Monday, 15 October 2012

Changes to MediShield to improve coverage from 1 March 2013

Premiums and deductibles will also be revised
By Salma Khalik, The Straits Times, 13 Oct 2012

SINGAPOREANS worried about hefty medical bills even as they live longer have a new lifeline from MediShield.

It is scrapping the maximum entry age - now 75 - for joining the low-cost catastrophic illness insurance scheme that will also pay out more from March. And it is extending coverage up to age 90.

The lifetime claim limit will go up from $200,000 to $300,000, while the maximum amount claimable each year will also rise, from $50,000 to $70,000.

Last year, 43 people reached the lifetime limit of $200,000, up from 11 people in 2010. Another 63 are close to the limit, having claimed more than $190,000.

More than 90 people had annual claims exceeding $50,000 in both 2009 and 2010. Figures for last year are not available yet.

The revisions to the lifetime and annual claim limits will allow these people to continue enjoying insurance coverage.

These were among various proposals put up by the Health Ministry in July, but the lifting of the entry age cap and allowing higher Medisave withdrawal to pay for premiums came from public feedback.

All the amendments to MediShield, which covers 92 per cent of the population, will take effect on March 1.

To cater to Singapore's rapidly ageing population, it will cover people up to age 90, from 85 now.

About 1,700 people aged 86 to 90 who were previously covered by MediShield will be invited to join the scheme again. They will have to pay premiums of $1,190 a year.

Yesterday, Health Minister Gan Kim Yong said that following public feedback, the maximum joining age of 75 will be removed, but anyone with pre-existing diseases will have such ailments excluded from coverage.

The insurance will not be expanded to babies born with congenital diseases or needing neonatal care. Mr Gan, speaking on the sidelines of a seniors' event at Republic Polytechnic, said these will form part of a bigger package to boost marriage and parenthood.

Other changes include allowing $100-a-day claims for acute psychiatric hospital care for up to 35 days a year.

Short stays at emergency departments will also be claimable.

To pay for these, premiums will go up by between $17 and $251 a year. The Government will give a one-off top-up to Medisave of between $50 and $400 for people on MediShield.

Deductibles - the amount patients have to pay before insurance kicks in - go up by $500: From $1,000 to $1,500 for C class, and from $1,500 to $2,000 for B2 and higher. There will be no change for those over age 80 as they already pay higher deductibles of $2,000 for C class and $3,000 for B2 and higher.

Mr Gan said MediShield is meant to cover big hospital bills, but today, it covers half the subsidised bills. With the change, it should cover about one in three C-class bills, he added.

"It is important to ensure that the deductible keeps pace with the bill size... so that premiums remain affordable," he said, noting that deductibles have to be adjusted periodically to keep pace with rising health-care costs.

To allow full payment of premiums with Medisave, the withdrawal limits will go up from $800 to $1,000 for those aged 76 to 80, and from $1,150 to $1,200 for those over 80.

But a request from the public to have Medisave pay for insurance riders, so patients will not need to pay either the deductible or co-payment, was rejected as the ministry fears such a move would "lead to overconsumption and overservicing of health care".

What MediShield changes mean
- What does higher deductibles mean?
It means that you will have to pay more before insurance kicks in. If you are a C-class patient, you will have to pay the first $1,500 before you can make a claim.

But this amount is cumulative, so it could come from more than one hospital stay during the insurance year.
- I haven't made any claims so why do I have to pay higher premiums?
Everyone in the same age band pays the same premium. Premiums have to go up so there is enough to meet the high claims by others.

Insurance is risk-pooling.

Everyone joins when they are healthy but, as the years go by, those who are well help those who are sick pay their big hospital bills.
- Why are psychiatric care claims limited to 35 days a year?
The Ministry of Health says this is to encourage patients who are well to be discharged promptly. Since this is a new inclusion, the limits may be reviewed as it gains experience with such claims.
- I'm getting psychiatric treatment. Will MediShield cover my bills only after March?
No, MediShield will not cover you for your mental illness since it was diagnosed before next March. Only those who are diagnosed after that date will be covered.
- I'm 87 and was covered by MediShield till I exceeded the maximum coverage age of 85. Since then, I've been diagnosed with a medical problem. Can I rejoin, now that coverage has been extended to age 90?
Yes, you can. So long as you were with MediShield till you were 85, the insurance will cover you for any medical conditions you suffer from.
- I'm 78 and have never been covered by MediShield. Can I join?
Yes, you can. But if you have a pre-existing disease such as a heart problem, the insurance will not cover you for treatments related to that. However, should you be hit by some other illness, such as cancer, you will be covered.
- Why does MediShield not cover people older than 90?
Health Minister Gan Kim Yong said this is because there are not many people over that age. Since MediShield is based on risk-pooling by people in similar age bands, with too few people in that age group it becomes ineffective.

Caring for babies with birth defects
Singapore Conversation will address health coverage for them: Minister
By Salma Khalik, The Straits Times, 13 Oct 2012

THE Ministry of Health is not rejecting the idea of using MediShield to cover babies born with neonatal problems or congenital defects. Rather, it wants it to be part of a bigger package on marriage and parenthood.

Health Minister Gan Kim Yong said yesterday that the ministry is, in principle, in favour of helping families pay for children's health-care costs.

But since this is now part of the Singapore Conversation, he added: "It is important for us to not look at these measures in isolation. We should look at it in a more comprehensive way."

He said the solution for the care of children born with medical problems could be a combination of MediShield and Medisave, or something else altogether.

He assured young couples planning to have children that such discussions should not take too long: "There are areas of the Conversation which could have an early harvest.

"The committee will discuss this quite soon and we hope we will come up with a decision quite shortly."

In 2010, about 9,000 babies were hospitalised for congenital and neonatal conditions in subsidised wards at public hospitals. Even though they were in B2 or C class wards, some 700 had bills that came to more than $5,000.

This is of concern to many would-be parents, and the idea of including such babies in the national health insurance scheme has come up several times over the past years.

Mr Gan said while many were supportive during feedback sessions on changes to be made to MediShield, some feared it might skew the behaviour of parents once they knew the bulk of the bill would be taken care of by insurance - leading to higher costs.

He added that how such children should be cared for is related to "what kind of Singapore we want to have in future".

The Prime Minister has suggested having Medisave accounts for every baby born, with the Government contributing.

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