How does pro-ration work in this case?

[martin]

Let say i have a private hospital bill of $20k. My company AIA plan covers me for up to A class in govt hospital but pro-ration of 65% for private hospital subject to co-payment of 10%. My personal enhanced incomeshield A also similar with 65% pro-ration and 10% co-payment and deductible $3500.

To file with Income first or AIA? If i take up plus rider with income, would the order still the same? Thanks.

 

[elnewbie]

All shield plans work on the basis of last payor status, so whatever your company plan doesn't pay, will then be considered for payment by your private shield plan.

 

[martin]

I mean i can choose which insurer to file my claims first, then any difference which i file first would be better? Also withboth pro-rationing at 65%, does it mean my portion is almost reduced to near zero?

 

[elnewbie]

You cannot choose.

If you tell the hospital that u have both AIA and incomeshield, hospital will claim from AIA first, then claim the rest from Incomeshield. If your AIA policy pays 100%, then no claim will be filed against Incomeshield.

I mean i can choose which insurer to file my claims first, then any difference which i file first would be better? Also withboth pro-rationing at 65%, does it mean my portion is almost reduced to near zero?

 

[wooty100]

Shields are last payor status. Shield Insurers will probably issue u a letter to you during claim process to fill up details of your other plans. Just submit accordingly.

 

[martin]

How about the math part. AIA pays 65%, ie, $13,000 but less 10% copayment. So when it reaches Income, they will look at my portion of $7000+ 10% of $13,000 total $8300? They minus $3500 deductible from here? Means $4800 then prorate 65% to $3120 and less 10% copayment. Means Income only pays $2808. Total i stillneed to pay $5492 of the whole bill?

Is myunderstanding correct?. Anyone can enlighten?

 

[martin]

Anyone can help clarify if my understanding of the computation above is correct? Much appreciate.

 

[Bigoya]

Let say i have a private hospital bill of $20k. My company AIA plan covers me for up to A class in govt hospital but pro-ration of 65% for private hospital subject to co-payment of 10%. My personal enhanced incomeshield A also similar with 65% pro-ration and 10% co-payment and deductible $3500.

To file with Income first or AIA? If i take up plus rider with income, would the order still the same? Thanks.

I doubt your company has AIA shield plan for you. It is another hospital plan that works similarly which has different claims limit and coverage from the shield plan, these are group insurance.

When u are hospitalized, always inform the hospital that you have ur personal incomshield A as the LOG of up to $10k can waive off the upfront cash deposit for you. Let NTUC settle with your company to see how much they can claim back from AIA.
Doing the reverse would mean more work on your side. Also, usually claiming from yiur company tend have a longer processing time.


For your pte hosp bill of $20k, pro-rated 65% will be covered. You need to pay $7k from your own pocket plus $3500 deductible.

($20k - $7k - $3.5k) x 0.1 = $950 (co-insurance)
NTUC pays $8,550. The rest you pay.

 

[Bigoya]

How about the math part. AIA pays 65%, ie, $13,000 but less 10% copayment. So when it reaches Income, they will look at my portion of $7000+ 10% of $13,000 total $8300? They minus $3500 deductible from here? Means $4800 then prorate 65% to $3120 and less 10% copayment. Means Income only pays $2808. Total i stillneed to pay $5492 of the whole bill?

Is myunderstanding correct?. Anyone can enlighten?

It seems ur company's plan do not have deductible, in that sense it might be better to claim from AIA 1st.

$20k bill - $7k - $1.3k = $11.7k (AIA pay)
You pay $8.3k

Since AIA have paid the clamable portion, NTUC don't need to pay anymore. It will not cover the bill of your remaining potion not covered by AIA.

 

[martin]

Thanks again, Bigoya. You have been a great help. You just cleared a big misunderstanding on my part. I always thought after one insurer take care of 65%, the remainder goes to the other insurer for them to pay 65% of this remainder. What you mean is that together they will only cover 65%, the remaining 35% i will definitely have to bear plus whatever deductible and co-payment.

 

[Bigoya]

Thanks again, Bigoya. You have been a great help. You just cleared a big misunderstanding on my part. I always thought after one insurer take care of 65%, the remainder goes to the other insurer for them to pay 65% of this remainder. What you mean is that together they will only cover 65%, the remaining 35% i will definitely have to bear plus whatever deductible and co-payment.

No problem Martin, it's always been a pleasure to help.

 

[dendii]

Do a efiling at the hospital for your Shield plan first. Efiling can only be done for the Shield plans so this will save you all sorts of trouble + admin work from the hospital.

There can be administrative fee charged on the hospital part which is not covered by your Shield plan.

Let your Shield plan provider claim from your Company insurance provider.

I mean i can choose which insurer to file my claims first, then any difference which i file first would be better? Also withboth pro-rationing at 65%, does it mean my portion is almost reduced to near zero?