Cognizant Senior Director & Above

Transcription

1 Cognizant Senior Director & Above 1 st November st October 2017

2 The plan covers recognised costs of services or treatment which are recommended by a medical practitioner, and are medically necessary for the care and treatment of an injury or sickness, as determined by Cigna s medical team, up to limits shown in the list of benefits. For the purposes of this policy, medically necessary is defined as: Medical necessity/medically necessary - medically necessary covered services and supplies are those determined by the medical team to be: required to diagnose or treat an illness, injury, disease or its symptoms; orthodox, and in accordance with generally accepted standards of medical practice; clinically appropriate in terms of type, frequency, extent, site and duration; not primarily for the convenience of the patient, physician or other health care provider; and rendered in the least intensive setting that is appropriate for the delivery of the services and supplies. Where applicable, the medical team may compare the cost-effectiveness of alternative services, settings or supplies when determining least intensive setting. Area of cover - Worldwide excluding US Plan Annual Maximum The total benefit payable in any one year of, per employee or dependant for all in-patient, out-patient, international emergency services and where selected, maternity and adult wellness benefits. In-Patient/Day Case Healthcare Benefits Up to US$2,500,000 per year of Hospital Charges for: Nursing and accommodation for in-patient treatment; Day case treatment; Operating theatre and recovery room; Prescribed medicines, drugs and dressings for in-patient or day case patient. Parental Accommodation This applies to dependent children under the age of 18. Cigna will pay reasonable costs for a parent staying in the same hospital with the child for up to 30 days in any one year of. Surgeons and Anaesthetists Fee Specialist Physician s Fees This benefit is paid in full for regular visits by a specialist physician during stays in hospital including intensive care by a specialist physician for as long as is required by medical necessity. Surgical Procedures Private Room

3 Radiotherapy, Chemotherapy and Oncology Radiology and Pathology Physiotherapy Where required due to medical necessity. Home Nursing Charges: This benefit will be paid: If recommended by a specialist immediately after hospital treatment for as long as is required by medical necessity; On a full time basis for as long as is required by medical necessity for treatment which would normally be provided in hospital. Surgical Appliance and/or Medical Appliance This benefit will be paid in respect of: An artificial limb, prosthesis or device which is inserted during surgery; An artificial prosthesis or device which is a necessary part of the treatment immediately following surgery for as long as is required by medical necessity; A prosthesis or appliance which is medically necessary and is part of the recuperation process on a short-term basis. Organ Transplant This benefit requires pre-approval. HIV/AIDS Treatment or tests in connection with Human Immunodeficiency Virus (HIV) related illness including Acquired Immune Deficiency Syndrome (AIDS). Psychiatric and Psychological Care This benefit will be paid in respect of psychiatric conditions, other mental health disorders or addictive conditions for a maximum of 180 days in any one year of. Private Ambulance This benefit is payable for transport to or from a hospital when ordered for medical reasons. International Emergency Services Emergency Medical Evacuation Medical Repatriation Repatriation of Mortal Remains This benefit requires pre-approval. Note: Cigna will consider charges made for or in connection with approved organ transplant services, including immunosuppressive medications, organ procurement costs, and donor s medical costs. The amount payable for donor s medical costs is reduced by the amount payable for those costs from any other plan or source. Certain transplants will not be covered based on general limitations (i.e. experimental procedures). The employee/dependant must contact Cigna before incurring costs relating to organ donation.

