What is TMIS

TMIS is a private hospitalisation insurance arrangement among participating insurance companies which provides continuous insurance coverage to an employee in the event:

• An employee’s employment is terminated by the employer or on his/her own accord, and
• The employee commences employment with another employer after the termination.

Which insurance plan qualifies to be included in the TMIS

It must be a group hospitalisation insurance plan which:
• Insures a minimum of 11 employees [as at policy inception or at renewal],
• Provides basic in-patient medical expense reimbursement benefits,
• Is wholly sponsored by the employer, with the employer paying 100% of the premium for the plan for employees during their employment. Employers may make arrangement to recover the premium for continuation benefits after the termination of employment, in whole or part from the employees based on their agreements, and
• Is non-optional in nature, i.e. an employee cannot choose whether to be insured under the plan or not.

What are the medical expenses eligible for TMIS special benefits

The following expenses that are reimbursed under a typical group hospitalisation insurance plan are eligible for TMIS benefits:
• Daily room and board
• Intensive care unit
• Miscellaneous hospital services
• In-hospital doctor’s visit
• In-patient and outpatient surgery

All pre/post hospitalisation outpatient, emergency outpatient accident and outpatient kidney dialysis/cancer treatment expenses are not eligible for TMIS benefits even if they can be reimbursed under the TMIS plan.

Who are eligible for TMIS benefits

An employee who is:
• Below the statutory retirement age,
• A Singaporean or Permanent Resident based in Singapore,
• Working full-time with the same employer, and
• On a permanent employment contract, or on a temporary employment contract of term 24 months or more is eligible for TMIS benefits.

An employee who is:
• Above the statutory retirement age, or
• Not a Singaporean or Permanent Resident, or
• A part-time employee, regardless of whether on permanent or temporary contract, or
• On a temporary contract with less than 24 months’ term.
is not eligible for TMIS benefits, even if the employee is insured under a TMIS plan.

Must all employees be provided with TMIS benefits

An employer does not have to provide TMIS benefits to 100% of its eligible workforce. TMIS benefits can be provided to pre-defined categories of employees, e.g. rank-and-file employees or executives who satisfy the TMIS benefit eligibility requirements under para. 4 above.

Although an employer is allowed to select categories of employees, individual selection of employees for TMIS benefits will not be allowed.

What are the TMIS benefits

When an eligible employee who is insured under a TMIS plan leaves his/her employer, he/she will be entitled to the following benefits:
• Continuation Benefits, and
• Transferability Benefits.

Continuation Benefits

When the eligible employee’s employment is terminated, he/she enjoys continuous hospitalisation insurance coverage from the termination date for up to maximum of 12 months.

Transferability Benefits

If after terminating employment with Employer A, an employee joins Employer B, where both Employers A and B provide TMIS benefits, he/she is entitled to:

• Group hospitalisation insurance under Employer B without having to provide evidence of good health, and
• Waiver of any exclusion of pre-existing medical conditions, provided he/she has been continuously insured under one or more TMIS plans for 12 months before joining Employer B. If he/she has not been continuously insured under TMIS plans for at least 12 months before joining Employer B, he/she will be entitled to the waiver when he/she has been insured under Employer B’s plan for a duration which completes the 12 months’ continuous coverage under the TMIS.

However, if the employee is hospitalised for treatment of a condition which is pre-existing when he/she joins Employer B, within the first 12 months of insurance while employed by Employer B, he/she is eligible to the lower of the:
a) Benefit entitlement under the current (Employer B’s) TMIS plan
OR
b) Benefit entitlement under the prior (Employer A’s) TMIS plan.

An example to illustrate:

Date of Termination with Employer A - 31 Dec 2003
Date of Employment with Employer B - 15 Jan 2004

The employee is hospitalised for an illness which he/she contracted while in Employer A’s employment, for which the benefit entitlement under the two employers’ TMIS plans are:

Benefit Entitlement Employee A Employer B

Daily Room & Board $240/day $360/day
Total of Eligible Benefits $3,000 $4,000

Assuming that the employee was hospitalised on:
i) 1 Mar 2004, total claim payable will be $3,000 (lower of $3,000 or $4,000)
ii) Mar 2005, total claim payable will be $4,000

Important Note:

The Transferability Benefit will not be available when the employee moves from an employer with a non-TMIS group hospitalisation insurance plan to an employer with a TMIS plan, and vice versa.

From which employer’s insurance plan will TMIS benefit claims be payable

Claims for Continuation Benefits will be payable from the previous employer’s TMIS plan.

Claims for Transferability Benefits on or after the employee has joined the new employer, will be payable from the new employer’s TMIS plan.

How do insurers verify eligibility of an employee under the TMIS

The employer will issue a Transferable Medical Insurance Certification (TMIC) to the employee upon his termination of employment. The TMIC must be submitted to the insurer when the employee submits a claim for Continuation Benefit, or to the new employer’s insurer should a claim arising from a pre-existing condition be made within 12 months of joining the new employer.

The blank TMIC is available on the Life Insurance Association and General Insurance Association websites: www.lia.org.sg and www.gia.org.sg

How will the premiums for TMIS benefits be charged

A participating insurer will charge a loading on the premium for a group hospitalization insurance plan without TMIS benefits, but otherwise, providing the same benefits as the TMIS plan.

When an eligible employee terminates employment with an employer which has a TMIS plan, the employer will pay premiums for 12 months of insurance for the leaving employee, at the prevailing premium rate for the employee’s benefits under the TMIS plan, including the loading noted above.

All premiums chargeable for TMIS benefits will be included in the usual group insurance premium invoice to be billed and paid by the employer. Insurers will not collect premiums directly from the employees.

Which are the insurance companies participating in the TMIS

There are currently 13 insurance companies participating in the TMIS. This list is posted on the websites of both the Life Insurance Association and General Insurance Association. (You can also refer to What is TMIS )

Any participating insurer wishing to withdraw from the TMIS must give at least 12 months’ notice to all the other participating companies, as well as to all their TMIS plan policyholders. They are not allowed to terminate any existing TMIS plan until the policy expires. Until such time, the policy remains a TMIS plan.

When will the TMIS be available

TMIS policies or conversion of existing medical policies into TMIS will be available for all policies incepted or renewed from 1 January 2004.

Source: Life Insurance Association Singapore