MOH to enhance MediShield Coverage

MOH seeks views on proposed MediShield coverage extension
By Vimita Mohandas / Sara Grosse, Channel NewsAsia, 18 Jul 2012

The Ministry of Health (MOH) has proposed enhancements to MediShield, its catastrophic illness insurance scheme, to provider greater coverage from the first quarter of next year.

MOH is proposing to extend coverage and increase payouts, but this means premiums will also be raised. However, it said that for the vast majority of MediShield policyholders, the increase will be less than S$10 per month.

The ministry plans to increase the annual policy limit from the current S$50,000 to S$70,000. The lifetime claim limit will also be raised from S$200,000 to S$300,000.

For Job Loei, who has been receiving dialysis treatment at the National Kidney Foundation for the past 18 years, the proposed increase of S$100,000 will be a welcome relief.

Mr Loei depends on MediShield and subsidies to reduce his monthly treatment costs from about S$1,800 to S$300. When he uses up the lifetime claim limit, his cash expenses will escalate to S$1,000 per month.

"My son is going to university next year and he's going to study in London. We are trying to apply for scholarship, but we are still waiting. This MediShield will come in very handy because with MediShield, then I don't have to worry about my financial constraints," he said.

"But if my MediShield is depleted then I will be worried because I'm not sure how I am going to help him. How am I going to support him for his studies? And moreover, I'm also the sole breadwinner. My wife has to look after her mum and my parents are also ageing."

The proposed increase in lifetime claim limit will help to cover his expenses for the next eight years, provided he does not incur any huge hospitalisation or medical bills.

The Health Ministry says MediShield claims have increased -- both in terms of the number of claims and the average payout per policyholder -- since 2008 when the MediShield scheme was last adjusted.

The number of claims per policy holder has increased by 9 per cent per year.

The average payout per policyholder has also risen by 12 per cent per year, due to inflation of medical costs by some 3 per cent a year.

Minister for Health Gan Kim Yong said: "First, the underlying inflation is between two and three per cent. This is generally in line with our top line inflation over the last few years.

"We also see a growing and greying population so we tend to use healthcare facilities more often and because of improved accessibility over the years, our population would then have better access so they tend to access healthcare facilities more often than before."

"The third component is the result of new technology, new methods of treatment and new drugs that are more effective and better. So with these new drugs and technology, it tends to be more expensive. So the overall cost will go up," he added.

With enhanced coverage and payouts, MediShield deductibles will also be adjusted accordingly.

The deductible for Class C bills will be increased from S$1,000 to S$1500 and S$1,500 to S$2,000 for Class B2 bills. The deductible is the amount of a hospital bill that patients have to pay before claiming insurance.
Premiums are also set to rise slightly under the proposed amendments.

Mr Gan said: "I understand that patients will be concerned about the affordability of both the premium as well as the deductible. And that's why earlier this year we announced the introduction of the one-time Medisave top-up to help with the payment of MediShield adjusted premiums.

"With the top-up, most Singaporeans will see the impact of not more than S$5 per month equivalent over the next few years. For the older Singaporeans many of them will actually see a reduction."

"For those who have to face higher deductibles, we have GST Voucher on Medisave which will go towards helping them pay their share of the co-payment. With GST Voucher, it will be enough to make up for the difference in premium and deductible," he added.

MOH also plans to extend MediShield coverage for treatment in short-stay wards in the Emergency Departments. The MediShield coverage will also be extended from age 85 to 90.

To help Singaporeans with mental illness, MediShield will also be extended to cover newly diagnosed patients who require inpatient psychiatric treatment. And as bills for subsidised inpatient treatment are generally lower, the daily claim sum will be S$100.

To encourage patients who are well to be discharged promptly, policyholders will be able to claim up to a maximum of 35 days of hospital stay per year.

MOH is also seeking public feedback on its plans to extend MediShield to cover congenital and neonatal conditions. A congenital disorder is a medical condition that is present at or before birth.

Kenneth Wee, whose five-year-old daughter Zoe was born with congenital conditions, said it would have helped if his family could have used MediShield to help pay for Zoe's treatments.

Zoe was born without a thumb on her left hand, and two thumbs on her right. Her parents later discovered she also had a hole in her heart.

To fix these medical conditions, Zoe underwent two major surgeries in the first year of her life. One surgery was to seal the hole in her heart, and the other to fuse her two thumbs together.

The surgeries cost her parents about $55,000, paid mostly through government subsidies and Medisave, but the couple still had to cough up some S$10,000 in cash for Zoe's medical bills.

Mr Wee said: "We were still quite a young family, so cash was always quite tight. It (being able to use Medishield) would have benefited us in terms of just easing a little bit of the financial burden."

