SINGAPORE: Caregivers and family members of Singaporeans who become severely disabled will go through a "simpler claims process" under the new CareShield Life scheme, the Ministry of Health (MOH) said on Thursday (Nov 1).
The ministry said this as it issued its findings on a case involving a resident whose experience with ElderShield payouts was raised by Workers' Party Member of Parliament Sylvia Lim during a debate on CareShield Life in Parliament in July.
CareShield Life, which will be implemented in 2020, is an enhanced version of the ElderShield insurance scheme targeting severe disability.
Sharing the experience of one of her former residents who is only known as Mr K, Ms Lim had voiced concerns about whether CareShield Life would be adopting the same eligibility criteria used for ElderShield.
Mr K was suffering from an advanced stage of kidney failure and had had a leg amputated due to diabetes, said Ms Lim.
His insurer decided to discontinue his ElderShield benefits after a panel doctor assessed that he could perform all six Activities of Daily Living - albeit with some assistance - and so stopped his payouts.
Said Ms Lim: "When I appealed on his behalf for a re-assessment, the insurer wrote back to him to fill up another claim form. Meanwhile, he was admitted to a hospice.
"When I saw him there, he (asked) me to write to the insurer to say that he would not be filling up the form as he was in the hospice. Eventually, his daughter filled up the form, and I understand that the hospice doctors assisted to get his ElderShield benefits restored.
"But within a month, he was dead."
In a Facebook post on Thursday, MOH elaborated on the details of Mr K's case.
He was assessed to be severely disabled in September 2014, after which his insurer started providing ElderShield payouts.
Two years later he went for a disability review assessment, which MOH said was "in line with the practice of periodic reviews to determine if payout recipients still meet the ElderShield claims criteria".
Then, a doctor deemed him able to perform all six Activities of Daily Living - albeit requiring some assistance. Mr K's insurer thus stopped his payouts from October 2016.
The same doctor subsequently conducted a second assessment in November for Mr K following an appeal from his family, said MOH.
Based on "new information obtained from Mr K’s past records and further observation of his condition" in November, the doctor assessed him to be severely disabled and thus eligible for ElderShield payouts once again.
"Given the change in assessment outcome within the short period of two months, the insurer asked Mr K to obtain a second opinion to confirm his disability status before resuming payouts," said MOH.
The insurer resumed the ElderShield payouts in April 2017 after Mr K’s hospice submitted an assessment that showed that he was severely disabled.
The insurer then told Mr K's family that it will back-pay Mr K’s ElderShield benefits from October 2016 to March 2017, said MOH.
"Moving forward, with CareShield Life, caregivers and family members of Singaporeans who become severely disabled will go through a simpler claims process which will be more convenient for policyholders," said MOH.