Extended Panel

Extended Panel (EP) is an initiative by the Multilateral Healthcare Insurance Committee (MHIC), which is appointed by the Ministry of Health (MOH), to allow integrated Shield Plan (IP) insurers to recognise each other’s panel doctors mutually. Under the EP, you may enjoy selected panel benefits when seeking pre-authorised treatments from specialists that are not on our panel, as long as they are on other Integrated Shield Plan insurers’ panels, follow our fee schedule, and meets our pre-authorisation terms and conditions. This provides policyholders a wider choice of doctors and supports better continuity of care for patients.

Extended Panel (EP) will be launched to customers with a PRUExtra plan on 7 June 2022.

Extended Panel (EP) is currently available for customers who have the following PRUExtra riders:

PRUExtra Premier

PRUExtra Premier CoPay

PRUExtra Preferred CoPay

PRUExtra Plus CoPay

PRUExtra Premier Lite CoPay

PRUExtra Plus Lite CoPay

A specialist qualifies as an Extended Panel (EP) specialist if he or she meets all of the following conditions:

is on the main panel of another IP insurer

has obtained pre-authorisation approval from us,

follows our fee schedule, and

meets pre-authorisation terms and conditions

The Extended Panel (EP) initiative gives Prudential’s customers even more options to seek treatment from specialists they prefer, even if the chosen specialists are not on Prudential’s panel, as long as the chosen specialists are on the main panel of another Integrated Shield Plan (IP) insurer.

When you choose to seek a pre-authorised treatment with an EP specialist, you can continue to enjoy selected panel benefits that comes with your plan. The benefits will differ based on the plan you have and whether the EP specialist provides the treatment at our Partner Healthcare Institution (Hospital or treatment centre) or not.

Benefits for PRUExtra Premier, PRUExtra Premier CoPay and PRUExtra Preferred CoPay Customers when using an EP

Here is a comparison of the benefits you enjoy when your EP specialist provides treatment at our PRUPanel Connect (PPC) Partner Healthcare Institution vs non-PRUPanel Connect (PPC) Partner Healthcare Institution.

For a list of PRUPanel Connect (PPC) Partner Healthcare Institution, visit https://www.prudential.com.sg/ppc

Benefits	Treatment at PRUPanel Connect (PPC) Partner Healthcare Institution	Treatment at non- PRUPanel Connect (PPC) Healthcare Institution
Pre-Authorisation of Claim	✔	✔
$3,000 co-payment cap per Policy Year for CoPay riders	✔	✔
1 level limit increase under the Claims-based pricing approach	✔	✘
Cashless medical treatment with a higher Letter of Guarantee amount	✔	✘
Value added services (i.e. concierge, transport, appointment booking)	✔	✘

Important Note: If you choose to seek treatment from a specialist who is not on Prudential’s Panel and also not an EP specialist, or if the specialist has not obtained the pre-authorisation before an admission/day surgery, you will not be able to enjoy the benefits listed above. For PRUExtra Preferred CoPay, the above benefits are not applicable for Private Hospitals and medical institutions under “No Access”.

Benefits for PRUExtra Plus CoPay, PRUExtra Premier Lite CoPay and PRUExtra Plus Lite CoPay Customers when using an EP

Here is a comparison of the benefits you enjoy when your EP specialist provides treatment at our PRUPanel Connect (PPC) Partner Healthcare Institution vs non-PRUPanel Connect (PPC) Partner Healthcare Institution.

For a list of PRUPanel Connect (PPC) Partner Healthcare Institution, visit https://www.prudential.com.sg/ppc

Benefits	Treatment at PRUPanel Connect (PPC) Partner Healthcare Institution	Treatment at non- PRUPanel Connect (PPC) Healthcare Institution
Pre-Authorisation of Claim	✔	✔
$3,000 co-payment cap per Policy Year for CoPay riders	✔	✔

Important Note: If you choose to seek treatment from a specialist who is not on Prudential’s Panel and also not an EP specialist, or if the specialist has not obtained the pre-authorisation before an admission/day surgery, you will not be able to enjoy the benefits listed above.

