covering the Insured where the
premium is paid using the Medisave funds maintained by the CPF Board, in the event the
premium for this Policy is also paid using Medisave funds;
(c) on the death of the Insured;
(d) on the day immediately following the 60th day of the expiry or termination of the Insured’s Valid
Pass or on the day when the Policy is converted to a Medisave-approved integrated medical
insurance plan due to the Insured becoming a Singapore Citizen or Singapore Permanent
Resident, whichever is earlier; or
(e) on the effective date of cancellation.
Termination of this Policy shall not affect any claim arising prior to such termination of this Policy. In
no instance shall any benefit be payable for expenses incurred on or after the date of termination,
regardless of whether the incurred expense is a direct result of a covered condition which occurred
before the termination of this Policy. Our acceptance of any premium after termination shall not create
a liability for us.
If the Policy is terminated due to occurrence of (b), (c), (d) or (e), we shall refund to you the portion of
the premiums paid for the Policy Year in respect of the period from the date of termination up to the
next policy anniversary.
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BENEFITS PROVISIONS
LIMITS ON ELIGIBLE EXPENSES
Eligible Expenses are:
(a) limited to Reasonable and Customary charges for medical expenses or fees incurred; and
(b) subject to the Limit of Compensation under each respective benefit stated in the Schedule of
Benefits of this Policy in accordance with the plan type applicable at the time such medical
expenses or fees are incurred.
BENEFITS
While this Policy is in-force, we shall pay up to the Limits of Compensation for each respective benefit
under this Policy for any Eligible Expenses incurred, less any Deductible and/or Co-insurance as
stated in the Schedule of Benefits and subject to the terms and conditions of this Policy.
In relation to the following benefits we shall pay up to the Limits of Compensation for each respective
benefit under this Policy for any Eligible Expenses incurred:
(a) Part (F)(ii) – Congenital Abnormalities of Insured’s Biological Child from Birth under Congenital
Abnormalities Benefits;
(b) Part (G)(i) – Insured (as the Living Donor) Donating an Organ under Living Donor Organ
Transplant Benefits;
(c) Part (G)(ii) – Non-insured (as the Living Donor) Donating an Organ to the Insured under Living
Donor Organ Transplant Benefits;
(d) Part (I)(i) – In-Hospital Psychiatric Treatment under Psychiatric Treatment Benefits; and
(e) Part (I)(ii) – Post-Hospitalisation Psychiatric Treatment under Psychiatric Treatment Benefits.
For such purposes, we reserve the right to:
(a) determine whether any particular Hospital or medical charge is a Reasonable and Customary
charge with reference (but not limited) to our claim data, relevant publications or information on
schedule of fees prescribed by the government, relevant authorities and recognized medical
associations in the locality; and
(b) adjust any and all sums payable in relation to any Hospital or medical charge, which is in our
opinion or in the opinion of our medical advisor, is not a Reasonable and Customary charge.
In the event of treatment for conditions for which guidelines on fees and medical practice (which
outline the most appropriate course of care for a specific condition, operation or procedure) may be
published by the Ministry of Health of Singapore or official medical body in Singapore, we will take
reference from these when assessing and paying claims.
Further, there are specific clinical situations where we may require additional criteria to be met in
order for a claim to be admitted. Refer to the list of clinical situations in Appendix A.
If you are receiving treatment that involves the use of high-cost technologies, you must obtain
approval from us prior to your treatment. Where approval from us has not been obtained, charges for
the use of such technology may not be covered under this Policy and we may not make payment for
such charges. Refer to the list of high-cost technologies in Appendix B.
In no instance shall any benefit be payable for any expense which is incurred before the Policy Date
or occurs after the termination or cancellation of the Policy, regardless of whether the incurred
expense is a direct result of a covered condition which occurred before the termination or cancellation
of the Policy.
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(A) Hospitalisation and Surgical Benefits
(i) Daily Room and Board Benefit
This benefit shall be equal to the Eligible Expenses incurred for room and board
charges for a Standard Room including high dependency ward charges, and includes
meals, prescriptions, professional charges, investigations and miscellaneous medical
charges incurred per day during the period for which the Insured requires
Confinement due to an Illness or Injury.
(ii) Daily Intensive Care Unit (ICU) Benefit
This benefit shall be equal to the Eligible Expenses incurred for ICU charges, and
includes meals, prescriptions, professional charges, investigations and miscellaneous
medical charges incurred per day during the period for which the Insured requires
Confinement at the ICU of a Hospital due to an Illness or Injury.
(iii) Community Hospital Benefit
This benefit shall be equal to the Eligible Expenses incurred for room and board
charges for a Standard Room and includes meals, inpatient prescriptions,
professional charges, investigations, laboratory tests, rehabilitation services and the
miscellaneous medical charges incurred per day during the period the Insured
requires to be treated as an inpatient in a Community Hospital due to an Illness or
Injury and provided such hospitalisation is immediately preceded by:
(a) Confinement in a Hospital; or

(b) treatment from a Restructured Hospital’s Accident and Emergency Unit in
Singapore,
and is referred by a Physician or Specialist of the Hospital or recommended by the

Restructured Hospital’s Accident and Emergency Unit in Singapore, to continue the
treatment for the Illness or Injury.
Such hospitalisation in the Community Hospital must be for a continuous period of not
less than six (6) hours.
(iv) Surgical Benefit
This benefit shall be equal to the Eligible Expenses incurred for Surgical Procedures,
surgical implants, Approved Medical Consumables and stereotactic radiosurgery
including operation theatre and anaesthesia fees as required by the Physician or
Specialist during Confinement due to an Illness or Injury.
(v) Organ Transplant Benefit
In the event of a full or partial human organ transplantation of the kidney(s), heart,
liver, lung, pancreas, cornea(s), skin or a bone marrow transplant where the Insured
is the recipient of organ or bone marrow, we shall reimburse the Eligible Expenses
incurred per transplant for the Surgical Procedure relating to the transplant including
operation theatre and anaesthesia fees as required by the Physician or Specialist
during Confinement in a Hospital due to an Illness or Injury.
We shall also reimburse the Eligible Expenses incurred for recovering such organs or
bone marrow as may be approved from time to time under the MediShield Life
Scheme from a non-living human organ donor (cadaveric donor) for the purpose of
facilitating the Insured’s transplant.
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The organ or bone marrow recovery costs arising from or in relation to or incidental to
the recovery of any organ or bone marrow or related parts of such organs or bone
marrow approved from time to time under the MediShield Life Scheme from a non-
living human organ or bone marrow donor (cadaveric donor) for the purpose of
facilitating the Insured’s transplant shall be limited to the following costs:
(a) charges for the donor’s extended stay, after he is certified dead, in a Hospital as
necessitated by the donation of his organ or bone marrow;
(b) charges for any surgical operation to remove the specified organ or bone marrow
from the donor’s body;
(c) charges for any pre-harvesting laboratory test and investigation related to the
medical status of the donor and the viability of the organ or bone marrow to be
transplanted;
(d) charges for any counselling provided by medical social workers to the donor’s
family in connection with the donation of his organ or bone marrow; and
(e) charges for the storage and transport of the specified organ or bone marrow
after the organ or bone marrow is removed from the donor’s body.
However, the organ or bone marrow transplant surgery has to be performed on the
Insured in a Hospital in Singapore before the relevant organ or bone marrow recovery
cost can be submitted for claim. We shall only reimburse the costs which are listed in
items (a) to (e) above. All other costs arising from or in relation to or incidental to the
recovery of any organ or bone marrow or related parts of such organ or bone marrow
approved from time to time under the MediShield Life Scheme from a non-living
human organ or bone marrow donor (cadaveric donor) for the purpose of facilitating
the Insured’s transplant are expressly excluded.
For the avoidance of doubt, we shall not pay for any cost if the organ or bone marrow
transplant is illegal or arises from any illegal transaction or practice.
(vi) Stem Cell Transplant Benefit
In the event of a stem cell transplant surgery, we shall reimburse the Eligible
Expenses incurred for the stem cell transplant Surgical Procedure including operation
theatre and anaesthesia fees as required by the Physician or Specialist during
Confinement in a Hospital due to an Illness or Injury.
For the avoidance of doubt, in relation to stem cell transplants, outpatient therapies
such as injection or extraction where the Insured does not require Confinement in a
Hospital shall not be covered.
Expenses incurred for Proton Beam Therapy and Cell, Tissue and Gene Therapy are
expressly excluded from the above Part (A) Hospitalisation and Surgical Benefits.
(B) Pre-Hospitalisation Benefit
If the Insured requires Confinement to undergo medical or surgical treatment due to an Illness
or Injury, we shall reimburse the Eligible Expenses for pre-hospitalisation treatment and test
including Specialist consultations, diagnostic x-rays or laboratory tests that the Insured is
required to undergo upon the written recommendation or approval of a Physician or Specialist
for the same Illness or Injury that causes the Confinement and within such period specified in
the Schedule of Benefits prior to such Confinement.
(C) Post-Hospitalisation Benefits
If the Insured requires Confinement to undergo medical or surgical treatment due to an Illness
or Injury, we shall reimburse the Eligible Expenses incurred for post-hospitalisation treatment
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and test for the same Illness or Injury treated during the Confinement as set out under this
Part (C)(i) – Post-Hospitalisation Treatment and Part (C)(ii) – Extended Post-Hospitalisation
Treatment for 30 Critical Illnesses.
No payment under this benefit shall be made for any routine medical check-up which is not
part of the post-hospitalisation medical treatment as recommended by the Physician or
Specialist and is not related to the Confinement. No payment shall be made for any
treatments, medical services, supplies and/or medication purchased within the period
specified in the Schedule of Benefits for the Post-Hospitalisation Benefits which are not
utilised within the same period.
(i) Post-Hospitalisation Treatment
We shall reimburse the Eligible Expenses incurred for any post-hospitalisation

medical treatment and test that the Insured is required to undergo upon the written
recommendation or approval of the Physician or Specialist provided they are done for
the same Illness or Injury that causes the Confinement and within such period
specified in the Schedule of Benefits following the day such Confinement ends.
(ii) Extended Post-Hospitalisation Treatment for 30 Critical Illnesses
We shall continue to reimburse the Eligible Expenses incurred for any post-
hospitalisation medical treatment and test that the Insured is required to undergo as a
direct result of one (1) of the 30 Critical Illnesses (as defined in Part (M) – Extra
Cover for 30 Critical Illnesses Benefit) for an additional 100 days immediately
following the expiry of 100 days from the day the Confinement ends for post-
hospitalisation treatment covered under Part (C)(i) – Post-Hospitalisation Treatment.
Such extended post-hospitalisation treatments and tests must be upon written

