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What Is a Pre-Authorisation Certificate in Singapore, and Why Do You Need It?
21 Aug 2025
Insurer Great Eastern (GE) announced on 17 June that it would pause issuing pre-authorisation certificates for its policyholders admitted to Mount Elizabeth and Mount Elizabeth Novena hospitals, citing high costs.
The move came as a surprise to both hospitals, GE agents themselves, and, of course, to GE policyholders.
However, even without pre-authorisation certificates, both hospitals can still issue letters of guarantee and file claims to GE for those who have upcoming treatments or surgeries.
But what does it all mean? Will patients have to pay out-of-pocket for their medical treatment? Yes — technically, all policyholders, regardless of insurer, must co-pay at least 5% of their bill under government regulations. This amount is usually covered by your MediSave, and possibly more if you have a rider. However, without a pre-authorisation certificate from your insurer, you may need to pay the full bill in cash first upon discharge, and claim it back later. Will other insurers follow suit? Some (e.g. AIA, Income) will continue to issue pre-authorisation certificates. What options do you have? We break it down.
What is a certificate of pre-authorisation?
A certificate of pre-authorisation (CPA), also known as a pre-authorisation certificate, is a document issued by your insurer to confirm that a specific medical treatment, procedure, and its estimated costs have been reviewed and approved before the treatment takes place. It provides assurance that your insurer has agreed to cover the treatment under your policy terms, often with a panel specialist at a panel hospital. A CPA helps reduce the risk of claim disputes later, but it does not eliminate your co-payment obligations (e.g. 5% minimum) or cover non-claimable items.
What is a letter of guarantee?
A letter of guarantee (LOG) is a document issued by your insurer to the hospital before admission. It reduces or waives the upfront cash deposit typically required for surgery or treatment. It serves as a commitment from the insurer to cover a portion of the bill, usually based on the insured amount and policy terms. However, it does not guarantee full claim approval. The insurer may still review the claim after discharge and can reject or adjust the amount if the treatment isn’t covered, is deemed non-essential, or exceeds your policy limits. You will still be responsible for any co-payment (minimum 5%), deductibles, or non-covered charges, and may be asked to settle the balance
What is the difference between a pre-authorisation certificate and a letter of guarantee?
Both the pre-authorisation certificate and the letter of guarantee can help ease the financial and administrative process of getting medical treatment, but they serve very different purposes. Here’s a quick comparison to help you understand which offers stronger assurance — and when each is used.
Feature | Pre-authorisation certificate
| Letter of guarantee |
|---|---|---|
Confirms claims approval? |  Yes, subject to approval |  No (just facilitates payment) |
Issued before treatment? | Yes | Yes, but closer to admission |
Reduces upfront deposit? |  May help indirectly | Yes, directly reduces deposit |
Still subject to review? | Rarely, but yes | Yes |
Process of issuing pre-authorisation certificates and letters of guarantee
If you receive a diagnosis that requires hospital admission — either as an inpatient or for day surgery — the specialist clinic will advise you on the cost of treatment and provide financial counselling.
The specialist clinic will then seek pre-authorisation from your insurer. If approved, your insurer will issue a certificate of pre-authorisation (CPA). You should present this CPA to the hospital’s business office during admission to get a cashless discharge.
Your insurer may also issue a LOG to ensure that payment for hospitalisation is covered by insurance. Not all insurers issue the LOG as it is not needed.
If you are an inpatient or undergoing day surgery, the hospital will assist you in navigating the administrative process by e-filing the final bill directly to your insurer. This means that you do not need to pay any cash up front for medical treatment, giving you the space to focus on your recovery.
Insurers that issue pre-authorisation certificates
Great Eastern’s recent move to pause pre-authorisation certificates for admissions at Mount Elizabeth Orchard and Mount Elizabeth Novena may have come as a surprise — but it’s not the only insurer without a traditional CPA process.
