Employee benefits terms in plain English
36 group insurance terms Singapore employers come across, from GHS and ward class to loss ratio, explained without the jargon.
36 of 36 terms
A
- As-charged
- A benefit that pays the actual eligible bill instead of applying a separate limit to each item, subject to the plan’s overall limits.
C
- Census
- The employee list insurers use to quote and set up a group plan.
- Co-insurance
- A percentage of an eligible bill that the employee pays, with the insurer paying the rest.
- Co-payment
- A fixed amount an employee pays for each visit or claim, with the insurer paying the rest.
D
- Day surgery
- An operation after which the patient goes home the same day.
- Deductible
- The part of a claim the employee pays before the insurance starts paying.
- Dependants’ cover
- Extending group medical cover to an employee’s spouse and children.
E
- Exclusions
- Treatments, conditions or situations a policy does not pay for.
F
- Free cover limit (FCL)
- The highest sum insured an insurer covers for each employee without asking for a health declaration.
- FWMI (foreign worker medical insurance)
- Medical insurance the Ministry of Manpower requires employers to buy for each Work Permit and S Pass holder, covering inpatient care and day surgery.
G
- GHS (group hospital and surgical)
- Group insurance that pays employees’ hospital and surgery bills, from the ward charges to the surgeon’s fee, up to the limits of the plan.
- GMM (group major medical)
- Group cover that sits on top of a hospital and surgical plan and pays a share of large bills once the GHS limits are used up.
- GPA (group personal accident)
- Group cover that pays if an employee is injured, disabled or killed in an accident, including the medical costs of treating accidental injuries.
- Group critical illness (GCI)
- Group cover that pays a lump sum when an employee is diagnosed with a covered critical illness, such as a major cancer, heart attack or stroke.
- GTL (group term life)
- Group life insurance that pays a lump sum to an employee’s family if the employee dies while covered, and usually if they become totally and permanently disabled.
H
- Health declaration
- A form on which an employee answers questions about their health, so the insurer can decide on terms for their cover.
I
- Inpatient and outpatient
- Inpatient care is treatment as an admitted hospital patient; outpatient care is treatment without being admitted.
- Integrated Shield Plan (IP)
- A personal hospital plan from a private insurer that sits on top of MediShield Life and covers higher wards and larger bills.
L
- Letter of guarantee (LOG)
- A letter from the insurer to a hospital promising to pay an employee’s eligible bill, so the employee does not pay a deposit or the whole bill upfront.
- Loss ratio
- The claims an insurer paid on a policy divided by the premiums it received, over the same period.
M
- MediShield Life integration
- Setting up group hospital cover to work together with MediShield Life, so the two share a bill instead of covering the same costs twice.
O
- Occupation class
- An insurer’s grouping of jobs by their risk of accident, used mainly to price personal accident cover.
P
- Panel and non-panel clinics
- Panel clinics have an arrangement with the insurer so employees pay little or nothing at the counter; at non-panel clinics employees pay first and claim afterwards.
- Pre- and post-hospitalisation
- Specialist visits, tests and treatment in the days before a hospital stay and after discharge, paid by a hospital plan when they relate to the admission.
- Pre-existing conditions
- Health conditions an employee had, or had symptoms of, before their cover started.
- Pro-ration
- Paying only a proportion of a bill when an employee is treated in a higher ward or more expensive hospital than their plan covers.
R
- Renewal
- The point, usually once a year, when a group policy ends and the insurer offers terms for the next year.
- Restructured hospital
- A public hospital in Singapore, run as a company owned by the government.
- Room and board
- The daily hospital charge for the bed, meals and basic nursing care, which plans cover up to a daily limit.
S
- Sum insured
- The amount a benefit pays, such as the lump sum under term life, personal accident or critical illness cover.
T
- Third-party administrator (TPA)
- A company that runs clinic panels and processes claims on behalf of an insurer.
- TPD (total and permanent disability)
- A disability that permanently prevents an employee from working, which most group term life plans pay out on.
U
- Underwriting
- How an insurer assesses a group and decides the terms and price it will offer.
W
- Waiting period
- A period after cover starts during which certain claims are not paid.
- Ward class
- The type of hospital ward a plan pays for, from a large subsidised ward in a public hospital to a single room in a private hospital.
- WICA (Work Injury Compensation Act)
- The law under which employers must insure certain employees for work injuries and occupational diseases.