Sunday 1 February 2015

MediShield Life Scheme Bill Passed Into Law on 29 January 2015

Bill passed, making health insurance for all a reality
Govt to subsidise at least 90% of any premium increase in first year
By Rachel Chang, Assistant Political Editor, The Straits Times, 30 Jan 2015

WITH a chorus of "ayes", universal health insurance became a reality in Singapore yesterday as Parliament passed the MediShield Life Scheme Bill into law.

It is a historic moment that marks the coming together of all Singaporeans to "build a health-care safety net that leaves no one behind", Health Minister Gan Kim Yong said as he announced more government subsidies for the higher premiums needed to support the new scheme.

The Government will subsidise at least 90 per cent of any increase in premium in the first year and at least 70 per cent in the second year, up from the 80 per cent and 60 per cent proposed earlier.

This means those without pre-existing medical conditions will not pay more than $3 a month in higher premiums for the first two years of the scheme, which will replace MediShield.

But even after the five-year transition period, two out of three households will continue to get permanent premium subsidies from a $4 billion fund.

MediShield Life provides lifetime coverage for all Singaporeans and permanent residents, regardless of age or pre-existing health conditions.

It gives the authorities powers to access their medical and income records to calculate premiums and subsidies - although individuals can opt out.

It also lets the authorities recover unpaid premiums through payroll deduction or measures such as barring the defaulter from leaving the country.

Defaulters who wilfully refuse to pay face a fine of up to 17 per cent on outstanding premiums and interest on the amount owed.

Many of the 23 MPs who rose to speak during the five-hour debate yesterday were worried that overly harsh action would be taken against defaulters, noting that this group may include the very poor, the very old and those in sudden financial difficulty.

Mr Gan assured them that a flexible and compassionate approach to defaulters would be taken, promising: "No one, especially our pioneers, will lose their MediShield Life coverage due to the inability to pay their premiums."

Action would be taken only against wilful defaulters - those who can pay but will not, he said.

MPs also stressed the need to safeguard confidential medical and income information, and to keep the list of pre-existing medical conditions as short as possible.

Those with pre-existing conditions must pay an additional premium of 30 per cent over 10 years due to their required treatments.

But on the fundamentals of the Bill, no MP disagreed.

All welcomed what Ms Denise Phua (Moulmein-Kallang GRC) called "the manifestation of the spirit of belonging to a country".

The key issue now, noted MPs like Dr Chia Shi-Lu (Tanjong Pagar GRC), is the scheme's sustainability: Medical costs could spiral as patients demand more expensive treatments, or people slacken in taking care of their health.

Agreeing, Mr Gan said the Government can monitor medical claims only for excessiveness, and the rest of society must step up.

Ordinary Singaporeans should "encourage each other to make healthy choices", he said. "All of us - patients, health-care providers, insurers, family members - need to do our part."

Update household details for MediShield Life
Subsidies will be decided based on information in government records
By Linette Lai And Kash Cheong, The Straits Times, 31 Jan 2015

THE start date for MediShield Life has not been announced but already, the Government is urging those who will be covered under the universal health insurance scheme to update their household information.

Subsidies for individuals will be decided using this information.

Government data is only accurate if it is up to date, Senior Minister of State for Health Amy Khor said in Parliament on Thursday when the scheme was passed.

"For example, we only know the latest address on your NRIC, and would not know if you have moved if you do not tell us," she said.

A married woman who has recently moved from her parents' bungalow into a Housing Board flat, for example, could receive lower subsidies than she ought to be getting.

Premium subsidies are determined by government records of the annual value of a person's residence, as well as his monthly per capita household income.

Those with the same NRIC address will be treated as part of the same household.

Those who need to update their addresses can do so at police posts or the Immigration and Checkpoints Authority, with relevant supporting documents.

HDB home dwellers with tenants sharing their flat should also update tenant records online with the Housing Board.

Another point to give thought to is whether individuals want to allow the Government access to their medical records.

These refer to existing records in government databases, including those used to process claims from public and private medical institutions.

These records are needed to determine if a person has a pre-existing medical condition which would mean higher premiums.

"With these checks, the vast majority of Singaporeans will not have to step forward to undergo further health assessments," said Minister of State for Health Lam Pin Min in Parliament.

Those who decline to give access to their information will be charged higher premiums.

On the ground, details about the new scheme were still not clear to some. Mr Joel Ong, 69, felt there have been "too many details (on MediShield Life) to digest at one go".