No, it is not compulsory. However, you will not be able to enjoy the benefits of being treated by an EP specialist if you choose to seek treatment from a specialist who is not on Prudential's Panel and also not an EP specialist.

Prudential does not require specialists to submit an application to be a part of our Extended Panel. As long as the specialist meets all the conditions of an EP specialist, he or she is deemed as an EP specialist.

EP Specialists may treat Prudential policyholders at any PPC or non-PPC Healthcare Institution. However, do note that benefits when using an Extended Panel may vary for PPC and non-PPC Healthcare Institutions. Please refer to the benefits of being treated by an EP specialist for a comparison.

Once you have selected your specialist, inform the clinic staff that you need their assistance to submit a pre-authorisation request to Prudential. Selected panel benefits are only available if the EP specialist has obtained pre-authorisation approval from Prudential, meets the terms and conditions and follows our fee schedule as laid down in the pre-authorisation certificate.

The specialist will need to submit 2 forms to Prudential for pre-authorisation purposes, namely the pre-authorisation form and the patient consent form, which are available at https://www.prudential.com.sg/ppc on 7 June 2022.

To be eligible for panel benefits when using an EP, it is mandatory to seek treatment from a specialist that meets the conditions.

Step 1: Specialist to book a date with the Healthcare Institution for the treatment

Step 2: Submit a pre-authorisation request to pre.auth@prudential.com.sg.

Step 3: Prudential processes the pre-authorisation request. In case approval is granted, EP Specialist must meet the terms and conditions, including specialists fees, as stated in the pre-authorisation certificate.

Step 4: E-File claim directly through Healthcare Institution as per terms on the basis of which the pre-authorisation certificate was granted

If all the above criteria are met and the claim is approved, the claim would be granted panel benefits when using an Extended Panel.

We will require between 1- 3 working days from the date we receive the completed pre-authorisation form and supporting documents. In the event further clarification is required, we may take longer to review the request.

We will issue the certificate of pre-authorisation stating the amount approved for the specific medical diagnosis, treatment date and procedures to the applicant.

Generally, we decline pre-authorisation requests due to policy exclusions, outstanding premiums or inadequate medical information necessary for assessing the pre-authorisation request.

The hospital has absolute discretion in determining whether a deposit is still required, even with the approved certificate of pre-authorisation.

If you are switching from a non-EP specialist to an EP specialist (within the same Policy Year) and have claimed from PRUShield prior to the switch to an EP specialist, you will be eligible for the stop-loss benefit but not eligible for 1 level limit increase under the Claims-based pricing approach.

Within the same Policy Year	Treatment at PPC Healthcare Institution	Treatment at a non-PPC Healthcare Institution
First Claim: Non-EP specialist (Before, on or after 7 Jun 2022)	No Stop-Loss Not eligible for 1 level limit increase under the Claims-based pricing approach
Second Claim: EP specialist (On or after 7 Jun 2022)	Stop-Loss Not eligible for 1 level limit increase under the Claims-based pricing approach

Yes, all admissions will have to be at a PRUPanel Connect Partner Healthcare Institution in order for you to enjoy the 1 level limit increase due to claims-based pricing.

EP benefits are applicable only for inpatient hospitalisation, day surgery claims, and pre- and post-hospitalisation claims where the main inpatient or day surgery claim has been approved as an EP case. EP benefits do not apply to outpatient treatments.

We are launching the EP programme on 7 June 2022. Admission before 7 June 2022 with an EP will not be eligible for any panel benefits.

Integrated Shield Plan (IP) insurers may adopt different approaches to rolling out EP. Some have chosen to provide EP to customers only after the next policy renewal while others have chosen to roll out the benefits to all customers on a fixed date.

No, panel benefits will only be granted when your treatment at an EP is pre-authorised, follow our fee schedules and meet pre-authorisation terms and conditions at the point of claim. Please note that a specialist may opt not to activate EP, depending on the case.