recommendation or approval of a Physician or Specialist for the critical illness where
the extended post-hospitalisation treatments and tests are done for the same critical
illness for which the Confinement was required under Part (C)(i) –- Post-
Hospitalisation Treatment.
This Extended Post-Hospitalisation Treatment for 30 Critical Illnesses shall not apply
and shall not be payable if Part C(i) - Post-Hospitalisation Treatment has been
claimed for a period of 200 or more days following the day such Confinement ends.
(D) Accidental Inpatient Dental Treatment Benefit
If the Insured requires Confinement to repair the Insured’s own sound natural teeth (dentures
and all related expenses are expressly excluded) necessitated by an Injury caused by an
Accident, we shall reimburse such Eligible Expenses incurred.
For the avoidance of doubt, Eligible Expenses incurred in respect of and in connection with
the Accidental Inpatient Dental Treatment Benefit are eligible to be reimbursed under Parts
(A), (B) and (C) under the Benefits Provisions of this Policy.
(E) Pregnancy Complications Benefit
We shall reimburse the Eligible Expenses incurred if the Insured requires Confinement in a
Hospital to undergo medical or surgical treatment due to one of the following pregnancy
complications as defined herein:
(a) Ectopic pregnancy – Diagnosis by an obstetrician of a condition in which implantation of a

fertilised ovum occurs outside the uterine cavity, and its subsequent complications;
(b) Pre-eclampsia or eclampsia – Diagnosis of pre-eclampsia or eclampsia by an
obstetrician;
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(c) Disseminated intravascular coagulation – Diagnosis of disseminated intravascular

coagulation by an obstetrician;
(d) Miscarriage – Diagnosis by an obstetrician of the death of the foetus of the Insured after
13 weeks of pregnancy as a result of a sudden unforeseen and involuntary event and
must not be due to a voluntary or malicious act;
(e) Acute fatty liver pregnancy – Diagnosis by an obstetrician of severe acute fatty liver
occurring during pregnancy and where at least three (3) of the following criteria must be
fulfilled:
(1) Imaging studies consistent to the diagnosis of a fatty liver;
(2) Bilirubin is persistently elevated above 150 umol/L (10 mg/dL) for a period of at least
five (5) days;
(3) Renal impairment; and/or
(4) Coagulopathy.
Liver damage in the presence eclampsia, pre-eclampsia and viral hepatitis shall be
excluded.
(f) Choriocarcinoma and hydatidiform mole – occurrence of a histologically confirmed
choriocarcinoma and/or molar pregnancy, and its subsequent complications;
(g) Postpartum haemorrhage requiring hysterectomy – the ongoing bleeding secondary to an
unresponsive and atonic uterus, a ruptured uterus, or a large cervical laceration
extending into the uterus requiring hysterectomy. Proof of actual undergoing of
hysterectomy is required;
(h) Still birth - Diagnosis by an obstetrician of the death of the foetus of the Insured after 26
weeks of pregnancy which meets the definition of still birth in the Registry of Births and
Deaths Act, and is a result of a sudden unforeseen and involuntary event and not any
voluntary or malicious act on the part of the Insured;
(i) Cervical incompetency - Diagnosis by an obstetrician of cervical incompetency requiring
cervical cerclage;
(j) Accreta placenta - Diagnosis by an obstetrician of abnormal trophoblast invasion into the
myometrium of the uterine wall, requiring cesarean hysterectomy during delivery;
(k) Placental abruption - Diagnosis by an obstetrician of partial or complete placental
detachment prior to delivery of the foetus in a pregnancy over 20 weeks in duration;
(l) Placenta praevia - Diagnosis by an obstetrician of the presence of placental tissue
extending over the internal cervical os, resulting in an indication for cesarean delivery;
(m) Antepartum, intrapartum and postpartum haemorrhage - Diagnosis by an obstetrician of
severe abnormal bleeding from the female genital tract at or after 20 weeks of pregnancy
before or during childbirth;
(n) Placental insufficiency and intrauterine growth restriction - Diagnosis by an obstetrician of
placental insufficiency leading to intrauterine growth restriction;
(o) Gestational diabetes mellitus - Diagnosis by an obstetrician of gestational diabetes
mellitus. The Diagnosis must have been made through a 75g oral glucose tolerance test;
(p) Obstetric cholestasis - Diagnosis by an obstetrician of obstetric cholestasis;
(q) Twin to twin transfusion syndrome - Diagnosis by an obstetrician of twin to twin
transfusion syndrome. There should be ultrasonic evidence of a single monochorionic
placenta with twin oligohydroamnios / polyhydramnios sequence;
(r) Infection of amniotic sac and membranes - Diagnosis by an obstetrician of infection of the
amniotic sac or membranes;
(s) Amniotic fluid embolism - a life threatening obstetric emergency characterised by sudden
cardiorespiratory collapsed and disseminated intravascular coagulation. The Diagnosis of
amniotic fluid embolism must be confirmed by an obstetrician;
(t) Fourth degree perineal laceration - Diagnosis by an obstetrician of a perineal laceration
following vaginal delivery which involves the perineal structures, external anal sphincter,
internal anal sphincter, and rectal mucosa. Perineal laceration less than fourth degree or
without identified degree are excluded;
(u) Uterine rupture - Diagnosis by an obstetrician of the uterine rupture, defined as the
complete disruption of all uterine layers, including the serosa, leading to change in
maternal or fetal status;
(v) Postpartum inversion of uterus - Diagnosis by an obstetrician of a condition in which the
uterine fundus collapses into the endometrial cavity, turning the uterus partially or
completely inside out;
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(w) Obstetric injury or damage to pelvic organs - Diagnosis by an obstetrician of injuries to

the pelvic organs or surrounding structures as a consequence of vaginal delivery;
(x) Complications resulting in a caesarean hysterectomy - removal of the uterus during a
caesarean section delivery in cases where removal of the uterus is solely due to
complications that have arisen during the pregnancy or delivery;
(y) Retained placenta and membranes - Diagnosis by an obstetrician of the retention of the
placenta or other products of conception in the uterus after delivery;
(z) Abscess of breast - abscess of breast associated with childbirth.
These pregnancy complications must have been first Diagnosed after the Insured has been
insured under this Policy for a continuous period of 10 months from the Policy Date the last
reinstatement date (if any) or effective date of plan upgrade (if any) of this Policy, whichever is
latest.
For the avoidance of doubt, Eligible Expenses incurred in respect of and in connection with
the Pregnancy Complications Benefit are eligible to be reimbursed under Parts (A), (B) and
(C) under the Benefits Provisions of this Policy.
(F) Congenital Abnormalities Benefits
(i) Congenital Abnormalities of Insured’s Biological Child from Birth
We shall reimburse the Eligible Expenses incurred by the Insured’s biological child if
the child is required to be Confined in a Hospital to undergo medical or surgical
treatment due to birth defects, including hereditary conditions and congenital sickness
or abnormalities during the first 24 months from date of birth of the child.
These conditions relating to the Insured’s biological child must be first Diagnosed by
a Physician or Specialist after the Insured has been insured under this Policy for a
continuous period of 10 months from the Policy Date, the last reinstatement date (if
any) or the effective date of plan upgrade (if any) of this Policy, whichever is latest.
This benefit applies only if the Insured is a female.
(ii) Congenital Abnormalities of Insured
We shall reimburse the Eligible Expenses incurred by the Insured if he is required to

be Confined in a Hospital to undergo medical or surgical treatment due to his own
birth defects, including hereditary conditions and congenital sickness or
abnormalities.
For the avoidance of doubt, the Eligible Expenses incurred in respect of and in connection
with Part (F)(i) – Congenital Abnormalities of Insured’s Biological Child from Birth and Part
(F)(ii) – Congenital Abnormalities of Insured are eligible to be reimbursed under Parts (A), (B)
and (C) under the Benefits Provisions of this Policy.
For the avoidance of doubt, all Eligible Expenses incurred in respect of an in connection with
Part (F)(i) – Congenital Abnormalities of Insured’s Biological Child from Birth and Part (F)(ii) –
Congenital Abnormalities of Insured, shall be accumulated towards its respective Limit of
Compensation under the Congenital Abnormalities Benefits stated in the Schedule of
Benefits.
(G) Living Donor Organ Transplant Benefits
In relation to Living Donor Organ Transplant Benefits, we shall not pay for any cost related to
the surgery to remove the organ from a living donor if the organ transplant is illegal or arises
from any illegal transaction or practice.
202004
(i) Insured (as the Living Donor) Donating an Organ
We shall reimburse the Eligible Expenses incurred by the Insured, who is the living
donor to remove his kidney or a part of his liver, for purpose of its transplantation into
the body of a living recipient, subject to the following:
(a) the surgery to remove the organ from the living Insured is approved under
MediShield Life Scheme and regulated under HOTA and is performed in a
Hospital in Singapore;
(b) the date the recipient of the organ is first Diagnosed of an organ failure is
after 24 months from the Policy Date, the last reinstatement date (if any), or
the effective date of the plan upgrade (if any) of this Policy, whichever is
latest; and
(c) the expenses incurred must be directly attributed to the Insured’s organ
donation surgery for the recipient’s organ transplant surgery and shall be
limited to the following costs:
(1) charges for any pre-hospitalisation treatment and test incurred by Insured
including Specialist consultations, diagnostic x-rays or laboratory tests
including pre-harvesting laboratory tests and investigations;
(2) charges for the Insured’s Confinement in Hospital as necessitated by the
donation of his organ;
(3) charges for the Surgical Procedure to remove the specified organ from
the Insured’s body;
(4) charges for the storage and transport of the specified organ after the
organ is removed from the Insured’s body; and
(5) charges for any post-hospitalisation treatment or test incurred by the
Insured including any post-transplant complication arising thereafter
following the organ donation surgery on the Insured.
Any counselling provided by medical social workers to the Insured’s family in