"It would be good if the Government sends us brochures, so we can keep it and read it in our own time," said Mr Ong, who works as a packer.

But another was glad that MediShield Life would be taking a less stringent approach than private insurers when it came to medical conditions.

Mr Seow Min Fook was excluded from a range of conditions in private insurers' policies on the basis of his high cholesterol and thyroid issues. "I always do my annual medical check-ups, so I'm confident my conditions are under control," said the 70-year- old retired project manager.

"But (my insurers) say if you have high cholesterol, you're excluded for anything to do with heart problems. In that sense, MediShield Life is better than private insurance for me."

MediShield Life to reflect 'fairness and compassion'
Higher premiums only for those with serious medical conditions: Minister
By Linette Lai, The Straits Times, 30 Jan 2015

PEOPLE with pre-existing medical conditions will be treated in a "fair and compassionate" way when MediShield Life kicks in, promised Health Minister Gan Kim Yong yesterday.

They will pay premiums that are 30 per cent higher, for 10 years.

Mr Gan was speaking in Parliament during the debate of the MediShield Life Scheme Bill, which was passed at the end of the session.

In his opening speech, he said the Health Ministry is reviewing the list of serious pre-existing conditions with help from specialists. It will disclose information on the broad categories of these ailments later. Those who have to pay higher premiums will be informed before MediShield Life starts.

During the debate, several MPs sought clarification on who will have to pay higher premiums.

Ms Denise Phua (Moulmein-Kallang GRC) asked if those with intellectual disabilities or other developmental disorders would incur higher premiums.

"Many of them... may experience challenges in schools and at workplaces that relate to their ability to learn, socialise and be included," she said.

"But physically - health-wise - these persons may not be at risk of requiring more medical treatment or hospitalisation than the rest of the population."

In response, Minister of State for Health Lam Pin Min said that those who did not require prolonged hospitalisation or expensive outpatient treatments would not have to pay extra.

"In other words, the mere existence of autism, on its own, is not the basis for imposing additional premiums," he said.

Workers' Party MP Lee Li Lian (Punggol East) and Nominated MP Chia Yong Yong asked if the 30 per cent extra premium would vary with a person's condition.

For the sake of simplicity, said Dr Lam, there is only one rate, which will be applied to those with serious pre-existing conditions. He said such conditions could include stroke, cancer, kidney failure and heart disease.

He added that MediShield Life will be less stringent than private insurance in providing coverage for minor medical conditions.

"Less severe conditions such as pre-cancer, well-managed hypertension and diabetes with no complications will not be subject to additional premiums," he said.

In his reply to Dr Fatimah Lateef (Marine Parade GRC), he said those with pre-existing HIV/Aids - treatment for which is not covered under MediShield - will receive coverage under MediShield Life but will pay a higher premium.

Dr Lam said people with medical conditions covered by MediShield will not pay anything extra.

Assurances, safeguards and premiums
The Straits Times, 30 Jan 2015

MINISTER Gan Kim Yong plus Dr Amy Khor and Dr Lam Pin Min from the Health Ministry touched on these points in yesterday's debate:

Dr Khor on what people must do to ensure their MediShield Life premium subsidies are computed correctly:

Update your NRIC address at police posts or the Immigration and Checkpoints Authority, with relevant supporting documents. If there are tenants in your HDB flat, please update your tenant records with HDB.

In a few months, look out for a letter from the Health Ministry asking for your household information to be confirmed. This can be done online, via a hotline or at specified community touch points like CitizenConnect centres in community clubs.

Dr Khor on Integrated Shield Plans:

MediShield as it is today forms the foundation of all Integrated Shield Plans (IPs), and the IPs ride on this foundation to provide additional coverage targeting the Class B1/A wards or private hospitals.

When MediShield Life is launched, it will become the new foundation.

To use everyday language, MediShield Life is like plain Milo, which is tasty enough for most people. IPs are like Milo Dinosaur or Milo Godzilla, which tastes even richer than Milo, but will definitely cost more.

Mr Gan on data privacy:

Eligibility checks for MediShield Life premium subsidies will only extend to existing income records in government databases.

These will not extend to private or commercial records, including any bank or credit card records.

Mr Gan on data access:

Only authorised persons can access, use or disclose medical and financial information for the specified purposes. They will be required to sign appropriate undertakings.

The minister in charge of the agency that controls the requested information must approve its disclosure, and can impose terms and conditions.

