Read a group insurance summary and say what it covers, for how much and with what limits.
The common way to learn what your workplace insurance covers is to find out at a clinic counter, bill in hand. Offer letters say little on the subject. Many people start a new job knowing they are insured and knowing nothing else about the arrangement. Being insured is one thing and understanding the rules of your cover is another. The rules decide how much of each bill you pay yourself.
Most employers that provide insurance buy a group policy. This is one contract with an insurer that covers every eligible employee. Group policies tend to be assembled from the same small set of parts.
Group hospital and surgical cover pays when you are admitted to hospital or need an operation. For most people this is the part worth the most, since hospital bills are where the big amounts are. Outpatient cover pays for visits to a GP, and some plans extend it to specialist visits if you have a referral. Dental cover is an extra that some employers provide. Some employers also include group term life, which pays out a lump sum if you die while you are on the payroll. Others include group personal accident cover, which pays out for death or injury that results from an accident.
The choice of parts, and the amount each one pays, is entirely your employer's. Two firms can each promise "medical benefits" and be describing very different plans, so the phrase on its own tells you little.
The headline matters less than five details: ward class, limits, co-payments, panel clinics and exclusions. Together they determine what the plan actually pays.
Ward class is the type of hospital ward your plan pays for. Pick a ward above that level and the gap in cost is yours to pay.
Limits are ceilings on what the plan will pay. There may be a ceiling for the whole year, a ceiling for each hospital stay or each illness, and separate ceilings on certain items, for example surgery or room charges.
A co-payment is the part of a bill you pay out of your own money. Plans set it either as a fixed sum for each visit or as a percentage of the bill.
Panel clinics are the clinics on the insurer's list. Many outpatient plans only pay in full, or with a small co-payment, if you go to one of these. Visit a clinic outside the panel and you may have to settle the whole bill and then claim some of it back, or you may recover nothing.
Exclusions are the things a plan won't pay for. Group plans commonly exclude pre-existing conditions (health problems you had before your cover began), or cover them only once a waiting period has passed. Certain treatments may be left out of a plan entirely. Anyone with an ongoing condition should read the exclusions before anything else.
Hui Min is a fictional new employee. The only mention of insurance in her offer letter was a single line promising group medical and hospitalisation coverage "as per company policy", and that was all she knew. During her second week she sprained her ankle at futsal. She saw a GP close to her office and paid S$65 (an invented figure) before leaving. Some time later a colleague mentioned that the company only covers GP visits at panel clinics, and the clinic she had gone to was not one of them. Her cover was real. She just hadn't known how it worked.
The details she was missing were never going to be in her offer letter. They sit in the benefits guide or policy summary that HR hands out to new joiners. Hers lists the following (all figures invented):
Hospital and surgical: up to S$20,000 a year, ward class B1, pre-existing conditions excluded for the first 12 months Outpatient: panel GP visits with a S$5 co-payment Dental: up to S$150 a year Group term life: 24 months of basic salary Flexible benefits: S$600 a year
She earns a basic salary of S$4,000 a month, which makes her group term life cover 24 x S$4,000 = S$96,000. In hospital, her plan pays for a B1 ward, and if she asks for a better ward she covers the extra cost. Hospital and surgical claims are capped at S$20,000 for the year. Anything she already had before joining is not covered until she has been there 12 months. At a panel clinic, a GP visit costs her S$5. She has since saved the panel clinic list as a bookmark on her phone.
First look through what HR gave you on joining. Failing that, the summary is often posted on the company intranet, or kept in the insurer's app if your employer uses one. If you still can't find it, ask HR outright for the policy summary or benefits guide. HR gets this request all the time. When you ask, request the panel clinic list and the claims procedure as well.
Once you have the summary, write down every part you are covered for, starting with hospital and surgical and going through to flexible benefits. Next to each one, record its ward class, limits, co-payments, panel clinic rules and exclusions.
The summary shows what the plan will pay. How far that goes for you depends on who relies on you, what illnesses run in your family and any conditions you already have. Someone whose family has a history of serious illness has more reason to worry about a low hospital limit. A group term life sum that is ample for a person with no dependants can fall well short for a person whose parents depend on their income. Lesson 3.2, "The gaps: cover that ends when the job ends", and Module 6 go further into whether your cover is enough for your circumstances.
For the moment, the goal is to know what you are covered for and to keep the practical details close at hand, as Hui Min does with the panel list on her phone. When you can state your ward class, limits, co-payment and exclusions, a clinic counter won't catch you out again.
Your next move is to find your own company's version of that summary and read it with a pen in hand.
Get your company's benefits guide. For hospital, outpatient and life cover, write down what is covered, the limits and the exclusions.
Junxiong-WFG Organisation is an authorised representative of AIA Financial Advisers Private Limited (Reg. No. 201715016G).