CMFAS HI Medical Expense & Group H&S Insurance question: insurer's total payout for the year

CMFAS HIMedical Expense & Group H&S Insurance

Mr Rahman's policy carries a per-disability (per-claim) deductible of S$1,000 and 10% co-insurance. During the same policy year he made three separate, unrelated claims of S$3,000 each. What is the insurer's total payout for the year?

A S$7,200
B S$8,100
C S$6,300
D S$5,400

Show the answer and explanation

Answer: D. S$5,400

A per-disability (per-claim) deductible is the most restrictive: the deductible is borne for each claim regardless of the year. Per claim: S$3,000 − S$1,000 = S$2,000, less 10% co-insurance (S$200) = S$1,800 paid. Three claims × S$1,800 = S$5,400.

Common mistake

Treating it like a per-annum deductible (one S$1,000 across all three claims) gives S$7,200 — but the deductible resets on every claim.

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Under the Transferable Medical Insurance Scheme (TMIS), the 'continuation of coverage' feature allows an employee whose employment ends to continue enjoying hospitalisation cover for up to Mr Faisal's policy carries a per-disability (per-claim) deductible of S$800 and 10% co-insurance. In the same policy year he made two separate, unrelated claims of S$5,000 and S$2,500. What is the insurer's total payout for the year?Mr Arjun's plan entitles him to a Class B1 ward, but he is admitted to a private hospital. The pro-ration factor is 55%, his 'as charged' bill is S$32,000, the annual deductible is S$3,500 and co-insurance is 10%. How much does the insurer pay?

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Original study material mapped to the public CMFAS HI syllabus. Unofficial, not endorsed by MAS or SCI. Verify figures and rules against current guidance before relying on them.