请问哈，五个plan, 都有这个general exclusions ? experimental or pioneering medical or surgical techniques and medical divices not approved by ……………..就是实验性药物这一块，目前看到NTUC有这一条，AIA也有，不知其他三家有没有这一条呢？
楼主看得好详细
GE 对这个试验型药物没有exclusion，是新加坡卫生部批准用于临床试验的药物就可以报销。
佩服楼主的细心，进来做保险吧，适合你的。
根据我以前对5家的了解，只有大东方保障实验性药物。这也是大东方医疗保险保障比较全面的细节之处。
可以比较下。小结是 AIA的 21条不保， NTUC的 26条不保， GE的 31条不保
当然里面的排除内容不尽相同，大家有时间可以读读。
GENERAL EXCLUSIONS 如下
AIA的Any Pre-existing Condition from which theInsured is suffering prior to the Policy Date or reinstatement date, whicheveris later, shall not be covered unless the Insured makes a declaration in theapplication for this Policy or on reinstatement and such application isspecifically accepted by us.This Policy also does not cover any claimsincurred directly or indirectly as a result of any of the following, whether ornot a declaration has been submitted and accepted by us:. (a) Entire stay in a Hospital or a medicalinstitution if such Confinement commences before the Policy Date; . (b) Serious Illness for which the Insured hasreceived medical treatment and advice, including follow-ups and consultations,during twelve (12) months prior to the Policy Date or reinstatement date,whichever is later; . (c) Treatment for congenital abnormalitiesincluding hereditary conditions and physical defects from childbirth (exceptwhere expressly covered by the Congenital Abnormalities Benefits under theBenefits Provisions of this Policy); . (d) Treatment arising from pregnancy, miscarriages,abortion, childbirth, sterilisation, contraception (except where expresslycovered by the Pregnancy Complications Benefit under the Benefits Provisions ofthis Policy); . (e) Treatment for infertility, sub-fertility,assisted conception or any contraceptive operation and sex change operations; . (f) Any Injury or Illness caused directly orindirectly, by self-destruction or intentional self-inflicted injury, abuse ofdrugs or alcohol or injuries sustained as a direct result of a criminal act orattempted suicide, whether the Insured is sane or insane; . (g) Treatments attributable to any sexuallytransmitted disease, including Acquired Immune Deficiency Syndrome (AIDS) andAIDS-related complications (except where HIV Due to Blood Transfusion andOccupationally Acquired HIV is expressly covered by the Extra Cover for 30Critical Illnesses Benefit under the Benefits Provisions of this Policy). Forthe purpose of this Policy:- . (i) The definition of AIDS shall be that used bythe World Health Organization in 1987, or any subsequent revision by the WorldHealth Organization of that definition; . (ii) Infection shall be deemed to have occurredwhere blood or other relevant tests indicate in our opinion either the presenceof any Human Immunodeficiency Virus or antibodies to such a virus; . (h) Treatment for mental illnesses and psychiatricdisorders, (except where expressly covered by the Psychiatric TreatmentBenefits under the Benefits Provisions of this Policy); . (i) Treatment for obesity, weight reduction orweight improvement; . (j) Treatment arising from injuries sustainedduring wars (whether war be declared or not), civil commotion, riots,revolutions, strikes, nuclear reaction or any war-like operations; . (k) Prostheses, corrective devices and medicalappliances which are not medically required, as well as the purchase of kidneydialysis machines, iron-lung and other such appliances; . (l) Any form of Surgical Procedure that is electivesuch as cosmetic or plastic surgery (except for medical reasons), dental(except where expressly covered by the Accidental Inpatient Dental TreatmentBenefit under the Benefits Provisions of this Policy) and correction forrefractive errors of the eye;. (m) Costs for routine eye and ear examinations,including costs of spectacles, contact lenses and hearing aids; . (n) Private nursing charges and nursing homeservices; . (o) Purchase of durable medical equipment such aswheelchairs and hospital beds used at home; . (p) Transport-related services including ambulancefee, emergency evacuation, repatriation assistance and repatriation of mortalremains; . (q) Outpatient consultations and treatments exceptwhere expressly covered by the following benefits under the Benefits Provisionsof this Policy: . (i) Pre-Hospitalisation Benefit; . (ii) Post-Hospitalisation Treatment under thePost-Hospitalisation Benefits; . (iii) Extended Post-Hospitalisation Treatment for30 Critical Illnesses under the Post-
Hospitalisation Benefits; . (iv) Insured (as the Living Donor) Donating anOrgan under the Living Donor Organ
Transplant Benefits; . (v) Post-Hospitalisation Psychiatric Treatmentunder the Psychiatric Treatment Benefits;
and . (vi) Outpatient Benefit; . (r) Vaccination; . (s) Costs incurred from the acquisition of an organor related parts of an organ from a living donor for an organ transplant andexpenses incurred by the living donor of such organ or related parts (exceptwhere expressly covered by the Living Donor Organ Transplant Benefits under theBenefits Provisions of this Policy); . (t) Overseas (outside Singapore) medical treatmentor hospitalisation (except where expressly covered by the Emergency Overseas(Outside Singapore) Medical Treatment Benefit under the Benefits Provisions ofthis Policy); or . (u) All other exclusions for MediShield set out inthe CPF Act and its regulations, unless otherwise provided under this Policy.
