Thursday 22 January 2015

Refuse to pay MediShield Life premiums? You could be jailed

Tough stance to address shortfall caused by those who can afford to pay but do not
By Salma Khalik, Senior Health Correspondent, The Straits Times, 21 Jan 2015

SINGAPOREANS or permanent residents who refuse to pay MediShield Life premiums once the universal health insurance is launched later this year could find themselves behind bars if they try to leave the country.

The premiums will be compulsory - not just for people living here but also those who are living overseas for long periods - under proposals introduced in Parliament on Monday by Health Minister Gan Kim Yong.

Singaporeans and PRs living overseas will be entitled to coverage should they fall sick in the future and decide to return here for treatment.

The Bill also gives the insurance administrator the power to have money from a defaulter's wages and bank accounts diverted to pay the premiums.

The maximum penalty for defaulters who try to flee the country, spelt out in the MediShield Life Scheme Bill, is a fine of up to $5,000 and imprisonment of up to a year, or both.

The person would be allowed to leave the country on payment of the outstanding premium to an immigration officer or the police.

But he might also have to pay a 17 per cent penalty for late payment, as well as any costs incurred in recovering the money.

The planned tough stance is to cover the shortfall caused by people who can afford to pay their premiums but refuse, resulting in a heavier burden on other policyholders.

The MediShield Life scheme provides everyone with protection against huge subsidised hospital bills for all their life, and reflects a caring society where everyone pulls together to help those in need.

But such penalties would not apply to people who have difficulty paying the annual premiums, which range from $130 for the young to $1,530 for people older than 90.

Most people will not have a problem paying the premiums as they can be deducted in full from their Medisave funds.

People from families with a per capita income of $2,600 or less - that is, a total income of $13,000 a month for a family of five - will also receive subsidies.

The lower the family income, the higher the subsidies - which range from 15 per cent to 50 per cent.

Pioneer Generation residents who were aged 80 or older last year will have their premiums covered fully by subsidies and Medisave top-ups.

Younger pioneers - those 65 and older last year who have been citizens since 1986 - regardless of their incomes, will also get heavy subsidies and top-ups that should cover more than half the cost of their premiums.

People who still have difficulty paying their premiums on top of these discounts can apply for additional help from the Government.

The Ministry of Health has stressed that penalties are intended only for those with the means but are recalcitrant about paying their premiums.

The MediShield Life Scheme Bill will be debated at the next sitting of Parliament.

The scheme is due to launch by the end of the year.

MediShield Life Scheme Bill: Government to have access to medical records
By Valerie Koh, TODAY, 19 Jan 2015

When universal health insurance scheme MediShield Life comes into force later this year, authorised public servants will have access to medical and financial records, and the Government will be able to impose penalties – as a last resort – on those who default on paying premiums.

Under new laws tabled in Parliament on Monday (Jan 19), authorised public servants – from the Central Provident Fund (CPF) Board and the Ministry of Health (MOH) – will be able to tap into various Government and administrative databases to carry out eligibility checks for premium subsidies. Details such as one’s residential address and monthly income are available in these databases.

This would also facilitate the identification of those with pre-existing medical conditions, who will be covered under MediShield Life at an additional premium of 30 per cent for a decade, said the MOH. Individuals can restrict access to their medical and financial records, should they be uncomfortable with sharing confidential information.

The MOH stressed that there will be safeguards in place to prevent the abuse of the databases, and only authorised people can access them for the purpose of administering the scheme. Anyone who accesses, uses or discloses the information without permission may be fined up to S$5,000, jailed up to a year, or both.

Under the MediShield Life Scheme Bill, penalties of up to 17 per cent of outstanding premiums and interest on late premiums will be slapped on those who default on payment. These recovery measures are meant to clamp down on wilful defaulters with the means to pay their premiums, and are adapted from existing income tax legislation, said the MOH.

Other steps include sending warning letters to remind defaulters of their outstanding bills and appointing agents - such as one’s employer, bank or tenant - to make payment from funds due to the defaulter. As a final, drastic measure, defaulters may be sued. More details will be spelt out in the second reading of the Bill, which is expected at the end of the month.

A MediShield Life Council – consisting members from the public and private sector – will be set up to review and make recommendations to Health Minister Gan Kim Yong on policy and scheme parameters. The Council will also review the administration of the scheme and advise the minister on related matters.

Following the enactment of these new laws, it will become an offence to provide false or misleading information, or omit key information deliberately. Those convicted of doing so may be fined up to S$5,000, jailed a maximum of one year, or both. They may also be required to pay penalties pegged to undercharged premiums or overpaid benefits.

MediShield Life: How will you benefit from it? Some examples
The Straits Times, 20 Jan 2015

The universal health insurance scheme MediShield Life, announced by Prime Minister Lee Hsien Loong during his 2013 National Day Rally, will kick in later this year. On Jan 19, Health Minister Gan Kim Yong tabled the MediShield Life Scheme Bill in Parliament. It provides details on how the scheme is to be implemented and administered. Among other things, it gives wide-ranging powers to the administrator to access people's income and health status without explicit consent from them.

Here's a look at MediShield Life and some examples of how it will benefit patients.

What is MediShield Life?
- A compulsory healthcare insurance scheme which covers all Singapore citizens and permanent residents for life.
- MediShield Life will replace MediShield, the current basic healthcare scheme.
- All Singapore citizens and permanent residents will be automatically covered under MediShield Life when it kicks in end 2015.