Here’s a breakdown of major insurers and whether they issue CPAs:
Insurer | Integrated Shield Plan | Issues certificate of
pre-authorisation (CPA) |
|---|---|---|
Great Eastern | GREAT SupremeHealth | Paused for Mount Elizabeth
Hospitals only |
AIA | AIA HealthShield Gold Max | Yes |
Prudential | PRUShield | Yes |
HSBC | HSBC Life Shield | Yes |
Raffles | Raffles Shield | Yes |
Income | IncomeShield | No |
Singlife | Singlife Shield | No (uses PAL for preferred
providers) |
While not all insurers issue CPAs, this doesn’t mean your treatment isn’t claimable. For example, Singlife provides cashless admission through a Pre-Admission Letter (PAL) when you visit its preferred medical providers — no CPA needed.
Income, on the other hand, requires all claims to be submitted electronically via MOH’s system after treatment. According to their website:
“All claims have to be submitted electronically by the hospital/medical institution through the system set up by the Ministry of Health.”
Ultimately, even without a CPA, you can still make claims — though you may need to pay upfront and seek reimbursement later.
Got more questions? We answer some of the most common ones below.
Can an insurer reject pre-authorisation?
Yes, insurers can reject a certificate of pre-authorisation (CPA) request. Common reasons include:
- The treatment cost exceeds your policy’s coverage limits
- The estimated bill is significantly higher than what the insurer deems reasonable
- The treatment is not considered medically necessary by the insurer
- The treatment is being performed by a doctor or hospital outside the insurer’s approved panel
Even if pre-authorisation is rejected, it doesn’t always mean you can’t proceed with treatment — it just means your insurer hasn’t agreed to cover it in advance. You may still claim for it later, subject to assessment.
In most cases, if you’re a Singaporean or PR with an Integrated Shield Plan (IP) and have held your rider for at least a year, no upfront deposit is required during admission — particularly when treated at panel hospitals.
Can I change insurers?
Yes, you can switch insurers — but it’s not always necessary, and not always beneficial.
Before making the switch, here are some important things to consider:
- Pre-existing and chronic conditions matter: If you have any pre-existing medical conditions, chronic conditions, or exclusions in your current plan, the new insurer may not cover them. You may face exclusions, loadings (higher premiums), or even rejection.
- Higher costs: Premiums at another insurer may be more expensive, especially if you’re older or have had health issues since your first policy.
- Loss of coverage continuity: Switching could reset your waiting period for certain claims or benefits. This is especially important for those with Integrated Shield Plan (IP) riders.
- No real need: Most IPs offer similar core coverage under MediShield Life. The main differences lie in the private insurer’s benefits, panel arrangements, and rider options — which may be better adjusted within your current insurer than starting over.
If you’re still considering a switch, always:
Tip: If your current plan meets your needs, consider adjusting your rider or panel doctor arrangement instead of switching providers altogether.
What happens to GE policyholders who are going through treatment at Mount Elizabeth Hospital?
If you’re a Great Eastern policyholder currently receiving treatment at Mount Elizabeth Hospital, rest assured — you will still receive the care you need.
In a statement to The Straits Times, IHH Healthcare Singapore’s Chief Operating Officer, Mr Yong Yih Ming, reassured patients that cashless admission remains available, even though Great Eastern has paused the issuance of pre-authorisation certificates for the hospitals.
He also noted that the hospitals are working closely with their specialists to offer transparent price packages, helping patients better manage their medical expenses.
Can a patient with pre-planned treatment still go to the hospital? What happens to patients with history in the hospital?
Yes — Great Eastern policyholders can still seek treatment at Mount Elizabeth hospitals, including those with upcoming procedures or a history of care at the facility.
According to IHH Healthcare Singapore’s COO Yong Yih Ming, these patients will continue to enjoy cashless admission despite Great Eastern’s temporary pause on issuing pre-authorisation certificates. There is no need to worry about upfront cash payments — existing arrangements remain in place to ensure continuity of care.