Dr Lam citing an example on who pays higher premiums:

The mere existence of autism on its own is not the basis for imposing additional premiums. However, if the person with autism also has a serious medical condition requiring prolonged hospitalisation or dialysis treatment, then additional premiums apply.

MPs: Get tough on defaulters, be kind in genuine cases
By Kash Cheong, The Straits Times, 30 Jan 2015

MEMBERS of Parliament supported tough penalties to recover outstanding premiums from wilful defaulters of the MediShield Life scheme but urged the Government to be compassionate to those who genuinely could not pay.

The issue of penalties and additional help for the needy was raised during the second reading of the MediShield Life Bill yesterday.

The newly passed Bill gives the Government legal powers to impose penalties on wilful defaulters - a small group who refuse to pay despite having the means to do so.

While agreeing such a mechanism for wilful defaulters was necessary, Ms Tin Pei Ling (Marine Parade GRC) said: "I am also cognisant of the need to avoid penalties on Singaporeans who just need a little more time."

Ms Denise Phua (Moulmein-Kallang GRC) made a similar point.

She asked for assurance that those who cannot pay for good reason will be treated with "not only justice but mercy".

There are those whose Medisave could have been depleted by big hospitalisation bills or because they were unemployed due to disabilities, she said.

Echoing the sentiment was Mr Ang Wei Neng (Jurong GRC) who said: "Penalties should be the last resort."

Mr Hri Kumar Nair (Bishan-Toa Payoh GRC) noted that it was not clear how much time a defaulter had to remedy the situation before penalties kicked in.

This is in contrast to the Income Tax Act, which states that payment may be enforced one month from the time the demand note is served, he said.

Responding to these concerns, Mr Gan said that penalties will be imposed with discretion.

Defaulters will be sent multiple reminders, with offers of government assistance, for an extended period of time before penalties kick in.

The MediShield Life Council will also provide direction on the broad approach towards premium recovery, he said.

They may also tap on the Medisave accounts of immediate family members such as spouses, parents or children, to pay for premiums. In addition, the Government will reach out to those who have insufficient Medisave balances and insufficient family support and assess if they need additional premium support.

Pensioners assured they will not lose current medical benefits
By Linette Lai, The Straits Times, 30 Jan 2015

GOVERNMENT pensioners need not fear that MediShield Life offers them fewer benefits than their current medical coverage schemes, Deputy Prime Minister Teo Chee Hean said yesterday.

Following a call in Parliament by Workers' Party MP Png Eng Huat (Hougang) for pensioners to be exempted from the new universal health-care scheme, Mr Teo dismissed the need for that.

He assured pensioners that after they move to MediShield Life, they will continue to receive all the benefits they currently enjoy.

The Government will also pay for their MediShield Life premiums, said Mr Teo, who is also Home Affairs Minister and Minister in charge of the civil service.

Most importantly, even after the pensioners die, their spouses will continue to be covered by the health-care scheme - a perk they would not have had under their old medical benefits schemes.

In his speech, Mr Png had referred to a news report stating that some pensioners now receive medical benefits superior to those offered by MediShield Life.

"How would MediShield Life be better for these pensioners when the Public Service Division has acknowledged that it is not?" Mr Png asked. "And why would the Government want to go to great lengths to match the benefits of Medishield Life with what the pensioners are currently receiving when a simple solution is to let them remain status quo?"

Mr Teo replied that the issue had already been addressed in Parliament previously, and that pensioners have been told of the benefits they will receive. He asked Mr Png to reassure pensioners instead of causing anxiety by "raising issues which are not true".

Mr Png countered that the elements of the government pension plan highlighted in his speech were based in fact."I just want to seek clarification - if pensioners were to go on MediShield Life, are they going to be expecting the same kind of (benefits)?"

Mr Teo replied that the answer as: "Yes, unequivocally yes."

He added: "I hope that the member, instead of raising red herrings, will help to reassure pensioners of this."

More about the scheme
By Kash Cheong, The Straits Times, 31 Jan 2015

1) Those with pre-existing conditions will have to pay higher premiums. What constitutes "pre-existing conditions"?

Stroke, cancer, kidney failure and heart diseases would qualify as "pre-existing conditions" and those suffering from these may incur additional premiums of 30 per cent for 10 years.

For those who had been under the earlier MediShield scheme or an Integrated Shield Plan and developed a medical condition only after their coverage started, the higher premiums would not apply. The Ministry of Health is reviewing the list of pre-existing conditions that will be subject to additional premiums.

2) Can those who are based overseas opt out?