Sylvia Mun, chief medical social worker at KK Women's and Children's Hospital, said: "What we normally see is that in a dual income family, one of the parents actually gives up their job to care for the child so it means a reduction in income for the family.

"The reality right now is that there are a lot of these families who are unable to actually put their children on insurance, the reason being that the (insurance) companies will say, 'we won't take it up because the child is born with a congenital problem'."

Currently, there are a handful of insurers that offer integrated shield plans for congenital abnormalities. Integrated shield plans are medical expense insurance policies that pay for hospitalisation costs, subject to limits.

There are five insurers that offer such plans: AIA,. Aviva, Great Eastern Life, NTUC Income and Prudential.

A spokesperson from Life Insurance Association Singapore said the "as-charged" integrated shield plans provides congenital abnormalities benefit for the insured, subject to a 24-month waiting period.

To cover congenital and neonatal conditions, the Ministry of Health is proposing that the cost of coverage be S$12 a year.

Parents may choose to opt out of this during the auto-cover exercise, but the Health Ministry says a high opt-out rate would result in higher premiums. The MediShield opt-out rate for each newborn cohort is less than 5 per cent.

With the extension, all new-born Singaporeans will be covered from birth throughout their lifetime so long as they do not opt out. MOH said the bulk of the cost borne will be in the younger ages, from one year old to 20 years old.

Chairman of the Government Parliamentary Committee for Health Dr Lam Pin Min welcomed the change.

"We do see quite a number of parents whose children are born with congenital conditions. Unfortunately, at this point in time, the medical expenses will not be covered by any health insurance plans," Dr Lam said.

"And if the child needs to be admitted to the intensive care unit, the medical expenses can actually go up to hundreds of thousands of dollars. And this is really a huge burden on the average family."

"With the implementation of the MediShield for congenital conditions, I hope that parents will be encouraged to able to purchase this insurance for at least the peace of mind," he added.

So far, the public has given mixed views on the proposed extension, especially on the cost, which is why MOH is seeking more feedback.

Health Minister Gan said: "There are different aspects of costs as well - whether the costs ought to be shared in a risk pool manner or whether it ought to be borne by the parents and to what extent should we cover them. So there are many other aspects of congenital and neonatal issues that we need to consider."

The public consultation on the extension of MediShield coverage ends August 15.

All feedback can be submitted online through a feedback form, or emailed to moh_info@moh.gov.sg.

MOH proposes enhancements to Medishield

By Vimita Mohandas, Channel NewsAsia, 18 Jul 2012 

Singapore's Ministry of Health (MOH) is proposing to enhance MediShield, its catastrophic illness insurance scheme, to provide greater coverage from the first quarter of 2013.

Under the proposed enhancements, MOH will extend MediShield coverage to include congenital and neo-natal conditions.

This will be an auto-cover exercise, which means all future Singapore Citizens' and Permanent Residents' babies will be covered throughout their lifetime from birth unless their parents choose to opt out from the scheme.

MOH also intends to extend MediShield coverage to policyholders up to the age of 90; to newly-diagnosed patients who need inpatient psychiatric treatment; and to short-stay wards in the emergency departments.

With the proposed enhancements, patients will be able to claim up to S$70,000 for their hospital bills annually, compared with the current S$50,000.

The lifetime limit will also be increased from S$200,000 to S$300,000 to help policyholders who face exceptionally large bills such as undergoing multiple surgeries after an accident.

MOH says MediShield deductibles will also be adjusted accordingly, as medical bills have become more expensive over the years.

The last adjustment was made in 2005.

Other proposed adjustments include increasing the deductibles for Class C bills from S$1,000 to S$1500 and S$1,500 to S$2,000 for Class B2 bills. The deductible is the amount of a hospital bill that patients have to pay before claiming insurance.

As bills for subsidised inpatient psychiatric treatment are generally lower, the ministry will extend coverage with a daily claim limit of S$100.

With the proposed extended coverage and payouts, MediShield premiums will have to be raised. 

But the Health Ministry says for the vast majority of policyholders, the increase in premiums will be less than S$10 a month, and with the additional government support given at this year's budget, Singaporeans aged 65 and below will have to fork out no more than S$5 per month over the next two years.

For the elderly, their premiums will be largely offset by the annual and one-time Medisave top-ups, so they will in fact see a decrease in premiums payable.

The government is seeking public feedback on the proposed MediShield enhancements, including plans to extend MediShield to cover congenital and neonatal conditions.

MOH says the support of parents is important as a high opt-out rate would reduce the benefit of risk-pooling and result in escalating premiums.

The proposed coverage will cost about S$12 per year, or about S$1 per month.

A public consultation will be launched from July 18 to August 15 to gather feedback.