4 Out-Patient Healthcare Benefits Out-Patient Annual Maximum The total benefit payable in any one year of, per employee or dependant for all out-patient benefits. Consultations with Medical Practitioners and Specialists Physiotherapy Where required due to medical necessity. Alternative Therapies This benefit relates only to: acupuncture, chiropody, homeopathy, ayurvedic treatment and appropriate treatment received from a registered Chinese Medicine Practitioner, where required due to medical necessity and considered a reasonable alternative for the condition being treated. There must be sufficient medical evidence the given treatment is proven to alleviate symptoms, and the treatment must be orthodox and adhere to the commonly accepted traditional practice of medicine. Chiropractic and Osteopathy Services Cancer Treatment This benefit includes: oncology, chemotherapy and radiotherapy and other outpatient treatment and prescribed drugs directly associated with a cancer condition. (Costs for this benefit will not count towards the Out-patient Annual Maximum limit, if one is applicable.) HIV/AIDS Treatment or tests in connection with Human Immunodeficiency Virus (HIV) related illness including Acquired Immune Deficiency Syndrome (AIDS). Hormone Replacement Therapy Non-Surgical and Minor Surgical Procedures and Treatment Prescribed Medicines, Drugs and Dressings Adult Travel Vaccinations This benefit will be payable for vaccinations related to travel. Emergency Dental Treatment This benefit will be payable for treatment received during the emergency visit within 24 hours after accidental damage to natural teeth. Dental emergency is defined in the note below.* Psychiatric and Psychological Care Well Child Tests For the purpose of preventive care, up to a maximum of 13 visits per dependent child under the age of 6, with annual immunisations payable for dependent children under the age of 18. Child Annual Eye and Hearing Tests One eye test and one hearing test for children under the age of 15. Up to US$9,000 per year of Up to US$1,000 per year of Up to US$1,500per year of Note: *Dental emergency - where severe pain that is not relieved by painkillers, or facial swelling or uncontrollable bleeding after an extraction, is being suffered and it is either outside the business hours of the member or dependant s usual dentist or the member or dependant is staying at a place which is away from the dental practice they usually visit. The treatment covered in such an instance is to purely stabilise the problem and relieve severe pain.

5 Maternity Benefits Routine In-Patient This benefit is payable to eligible females covered under this plan Routine Out-Patient This benefit is payable to eligible females covered under this plan. Complicated In-Patient This benefit is payable to eligible females covered under this plan, and includes elective and non-elective Caesarean sections. Complicated Out-Patient This benefit is payable to eligible females covered under this plan. US$9,000 per year of Unlimited per year of Flexible Benefits Flexible benefits: This benefit covers Gym membership, Spas, Supplements, All sports coaching, Baby Gym, Booking of sports facilities such as tennis court, Group classes such as swimming class, Durable Medical Equipment, Prosthetic and Orthotic Supplies (DMEPOS), Health Screening or Preventive Health Exams, Vision Care, Fitbit, Apple Watch, and Autism related expenses. up to a combined limit of US$725 per year of

6 Exclusions Cigna will not pay benefit for the following treatments and extras: a b c d e f g h i j k l m n o p q r s t u v Treatment that arises from or is in any way connected with attempted suicide or any injury or illness that you inflict upon yourself which exceeds an upper lifetime limit of US$150,000 per patient. Treatment for or in connection with speech therapy that is not restorative in nature, or if such therapy is (a) used to improve speech skills that have not fully developed; (b) can be considered custodial or educational; or (c) is intended to maintain speech communication. Dental or orthodontic treatment unless benefit is specifically provided in the list of benefits. Private prescriptions or dressings for use as an out-patient unless the out-patient list of benefits has been chosen. Charges for out-patient treatment, except charges for cancer treatment, unless the out-patient list of benefits has been chosen. Nutritional and dietary supplements including, but not limited to, vitamins (except for prenatal vitamins if maternity cover is elected), minerals, herbs, meal supplements, sports nutrition products, natural food supplements, and other related products used to boost the nutritional content of the diet. This exclusion does not apply to Flexible Benefits; Out-patient psychiatric and psychological care, unless benefit is specifically provided in the list of benefits. Treatment in nature cure clinics, health spas and nursing homes. This exclusion does not apply to Flexible Benefits; Charges for residential stays in a hospital which are arranged wholly or partly for domestic reasons or where treatment is not required or where the hospital has effectively become the place of domicile or permanent abode. Charges for hospital accommodation which are greater than those of a standard private room at the same hospital. Deluxe, executive rooms or VIP suites are not covered. Pregnancy or childbirth, including any complications, unless benefit is specifically provided in the list of benefits. Treatment needed because of or relating to male or female birth control, except for treatment received in Singapore within the agreed Parkway Health provider network. Treatment needed because of or relating to infertility or any type of fertility treatment, including complications arising out of such treatment, with the exception of the investigation of infertility to the point of diagnosis. Treatment by way of the intentional termination of pregnancy, unless two medical practitioners certify in writing that the pregnancy were to endanger the life or mental stability of the mother. Treatment by way of nursery care for a dependant in a hospital following childbirth, unless due to medical necessity during treatment that is otherwise covered by this policy. Treatment for kidney dialysis at a location other than in the patient s location of assignment, or if unavailable, the patient s country of domicile or centre of excellence nearest the location of assignment. Travel and accommodation expenses in connection with treatment for kidney dialysis. Treatment to change the refraction of one or both eyes, including refractive keratotomy (RK) and photorefractive keratectomy (PRK), unless Cigna agrees in writing. Injury or disability directly or indirectly caused or contributed to whilst engaging in or taking part in war, invasion, act of terrorist activities, rebellion (whether war be declared or not), civil war, commotion, military or usurped power, martial law, riot or the act of any lawfully constituted authority, or while you or your dependants are carrying out army, naval or air services operations, whether or not war has been declared. Treatment outside the selected area of coverage if one of the reasons the patient travelled was for that treatment. Any form of non-emergency travel costs. International services expenses for emergency evacuation, medical repatriation, repatriation of mortal remains and transportation costs for third parties.