No, MediShield Life is compulsory for all Singapore citizens and permanent residents (PRs), regardless of place of residence. Those who live overseas may come back toseek treatment when they are ill as their families may be here.

3) Why doesn't the scheme have a no-claims bonus like for motor insurance?

The concern was that such incentives might lead patients to delay treatment so as to maintain their bonus.

4) Can those who can't afford the premiums tap family members' Medisave?

Immediate family, such as parents and spouses, will be able to use Medisave to pay their loved ones' premiums. For siblings, it is case by case.

5) How do you know how much you have to pay?

In a few months, the Government will send out letters on this. A premium calculator, which gives an estimate, is available at www.

6) The Government can access a person's data to check for pre-existing conditions, among other things. Are there measures to prevent abuse?

Inappropriate access, use or disclosure of private information may be punished with a fine of up to $5,000 or jail of up to 12 months, or both.

7) And for those still confused about MediShield Life...

It is a national insurance plan that provides coverage for all Singapore citizens and PRs, young or old, sick or poor. It covers everyone for B2- and C-class wards. It is an enhanced version of MediShield and provides better benefits including higher claim limits for hospitalisation and outpatient cancer treatments.

All Singapore citizens and PRs will be covered for life. It kicks in by the end of this year.

Integrated Shield Plans: To keep or not?
The Straits Times, 2 Feb 2015

When MediShield Life starts later this year, it will provide everyone, both sick and healthy, with cradle-to-grave health insurance cover. There will no longer be any lifetime limits, and benefits and premiums will be higher than under the current MediShield. This has caused many people who are currently on the Integrated Shield Plans (IPs), which cover them for more than subsidised hospital care, to ask if they can drop these additional plans which have higher premiums, and simply rely on MediShield Life. Today, six in 10 people on MediShield have IPs. Some certainly should continue with their IPs while others would do better to downgrade to the basic MediShield Life.

Senior Health Correspondent Salma Khalik gives some pointers to help you decide which route to take if you are currently on an IP.

THERE are five insurers - AIA, Aviva, Great Eastern, NTUC Income and Prudential - that offer three categories of Integrated Shield Plans or IPs: for treatment at private hospitals; public hospital A class; and public hospital B1 class.

Public hospital B2 and C class wards are heavily subsidised and can be covered by the basic MediShield Life.

UP TO the age of about 40 years, the premiums for IPs are relatively low, as younger people are less likely to require expensive hospital stays. This reason alone makes IPs worth considering, especially if you do not have company health cover.

Current premiums range from $78 to $383 a year, but will rise when MediShield Life starts as all IPs have to incorporate it. MediShield premiums are $50-$105 today but will rise to $130-$310 a year when it becomes MediShield Life. Those who do have good hospital coverage provided by their employer should look at considerations for older workers.

PREMIUMS start going up rather sharply from the age of 41 years as that's the age when people start getting chronic problems like blood pressure and high cholesterol levels which put them at higher risk of serious illness. That is also when the incidence of cancer and diabetes starts to climb.

IP premiums range from $631 to $1,667 a year. While these premiums might still appear pretty affordable as up to $800 can be paid with Medisave money and they are still drawing a salary, it is time for those who have hospital cover from their employer to ask themselves the following question: What class of ward am I likely to use after I retire?

This is because, for them, it is only after they retire and no longer have company health coverage that MediShield Life of IP becomes their main health insurance.

Remember that insurance, unless you also buy a rider, does not pay the whole hospital bill.

The deductible, or the initial amount the patient needs to pay, ranges from $1,500 to $3,500 depending on the ward class. There is also a 10 per cent co-insurance for the rest of the bill that the patient needs to pay for.

Many patients take stock only at the point of admission.

Today, 60-70 per cent of people with IPs pegged at private hospitals or public hospital A class ward choose a lower hospital class than their insurance entitles them to - which essentially means that they have chosen the wrong IP and have been paying higher premiums than they needed to for years.

Another thing to look at is not the premiums you are currently paying, but the amount you will need to pay a decade or two after retirement. One in three people aged 65 is expected to live beyond 90 years. Would you be able to afford those premiums then?

If the answer is no, then do you want to pay high premiums up till the point when you cannot afford them, or downgrade early and save on a lot of money in the coming years.

IF YOU have retired and need to be more careful with what you spend, you too should look 10-20 years down the road and see if the premiums are likely to remain affordable.

Remember that the premiums are also likely to rise as cost of health care goes up, so the premiums you will need to pay in future will be higher than what you see charged for older people today.

