How CCRP Works

(A) Applicant submits Request for Determination (RFD) Application

(B) CCRP Secretariat reviews Application & confirms prevailing requirements fulfilled by Applicant. CCRP Secretariat will approach Respondent to obtain agreement. Payment will only be requested from Applicant once Respondent agrees to participate.

(C) Secretariat reviews Application to ascertain whether the determination sought by parties can be made through CCRP

(D) If suitable, Formation of CCRP Panel to be assigned to the case

(E) Review & Determination of Outcome by CCRP Panel

(F) Notification of Outcome

If not suitable, parties to be advised on alternative avenues

Applicant

IP Policyholder (Patient)
Medical Practitioner / Institution
IP Insurer

Eligibility Criteria Overview

Respondent
Doctor/Medical Institution
IP Insurer
Need to fulfil 3-incident trend threshold?
(2 past cases with similar trend + present case applying for resolution)
  • Over-charging
  • Over-servicing
Not Applicable
  • Over-charging
  • Over-servicing
  • Deviations from practice norms
Determination of whether a procedure was medically necessary
Non-payment of claim for medically necessary treatments/procedures
Not Applicable
NOT APPLICABLE
  • The disputes filed with the CCRP should be within six (6) months after the IP insurer's final reply to the IP policyholder (patient).
YES
  • The disputes filed with the CCRP should be within six (6) months after the IP insurer's final reply to the medical practitioner, medical institution or policyholder; and the earlier two cases must occur within last five (5) years.

  • The 3rd incident, i.e., the current ongoing unresolved dispute, will be the case being reviewed whilst the earlier two cases will serve as documentary proof.

Eligibility Criteria Overview

Applicant
IP Policyholder (Patient)
Doctor/Medical Institution
  • Over-charging
  • Over-servicing
IP Insurer
Determination of whether a procedure was medically necessary
Need to fulfil 3-incident trend threshold? (2 past cases with similar trend + present case applying for resolution)
NOT APPLICABLE
  • The disputes filed with the CCRP should be within six (6) months after the IP insurer's final reply to the IP policyholder (patient).
Applicant
Medical Practitioner / Institution
Doctor/Medical Institution
Not Applicable
IP Insurer
Non-payment of claim for medically necessary treatments/procedures
Need to fulfil 3-incident trend threshold? (2 past cases with similar trend + present case applying for resolution)
YES
  • The disputes filed with the CCRP should be within six (6) months after the IP insurer's final reply to the medical practitioner, medical institution or policyholder; and the earlier two cases must occur within last five (5) years.

  • The 3rd incident, i.e., the current ongoing unresolved dispute, will be the case being reviewed whilst the earlier two cases will serve as documentary proof.
Applicant
IP Insurer
Doctor/Medical Institution
  • Over-charging
  • Over-servicing
  • Deviations from practice norms
IP Insurer
Not Applicable
Need to fulfil 3-incident trend threshold? (2 past cases with similar trend + present case applying for resolution)
YES
  • The disputes filed with the CCRP should be within six (6) months after the IP insurer's final reply to the medical practitioner, medical institution or policyholder; and the earlier two cases must occur within last five (5) years.

  • The 3rd incident, i.e., the current ongoing unresolved dispute, will be the case being reviewed whilst the earlier two cases will serve as documentary proof.

Prevailing Requirements

CCRP is a voluntary process. Parties therefore need to enter a contractual agreement to have their dispute be heard and resolved by the CCRP and be bound by its decision, failing which either party may commence civil (court) action for breach of contract.

(A) Case Eligibility

Parties should attempt to resolve the disputes amongst themselves at first instance.


  • For example, policyholders with clinical-related issues against the IP insurers’ decision to turn down their claim, should show that they have not been able to resolve the dispute with the IP insurer before filing a request with the CCRP.

  • This is because all IP insurers have claims and complaints management capability that can deal with specific issues from an individual’s purchased IP Plan

A 3-Incidents Trend Threshold will apply to applications from IP Insurers, doctors and medical institutions (within a 5-year period).

The Application request must be filed with CCRP within 6 months after the IP insurer's final reply to the medical practitioner, medical institution or policyholder; and the earlier two cases must occur within the last five (5) years.

The 3rd incident, i.e., the current ongoing unresolved dispute, will be the case being reviewed whilst the earlier two cases will serve as documentary proof.

Exemption: The 3-incident trend threshold will not apply to application requests from policyholders.

Timeframe example for a Case

IP Policyholder (Patient)

Disputes not eligible (IP Insurer’s final reply dated before 1 May 2021)

1 May 2021

1st incident (unresolved)

Dispute eligible to be filed for CCRP evaluation (within 6 months from IP Insurer’s final reply)

1 Nov 2021

RFD Submitted on

31 Oct 2016

Medical Practitioners / Institutions / Clinics / IP Insurers / Corporate Entities

1 May 2021

1 Nov 2021

RFD Submitted on

Disputes eligible to be filed for CCRP evaluation (2 past incidents within a 5-period)

Dispute eligible to be filed for CCRP evaluation (within 6 months from IP Insurer’s final reply)

1st & 2nd incident (Past attempts to resolve)

3rd incident (unresolved)

For patient / IP Policyholder

Disputes not eligible (IP Insurer’s final reply dated before 1 May 2021)

1 May 2021

1 May 2021

1st incident (unresolved)

Dispute eligible to be filed for CCRP evaluation (within 6 months from IP Insurer’s final reply)

1 Nov 2021

RFB Submitted on

31 Oct 2016

1 May 2021

Medical Practitioners / Institutions / Clinics / IP Insurers / Corporate Entities

Disputes eligible to be filed for CCRP evaluation (2 past incidents within a 5-period)

1st & 2nd incident (Past attempts to resolve)

1 May 2021

1 Nov 2021

RFB Submitted on

Dispute eligible to be filed for CCRP evaluation (within 6 months from IP Insurer’s final reply)

3rd incident (unresolved)

(B) Evaluation & Review Process

Evaluation will be via an anonymous document-based review of statements and case materials submitted by the parties involved, i.e., parties need not be present.

Evaluation and decision will be made by an appointed CCRP panel (de-conflicted and anonymised to each other).

The CCRP Panel will comprise of 3 medical specialists from Academy of Medicine, Singapore (AMS) and 2 medical directors from selected IP insurer recommended by Life Insurance Association (LIA), and 1 non-voting layperson representative from Consumers Association Singapore (CASE).

CCRP Panel’s decision is final and there is no avenue for appeal.