NTUC 的4.18 Exclusions
The following treatment items, procedures,conditions, activities and their related complications are not covered under yourpolicy.
1. a Astay in hospital if the insured was admitted to the hospital beforethe start date. 2. b Anypre-existing illness, disease or condition from which the insured wassuffering, unless declared in the application form and we acceptedthe application without any exclusions. However, we will exclude any pre-existingillness, disease or condition which is specifically excluded in yourpolicy, whether a declaration was made in the application form ornot. To avoid doubt, any pre-existing illness, disease or condition thatwas covered under MediShield before the start date of yourpolicy will continue to be covered under MediShield as long as the insuredsatisfies the eligibility criteria for MediShield under the act andregulations at the time the claim is made under your policy. 3. c Cosmeticsurgery or any medical treatment claimed to generally prevent illness, promote health or improve bodily function orappearance.
4. d Generaloutpatient medical expenses (unless this is covered under outpatient hospitaltreatment, pre-hospitalisation treatment or post-hospitalisation treatment). 5. e Treatmentfor birth defects, including hereditary conditions and disorders and congenitalsickness or abnormalities (unless we do cover it under congenitalabnormalities benefit). 6. f Overseasmedical treatment (unless we cover it under emergency overseastreatment). 7. g Psychologicaldisorders, personality disorders, mental conditions or behavioural disorders,including any addiction or dependence arising from these disorders such asgambling or gaming addiction (unless we cover it under inpatientpsychiatric treatment benefit). 8. h Pregnancy,childbirth, miscarriage, abortion or termination of pregnancy, or any form ofrelated stay in hospital or treatment (unless we cover this underpregnancy complications benefit). 9. i Infertility,sub-fertility, assisted conception, erectile dysfunction, impotence or anycontraceptive treatment. 10. j Treatmentof sexually-transmitted diseases. 11. k Acquiredimmunodeficiency syndrome (AIDS), AIDS-related complex or infection by humanimmunodeficiency virus (HIV) (except HIV due to blood transfusion and occupationallyacquired HIV). 12. l Treatmentfor self-inflicted injuries or injuries or illnesses resulting from attemptedsuicide, whether the insured is sane or insane. 13. m Drugor alcohol misuse. 14. n Expensesof getting an organ or body part for a transplant from a living organ donor forthe insured and all expenses the living organ donor has to pay(unless this is covered under living organ donor (insured) transplant benefitor living organ donor (non-insured) transplant benefit). 15. o Dentaltreatment (unless this is covered under accident inpatient dental treatment ). 16. p Transport-relatedservices including ambulance fees, emergency evacuation, sending home a body orashes. 17. q Sex-changeoperations. 18. r Buyingor renting special braces, appliances, equipment, machines and other devices,such as wheelchairs, walking or home aids, dialysis machines, iron lungs,oxygen machines and any other hospital-type equipment to use at home or as anoutpatient. 19. s Optionalitems which are outside the scope of treatment, prosthesis and correctivedevices, and medical appliances which are not needed surgically (unless this iscovered under prosthesis benefit). 20. t Experimentalor pioneering medical or surgical techniques and medical devices not approvedby the Institutional Review Board and the Centre of Medical Device Regulationand medical trials for medicinal products whether or not these trials have a clinicaltrial certificate issued by the Health Sciences Authority of Singapore. 21. u Privatenursing charges and nursing home services. 22. v Vaccinations.23. w Treatmentof injuries arising from being directly involved in civil commotion, riot orstrike. 24. x Theconsequences arising, whether directly or indirectly, from nuclear fallout,radioactivity, any nuclear fuel, material or waste, war and related risks. 25. y Rest cures, hospice care, home or outpatient nursing or palliativecare, convalescent care in convalescent or nursing homes, sanatoriums orsimilar establishments, outpatient rehabilitation services such as counsellingand physical rehabilitation.
26. z Alternative or complementary treatments, including traditional Chinesemedicine (TCM) or a stay in any health-care establishment for social ornon-medical reasons.
GE大东方的 EXCLUSIONS
Under this Policy, the Company will not pay any benefit in reimbursement of Expenses incurred for, or the consequences of, the following:
1. (a)Pregnancy and childbirth (including Caesarean section, vacuum extraction or forceps deliveryand the consequences thereof) except for Pregnancy and Childbirth Complications.
2. (b)Elective abortion, spontaneous miscarriage occurring within first trimester of pregnancy, birthcontrol*, sterilization*, infertility*, sub-fertility* or impotence treatment.
for male or female
3. (c)Routine physical or any other examinations not related to the treatment or diagnosis of an Injury,illness or disease.
4. (d)Instrument examinations and laboratory tests not ordered by a Physician or not resulting in adiagnosis of a condition leading to Hospitalisation, Surgery, Kidney Dialysis Treatment, CancerTreatment or Accidental Dental Treatment.