connection with the donation of his organ shall not be covered by this Policy.
(ii) Non-insured (as the Living Donor) Donating an Organ to the Insured
We shall reimburse the Eligible Expenses incurred by a living donor who is not the
Insured under this Policy to remove his kidney or a part of his liver, for purpose of its
transplantation into the body of the Insured, who is the recipient of the organ, subject
to the following:
(a) the surgery to remove the organ from the living donor is approved under
MediShield Life Scheme and regulated under HOTA and is performed in a
Hospital in Singapore;
(b) the living donor is not eligible to be reimbursed for his organ donation surgery
under MediShield Life Scheme, a Medisave-approved integrated medical
insurance plan or any other insurance plan;
(c) the Insured, with the agreement from the living donor, agrees to claim under
his Policy to reimburse the living donor for the organ donation surgery; and
(d) the expenses incurred must be directly attributed to the organ donation
surgery of the living donor for the Insured’s own organ transplant surgery and
shall be limited to the following costs:
(1) charges for the living donor’s Confinement in Hospital as necessitated by
the donation of the organ;
(2) charges for the Surgical Procedure to remove the specified organ from
the living donor’s body; and
(3) charges for the storage and transport of the specified organ after the
organ is removed from the living donor’s body.
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The following expenses are expressly excluded from the above Part (G)(ii) – Non-
insured (as the Living Donor) Donating an Organ to the Insured:
(a) charges for any pre-hospitalisation treatment or test incurred by the living donor
including Specialist consultation, diagnostic x-rays or laboratory tests including
pre-harvesting laboratory tests and investigations;
(b) charges for any post-hospitalisation treatment or test incurred by the living donor
including any post-transplant complication arising thereafter following the organ
donation surgery on the living donor; and
(c) charges for any counselling provided by medical social workers to the living
donor’s family in connection with the donation of his organ.
For the avoidance of doubt, all Eligible Expenses incurred in respect of and in connection with
Part (G)(i) –- Insured (as the Living Donor) Donating an Organ and Part (G)(ii) – Non-insured
(as the Living Donor) Donating an Organ to the Insured, shall be accumulated towards its
respective Limit of Compensation under the Living Donor Organ Transplant Benefits stated in
the Schedule of Benefits.
(H) Emergency Overseas (Outside Singapore) Medical Treatment Benefit
We shall reimburse the Eligible Expenses incurred for overseas medical or surgical treatment
if the Insured is Confined in a Hospital outside Singapore as a result of an Emergency outside
of Singapore, limited to Reasonable and Customary charges which would have been incurred
for similar medical treatment or surgery carried out in a private Hospital in Singapore.
If we admit the claims for the Eligible Expenses incurred for a Confinement in a Hospital
outside of Singapore, we shall convert all bills rendered to the contract currency based on
such prevailing exchange rate as may be determined by us to be in effect on the date of
leaving the Hospital or date the overseas medical or surgical treatment is incurred.
Eligible Expenses incurred in respect of and in connection with the Emergency Overseas
(Outside Singapore) Medical Treatment Benefit are eligible to be reimbursed:
(i) under Part (A) under the Benefits Provisions of this Policy; and
(ii) under Part (C) under the Benefits Provisions of this Policy, provided that the post-
hospitalisation treatment and tests are done in Singapore and within such period
specified in the Schedule of Benefits following the day such Confinement ends.
(I) Psychiatric Treatment Benefits
(i) In-Hospital Psychiatric Treatment
We shall reimburse the Eligible Expenses incurred for medical or surgical treatment
including room and board charges for a Standard Room, meals, prescriptions,
professional charges, investigations and miscellaneous medical charges incurred per
day during the period the Insured is Confined in a Hospital to receive psychiatric
treatment provided by a Psychiatrist. Such hospitalisation and psychiatric treatment
must be advised in writing for the Insured by a Psychiatrist and administered to the
Insured under the direct supervision of a Psychiatrist.
(ii) Post-Hospitalisation Psychiatric Treatment
If the Insured requires Confinement in a Hospital for psychiatric treatment, we shall

reimburse the Eligible Expenses incurred for post-hospitalisation psychiatric
treatments and tests that the Insured is required to undergo, within the period
specified in the Schedule of Benefits following the day such Confinement ends. Such
post-hospitalisation psychiatric treatment must be for the same condition that
202004
necessitates the Confinement for which In-Hospital Psychiatric Treatment is payable

under Part (I)(i) – In-Hospital Psychiatric Treatment.
No payment shall be made for any routine medical check-up which is not part of the
post-hospitalisation psychiatric medical treatment by the Physician or Specialist.
No payment shall be made for any treatments, medical services, supplies and/or
medication purchased within the period specified in the Schedule of Benefits for the
Post-Hospitalisation Psychiatric Treatment which is not utilised within the same
period.
For the avoidance of doubt, all Eligible Expenses incurred in respect of and in connection with
Part (I)(i) – In-Hospital Psychiatric Treatment and Part (I)(ii) – Post-Hospitalisation Psychiatric
Treatment are accumulated towards its respective Limit of Compensation under Psychiatric
Treatment Benefits as stated in the Schedule of Benefits.
(J) Outpatient Benefit
This benefit shall be equal to the Eligible Expenses incurred during the following course of
treatments:
(a) radiotherapy for cancer;

(b) stereotactic radiotherapy for cancer;
(c) chemotherapy for cancer;
(d) immunotherapy for cancer;
(e) renal dialysis;
(f) erythropoietin;
(g) immunosuppressant drugs approved by the Health Sciences Authority which are
prescribed to the Insured following an organ transplant; and
(h) long-term parenteral nutrition.
In relation to immunosuppressant drugs, we shall not reimburse the immunosuppressant

drugs if the organ transplant is illegal or arises from any illegal transaction or practice.
In relation to long-term parenteral nutrition, we will cover for the parenteral nutrition bags and
consumables necessary for the administration of parenteral nutrition, and the Insured must
fulfill all the clinical criteria for long-term parenteral nutrition under the MediShield Life
Scheme.
Confinement is not required for this benefit to be payable. The Eligible Expenses incurred
under the Outpatient Benefit are not subject to Deductible but are subject to Co-insurance.
Expenses incurred for Proton Beam Therapy and Cell, Tissue and Gene Therapy are
expressly excluded from the above Part (J) Outpatient Benefit.
(K) Final Expense Benefit
The Final Expense Benefit shall be reimbursed to waive the Deductible and Co-Insurance
incurred in that Policy Year, in the event the Insured dies:
(a) during Confinement in a Hospital; or

(b) within 30 days following discharged from the Hospital after Confinement, provided the
death is as result of an Illness or Injury that has led to the Confinement.
The total amount payable as Final Expense Benefit is subject to the Limit of Compensation
stated in the Schedule of Benefits.
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(L) Waiver of Premium for 1 Year Benefit (Upon Total and Permanent Disability)
If the Insured, before policy anniversary occurring on or immediately following the Insured’s
70th birthday, sustains Total and Permanent Disability while this Policy is in-force, we will
waive the premium for one (1) year, starting from the next premium due immediately following
the date of commencement of such Total and Permanent Disability. Subsequent premiums
due, following the waiver of one (1) year of premium, shall be payable by you.
For the purpose of this benefit, Total and Permanent Disability shall refer to “TPD 1”, “TPD
2” and “TPD 3”.
"TPD 1" means disability sustained by the Insured before the policy anniversary occurring on
or immediately following the Insured‘s 65th birthday, such that from the time the disability
commences and at any time thereafter:
(a) the Insured is not capable of doing or carrying out any work, occupation or profession, to
earn or obtain any wages, compensation or profit; and
(b) such disability must continue uninterrupted for at least six (6) consecutive months (“TPD
Period”) and there is no possibility of improvement for an indefinite time.
"TPD 2" means disability sustained by the Insured on and after the policy anniversary
occurring on or immediately following the Insured’s 65th birthday, such that from the time the
disability commences and at any time thereafter:
(a) the Insured is not capable of performing at least two (2) of the following six (6) “Activities
of Daily Living” even with the aid of special equipment, and always to require the physical
assistance of another person throughout the entire activity; and
(b) such disability must continue uninterrupted for at least six (6) consecutive months (“TPD
Period”).
Notwithstanding any of the above, we shall immediately recognise the occurrence of any of
the following as “TPD 3”:
(a) total and irrecoverable loss of sight of both eyes; or

(b) loss by complete severance or the total and irrecoverable loss of use of two (2) limbs at
or above the wrist or ankle; or
(c) total and irrecoverable loss of sight of one (1) eye; and
(i) loss by complete severance of one (1) limb at or above the wrist or at or above the
ankle; or
(ii) total and irrecoverable loss of use of one (1) limb at or above the wrist or at or above
the ankle.
In the case of a juvenile, we will only admit a claim for this benefit as a result of TPD 3.
For purpose of this benefit, an Insured will be considered a juvenile until such time he:
(a) reaches the age of 16 and he becomes gainfully employed or self-employed; or

(b) attains the age of 21, whichever is earlier.
For purpose of this benefit, “Activities of Daily Living” are:
Washing the ability to wash in the bath or shower (including getting into and out of
the bath or shower) or wash satisfactorily by other means;
Dressing the ability to put on, take off, secure and unfasten all garments and, as
appropriate, any braces, artificial limbs or other surgical appliances;
Transferring the ability to move from a bed to an upright chair or wheelchair and vice
versa;
Mobility the ability to move indoors from room to room on level surfaces;
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Toileting the ability to use the lavatory or otherwise manage bowel and bladder
functions so as to maintain a satisfactory level of personal hygiene;
Feeding the ability to feed oneself once food has been prepared and made
available.
The diagnosis of the Total and Permanent Disability must be confirmed and certified by a
Physician.
(M) Extra Cover for 30 Critical Illnesses Benefit
In the event the Insured requires medical or surgical treatment as a direct result of one of the
following 30 Critical Illnesses listed below, the limits (Critical Illnesses Limit Per Policy Year
and Critical Illnesses Limit Per Lifetime) under the Extra Cover for 30 Critical Illnesses Benefit
stated in the Schedule of Benefits shall be provided as additional limits above the limits
(Maximum Limit Per Policy Year and Maximum Limit Per Lifetime) under the Maximum Claim
Limit stated in the Schedule of Benefits. The Eligible Expenses incurred shall be first
accumulated towards the Critical Illnesses Limit Per Policy Year (for the applicable Policy
Year). If the Eligible Expenses exceeds the Critical Illnesses Limit Per Policy Year (for the
applicable Policy Year), the excess amount shall be accumulated towards the Maximum Limit
Per Policy Year (for the applicable Policy Year).
This Extra Cover for 30 Critical Illnesses Benefit shall not be provided as an additional limit
above the Maximum Limit Per Policy Year of S$2,000,000 under the Maximum Claim Limit.
List of 30 Critical Illnesses:
1. Heart Attack of Specified Severity

2. Stroke
3. Coronary Artery By-pass Surgery
4. HIV Due to Blood Transfusion and Occupationally Acquired HIV
5. Angioplasty & Other Invasive Treatment for Coronary Artery
6. Major Cancers
7. Fulminant Hepatitis
8. Primary Pulmonary Hypertension
9. Kidney Failure
10. Major Organ / Bone Marrow Transplantation
11. Multiple Sclerosis
12. Blindness (Loss of Sight)
13. Paralysis (Loss of Use of Limbs)
14. Muscular Dystrophy
15. Alzheimer’s Disease / Severe Dementia
16. Coma
17. Deafness (Loss of Hearing)
18. Heart Valve Surgery
19. Loss of Speech
20. Major Burns
21. Surgery to Aorta
22. Terminal Illness
23. End Stage Lung Disease
24. End Stage Liver Failure
25. Motor Neurone Disease
26. Parkinson’s Disease
27. Aplastic Anaemia
28. Benign Brain Tumor
29. Bacterial Meningitis
30. Viral Encephalitis
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Definitions of 30 Critical Illnesses
1. Heart Attack of Specified Severity
Death of heart muscle due to obstruction of blood flow, that is evident by at least three (3) of
the following criteria proving the occurrence of a new heart attack:
(a) History of typical chest pain;

(b) New characteristic electrocardiographic changes; with the development of any of the
following: ST elevation or depression, T wave inversion, pathological Q waves or left
bundle branch block;
(c) Elevation of the cardiac biomarkers, inclusive of CKMB above the generally accepted
normal laboratory levels or cardiac troponin T or I at 0.5ng/ml and above;
(d) Imaging evidence of new loss of viable myocardium or new regional wall motion
abnormality. The imaging must be done by cardiologist specified by us.
For the above definition, the following are excluded:
(a) Angina;
(b) Heart attack of indeterminate age; and
(c) A rise in cardiac biomarkers or troponin T or I following an intra-arterial cardiac procedure
including, but not limited to, coronary angiography and coronary angioplasty.
Explanatory note: 0.5ng/ml = 0.5ug/L = 500pg/ml.
2. Stroke
A cerebrovascular incident including infarction of brain tissue, cerebral and subarachnoid

haemorrhage, intracerebral embolism and cerebral thrombosis resulting in permanent
neurological deficit with persisting clinical symptoms. This Diagnosis must be supported by all
of the following conditions:
(a) Evidence of permanent clinical neurological deficit confirmed by a neurologist at least six (6)
weeks after the event; and
(b) Findings on magnetic resonance imaging, computerised tomography, or other reliable
imaging techniques consistent with the Diagnosis of a new stroke.
The following are excluded:
(a) Transient ischaemic attacks;