What are the key differences between MediShield and MediShield Life?
- MediShield Life covers everyone, including those with pre-existing conditions who are not covered under MediShield today.
- MediShield Life has higher claim limits for hospital bills and outpatient cancer treatment.
- There is no more lifetime claim limit under MediShield Life; MediShield has a lifetime claim limit of S$300,000.
Here's a comparison between the MediShield and MediShield Life schemes:

What are the different MediShield Life premium subsidies and who are eligible for them?
- Premium subsidies for the lower- to middle-income-earners (covering up to two-thirds of households);
- Transitional subsidies for all Singapore Citizens;
- Special premium subsidies and Medisave top-ups for the pioneer generation for life.
Premium subsidies for lower- and middle-income households are applicable to Singapore citizens and permanent residents with monthly per capita household income (PCHI) of up to $2,600, and living in residences with an annual value of $21,000 or less. PCHI is the total household income divided by the number of family members living under same roof.

The government will provide additional financial assistance for those who cannot afford premiums even after subsidies. No Singaporean will drop out of MediShield Life due to inability to pay for premiums.

Do I need to apply for MediShield Life?

No. All Singapore Citizens and Permanent Residents will be automatically covered under MediShield Life when it is implemented in end 2015. CPF Board will inform you of the details nearer to the implementation date.

How much will MediShield Life premiums cost?

Go to to calculate your estimated MediShield Life premiums after subsidies. The premiums can be full paid from Medisave. Those with serious pre-existing conditions will have to pay 30 per cent higher premiums for 10 years.

Granting access to health and income data makes sense
By Salma Khalik, Senior Health Correspondent, The Straits Times, 24 Jan 2015

THE wide-ranging powers that a proposed law grants the Central Provident Fund (CPF) Board as administrator of a new, mandatory national health insurance have sparked mixed reactions.

Those against are uncomfortable with the Government wanting complete access to details of their income and health. Those for it are glad not to have to fill in forms and provide certified copies of their income and health status.

The MediShield Life Bill tabled in Parliament on Monday gives the CPF Board power to access income tax and health records of Singaporeans and permanent residents. MediShield Life is due to be launched at the end of this year.

The proposed law means that those who want to qualify for premium subsidies do not need to give their consent for the release of information, as consent is presumed.

Those who object can opt out, but they will not have access to subsidies. Should they change their minds at a later date, they can apply for subsidies by providing documentary proof of their financial status.

While some have criticised the measure as being draconian, it is, in fact, a highly practical solution to what would otherwise be a bureaucratic nightmare: identifying people who qualify for subsidies.

The Government has promised to subsidise the MediShield Life premiums of two-thirds of the population. The subsidies cover people from families where the per capita household income is $2,600 a month or lower.

Next comes the question of how to identify the people who qualify. Should everyone who might qualify be made to apply for the subsidies, giving details of their income and number of people in their household?

That would be tedious for the individuals and families, to say nothing of the massive bureaucracy needed to sift through and verify 21/2 million applications from people who would qualify for some subsidy.

Hence the decision to automate the process by getting information that is already available within the Government - such as CPF contributions by those who are employed, or tax returns for the self-employed.

The number of people in a household can also be worked out, as identity cards include a person's address.

However, while the Government has such information, it is not easily shared among ministries because of its confidential nature. That is why Parliament has to approve the release of the information to the administrator of MediShield Life - the CPF Board.

MPs like Dr Chia Shi-Lu are very happy with the move, as they have been getting complaints from people about the repeated declarations they have to make when applying for subsidies.

Clearly, the people supporting this move are the ones who need and expect to receive subsidies.

The ones who object are likely those with higher incomes who are less likely to receive any subsidies after four years. (Everyone gets transitional subsidies for the first four years.)

But the naysayers' feelings have been pre-empted, and people can refuse to give the CPF Board access to their information. In return, those who opt out forfeit the right to claim subsidies for themselves or their household members.

Giving the CPF Board access to income information makes it easy for those who require financial help to get it. It does not affect the well-to-do who may oppose such intrusion into their affairs.

The same applies to determining if someone has a pre-existing disease. Instead of sending all newcomers to MediShield to the doctor for a check-up - which comes at additional cost to the person - it is far easier to just check his medical records with hospitals to see if he is suffering from a major ailment.

The only ones affected by this are those currently excluded from MediShield for some pre-existing conditions. MediShield Life, being a universal insurance plan, may cover the condition if it is not too serious.

So, those who want their current illness to come under the MediShield Life umbrella have to consent to letting the CPF Board access their health information from hospitals.

If they don't want the Government poking its nose into their health status, they can also refuse permission. But they must then be prepared to pay a 30 per cent penalty on their premium to cover pre-existing conditions for the first 10 years.

As for fears over the security of information and confidentiality, the Bill has a penalty - a fine of up to $5,000 and a jail term of up to a year, or both - to deter leaks and ensure they do not take place with impunity. Only those authorised to look at the income and health records may do so, and they cannot use the information for any purpose other than MediShield Life.

There have also been some strong reactions against the penalties for people who default on premiums. They face a fine of up to $5,000 and jail term of up to one year if they try to flee the country without paying premiums.

I found the criticisms rather surprising. Why would anyone rush to the defence of those so anti-social as to refuse to pay the premium for a health insurance plan that benefits the old, the sick and the needy?

The penalty does not apply to people who have difficulty paying the premiums. That has been made very clear by the Ministry of Health.

It is there only for recalcitrants who have the money, but refuse to part with it. In the meantime, these free-riders continue to be covered by the insurance, which has promised to cover everyone, for life.

Despite the chatter on some social media sites, an objective look at the provisions in the MediShield Life Bill suggests that its provisions are eminently sensible. They empower the administrator of the insurance plan to access relevant information in allocating subsidies, and set stiff penalties for free-riders.


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