5. (e)All Dental Treatment not defined as Accidental Dental Treatment.
6. (f)Elective cosmetic or plastic surgery except for:
(i) Breast Reconstruction after Mastectomy; and
(ii) Injury sustained as a result of an Accident, which occurs after the Last Policy Effective Date.
7. (g) Treatment of psychiatric,emotional, personality, mental and nervous disorders including depression(except for Psychiatric Treatment if covered under this Policy as indicated inSchedule B). 8. (h) Treatment of alcoholism ordrug abuse. 9. (i) Treatment provided to theLife Assured by the Policyholder, or a family member of the Life Assured or thePolicyholder, or self-treatment by the Life Assured, including the prescriptionof drugs. 10. (j) Transport for trips madefor the purpose of obtaining medical treatment. 11. (k) Purchase and rental ofprostheses, corrective devices and medical appliances unless the prostheses,corrective device or medical appliance satisfies the definition of a SurgicalImplant or of Approved Medical Consumables. Medical appliances include but arenot limited to kidney dialysis machines, iron lung, and durable medicalequipment (e.g. wheelchairs and hospital beds) used at home. 12. (l) Acquisition of the organitself for an organ transplant, (except for the procurement costs incurreddirectly by the Hospital for the procurement of the organ for transplantationinto the Life Assured where the donor of the organ is already dead at the timeof the removal of any of the organs in the Country of Issue or outside theCountry of Issue). 13. (m) All Expenses incurred bythe donor for an organ transplant except for Living Organ Donor Transplant(Kidney / Liver). 14. (n) Self-inflicted injuries orsuicide or attempted suicide, whether sane or insane. 15. (o) AIDS and all illnesses ordiseases caused by or related to the Human Immunodeficiency Virus (“HIV”)except for Human Immunodeficiency Virus (“HIV”) Due to Blood Transfusion andOccupationally Acquired HIV. 16. (p) Sexually-transmitteddiseases. 17. (q) Violation or attemptedviolation of law and resistance to lawful arrest or any resultant imprisonment.18. (r) War (whether declared ornot), invasion, terrorist activities, rebellion, revolution, civil war or anywarlike operations. 19. (s) Being in or on an aircraftof any type, or boarding or descending from any aircraft, except as afare-paying passenger or crew member on an aircraft on a regular scheduledroute operated by a recognised airline. 20. (t) The Life Assured engagingin any sport in a professional capacity or where the Life Assured would orcould earn income or remuneration or win monetary rewards from engaging in suchsport. 21. (u) Medical treatment,Hospitalisation, Surgery and consultation provided to and investigation of theLife Assured commencing: 1. (i) Before the CommencementDate of Insurance of the Life Assured for any condition; 2. (ii) On or after theCommencement Date of Insurance of the Life Assured which are follow-up medicaltreatment(s), consultation(s) or further investigation(s) of the Life Assuredfor that condition for which he received medical treatment, consultation orinvestigation before the Commencement Date of Insurance of the Life Assured. 22. (v) Any treatment provided tothe Life Assured after the Renewal Date of this Policy unless the insurance hasbeen renewed on or before that date in accordance with Clause 8 of this Policy.23 w)Private nursing charges and nursing home services.
24. (x) Medical or surgicaltreatment outside Singapore except in the case of an Emergency. 25. (y) Treatment for obesity,weight reduction or weight improvement regardless of whether it is MedicallyNecessary or otherwise. 26. (z) Ambulance fee. 27. (aa) Vaccination. 28. (bb) Correction forrefractive errors of the eye, routine eye and eye examinations, costs ofspectacles, costs of contact lenses and costs of hearing aids.
29. (cc) Mountaineering, diving,bungee jumping, racing other than racing on foot, wakeboarding, hang- gliding,rock climbing, parachuting, ballooning, handling of explosives or firearms andall activities which are potentially life-threatening or where there is a riskof bodily injury to the Life Assured.
30. (dd) Ionizing radiation or contamination byradioactivity from any nuclear fuel or nuclear waste from process of nuclearfission or from any nuclear weapons material.
5.2 Pre-existing Conditions
目前应该只有大东方和AIA没有这个排除条款，故有保试验中的药物和疗程。
小五抱歉看错一个CONTRACT. AIA 没有这一条。 楼上各位都是专业人士，听说MOH网站上有可以查五家住院保险的市场占有率，市场大头是NTUC 和AIA. 可以帮我找找LINK吗。
关于占有率，目前没有发现可以站住脚的文献。各个保险公司说法不一。
时不时看到这个试验性药物报销的问题，有些困惑。
PRUShield保单里面没有单独写出来不报。从楼上小五贴出来的看，其他公司的住院保险也没有单独写出来不报，除了楼主贴的那个。
有个问题是，医生给开的药，难道不都是经过卫生部等相关部门批准了的吗？或者说，医生们可以不经过批准自己引进药物吗？
如果所有的药都经过卫生部批准了，那么这个条款的讨论还有意义吗？