HospitalWise Proposal Form | OCBC Singapore

HospitalWise Proposal Form

Thank you for trusting Great Eastern to cover you and your loved ones in the event of hospitalisation with HospitalWise.

To make protection more affordable for you, we are offering one month free coverage for an Annual Premium plan from now till 30 June 2020.

Complete and submit the form below to apply.

Your Coverage
  • Starter
  • Essential
Benefits Starter Essential
Adults Child Adults Child
Annual Policy Limit S$150,000 S$75,000 S$225,000 S$112,500
Daily Cash Benefit
(due to illness or accident)
S$200 S$100 S$300 S$150
Daily Cash Benefit in ICU
(due to illness or accident)
S$400 S$200 S$600 S$300
Daily Cash Benefit in Nursing Home (up to 30 days) S$100 S$50 S$150 S$75
Hospital Expenses
(due to illness)
S$1,000 S$500 S$1,500 S$750
No Claim Bonus 15% 15%
our premiums

Premiums for Starter Plan – Pay less for year-round protection with 1 month free coverage for Annual Premium plan

Age group Annual Premium
(with GST) Usual price
Annual Premium with 1 month free coverage
(with GST) Limited time only
Child
1 - 17
(extendable to 25)

S$205.44

S$188.32

Adult
18 - 30

S$231.12

S$211.86

31 - 40

S$282.48

S$258.94

41 - 50

S$346.68

S$317.79

51 - 60

S$410.88

S$376.64

61 - 65
(for renewal only)

S$564.96

S$517.88 

Premiums for Starter Plan – Pay less for year-round protection with 1 month free coverage for Annual Premium plan

Child

1 - 17
(extendable to 25)
Annual Premium
(with GST)

S$205.44

Usual price
Annual Premium with 1 month free coverage
(with GST)

S$188.32

Limited time only

Adult

18 - 30
Annual Premium
(with GST)

S$231.12

Usual price
Annual Premium with 1 month free coverage
(with GST)

S$211.86

Limited time only
31 - 40
Annual Premium
(with GST)

S$282.48

Usual price
Annual Premium with 1 month free coverage
(with GST)

S$258.94

Limited time only
41 - 50
Annual Premium
(with GST)

S$346.68

Usual price
Annual Premium with 1 month free coverage
(with GST)

S$317.79

Limited time only
51 - 60
Annual Premium
(with GST)

S$410.88

Usual price
Annual Premium with 1 month free coverage
(with GST)

S$376.64

Limited time only
61 - 65
(for renewal only)
Annual Premium
(with GST)

S$564.96

Usual price
Annual Premium with 1 month free coverage
(with GST)

S$517.88 

Limited time only

*Annual premiums for renewal (age 61 to 65) for Starter and Essential plans are S$517.88 (U.P. S$564.96) and S$776.82 (U.P. S$847.44) respectively.

Premiums for Essential Plan – Pay less for year-round protection with 1 month free coverage for Annual Premium plan

Age group Annual Premium
(with GST) Usual price
Annual Premium with 1 month free coverage
(with GST) Limited time only
Child
1 - 17
(extendable to 25)

S$308.16

S$282.48

Adult
18 - 30

S$346.68

S$317.79

31 - 40

S$423.72

S$388.41

41 - 50

S$520.02

S$476.68

51 - 60

S$616.32

S$564.96

61 - 65
(for renewal only)

S$847.44

S$776.82

Premiums for Essential Plan – Pay less for year-round protection with 1 month free coverage for Annual Premium plan

Child

1 - 17
(extendable to 25)
Annual Premium
(with GST)

S$308.16

Usual price
Annual Premium with 1 month free coverage
(with GST)

S$282.48

Limited time only

Adult

18 - 30
Annual Premium
(with GST)

S$346.68

Usual price
Annual Premium with 1 month free coverage
(with GST)

S$317.79

Limited time only
31 - 40
Annual Premium
(with GST)

S$423.72

Usual price
Annual Premium with 1 month free coverage
(with GST)

S$388.41

Limited time only
41 - 50
Annual Premium
(with GST)

S$520.02

Usual price
Annual Premium with 1 month free coverage
(with GST)

S$476.68

Limited time only
51 - 60
Annual Premium
(with GST)

S$616.32

Usual price
Annual Premium with 1 month free coverage
(with GST)

S$564.96

Limited time only
61 - 65
(for renewal only)
Annual Premium
(with GST)

S$847.44

Usual price
Annual Premium with 1 month free coverage
(with GST)

S$776.82

Limited time only

*Annual premiums for renewal (age 61 to 65) for Starter and Essential plans are S$517.88 (U.P. S$564.96) and S$776.82 (U.P. S$847.44) respectively.

