{"id":4029,"date":"2020-08-06T08:00:00","date_gmt":"2020-08-06T00:00:00","guid":{"rendered":"https:\/\/www.pzl.sg\/blog\/?p=4029"},"modified":"2025-12-13T07:10:53","modified_gmt":"2025-12-12T23:10:53","slug":"life-insurance-association-singapore-critical-illness-framework","status":"publish","type":"post","link":"https:\/\/www.pzl.sg\/blog\/life-insurance-association-singapore-critical-illness-framework\/","title":{"rendered":"Life Insurance Association Singapore (LIA) Critical Illness Framework 2020"},"content":{"rendered":"\n

Overall, the Life Insurance Association Singapore (LIA) Critical Illness framework strives to balance both the insurers’ and the consumers’ interest. This is for the purpose of offering clear and consistent coverage across the insurance industry. With this in mind, let’s understand how the framework works in Singapore.<\/p>\n\n\n\n

Table of Contents:<\/h3>\n\n\n\n
    \n
  1. When to apply the LIA Critical Illness framework<\/a><\/li>\n\n\n\n
  2. 90-Day Waiting Period<\/a><\/li>\n\n\n\n
  3. Summary<\/a><\/li>\n<\/ol>\n\n\n\n

    Part 1: When to apply the LIA Critical Illness framework<\/h2>\n\n\n\n

    Altogether, the LIA has put together a standard list of 37 medical conditions<\/strong>. In detail, this list was compiled by way of common definitions. At the same time, the definitions covers the “severe” stage<\/strong> of the respective medical conditions. Let’s go through three examples to have a better understanding to this end.<\/p>\n\n\n\n

    \"LIA
    LIA Critical Illness Framework 2019: Industry List of 37 Critical Illnesses<\/figcaption><\/figure>\n\n\n\n

    Scenario 1.1: An insurer covers a medical condition on the LIA Critical Illness framework. Additionally, this benefit is provided at the \u201csevere\u201d stage.<\/h3>\n\n\n\n

    On this occasion, there are two things that the insurer must comply with:<\/p>\n\n\n\n

      \n
    1. Firstly, the insurer must follow the name used on the LIA\u2019s list of 37 medical conditions.<\/li>\n\n\n\n
    2. Next, it must adopt the LIA\u2019s common definition for the medical condition.<\/li>\n<\/ol>\n\n\n\n

      To illustrate, let\u2019s assume that the insurer wants to provide coverage for the severe stage of Lung Disease. Seeing that this condition is on<\/strong> the LIA Critical Illness framework, the insurer needs to adopt the name \u201cEnd Stage Lung Disease\u201d. By the same token, the insurer will need to adopt the LIA\u2019s definition to admit the claim.<\/p>\n\n\n\n

      Despite that, there is no minimum<\/strong> number of medical conditions that an insurer must cover. For instance, some insurers only cover 36 medical conditions for the \u201csevere\u201d stage critical illness.<\/p>\n\n\n\n

      Scenario 1.2: An insurer covers a medical condition on the LIA Critical Illness framework. However, this benefit is provided at the \u201cmildly-moderately severe\u201d stage, or the \u201cextremely severe\u201d stage.<\/h3>\n\n\n\n

      In other words, the insurer wants to provide coverage for a medical condition on the LIA\u2019s list. However, this coverage is not<\/strong> at the \u201csevere\u201d stage.<\/p>\n\n\n\n

      To demonstrate, an insurer wants to provide an early stage cover for Lung Disease. (Recall: The name for \u201csevere\u201d stage lung disease is \u201cEnd Stage Lung Disease\u201d.)<\/p>\n\n\n\n

      In this case, Life Insurance Association Singapore does not<\/strong> provide any names or definitions. Hence, the insurer may give its own \u201cname\u201d for the medical condition, e.g. \u201cSevere Asthma\u201d. In like manner, the insurer may use its own definition<\/strong> to admit a claim for Severe Asthma.<\/p>\n\n\n\n

      Under those circumstances, different insurers may adopt a different definition for a similar medical condition. In order to protect your own interest, I will encourage you to read the definitions carefully. Otherwise, you won\u2019t know whether the scope of coverage is reasonable.<\/p>\n\n\n\n

      Example: Multi-Claim Critical Illness \u2013 Recurrent Heart Attack<\/strong><\/p>\n\n\n\n

      For example, this definition is extracted from Insurer A:<\/p>\n\n\n\n

      \n

      Another occurrence of a heart attack occurring after two years from the date of the last Diagnosis of any Critical Illness Stage<\/strong> of the Heart Attack of Specified Severity or the Relapsed Heart Attack.<\/p>\n<\/blockquote>\n\n\n\n

      By comparison, this definition is extracted from Insurer B:<\/p>\n\n\n\n

      \n

      Defined as a separate Heart Attack and not a progression<\/strong> of the previous one(s). The cardiologist must certify that the Heart Attack as diagnosed for the subsequent claim is at a different location of the heart<\/strong> from the previous Heart Attacks(s). Furthermore, there is a waiting period of two years from the date of diagnosis of severe stage<\/strong> critical illness claimed.<\/p>\n<\/blockquote>\n\n\n\n

      Basically, Insurer A does not impose any restrictions on the location for the second heart attack. If you had a heart attack once, then what is the chance that the same<\/strong> coronary artery becomes blocked again?<\/p>\n\n\n\n

      Scenario 1.3: An Insurer covers a medical condition that is not on the LIA Critical Illness framework.<\/h3>\n\n\n\n

      In this situation, the insurer may use their own definitions<\/strong> in respect of all stages<\/strong> of illness progression.<\/p>\n\n\n\n

      Take the case of AIA Singapore where it covers 43 medical conditions for some of its critical illness benefits. For the same reason, it will follow the LIA\u2019s framework for the 37 medical conditions. Thereafter, AIA will adopt its own definitions for the 6 conditions that are not on the LIA Critical Illness framework.<\/p>\n\n\n\n

      For instance, the insurer may wish to cover brain damage and this is not on the LIA Critical Illness framework. Therefore, it may give the condition its own name, e.g. \u201cAcquired Brain Damage\u201d. In the same way, the insurer will define the situation when a claim is admissible to that end.<\/p>\n\n\n\n

      Part 2: 90-Day Waiting Period<\/h2>\n\n\n\n

      Above all, there is a 90 day waiting period for the below mentioned critical illnesses at the severe stage:<\/p>\n\n\n\n