Now, the highest premiums for private hospital plans is more than $8,000 a year. It is about $5,000 a year for B1 plans. MediShield Life premiums for people 65 years and older will hold steady for at least five years at $815-$1,530 a year before subsidies.

IF YOU are already suffering from a serious long- term ailment and are already collecting from the insurance, you probably should carry on to ensure that your coverage is not reduced. This applies to people of all ages.

Another group that might want to hang on to their IPs are diabetics with a high potential for kidney failure. If you qualify for subsidised dialysis, MediShield Life is enough. If you don't, you will need dialysis at a private centre.

B1 and A class plans that say they cover dialysis "as charged" refer to public hospitals and institutions only, but there are currently no public institutions offering private dialysis.

DOWNGRADING from an IP to the basic MediShield is never a problem and can be done any time. But moving to a higher plan will depend on whether you have any pre-existing medical problems that will result in exclusions in your coverage. The older you get, the more difficult it will be to change to a higher plan.

IN THAT case, the best thing to do is to hang on to your current plan for one more year. When MediShield Life is launched, the IPs will revise their premiums. By early next year, the picture will be clearer and you can then decide on the best scheme for you and your family.

MediShield Life to cover HIV patients
They can make claims, but need to pay 30% higher premiums for 10 years
By Linette Lai, The Straits Times, 16 Feb 2015

WHEN it comes to health insurance, people with the human immunodeficiency virus (HIV) often find themselves in a dilemma.

The uninsured find it hard to get coverage, while those who are already insured fear that their policies may be voided if they make a claim.

But MediShield Life, which will start by the end of this year, will provide many in this group with proper insurance coverage for the first time.

"Most of us feel very trapped, because we're not sure how to go about making claims," said 29-year-old Avin Tan, who has gone public about his HIV status.

"Some (insurers) will tell you that as long as you have been diagnosed with HIV, you will not be able to make any claims at all."

He has known of people with HIV who made successful claims, but also of others who had their policies voided, although the illness for which they were claiming was unrelated to HIV.

Most HIV-positive people keep their condition a secret, worried that insurance agents, who are often family friends, may alert others to their condition.

Health Ministry statistics from 2013 show that there are around 6,200 Singapore residents with HIV. About 450 new cases were diagnosed that year.

Typically, the disease is managed with medication that helps to control its spread. It takes between eight and 10 years for HIV to become acquired immune deficiency syndrome (Aids).

At this stage, many develop complications that require hospitalisation, said infectious diseases specialist Adrian Ong of Mount Elizabeth Hospital.

With proper treatment, however, most can expect to lead "long, normal and healthy lives".

Yet, none of the five Integrated Shield Plan (IP) providers - whose IPs cover two-thirds of Singaporeans and permanent residents - will cover HIV, even at higher premiums. The exceptions are if the virus was acquired through a blood transfusion or in the course of one's work as a medical professional, for example.

Currently, MediShield - the Government's basic health insurance scheme - excludes the treatment of any condition caused by HIV or Aids.

This means that if someone with HIV/Aids develops cancer as a result of his condition, he will be on his own, even though chemotherapy is covered by MediShield.

But MediShield Life will lift this restriction.

Those with HIV/Aids can make claims, although they will have to pay premiums that are 30 per cent higher for 10 years.

"This will go a long way to alleviate the burden experienced by infected persons, as well as the stigmatisation of HIV infection in the country," said a spokesman for advocacy group Action for Aids.

Added Mr Tan, who is a manager with the group: "This is quite a big step for the Government. Hopefully, this will get private insurers to also come on board."

Second Reading Speech by Mr Gan Kim Yong, Minister for Health, on the MediShield Life Scheme Bill, on 29 January 2015

Speech by Dr Amy Khor, Senior Minister of State for Health, on the MediShield Life Scheme Bill, on 29 January 2015

Speech by Dr Lam Pin Min, Minister of State for Health, on the MediShield Life Scheme Bill, on 29 January 2015

Closing Speech by Health Minister Mr Gan Kim Yong on the MediShield Life Scheme Bill on 29 Jan 2015

Transitional Subsidies for MediShield Life Premiums to Increase in First Two Years of MediShield Life

Factsheet on the MediShield Life Scheme Bill

Refuse to pay MediShield Life premiums? You could be jailed

MediShield Life Dialogue session with REACH

MediShield Life Q&A

MediShield Life FAQs

Household Check Exercise to ensure Singapore Residents receive the correct Premium Subsidies

MediShield Life

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