7 w x y Any expenses for ship-to-shore evacuations. Sex change operations or any treatment needed to prepare for or recover from these operations (for example, psychological counselling) including complications arising out of such treatment. Treatment that arises from or is any way connected with injury, sickness or disablement as a result of : taking part in a sporting activity on a professional basis; or solo scuba-diving or scuba diving at depths below 30 metres unless the diver is PADI qualified (or equivalent) for that depth. z aa Any form of treatment (or procedure) that is deemed by the medical team to be experimental, investigative, or unproven, or does not amount to orthodox treatment or does not adhere to the commonly accepted, customary or traditional practice of medicine in the location where the treatment is given at the time of the commencement of the procedure or treatment. Expenses relating to: any form of sterilisation or contraception including vasectomy, except for treatment received in Singapore within the agreed Parkway Health provider network; any form of plastic, cosmetic or reconstructive surgery or treatment, even for psychological reasons, unless it is of medical necessity as a direct result of the patient having an accident or because of other surgery, which itself would have been covered under the plan; appliances (including spectacles, unless benefit is specifically provided under the list of benefits, and hearing aids) which do not fall within Cigna s definition of surgical appliance and/or medical appliance. This exclusion does not apply to Flexible Benefits; hearing tests, except for one hearing test per year of for a dependant child under the age of 15 years, if benefit is specifically provided in the list of benefits; eye tests, except for one eye test per year of for a dependant child under the age of 15 years, if benefit is specifically provided in the list of benefits; incidental costs including newspapers, taxi fares, telephone calls, guests meals and hotel accommodation; routine examinations or tests, including health screens and medical examinations, except for Well Child Tests for a dependant child, and those specifically included under the list of benefits. This exclusion does not apply to Flexible Benefits; costs or fees for filling in a claim form or other administration charges. bb cc Costs that have been or can be paid by another company, person, organisation or public programme. If you are covered by other, Cigna will only pay its part of your benefit. If another person, organisation or public programme is responsible for paying the costs of treatment, Cigna may claim back any of these costs it has paid. Cigna s products and services may not be available in all jurisdictions and are expressly excluded from this policy where prohibited by applicable law, including but not limited to, anti-corruption laws and economic sanctions programs administered by the U.S. Treasury Department s Office of Foreign Assets Control. dd Over-the-counter drugs without prescription. ee Orthoses and orthotic devices unless medically necessary on a short-term basis due to an acute injury or surgery. This exclusion does not apply to Flexible Benefits.