HospitalWise Proposal Form

Underwritten by Great Eastern General Insurance Limited (Reg. No. 1920 00003W)
A wholly-owned subsidiary of Great Eastern Holdings Limited and a member of the OCBC Group

Important Notes:

  1. Statement pursuant to Section 25(5) of the Insurance Act (Cap 142) (or any subsequent amendment thereof), you are to disclose in this proposal form, fully and faithfully, all the facts you know, or ought to know, which may affect the insurance cover you are applying for. Otherwise, you may receive nothing from the policy.
  2. This policy is subject to the Premium Before Cover Warranty Clause, which requires the premium to be paid and received on or before the inception date of the policy.
  3. This plan is protected under the Policy Owners’ Protection Scheme which is administered by the Singapore Deposit Insurance Corporation (SDIC). Coverage for your policy is automatic and no further action is required from you. For more information on the types of benefits that are covered under the scheme as well as the limits of coverage, where applicable, please contact Great Eastern or visit the General Insurance Association (GIA) or SDIC websites (www.gia.org.sg or www.sdic.org.sg).
1
Particulars of proposer
2
Particular(s) of insured person(s)
3
Plan selection
4
General questions
5
Declaration and submit
Submitted

Particulars of proposer

If you are purchasing HospitalWise for your child, please ensure that you (the proposer) and/or your spouse are purchasing this plan in the same application.

Are you buying this insurance for yourself?
Salutation
Gender
Nationality
Marital Status
Mobile Number
Home Number

Particular(s) of insured person(s)

Eligible Entry Age:

  • Adult(s) aged between 18 and 59 (both ages inclusive)
  • Child(ren) aged between 1 and 17, or up to age 25 (all ages inclusive) if pursuing full-time education in a recognized tertiary education institution
Relationship
Gender
Nationality
Please note that you can only purchase HospitalWise for your child if you (the proposer) and/or your spouse are purchasing this plan in the same application.
Relationship
Gender
Nationality
Please note that you can only purchase HospitalWise for your child if you (the proposer) and/or your spouse are purchasing this plan in the same application.
Relationship
Gender
Nationality
Please note that you can only purchase HospitalWise for your child if you (the proposer) and/or your spouse are purchasing this plan in the same application.
Relationship
Gender
Nationality
Please note that you can only purchase HospitalWise for your child if you (the proposer) and/or your spouse are purchasing this plan in the same application.

Plan selection

Please select your preferred plan type and indicate the premium applicable for each Insured Person. The same plan type will apply to all Insured Person(s) in the proposal.

The premium is payable by Credit Card (Visa/MasterCard) only. A representative from Great Eastern will contact you to assist in completing the premium payment once the form is submitted.

General questions

1. Does the person(s) to be insured suffer or have suffered from any physical impairment or deformity or prolonged and/or recurring illness of any kind?

2. Have the person(s) to be insured undergone any surgical operation or been confined or treated in hospital/medical institution within the last 5 years, or is any treatment currently being performed or any operation/hospital confinement scheduled?

If your answer is “yes” to Question 1 and/or 2, please provide details of date/duration/place of hospitalisation, medical conditions, attending physician.

3. Has the application by the person(s) to be insured ever been declined or accepted at other than normal terms by any Insurance Company(ies) including Great Eastern General Insurance Limited?

If your answer is “yes” to Question 3, please provide details.

Declaration

  1. I declare that I am aware that I can seek advice from a qualified adviser before I submit this proposal form. Should I choose not to, I take sole responsibility to ensure that this product is appropriate to my financial needs and insurance objectives.
  2. I declare that the information given in this application is true and that no material fact(s), that is, fact(s) likely to influence the assessment and acceptance of this application have been withheld and to the best of my knowledge and belief the information given herein is true and complete.
  3. I understand and agree that no insurance shall take effect until this application has been fully accepted, full payment is received and a policy is issued by Great Eastern General Insurance Limited (“GEG”).
  4. I understand and agree that the declarations and disclosures herein shall form the basis of the policy, and subject to the policy terms, conditions and exclusions.
  5. I hereby declare that I am aware that the benefits of this policy will not be payable if the losses in the policy occur as a result of pre-existing medical condition or disease declared/undeclared.
  6. I hereby declare that I am aware that the benefits of the policy will only be payable upon hospitalisation as a result of illness or an accident.
  7. I declare and agree that the policy shall not cover any bodily injury which arises in the course of the Insured Person's occupation if it falls within the following categories or involves the following activities:
    1. Police force personnel, fire service personnel, civil defence personnel, CISCO (the Commercial and Industrial Security Corporation) personnel or security officers or security guards or military personnel of any country or international authority, including National Service under Section 10 of the Enlistment Act Cap 93 of the Republic of Singapore, other than for reservist training under Section 14 of the Enlistment Act, Chapter 93 of Singapore.
    2. A chauffeur, despatch rider or a bus, taxi, delivery van or heavy vehicle driver, whether Part-time or Full-time.
    3. Professional divers, ship crews, workers on board vessels, oil and gas rig workers, offshore workers, stevedores, shipbreakers.
    4. Pilots, aircrew or any occupation involving aviation activities or air travel.
    5. construction workers, unskilled workers or any occupations involving height and/or works underground and/or travel beyond normal speed on land and/or handling of hazardous chemical/electricity, woodworking related occupations, welders or any occupations involving heat.
  8. I declare that no such insurance has been terminated in the last 12 months due to breach of any premium payment condition.
  9. I agree that the policy is issued as a Singapore policy expressed in Singapore dollars and all payments under the policy, whether to or by GEG will be payable in Singapore dollars. I also agree that the policy will be entered in the register of Singapore policies.
  10. I understand and agree that an electronic record of this proposal form shall have the same effect as that of an original.