(b) Brain damage due to an accident or injury, infection, vasculitis, and inflammatory disease;
(c) Vascular disease affecting the eye or optic nerve; and
(d) Ischaemic disorders of the vestibular system.
Permanent means expected to last throughout the lifetime of the Insured.
Permanent neurological deficit with persisting clinical symptoms means symptoms of

dysfunction in the nervous system that are present on clinical examination and expected to
last throughout the lifetime of the Insured. Symptoms that are covered include numbness,
paralysis, localized weakness, dysarthria (difficulty with speech), aphasia (inability to speak),
dysphagia (difficulty swallowing), visual impairment, difficulty in walking, lack of coordination,
tremor, seizures, dementia, delirium and coma.
3. Coronary Artery By-pass Surgery
The actual undergoing of open-chest surgery or minimally invasive direct coronary artery by-
pass surgery to correct the narrowing or blockage of one (1) or more coronary arteries with
bypass grafts. This Diagnosis must be supported by angiographic evidence of significant
202004
coronary artery obstruction and the procedure must be considered Medically Necessary by a
consultant cardiologist.
Angioplasty and all other intra-arterial, catheter based techniques, ‘keyhole’ or laser
procedures are excluded.
4. HIV Due to Blood Transfusion and Occupationally Acquired HIV
(a) Infection with the Human Immunodeficiency Virus (HIV) through a blood transfusion,
provided that all of the following conditions are met:
x The blood transfusion was Medically Necessary or given as part of a medical

treatment;
x The blood transfusion was received in Singapore after the Policy Date, endorsement
date or reinstatement date of this Policy, whichever is the later;
x The source of the infection is established to be from the Institution that provided the
blood transfusion and the Institution is able to trace the origin of the HIV tainted
blood; and
x The Insured does not suffer from thalassaemia major or haemophilia.
(b) Infection with the Human Immunodeficiency Virus (HIV) which resulted from an accident
occurring after the Policy Date, endorsement date or reinstatement date of this Policy,
whichever is the later whilst the Insured was carrying out the normal professional duties
of his or her occupation in Singapore, provided that all of the following are proven to our
satisfaction:
x Proof of the accident giving rise to the infection must be reported to us within 30 days
of the accident taking place;
x Proof that the accident involved a definite source of the HIV infected fluids;
x Proof of sero-conversion from HIV negative to HIV positive occurring during the 180
days after the documented accident. This proof must include a negative HIV antibody
test conducted within five (5) days of the accident; and
x HIV infection resulting from any other means including sexual activity and the use of
intravenous drugs is excluded.
This benefit is only payable when the occupation of the Insured is a medical practitioner,
housemen, medical student, state registered nurse, medical laboratory technician, dentist
(surgeon and nurse) or paramedical worker, working in medical centre or clinic (in Singapore).
This benefit will not apply under either section (a) or (b) where a cure has become available
prior to the infection. “Cure” means any treatment that renders the HIV inactive or non-
infectious.
5. Angioplasty & Other Invasive Treatment for Coronary Artery
The actual undergoing of balloon angioplasty or similar intra arterial catheter procedure to
correct a narrowing of minimum 60% stenosis, of one (1) or more major coronary arteries as
shown by angiographic evidence. The revascularisation must be considered Medically
Necessary by a consultant cardiologist.
Coronary arteries herein refer to left main stem, left anterior descending, circumflex and right
coronary artery.
Diagnostic angiography is excluded.
6. Major Cancers
A malignant tumour positively diagnosed with histological confirmation and characterised by

the uncontrolled growth of malignant cells with invasion and destruction of normal tissue.
202004
The term malignant tumour includes leukemia, lymphoma and sarcoma.
For the above definition, the following are excluded:
(a) All tumours which are histologically classified as any of the following:
- Pre-malignant;
- Non-invasive;
- Carcinoma-in-situ;
- Having borderline malignancy;
- Having any degree of malignant potential;
- Having suspicious malignancy;
- Neoplasm of uncertain or unknown behavior; or
- Cervical dysplasia CIN-1, CIN-2 and CIN-3;
(b) Any non-melanoma skin carcinoma unless there is evidence of metastases to lymph
nodes or beyond;
(c) Malignant melanoma that has not caused invasion beyond the epidermis;
(d) All prostate cancers histologically described as T1N0M0 (TNM classification) or below; or
prostate cancers of another equivalent or lesser classification;
(e) All thyroid cancers histologically classified as T1N0M0 (TNM classification) or below;
(f) All tumours of the urinary bladder histologically classified as T1N0M0 (TNM classification)
or below;
(g) All gastro-intestinal stromal tumours histologically classified as T1N0M0 (TNM
classification) or below and with mitotic count of less than or equal to 5/50 HPFs;
(h) Chronic lymphocytic leukaemia less than RAI stage 3; and
(i) All tumours in the presence of HIV infection.
7. Fulminant Hepatitis
A submassive to massive necrosis of the liver by the hepatitis virus, leading precipitously to
liver failure. This Diagnosis must be supported by all of the following:
(a) Rapid decreasing of liver size as confirmed by abdominal ultrasound;

(b) Necrosis involving entire lobules, leaving only a collapsed reticular framework;
(c) Rapid deterioration of liver function tests;
(d) Deepening jaundice; and
(e) Hepatic encephalopathy.
8. Primary Pulmonary Hypertension
Primary pulmonary hypertension with substantial right ventricular enlargement confirmed by

investigations including cardiac catheterisation, resulting in permanent physical impairment of
at least Class IV of the New York Heart Association (NYHA) Classification of Cardiac
Impairment.
The NYHA Classification of Cardiac Impairment:

Class I: No limitation of physical activity. Ordinary physical activity does not cause
undue fatigue, dyspnea or anginal pain.
Class II: Slight limitation of physical activity. Ordinary physical activity results in
symptoms.
Class III: Marked limitation of physical activity. Comfortable at rest, but less than
ordinary activity causes symptoms.
Class IV: Unable to engage in any physical activity without discomfort. Symptoms may be
present even at rest.
9. Kidney Failure
Chronic irreversible failure of both kidneys requiring either permanent renal dialysis or kidney
transplantation.
202004
10. Major Organ / Bone Marrow Transplantation
The receipt of a transplant of:

(a) Human bone marrow using haematopoietic stem cells preceded by total bone marrow
ablation; or
(b) One (1) of the following human organs: heart, lung, liver, kidney, pancreas, that resulted
from irreversible end stage failure of the relevant organ.
Other stem cell transplants are excluded.
11. Multiple Sclerosis
The definite occurrence of multiple sclerosis. The Diagnosis must be supported by all of the
following:
(a) Investigations which unequivocally confirm the Diagnosis to be multiple sclerosis;

(b) Multiple neurological deficits which occurred over a continuous period of at least six (6)
months; and
(c) Well documented history of exacerbations and remissions of said symptoms or
neurological deficits.
Other causes of neurological damage such as SLE and HIV are excluded.
12. Blindness (Loss of Sight)
Permanent and irreversible loss of sight in both eyes as a result of illness or accident to the
extent that even when tested with the use of visual aids, vision is measured at 3/60 or worse
in both eyes using a snellen eye chart or equivalent test, or visual field of 20 degrees or less
in both eyes. The blindness must be confirmed by an ophthalmologist.
13. Paralysis (Loss of Use of Limbs)
Total and irreversible loss of use of at least two (2) entire limbs due to injury or disease
persisting for a period of at least six (6) weeks and with no foreseeable possibility of recovery.
This condition must be confirmed by a consultant neurologist.
Self-inflicted injuries are excluded.
14. Muscular Dystrophy
A group of hereditary degenerative diseases of muscle characterised by weakness and

atrophy of muscle. The Diagnosis of muscular dystrophy must be unequivocal and made by a
consultant neurologist. The condition must result in the inability of the Insured to perform
(whether aided or unaided) at least three (3) of the following six (6) “Activities of Daily Living”
for a continuous period of at least six (6) months:
Activities of Daily Living:

Washing the ability to wash in the bath or shower (including getting into and out of
the bath or shower) or wash satisfactorily by other means;
versa;
Feeding the ability to feed oneself once food has been prepared and made
available.
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For the purpose of this definition, “aided” shall mean with the aid of special equipment, device
and/or apparatus and not pertaining to human aid.
15. Alzheimer’s Disease / Severe Dementia
Deterioration or loss of intellectual capacity as confirmed by clinical evaluation and imaging

tests, arising from alzheimer's disease or irreversible organic disorders, resulting in significant
reduction in mental and social functioning requiring the continuous supervision of the Insured.
This Diagnosis must be supported by the clinical confirmation of an appropriate consultant
and supported by our appointed Physician.
(a) Non-organic diseases such as neurosis and psychiatric illnesses; and

(b) Alcohol related brain damage.
16. Coma
A coma that persists for at least 96 hours. This Diagnosis must be supported by evidence of
all of the following:
(a) No response to external stimuli for at least 96 hours;

(b) Life support measures are necessary to sustain life; and
(c) Brain damage resulting in permanent neurological deficit which must be assessed at least
30 days after the onset of the coma.
Coma resulting directly from alcohol or drug abuse is excluded.
17. Deafness (Loss of Hearing)
Total and irreversible loss of hearing in both ears as a result of illness or accident. This
Diagnosis must be supported by audiometric and sound-threshold tests provided and certified
by an Ear, Nose, Throat (ENT) Specialist.
Total means “the loss of at least 80 decibels in all frequencies of hearing”.
18. Heart Valve Surgery
The actual undergoing of open-heart surgery to replace or repair heart valve abnormalities.
The Diagnosis of heart valve abnormality must be supported by cardiac catheterisation or
echocardiogram and the procedure must be considered Medically Necessary by a consultant
cardiologist.
19. Loss of Speech
Total and irrecoverable loss of the ability to speak as a result of injury or disease to the vocal
cords. The inability to speak must be established for a continuous period of 12 months. This
Diagnosis must be supported by medical evidence furnished by an Ear, Nose, Throat (ENT)
Specialist.
All psychiatric related causes are excluded.
20. Major Burns
Third degree (full thickness of the skin) burns covering at least 20% of the surface of the
Insured’s body.
202004
21. Surgery to Aorta
The actual undergoing of major surgery to repair or correct an aneurysm, narrowing,

obstruction or dissection of the aorta through surgical opening of the chest or abdomen. For
the purpose of this definition, aorta shall mean the thoracic and abdominal aorta but not its
branches.
Surgery performed using only minimally invasive or intra arterial techniques are excluded.
22. Terminal Illness
The conclusive Diagnosis of an illness that is expected to result in the death of the Insured
within 12 months. This Diagnosis must be supported by a Specialist and confirmed by our
appointed Physician.
Terminal illness in the presence of HIV infection is excluded.
23. End Stage Lung Disease
End stage lung disease, causing chronic respiratory failure. This Diagnosis must be
supported by evidence of all of the following:
(a) FEV1 test results which are consistently less than one (1) litre;
(b) Permanent supplementary oxygen therapy for hypoxemia;
(c) Arterial blood gas analyses with partial oxygen pressures of 55mmHg or less (PaO2 ≤
55mmHg); and
(d) Dyspnea at rest.
The Diagnosis must be confirmed by a respiratory Physician or Specialist.
24. End Stage Liver Failure
End stage liver failure as evidenced by all of the following:
(a) Permanent jaundice;