8 Dental Benefits Plan Annual Maximum The total benefit payable in any one year of, per employee or dependant for all dental benefits. Dental Benefits Class One Investigative and Preventative Treatment. Benefits include: X-rays, Scale and Polish. Class Two Basic Restorative Treatment, Periodontal Treatment and Treatment of Dental Injury. Benefits include: Root canal treatment, extractions, surgical procedures, occasional treatment, anaesthetics, periodontal treatment. Class Three Major Restorative Treatment. Benefits include: Dentures acrylic/synthetic, metal and metal/acrylic, crowns, inlays, mouthguard or occlusal splint Orthodontic Treatment maximum benefit for dependent children under the age of 18. Up to US$1,625 per year of 50% Refund Up to US$750 per year of Notes 1. Examinations and Scale and Polish will both be limited to 2 visits per year of. 2. Full case assessment will be limited to one per year of. 3. X-rays will be limited to four Bitewings and six Intra Oral per year of and OPG every 3 years. 4. Prolonged periodontal treatment limit of one course per year of.

9 Exclusions Cigna will not pay benefit for the following treatments and extras: a Benefit is not payable for treatment which: is directly or indirectly caused or contributed to whilst engaging in or taking part in war, invasion, act of terrorist activities, rebellion, (whether war be declared or not), civil war, commotion, military or usurped power, martial law, riot or the act or any lawfully constituted authority, or while the employee or dependants are carrying out army, naval or air services operations, whether or not war has been declared; is purely cosmetic; is not necessary for continued oral health; is in any way caused by the patient carrying out an illegal act. b Benefit is not payable for refunding costs which: are fees for filling in a claim form or other administration charges; have been or can be paid by another company, person, organisation or public programme. If the employee or dependants are covered by other, Cigna will only pay its part of the benefit. If another person, organisation or public programme is responsible for paying the costs of treatment, Cigna may claim back any of these costs it has paid. c Benefit is not payable for the following procedures, services or items: replacing any dental appliance which is lost or stolen; replacing a bridge, crown or denture which is or can be made usable according to a standard acceptable to a dentist of ordinary competence and skill in the location where the treatment is given, at the time of the commencement of the procedure or treatment; replacing a bridge, crown or denture within five years of original fitting unless: o the replacement is needed because of the placement of an original opposing full denture or extraction of natural teeth is needed; or o the bridge, crown or denture, while in the mouth, has been damaged beyond repair because of an injury the employee or their dependant receives while covered under the plan. porcelain or acrylic veneers on the upper and lower first, second and third molars and premolars; crowns or pontics on or replacing the upper and lower first, second and third molars unless: o they are constructed of either porcelain, porcelain bonded-to-metal or metal alone, e.g. gold alloy crown; or o a temporary crown or pontic is required as part of routine or emergency dental treatment. surgical implants of any type including any attaching prosthetic device; procedures and materials which are deemed by the medical team to be experimental, investigative, or unproven or which do not meet accepted dental standards; instruction for plaque control, oral hygiene and diet; procedures, services and supplies which are deemed by Cigna to be medical procedures, services and supplies including mouthwashes and also including services and supplies provided in a hospital (except where dental treatment is neither wholly nor partly the reason for the stay in hospital); orthodontic treatment for any employees, and for dependants who are aged 18 years or older; bite registration, precision or semi-precision attachments; procedures, appliances or restorations (except full dentures) whose main purpose is to: o change vertical dimensions: or o stabilise periodontally involved teeth; or o restore occlusion.

10 Vision Care Vision Benefits One eye examination per year of by an Optometrist or an Ophthalmologist Expenses for: Lenses to correct vision, Eyeglass frames, Prescription sunglasses Covered under Flexible Benefits Exclusions Cigna will not pay benefit for the following expenses; More than one eye examination in any one year of ; Sunglasses, unless medically prescribed; Medical or surgical treatment of the eye; Lenses which are not a medical necessity and are not prescribed by an Optometrist or Ophthalmologist or frames for such lenses.

11 Cigna Europe Insurance Company S.A.-N.V., Singapore Branch, registered at 152 Beach Road, #26-05 The Gateway East, Singapore Cigna Europe Insurance Company S.A-N.V. is a private limited liability company under Belgian law, with its registered office in Belgium, 52 avenue de Cortenbergh, 1000 Brussels, RPM Brussels nr , subject to the prudential supervision of the National Bank of Belgium, and Regulated by the Monetary Authority of Singapore (General Insurer identification number: ID871). COGNIZANT.SENIOR DIRECTOR AND ABOVE/SGP/EN/1016