Policy Application, Service and Administration

Where the proposer(s) is/are an individual or individuals, by providing the information set out above, the proposer(s) agree and consent to Great Eastern and its related corporations (collectively, the "Companies"), as well as their respective representatives, agents, the Companies' authorised service providers and relevant third parties (the Companies and all the other foregoing parties, collectively, “Great Eastern Persons”), collecting, using and/or disclosing the proposer(s)' personal data, for purposes reasonably required by the Companies to evaluate the proposer(s)' proposal and to provide the products or services which the proposer(s) is/are applying for (including any policy renewals and policy upgrades, substitutions or replacements) and such other purposes as described in Great Eastern's Privacy Statement (collectively, the “Purposes”) which is accessible from Great Eastern Singapore's website, which the proposer(s) confirm the proposer(s) has/have read and understood.

Where the proposer is not an individual, the proposer hereby confirms and represents to Great Eastern and its related corporations (collectively, the "Companies"), as well as their respective representatives, agents, the Companies' authorised service providers and relevant third parties (the Companies and all the other foregoing parties, collectively, “Great Eastern Persons”), that the insured individuals of the Policy the proposer is applying for (“Insured Individuals”) have agreed and consented to the disclosure of their personal data to the Great Eastern Persons, for purposes reasonably required by the Great Eastern Persons to evaluate the proposal and to provide the products or services which the proposer is applying for, and such other purposes as described in Great Eastern's Privacy Statement (collectively, the “Purposes”) which is accessible from Great Eastern Singapore's website, and which the proposer confirms it has read and understood. In respect of the Insured Individuals who are subsequently enrolled into the Policy, the proposer further undertakes that it shall ensure and procure that each Insured Individual has provided such agreement and consent in relation to his/her personal data for the Purposes.

OCBC Marketing consent

Before submitting your application, please read and understand the following:

  1. HospitalWise is offered and provided by GEG, and not OCBC.
  2. I authorise the transfer of the above information provided by me from OCBC to GEG for my application.
  3. I have reviewed and confirm that the information I have provided in this application is true, accurate and complete.

We have received your submission.

A representative from Great Eastern will contact you by email or phone call within the next working day to assist you in completing your application for the HospitalWise policy.

For any enquiries, you can email us at GICare-sg@greateasterngeneral.com or contact +65 6248 2888 on Mondays to Fridays, 9.00am to 5.30pm excluding public holidays.


Reference No.:

Date and time:

Disclaimer

The above is for general information only. It is not a contract of insurance. It does not constitute an offer to buy an insurance product or service. It is also not intended to provide any insurance or financial advice. This document does not take into account your particular investment and protection aims, financial situation or needs. Please ask a financial adviser for advice about whether the insurance product is suitable for you before you commit to buying the product. If you choose not to get advice from a financial adviser, you should consider whether the product is suitable for you. If you decide that the policy is not suitable after purchasing it, you may terminate the policy in accordance with the free look provision, if any, and the insurer may recover from you any expense incurred by the insurer in underwriting the policy. The precise terms and conditions of the plans are specified in the insurance policy contract. It is usually detrimental to replace an existing accident and health plan with a new one. A penalty may be imposed for early plan termination and the new plan may cost more, or have less benefits at the same cost. HospitalWise is underwritten by Great Eastern General Insurance Limited, a wholly-owned subsidiary of Great Eastern Holdings Limited and member of the OCBC Group. HospitalWise is not a bank deposit or obligation of, or guaranteed by OCBC Bank.

No representation or warranty whatsoever (including without limitation any representation or warranty as to accuracy, usefulness, adequacy, timeliness or completeness) in respect of any information (including without limitation any statement, figures, opinion, view or estimate) provided herein is given by OCBC Bank and it should not be relied upon as such. OCBC Bank does not undertake an obligation to update the information or to correct any inaccuracy that may become apparent at a later time. All information presented is subject to change without notice. OCBC Bank shall not be responsible or liable for any loss or damage whatsoever arising directly or indirectly howsoever in connection with or as a result of any person acting on any information provided herein.