(b) Ascites; and
(c) Hepatic encephalopathy.
Liver disease secondary to alcohol or drug abuse is excluded.
25. Motor Neurone Disease
Motor neurone disease characterised by progressive degeneration of corticospinal tracts and

anterior horn cells or bulbar efferent neurones which include spinal muscular atrophy,
progressive bulbar palsy, amyotrophic lateral sclerosis and primary lateral sclerosis. This
Diagnosis must be confirmed by a neurologist as progressive and resulting in permanent
neurological deficit.
26. Parkinson’s Disease
The unequivocal Diagnosis of idiopathic parkinson’s disease by a consultant neurologist. This

Diagnosis must be supported by all of the following conditions:
(a) The disease cannot be controlled with medication;

(b) Signs of progressive impairment; and
(c) Inability of the Insured to perform (whether aided or unaided) at least three (3) of the
following six (6) “Activities of Daily Living” for a continuous period of at least six (6)
months:
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Activities of Daily Living:
Washing the ability to wash in the bath or shower (including getting into and out of the
bath or shower) or wash satisfactorily by other means;
versa;
Feeding the ability to feed oneself once food has been prepared and made available.
Drug-induced or toxic causes of parkinsonism or all other causes of parkinson’s disease are
excluded.
For the purpose of this definition, “aided” shall mean with the aid of special equipment, device
and/or apparatus and not pertaining to human aid.
27. Aplastic Anaemia
Chronic persistent bone marrow failure, confirmed by biopsy, which results in anaemia,
neutropenia and thrombocytopenia requiring treatment with at least one (1) of the following:
(a) Blood product transfusion;

(b) Marrow stimulating agents;
(c) Immunosuppressive agents; or
(d) Bone marrow transplantation.
The Diagnosis must be confirmed by a haematologist.
28. Benign Brain Tumor
Benign brain tumour means a non-malignant tumour located in the cranial vault and limited to
the brain, meninges or cranial nerves where all of the following conditions are met:
(a) It is life threatening;

(b) It has caused damage to the brain;
(c) It has undergone surgical removal or, if inoperable, has caused a permanent neurological
deficit; and
(d) Its presence must be confirmed by a neurologist or neurosurgeon and supported by
findings on magnetic resonance imaging, computerised tomography, or other reliable
imaging techniques.
(a) Cysts;
(b) Granulomas;
(c) Vascular malformations;
(d) Haematomas; and
(e) Tumours of the pituitary gland or spinal cord.
29. Bacterial Meningitis
Bacterial infection resulting in severe inflammation of the membranes of the brain or spinal
cord resulting in significant, irreversible and permanent neurological deficit. The neurological
deficit must persist for at least six (6) weeks. This Diagnosis must be confirmed by:
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(a) The presence of bacterial infection in cerebrospinal fluid by lumbar puncture; and
(b) A consultant neurologist.
Bacterial meningitis in the presence of HIV infection is excluded.
30. Viral Encephalitis
Severe inflammation of brain substance (cerebral hemisphere, brainstem or cerebellum)

caused by viral infection and resulting in permanent neurological deficit. This Diagnosis must
be certified by a consultant neurologist and the permanent neurological deficit must be
documented for at least six (6) weeks.
Encephalitis caused by HIV infection is excluded.
(N) Cell, Tissue and Gene Therapy Benefit
With effect from 1 June 2020, we shall reimburse the Eligible Expenses incurred if the Insured
requires cell, tissue and gene therapy as an inpatient, outpatient or day surgery procedure.
(O) Proton Beam Therapy Benefit
With effect from 1 June 2020, we shall reimburse the Eligible Expenses incurred if the Insured
requires proton beam therapy as an inpatient, outpatient or day surgery procedure.
202004
PRO-RATION FACTOR
For any Confinement on or after 1 June 2020, if the Insured, without obtaining a Certificate of Pre-
authorisation, incurs Eligible Expenses for non-Emergency Confinement with non-AIA Preferred
Providers, such charges will first be reduced by multiplying the original amount of such charges with
the Pro-ration Factor (as specified under the Schedule of Benefits) before the application of any
Deductible and/or Co-insurance as set out in the Schedule of Benefits.
The following non-Emergency Surgical Procedures and type of Confinement as set out in Table A
below are not subject to Pro-ration Factor:
Table A - List of Procedures / Confinement that are not subject to Pro-ration

Table of Surgical
Procedures Code / Description
Ward Type
SM700N Nose, Nasendoscopy
SA840S Skin and Subcutaneous Tissue, Hematoma, Abscess/Cellulitis/Similar lesion<3cm,
Saucerisation/lncision & Drainage
SA852S Skin and Subcutaneous Tissue, Tumor/Cyst/Ulcer/ Scar, Excision Punch/Shave biopsy,
Lesion size up to and including 15mm in diameter
SA853S Skin and Subcutaneous Tissue, Wound, Debridement <3cm
SF804T Tongue, Tongue Tie, Release
SA843S Skin and Subcutaneous Tissue, Laceration (superficial) of less than 7cm, Repair
SL846E Eyelids, Tumor, Shaving Excision
SB745J Joint, Various Lesions, Joint aspiration/arthrocentesis/injection
SA704B Breast, Lumps, Imaging Guided Vacuum assisted Biopsy / Mammotome, Single lesion
SA706B Breast, Lumps, Imaging Guided Vacuum assisted Biopsy / Mammotome, > 1 lesions
O, P Admission to short stay ward as defined in paragraph (b) of the definition of “Confined
or Confinement”
If there are multiple Surgical Procedures for a claim, the exemption from the Pro-ration Factor shall
only apply if all of such Surgical Procedures are listed in Table A above.
The list in Table A above, which may be amended from time to time, is available in our website
(www.aia.com.sg/healthshieldsupport). The revised list, will be applicable to any Surgical Procedure
or Confinement which occurred on and from the effective date of the revised list.
LIMIT PER POLICY YEAR
The Limit Per Policy Year is the maximum claimable amount that the Insured can claim in one (1)
Policy Year from under this Policy.
In the event of any benefit payment by us for a loss insured under this Policy (including any
reimbursed amount exceeding the Critical Illnesses Limit Per Policy Year which is accumulated
towards the Maximum Limit Per Policy Year (for the applicable Policy Year)), such amount paid shall
be accumulated towards the Maximum Limit Per Policy Year (for the applicable Policy Year).
The remaining balance of the Maximum Limit Per Policy Year for a particular Policy Year is computed
by deducting all accumulated benefit payments (including any reimbursed amount exceeding the
Critical Illnesses Limit Per Policy Year which is accumulated towards the Maximum Limit Per Policy
Year (for the applicable Policy Year)) in that same Policy Year from the Maximum Limit Per Policy
Year.
In the event that the Insured is admitted into a Hospital in a Policy Year and the Confinement in a
Hospital or outpatient consultations and treatments (if any) arising from the Confinement in a Hospital
extends into the following Policy Year, the Eligible Expenses payable will be subject to the Policy Year
Limit of the Policy Year in which the Confinement commenced.
202004
In the event there is no Confinement, the claim amount payable for outpatient consultations and
treatments will be determined based on the Policy Year Limit applicable on the date the medical
expenses are incurred regardless of the actual date of usage of such medical services.
Deductibles shall be applied in each Policy Year before any benefit becomes payable under this
Policy.
202004
GENERAL EXCLUSIONS
Any Pre-existing Condition from which the Insured is suffering prior to the Policy Date or
reinstatement date, whichever is later, shall not be covered unless the Insured makes a declaration in
the application for this Policy or on reinstatement and such application is specifically accepted by us.
This Policy also does not cover any claims incurred directly or indirectly as a result of any of the
following, whether or not a declaration has been submitted and accepted by us:
(a) Any medical treatment which commences before the Policy Date;
(b) Medical devices, drugs and therapeutic products not registered^ with the Health Sciences
Authority of Singapore;
^ Registered refers to health products that are currently registered under Part VII of the Health Products
Act (Chapter 122D). Information on the list of all registered products in Singapore can be found on the
website of the Health Sciences Authority of Singapore at www.hsa.gov.sg.
(c) Experimental or pioneering medical or surgical techniques, as determined by our medical

advisor;
(d) Serious Illness for which the Insured has received medical treatment and advice, including
follow-ups and consultations, during twelve (12) months prior to the Policy Date or
reinstatement date, whichever is later;
(e) Treatment for congenital abnormalities including hereditary conditions and physical defects
from childbirth (except where expressly covered by Part (F) – Congenital Abnormalities
Benefits under the Benefits Provisions of this Policy);
(f) Treatment arising from pregnancy, miscarriages, abortion, childbirth, sterilisation,

contraception (except where expressly covered by Part (E) – Pregnancy Complications
Benefit under the Benefits Provisions of this Policy);
(g) Treatment for infertility, sub-fertility, assisted conception or any contraceptive operation and
sex change operations;
(h) Any injury or illness caused directly or indirectly, by self-destruction or intentional self-inflicted
injury, abuse or misuse of drugs or alcohol, drug overdose (whether intentional, accidental or
otherwise) or injuries sustained as a direct result of a criminal act or attempted suicide,
whether the Insured is sane or insane;
(i) Treatments attributable to any sexually transmitted disease, including Acquired Immune
Deficiency Syndrome (AIDS) and AIDS-related complications (except where HIV Due to
Blood Transfusion and Occupationally Acquired HIV is expressly covered by Part (M) – Extra
Cover for 30 Critical Illnesses Benefit under the Benefits Provisions of this Policy). For the
purpose of this Policy:
(i) The definition of AIDS shall be that used by the World Health Organisation in 1987, or
any subsequent revision by the World Health Organisation of that definition;
(ii) Infection shall be deemed to have occurred where blood or other relevant tests indicate in
our opinion or in the opinion of our medical advisor either the presence of any Human
Immunodeficiency Virus or antibodies to such a virus;
(j) Treatment for mental illnesses and psychiatric disorders (except where expressly covered by
Part (I) – Psychiatric Treatment Benefits under the Benefits Provisions of this Policy);
(k) Treatment for obesity, weight reduction or weight improvement;
202004
(l) Treatment arising from injuries sustained during wars (whether war be declared or not), civil
commotion, riots, revolutions, strikes, nuclear reaction or any war-like operations;
(m) Buying or renting, for use at home or as an outpatient, of special medical appliances, braces,
prostheses, durable medical equipment or machines, corrective devices, wheelchairs, walking
aids, home aids, kidney dialysis machines, iron-lungs, oxygen machines, hospital beds or any
hospital equipment;
(n) Any form of cosmetic or plastic surgery (except if it is for the correction of a functional defect
or breast reconstruction following mastectomy);
(o) Dental treatment, (except where expressly covered by Part (D) – Accidental Inpatient Dental
Treatment Benefit under the Benefits Provisions of this Policy);
(p) Correction for refractive errors of the eye;
(q) Costs for routine eye and ear examinations, including costs of spectacles, contact lenses and
hearing aids;
(r) Rest cures, hospice care, home or outpatient nursing, convalescent care in convalescent or
nursing home, sanatoriums or similar establishments;
(s) Transport-related services including ambulance fee, emergency evacuation, repatriation

assistance and repatriation of mortal remains;
(t) Preventive, screening and health-enhancing treatments; any treatments, medical services
and / or supplies which are preventive, screening or health-enhancing in purpose, including
but not limited to genetic tests, vitamins, health supplements, dietary replacements and non-
prescribed drugs;
(u) Treatments for acne, pigmentation, keloids, skin tags, moles, alopecia, and circumcision
(except where it is Medically Necessary);
(v) Vaccination;
(w) Costs incurred from the acquisition of an organ or related parts of an organ from a living
donor for an organ transplant and expenses incurred by the living donor of such organ or
related parts (except where expressly covered by Part (G) – Living Donor Organ Transplant
Benefits under the Benefits Provisions of this Policy);
(x) Overseas (outside Singapore) medical treatment or hospitalisation (except where expressly
covered by Part (H) – Emergency Overseas (Outside Singapore) Medical Treatment Benefit
under the Benefits Provisions of this Policy);
(y) All other exclusions for MediShield Life Scheme set out in the CPF Act and its regulations,
unless otherwise provided under this Policy;
(z) Non-medical items such as, but not limited to, parking fees, Hospital administration and
registration fees and, laundry, rental of television, newspaper and, medical report fees;
(aa) Alternative or complementary treatments, including traditional chinese medicine, podiatric,

chiropractic or osteopathic treatment or a stay in any health-care establishment for social or
non-medical reasons;
(bb) Medical services, including hospital confinement, primarily for diagnosis, preventive purpose,
x-ray examinations, general physical or medical check-up;
(cc) Violation or attempted violation of law, resistance to lawful arrest or any resultant
imprisonment;
202004
(dd) Uses of therapeutic products and medical devices for indication which have not been
approved by a regulatory authority in Singapore. This exclusion shall not apply in the event
that both of the following are true:
(i) the therapeutic product or medical device has been approved by the regulatory authority
in Singapore; and
(ii) an overseas regulatory agency recognised by the Health Sciences Authority as one of its
reference drug regulatory agencies has approved the product or device for that indication;
(ee) Medical services, prescription and appliances that are not directly for the treatment of the
Illness or Injury which is the cause of the Confinement;
(ff) Surgical procedures not specified within the “Table of Surgical Procedures” (TOSP) Table 1 to
7 under the Medisave Scheme operated by the Ministry of Health of Singapore, including
procedures classified as “Minor Surgical Procedures” (MSP) in the TOSP schedule;
(gg) Confinement at Non-MediShield Life Accredited Medical Institutions (except where expressly
covered by Part (H) – Emergency Overseas (Outside Singapore) Medical Treatment Benefit
under the Benefits Provisions of this Policy);
(hh) Confinement that is not Medically Necessary; or
(ii) Medical fees or expenses which are in excess of the Reasonable and Customary charges.
202004
PREMIUM PROVISIONS
PAYMENT
All premiums are inclusive of the prevailing GST and shall be payable to us on or before the Premium
Due Date. If you meet the eligible conditions set down by CPF Board on using Medisave funds to pay
for premiums of a medical insurance plan, premiums may be deducted from your Medisave account
maintained with the CPF Board. If not, the premium due must be paid in cash, cheque or any other
payment methods as approved by us.
In the case where the premium exceeds the maximum Medisave withdrawal amount allowed for any
medical insurance plan covering the Insured where premium is paid using Medisave funds maintained
by the CPF Board, or the balance in your Medisave account is insufficient to pay in full the premium
due on the Premium Due Date, the shortfall in the premium shall be paid in cash within the Grace
Period failing which this Policy shall automatically terminate.
We shall inform you of the premiums payable under this Policy, based on such rates as may be
determined by us from time to time.
PREMIUM RATE
Premium rates payable for this Policy are not guaranteed and are expected to be adjusted from time
to time in line with our claims experience, medical inflation and general cost of treatments, supplies or
medical services in Singapore.
We have the right to change the premium rate, provided that we send you a written notification at
least 31 days in advance of such change in premium rate.
RENEWAL
Subject to the Cancellation Clause and Termination Clause set out in this Policy, your Policy is
guaranteed yearly renewable on the policy anniversary date by payment of the premiums in advance,
before the end of the Grace Period, subject to our acceptance and the following:
(a) your Policy is in-force on the date of renewal; and

(b) we receive and accept payment of your Policy’s premium in accordance with the premium rates
then applicable to the Insured’s attained age at next birthday on the date of renewal.
REINSTATEMENT
If your Policy lapses due to non-payment of premium, you may reinstate this Policy within two (2)
years from the date this Policy lapses subject to underwriting (including producing evidence of
insurability) and such other requirements we may have to our satisfaction. Additional terms, including
exclusions, may be imposed and are subject to our review at the time of reinstatement. Such
reinstatement, if approved by us, shall only cover hospitalisation, surgery and treatment occurring
after the reinstatement date.
202004
CLAIMS PROCEDURES
HOSPITALISATION
We must be notified through the submission of a completed hospitalisation (or accident) claim form
and other proof of loss documents as may be determined by us to our satisfaction. Such claim
submission must be filed with us within 60 days from the date of discharge from the Hospital or the
date of receiving treatment as an out-patient, and there must be sufficient particulars to enable us to
identify the Insured and the occurrence, nature and extent of the loss.
The occurrence of a claim must be proven to our satisfaction at your own expense, and any such
proof shall include the following:
(a) proof of treatment or surgery;

(b) the Hospital’s original and final statement of accounts, bills and receipts;
(c) a certified true copy of the Insured’s Valid Pass and travel document or passport; and
(d) such other documents as we may require.
In the event of any dispute or disagreement regarding the appropriateness or correctness of the
Diagnosis, we shall have the right to call for an examination of the Insured and the evidence used in
arriving at such opinion. An independent acknowledged medical specialist in the relevant field
concerned shall conduct this examination and we shall select this medical specialist.
TOTAL AND PERMANENT DISABILITY
We must be notified through the submission of a disability claim form and other proof of loss
documents as may be determined by us to our satisfaction. Such claim submission and proof of loss
must be filed with us within 60 days from the date the Insured satisfies the TPD definition and there
must be sufficient particulars to enable us to identify the Insured and the occurrence, nature and
extent of the loss.
The Diagnosis and occurrence of disability resulting in the Insured satisfying the TPD definition must
be proven to our satisfaction at your expense, and any such proof shall include the following:
(a) evidence provided by the appropriate Physician;

(b) appropriate medical investigations and/or reports including, but not limited to, clinical, radiological,
histological and laboratory evidence;
(c) a certified true copy of the Insured’s Valid Pass and travel document or passport; and
(d) such other documents as we may require.
Any payment or continued payment of any benefit shall always be subject to:
(a) the Diagnosis and occurrence of disability resulting in the Insured satisfying the TPD definition
being proven to our satisfaction;
(b) at our request from time to time, and at your sole cost and expense,
(i) the undertaking of any examination or re-examination of the evidence submitted under this
clause;
(ii) the undertaking of any examination or re-examination of the Insured; and/or
(iii) the provision of any further document, evidence or regular medical evidence;
(c) in the event of a dispute, the examination or re-examination of the Insured by an independent
expert as selected by us should we deem that such examination or re-examination is required.
The opinion of such expert shall be binding on you and us and the cost and fees of such
independent expert shall be borne by you. We shall have the right to examine the body of the
Insured and to require an autopsy to be conducted in the case of death.
Medical terms used, unless otherwise specified, will have the technical meaning as generally
understood and used by medical specialists in the relevant field.
202004
PAYMENT OF BENEFITS
All benefits under this Policy are payable to you (except for Part (L) – Waiver of Premium for 1 Year
Benefit (Upon Total and Permanent Disability)), your legal representative, the Hospital, the
Community Hospital or such other authorised parties (as the case may be) and such payment shall be
a valid discharge of our liability under this Policy.
202004
DEFINITIONS
In your Policy, the following definitions shall apply (where applicable):
Accident refers to an unforeseen and involuntary event.
AIA Preferred Providers refer to all Government / Restructured Hospitals and to medical service
providers in Singapore listed in our website, such list as approved and may be amended by us at our
discretion from time to time.
Approved Medical Consumables refer to:

(a) Intravascular electrodes used for electrophysiological procedures.
(b) Percutaneous Transluminal Coronary Angioplasty (PTCA) balloons.
(c) Intra-aortic balloons (or balloon catheters).
Certificate of Pre-authorisation refers to a certificate issued in writing by us to pre-authorise a claim

on Eligible Expenses to be incurred for a planned Confinement. The Certificate of Pre-authorisation
must be obtained by you prior to the commencement of that planned Confinement. The Certificate of
Pre-authorisation may be issued subject to such conditions decided by us in our sole discretion.
Co-insurance refers to the amount you need to co-pay on the Eligible Expenses which is a fixed
percentage (as specified in the Schedule of Benefits) of the Eligible Expenses in excess of the
Deductible (if any).
Community Hospital refers to a community hospital approved by the Ministry of Health of Singapore
to provide an intermediate level of care for individuals who have simple ailments and do not require
Specialist medical treatment and nursing care. For the avoidance of doubt, hospices, convalescent
centres, Hospitals and homes are not Community Hospitals.
Confined or Confinement refers to:

(a) any period of hospitalisation in a Hospital for which a daily room and board charge is incurred for
medical treatment as an inpatient;
(b) admission into a short stay ward for medical treatment, examination or observation at the
Accident and Emergency Department in a Hospital (for a period of not less than six (6) hours); or
(c) admission of any duration in a Hospital or medical institution which is lawfully operated in
Singapore, approved under the MediShield Life Scheme and accredited by the Ministry of Health
of Singapore, for the purpose of a Surgical Procedure.
CPF refers to the Central Provident Fund established under the Central Provident Fund Act (Cap. 36).
Deductible refers to the deductible amount as specified in the Schedule of Benefits, which is the total
amount of Eligible Expenses incurred per Policy Year which is borne by you before any benefit
becomes payable under this Policy. Part (J) – Outpatient Benefit and Part (K) – Final Expense Benefit
are not subject to a Deductible.
Diagnosed or Diagnosis refers to a definitive conclusion made by a Physician or Specialist based

upon such specific evidence as referred to in this Policy in the definition of the particular condition, or,
in the absence of such specific evidence, based upon radiological, clinical, histological, or laboratory
evidence acceptable by us. Such Diagnosis must be supported by our medical advisor who may base
his/her opinion on the medical evidence submitted by you, the Insured, and/or any additional evidence
that he/she may require.
DP refers to plan type which covers an Insured who is a Foreigner and dependant of a Singapore
Citizen or Singapore Permanent Resident.
Eligible Expenses refer to the expenses incurred for medical or surgical treatment under the Benefits
Provisions of this Policy during the period the Policy is in-force.
202004
Emergency refers to a sudden or unexpected occurrence of a serious medical condition or Injury,

which in our opinion or in the opinion of our medical advisor requires urgent remedial treatment to
avoid death or serious impairment to the Insured’s immediate or long-term health. For this purpose,
we shall reserve the absolute right to determine if such sudden or unexpected occurrence of a serious
medical condition or Injury is deemed as an Emergency.
Family Members refer to your or the Insured’s lawful spouse, father, mother, brother, sister and/or
legal children.
Foreigner refers to a person who is not a Singapore Citizen or Singapore Permanent Resident.
Government / Restructured Hospital refers to the Singapore government hospitals and Singapore
government medical institutions which are approved by the Ministry of Health of Singapore under the
MediShield Life Scheme.
Grace Period refers to the extra 60 days that we give you from the Premium Due Date, for you to pay
your premiums.
GST refers to the goods and services tax according to the GST Act (Cap. 117).
HOTA refers to the Human Organ Transplant Act (Chapter 131A), as amended, extended or re-
enacted from time to time.
Hospital refers to a lawfully operated institution in Singapore registered as a hospital and accredited
by the Ministry of Health of Singapore, under the MediShield Life Scheme, for the care and treatment
of injured or ill persons and which provides facilities for diagnosis, major surgery and full-time nursing
service, including Government/Restructured Hospitals and is not primarily a rest or convalescent
home, Community Hospital or similar establishment or, other than incidentally, a place for alcoholics
or drug addicts. Our medical advisor must recognise a facility outside Singapore as being equivalent
in status.
Illness refers to a physical condition marked by a pathological deviation from the normal healthy
state.
Injury refers to bodily injury effected directly and independently of all other causes by Accident.
Insured refers to the person as named in the Policy Schedule of your Policy.
Intensive Care Unit or ICU refers to a section within a Hospital which is designated as an intensive
care unit by such Hospital and which is operating on a 24-hour basis solely for treatment of patients in
critical medical condition and which is equipped to provide special nursing and medical services not
available elsewhere in such Hospital. For purpose of this definition, Intensive Care Unit or ICU shall
also refer to a Coronary Care Unit, Cardiac Care Unit or Critical Care Unit in a Hospital.
Issue Date refers to the date when the Policy was issued to you and is shown on your Policy
Schedule or endorsement.
Limits of Compensation refers to the limits of compensation stated in the Schedule of Benefits for
which each respective benefit is subject to in accordance to the plan type and Hospital ward
entitlement.
Limit Per Lifetime refers to the maximum total amount of all reimbursements that we shall make for
the Eligible Expenses which are accumulated towards the Critical Illnesses Limit Per Lifetime under
Part (M) – Extra Cover for 30 Critical Illnesses Benefit and the Maximum Limit Per Lifetime under the
Maximum Claim Limit during the Insured’s lifetime and which are the limits stated in the Schedule of
Benefits.
202004
Limit Per Policy Year refers to the maximum reimbursement that we shall make for the Eligible
Expenses which are accumulated towards the Critical Illnesses Limit Per Policy Year under Part (M) –
Extra Cover for 30 Critical Illnesses Benefit and the Maximum Limit Per Policy Year under the
Maximum Claim Limit in any one Policy Year and which are the limits stated in the Schedule of
Benefits. Eligible Expenses which are incurred in the current Policy Year where the payout is made in
the subsequent Policy Year shall be accumulated under the current Policy Year’s limit. Such payouts
shall not be accumulated towards the Policy Year limit in the subsequent Policy Year.
Medically Necessary refers to a medical service treatment, service and/or supply which is:
(a) consistent with the Diagnosis and customary medical treatment, service and/or supply for an
Illness or Injury;
(b) in accordance with standards of good medical practice, consistent with current standard of
professional medical care, and proven medical benefits;
(c) not for the convenience of the Insured or the Physician or Specialist, and unable to be reasonably
rendered out of a Hospital, an Outpatient Centre or a Community Hospital;
(d) not of an experimental, investigational or research nature, preventive or screening nature; and
(e) unable to be omitted without negatively affecting the medical condition which the Insured is
Diagnosed for.
MediShield Life Scheme refers to the scheme administered by the CPF Board, and is governed by
the MediShield Life Scheme Act 2015 as amended from time to time.
NDP refers to plan type which covers an Insured who is a Foreigner and not a dependant of a
Singapore Citizen or Singapore Permanent Resident.
Non-Participating refers to a policy that does not share in the divisible surplus of our participating life
fund.
Outpatient Centre refers to a Medisave / MediShield accredited centre for treatments covered under
Part (J) – Outpatient Benefit.
Physician refers to any person qualified as a medical practitioner by a medical degree in western
medicine and who is legally registered with, authorised and/or licensed by the relevant authority in the
geographical area of his practice to render medical or surgical treatment and who in rendering
treatment is practicing within the scope of his licensing and training in the geographical area of
practice, but excluding you, the Insured and respective spouses and Family Members of such
persons.
Policy consists of:

(a) this Policy;
(b) the Policy Schedule;
(c) the application; and
(d) the endorsements (if any).
Policy Date refers to the date shown on your Policy Schedule for your Policy and is the date from
which policy anniversary, policy years and months and Premium Due Dates are determined and is the
date from which your insurance coverage starts.
Policy Schedule refers to the schedule that is issued with your Policy that includes the plan name,
product and/or code names of your Policy. This includes renewal certificate or endorsement.
Policy Year refers to 12 months starting from the Policy Date of this Policy and in the case of Policy
renewal, each consecutive 12 months period following the renewal date of this Policy.
Pre-existing Condition refers to any physical condition, impairment or the existence of any illness or
disease that was diagnosed, treated, or for which a Physician or Specialist was consulted at any time
prior to the Policy Date or last reinstatement date of this Policy (if any), whichever is later. For this
purpose, an illness or disease has occurred when it has been investigated, diagnosed or treated or
202004
when its signs or symptoms have manifested which would cause an ordinary prudent person to seek
Diagnosis, care or treatment.
Premium Due Date refers to the date when your premium payment is due.
Psychiatrist refers to any person qualified as a medical practitioner by a medical degree in

psychiatric treatment who is legally registered with, authorised and/or licensed by the relevant
authority in the geographical area of his practice to render psychiatric treatment, and who in rendering
treatment is practicing within the scope of his licensing and training, but excluding you, the Insured
and respective spouses and Family Members of such persons.
Reasonable and Customary refers to any fee or expense which is charged for treatment, supplies or
medical service that is Medically Necessary to treat the condition and which is in accordance with the
standards of good medical practice for the care of an injured or ill person under the supervision or
order of a Physician or Specialist and which does not in our opinion or in the opinion of our medical
advisor:
(a) exceed the usual level of charges for similar treatment, supplies or medical services in Singapore;
(b) include fees or charges that would not have been made if no insurance had existed;
(c) exceed the upper bound of the fee benchmarks recommended by the Singapore government, the
Ministry of Health of Singapore or official bodies such as the Health Sciences Authority and the
Allied Health Professions Council, including the Ministry of Health of Singapore Fee Benchmarks
for Private Sector Surgeon Fees; or
(d) exceed our internal benchmarks for episodes of care with similar diagnoses or procedures
performed.
Serious Illness refers to any of the following Illness:

(a) Blood disorder
(b) Cancer
(c) Cerebrovascular accidents (stroke)
(d) Chronic liver cirrhosis
(e) Chronic obstructive lung disease
(f) Chronic renal disease, including renal failure
(g) Coronary artery disease
(h) Degenerative disease
(i) Ischaemic heart disease
(j) Rheumatic heart disease
(k) Systemic lupus erythematosus
(l) Any Illness, disorder or condition which is life threatening or terminal.
Specialist refers to a qualified and licensed Physician, possessing the necessary additional
qualifications and expertise to practice as a recognised specialist of diagnostic techniques, treatment
and prevention by the Ministry of Health of Singapore, but excluding you, the Insured and respective
spouses and Family Members of such persons.
Standard Room refers to a room equipped with a minimum standard, like the following:
(a) suitable bed, mattress, pillow, a chair and locker facility;
(b) bed screening facilities;
(c) adequate lighting and ventilation;
(d) an effective nurse-to-patient call bell system; and
(e) adequate toilet facilities / wash basin.
It shall exclude deluxe rooms, luxury suites, superior room, super rooms and other special rooms that
may also be available at the Hospital (or at a Community Hospital, with regards to Part A (iii) –
Community Hospital Benefit).
For a single room in a Private Hospital, we shall only pay the room and board rates up to the rates
charged for a standard single room.
202004
Surgical Procedures refer to the types of surgical operations listed in the "Table of Surgical
Procedures" under the Medisave Scheme operated by the Ministry of Health of Singapore (Table 1 to
Table 7) excluding (a) all surgical operations stated in the General Exclusions and (b) any other
surgical operations that are not specified in the said "Table of Surgical Procedures".
Valid Pass refers to a valid pass issued and recognised by the Immigration and Checkpoint Authority
or the Ministry of Manpower of Singapore and deemed acceptable by us.
We, us or our refers to the AIA Singapore Private Limited (Reg. No. 201106386R) (“AIA Singapore”).
You or your refers to the Policy Owner as shown in the Policy Schedule of your Policy.
Wherever the context requires, masculine form shall apply to the feminine and singular term shall
include the plural and vice versa.
202004
SCHEDULE OF BENEFITS
Limits of Compensation
(figures are in Singapore Dollars and inclusive of GST)
Plan Type AIA HealthShield Gold Max A
Hospital Ward Entitlement Standard Room in Private Hospital and below
(A) Hospitalisation and Surgical Benefits

(i) Daily Room and Board Benefit1 As Charged
(ii) Daily ICU Benefit1 As Charged
(iii) Community Hospital Benefit As Charged
(iv) Surgical Benefit
(including Organ Transplant
Benefit and Stem Cell Transplant As Charged
Benefit)
x Surgical Procedures2
x Surgical Implants and
Approved Medical As Charged
Consumables
x Stereotactic Radiosurgery3 As Charged
As Charged
(B) Pre-Hospitalisation Benefit Within 100 days before Confinement
If admitted to / treated by AIA Preferred Providers4,5:

Within 13 months before Confinement
(C) Post-Hospitalisation Benefits
As Charged
Within 100 days after Confinement

(i) Post-Hospitalisation Treatment
if admitted to / treated by AIA Preferred Providers 4,5:
Within 13 months after Confinement
(ii)
Extended Post-Hospitalisation
Treatment for 30 Critical Illnesses
As Charged6
(within 100 days following expiry
of Post-Hospitalisation Treatment)
(D) Accidental Inpatient Dental Subject to the respective Limits of Compensation applicable to Benefits under
Treatment Benefit Parts (A), (B) and (C)
(E) Pregnancy Complications

As Charged
Benefit
(F) Congenital Abnormalities
Benefits
(i) Congenital Abnormalities of 20,000 per lifetime
Insured’s Biological Child from Limited to 5,000 per child
Birth (for female Insured)7
(ii) Congenital Abnormalities of Subject to the respective Limits of Compensation applicable to Benefits under
Insured Parts (A), (B) and (C)
(G) Living Donor Organ Transplant

Benefits
(i) Insured (as the Living Donor) 60,000 per organ transplant
Donating an Organ7
(ii) Non-insured (as the Living Donor) 60,000 per organ transplant
Donating an Organ to the
Insured7
(H) Emergency Overseas (Outside Subject to the respective Limits of Compensation applicable to Benefits under
Singapore) Medical Treatment Parts (A) and (C)
Benefits8
202004

(I) Psychiatric Treatment Benefits
(i) In-Hospital Psychiatric

Treatment1,7 5,000 per Policy Year
(ii) Post-Hospitalisation Psychiatric
Treatment
5,000 per Policy Year
(within 200 days after
Confinement)7
(J) Outpatient Benefit9
x Radiotherapy for cancer As Charged
x Stereotactic Radiotherapy for
As Charged
cancer
x Chemotherapy for cancer As Charged
x Immunotherapy for cancer As Charged
x Renal Dialysis As Charged
x Erythropoietin As Charged
x Approved
Immunosuppressant
As Charged
prescribed for Organ
Transplant10
x Long-Term Parenteral
As Charged
Nutrition
(K) Final Expense Benefit9 5,000 per Policy
(L) Waiver of Premium for 1 Year
Benefit (Upon Total and Waiver of one year premium
Permanent Disability)9
(M) Extra Cover for 30 Critical
Illnesses Benefit11
x Critical Illnesses Limit Per
100,000
Policy Year
x Critical Illnesses Limit Per
Unlimited
Lifetime
Cell, Tissue and Gene Therapy
(N) 70,000 per Policy Year
Benefit ^
(O) Proton Beam Therapy Benefit ^ 70,000 per Policy Year
Maximum Claim Limit
x Maximum Limit Per 1,000,000
Policy Year
If admitted to / treated by AIA Preferred Providers 5,12:
2,000,000
x Maximum Limit Per
Unlimited
Lifetime
For non-Emergency Confinement by / to non-AIA Preferred Providers and
without Certificate of Pre-authorisation13:
85%
Pro-ration Factor
Other than the above14:
100%
Deductible (per Policy Year)
x Below age 82 next birthday
Inpatient
C Class Ward 1,500
B2 Class Ward 2,000
B1 Class Ward 2,500
A Class Ward 3,500
Private Hospital (All ward 3,500
202004

types except day surgery
and short stay ward)
Day Surgery/Short Stay Ward 2,000
x Ages 82 next birthday and
above
Inpatient
C Class Ward 1,500
B2 Class Ward 2,250
B1 Class Ward 3,000
A Class Ward 4,500
Private Hospital (All ward
types except day surgery 4,500
and short stay ward)
Day Surgery/Short Stay Ward 3,000
Co-insurance 10%
Maximum Coverage Period Lifetime
^ Applicable from 1 June 2020.

1
Inclusive of meals, prescriptions, professional charges, investigations and other miscellaneous medical charges.
2 Surgical Procedures refer to the types of surgical operations listed in the "Table of Surgical Procedures" under the
Medisave Scheme operated by the Ministry of Health of Singapore excluding (a) all surgical operations stated in the
General Exclusions and (b) any other surgical operations that are not specified in the said "Table of Surgical
Procedures". The costs of any surgical implants, Approved Medical Consumables and/or stereotactic radiosurgery
procedure are not included in this portion of the benefit.
3
Stereotactic radiosurgery means the gamma knife treatment or the novalis shaped beam treatment of neurosurgical
or neurological disorders.
4
To be eligible for the 13 months cover for Pre-Hospitalisation Benefit and Post-Hospitalisation Benefit (Post-
Hospitalisation Treatment), the Confinement following the pre-hospitalisation treatment and the Confinement prior to
the post-hospitalisation treatment respectively must be administered by AIA Preferred Providers.
5
In the event where there are more than one (1) treating Physicians or Specialists for the same Confinement and/or
Surgical Procedures, the main treating Physician or Specialist must be an AIA Preferred Provider.
6 The Extended Post-Hospitalisation Treatment for 30 Critical Illnesses shall not apply and shall not be payable if the
Post-Hospitalisation Treatment has been claimed for a period of 200 or more days following the day such
Confinement ends.
7 The maximum amount reimbursed under the following benefits shall be equal to the amount stated under the Limits
of Compensation:
(a) Part (F)(i) – Congenital Abnormalities of Insured’s Biological Child from Birth (for female Insured) under
Congenital Abnormalities Benefits
(b) Part (G)(i) – Insured (as the Living Donor) Donating an Organ under Living Donor Organ Transplant Benefits
(c) Part (G((ii) – Non-insured (as the Living Donor) Donating an Organ to the Insured under Living Donor Organ
Transplant Benefits
(d) Part (I)(i) - In-Hospital Psychiatric Treatment under Psychiatric Treatment Benefits
(e) Part (I)(ii) – Post-Hospitalisation Psychiatric Treatment under Psychiatric Treatment Benefits
8 The Deductible applied to Eligible Expenses incurred under the Emergency Overseas (Outside Singapore) Medical
Treatment Benefits shall be equivalent to that of an A Class Ward/Private Hospital in Singapore. Benefit payable
under the Emergency Overseas (Outside Singapore) Medical Treatment Benefits shall be limited to the level of
Reasonable and Customary charges in a Singapore Private Hospital.
9
Eligible Expenses incurred under the Outpatient Benefit are not subject to the Deductible but are subject to Co-
insurance. The Final Expense Benefit and Waiver of Premium for 1 Year Benefit (upon TPD) are not subject to
either the Deductible or Co-insurance.
10
In the event of an organ transplant surgery, we shall reimburse the charges for any of the immunosuppressants
approved by Health Sciences Authority for organ transplant.
202004
11
The Limit Per Policy Year under the Extra Cover for 30 Critical Illnesses Benefit shall be provided as additional limits
above the Limit Per Policy Year under the Maximum Claim Limit. This Extra Cover for 30 Critical Illnesses Benefit
shall not be provided as an additional limit above the Maximum Limit Per Policy Year of $2,000,000 under the
Maximum Claim Limit.
12
To be eligible for the S$2,000,000 Maximum Limit Per Policy Year, all Confinement and treatments under Part (J) –
Outpatient Benefit for the same Policy Year must be administered by AIA Preferred Providers.
13 The Pro-ration Factor shall only apply for such Confinement on or after 1 June 2020. Prior to 1 June 2020, such Pro-
ration Factor shall be 100%.
14 This includes the non-Emergency Surgical Procedures and type of Confinement as listed in Table A – List of
Surgical Procedures / Confinement that are not subject to Pro-ration Factor in the Pro-ration Factor clause.
202004
APPENDIX A
The list of clinical situation(s) referred to under the Benefit Provisions of this Policy is / are:
x Ptosis surgery
The details on the additional criteria, which may be amended from time to time, for the above clinical
situations are available in our website (www.aia.com.sg/healthshieldsupport).
202004
APPENDIX B
The list of high-cost technologies referred to under the Benefit Provisions of this Policy are:
x Proton beam therapy
x CAR T-cell therapy
202004
This page is intentionally left blank
AIA Singapore Private Limited
(Reg. No. 201106386R)
1 Robinson Road, AIA Tower, Singapore 048542
Monday - Friday 8.45am - 5.30pm
AIA Customer Care Hotline: 1800 248 8000
aia.com.sg
HSG0003 (04/2019 11/2019 04/2020)

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Your Policy Contract

AIA HealthShield Gold Max

General Provisions .................................................................................................................................. 2

RIGHTS OF THIRD PARTIES

This Policy shall be Non-Participating.

Your Policy is treated as void:

CHANGE OF POLICY TERMS AND CONDITIONS

CHANGE OF CITIZENSHIP/ RESIDENCY/ VALID PASS STATUS

LIMITS ON ELIGIBLE EXPENSES

Eligible Expenses are:

For such purposes, we reserve the right to:

(A) Hospitalisation and Surgical Benefits

(i) Daily Room and Board Benefit

(ii) Daily Intensive Care Unit (ICU) Benefit

(iii) Community Hospital Benefit

(a) Confinement in a Hospital; or

and is referred by a Physician or Specialist of the Hospital or recommended by the

(iv) Surgical Benefit

(v) Organ Transplant Benefit

(vi) Stem Cell Transplant Benefit

(B) Pre-Hospitalisation Benefit

(C) Post-Hospitalisation Benefits

(i) Post-Hospitalisation Treatment

We shall reimburse the Eligible Expenses incurred for any post-hospitalisation

(ii) Extended Post-Hospitalisation Treatment for 30 Critical Illnesses

Such extended post-hospitalisation treatments and tests must be upon written

(D) Accidental Inpatient Dental Treatment Benefit

(E) Pregnancy Complications Benefit

(a) Ectopic pregnancy – Diagnosis by an obstetrician of a condition in which implantation of a

(c) Disseminated intravascular coagulation – Diagnosis of disseminated intravascular

(w) Obstetric injury or damage to pelvic organs - Diagnosis by an obstetrician of injuries to

(F) Congenital Abnormalities Benefits

(i) Congenital Abnormalities of Insured’s Biological Child from Birth

This benefit applies only if the Insured is a female.

(ii) Congenital Abnormalities of Insured

We shall reimburse the Eligible Expenses incurred by the Insured if he is required to

(G) Living Donor Organ Transplant Benefits

(i) Insured (as the Living Donor) Donating an Organ

Any counselling provided by medical social workers to the Insured’s family in

(H) Emergency Overseas (Outside Singapore) Medical Treatment Benefit

(I) Psychiatric Treatment Benefits

(i) In-Hospital Psychiatric Treatment

(ii) Post-Hospitalisation Psychiatric Treatment

If the Insured requires Confinement in a Hospital for psychiatric treatment, we shall

necessitates the Confinement for which In-Hospital Psychiatric Treatment is payable

(J) Outpatient Benefit

(a) radiotherapy for cancer;

In relation to immunosuppressant drugs, we shall not reimburse the immunosuppressant

(K) Final Expense Benefit

(a) during Confinement in a Hospital; or

(a) total and irrecoverable loss of sight of both eyes; or

(a) reaches the age of 16 and he becomes gainfully employed or self-employed; or

For purpose of this benefit, “Activities of Daily Living” are:

(M) Extra Cover for 30 Critical Illnesses Benefit

List of 30 Critical Illnesses:

1. Heart Attack of Specified Severity

Definitions of 30 Critical Illnesses

1. Heart Attack of Specified Severity

(a) History of typical chest pain;

For the above definition, the following are excluded: