MediShield Life premiums may rise by up to 35% for some, higher claim limits proposed as part of review

SINGAPORE: Premiums for MediShield Life may increase by up to 35 per cent in the next few years - before subsidies - as the MediShield Life Council seeks to improve benefits of Singapore’s national health insurance scheme.

“The MediShield Life Council has made preliminary recommendations for the MediShield Life benefits to be enhanced, and for premiums to be correspondingly adjusted,” said the Ministry of Health (MOH) on Tuesday (Sep 29). 

This is the first major review of MediShield Life since it was launched in 2015.

Among the recommendations are to raise the policy year claim limit, introduce higher claim limits for daily ward and treatment charges, as well as to remove standard exclusions for treatments arising from attempted suicide, drug addiction and alcoholism.

A public consultation on the recommendations will be held from Tuesday until 6pm on Oct 20.

Authorities expect to implement the changes in early 2021.

HIGHER PREMIUMS

Under the recommendations, those aged 61 and above will see the highest increase in premiums of about 35 per cent, before subsidies.

But the net increase for all Singaporeans will be kept to about 10 per cent in the first year, after factoring in existing and additional subsidies, including a one-off COVID-19 subsidy announced on Tuesday.

The COVID-19 subsidy will cover 70 per cent of the net increase in premiums in the first year and 30 per cent in the second year.

READ: Singaporeans to receive COVID-19 subsidy to offset proposed increase in MediShield Life premiums

The MediShield Life Council said that while premiums have been kept constant so far, MediShield Life payouts have increased by close to 40 per cent over the last four years, with the number of claimants increasing by almost 30 per cent.

It also noted that premiums were not adjusted when enhancements were rolled out from 2018.

READ: More Singaporeans to benefit from higher healthcare subsidies under revised income criteria 

“This round of adjustments will also take these enhancements into account,” said the council.

“Premiums need to be adjusted periodically to support enhancements that provide better coverage and higher payouts, and to keep pace with healthcare cost inflation and actual claims experience.”

Lower- and middle-income households, as well as Merdeka and Pioneer Generation seniors, will continue to receive premium subsidies and support.

Premiums will continue to be fully payable through MediSave, said the council, adding that the total household premiums should remain within annual MediSave contributions and inflows for most typical households.

HIGHER ANNUAL CLAIM LIMITS

Claim limits should be “refreshed” to cover nine in 10 subsidised bills, with claim limits to be reviewed every three years, said the council.

The MediShield Life Council recommended raising the policy year claim limit from S$100,000 to S$150,000. This would give Singaporeans better protection against exceptionally large bills from long or multiple hospitalisations throughout the year, it said in its public consultation paper.

Citing a case where an eight-year-old Singaporean had to be hospitalised for 147 days – including more than 80 days in the intensive care unit - for epilepsy and underwent five surgical procedures during the stay, the council noted that the child’s total medical bill came up to S$546,500.

While the family received government subsidies and additional MediFund support, they could only claim up to S$100,000 from MediShield Life. This meant that they had to use their MediSave to pay the final S$1,400 of their bill. 

The proposed higher MediShield Life policy year claim limit would provide more support for such patients.

READ: Higher MediShield Life claim limits from Jan 1, 2020 

HIGHER CLAIM LIMITS FOR SUB-ACUTE CARE

Another recommendation is treatment-specific claim limits for community hospital care and outpatient radiotherapy.

Both rehabilitation and sub-acute care at community hospitals are currently subjected to the same claim limit of S$350 a day. However, sub-acute care is about 20 per cent more expensive than rehabilitative care.

The council raised the case of one 60-year-old Singaporean who underwent sub-acute care at a community hospital for 25 days due to a bone infection. The total bill was S$17,300.

While the patient received government subsidies and a MediShield Life payout, their bill exceeded the claimable amount for MediShield Life. This meant that the patient had to pay the remaining S$2,212 with MediSave.

“Introducing separate claim limits for sub-acute care and rehabilitative care will ensure that both groups of patients will enjoy similar levels of coverage under MediShield Life,” said the council.

Such treatment-specific claim limits should also be applied to outpatient radiotherapy, to improve coverage for costlier treatments, it added.

HIGHER DAILY WARD CLAIM LIMITS

Patients with short hospital stays could receive more support, as the council proposed increasing claim limits for daily ward and treatment charges for the first two days of acute hospital stays.

Ward and treatment charges for patients in acute hospitals have a claim limit of S$700 a day for normal wards and S$1,200 a day for intensive care unit wards.

However, patients tend to incur higher charges during the earlier part of their stay due to costly tests and investigations to diagnose their conditions. Patients with longer stays benefit more, as the aggregate claim limit over a longer hospital stay is enough to cover the high initial charges, said the council.

The higher claim limits for the first two days of hospitalisation would “better cover short stays”, said the council.

READ: MediShield Life coverage extended to serious pregnancy, delivery-related complications 

LOWER DEDUCTIBLE FOR DAY SURGERY

To encourage older patients to undergo day surgery, the council recommended lowering the deductible for day surgery patients above 80 years old from S$3,000 to S$2,000. This will match the amount payable for inpatient stays in C class wards. 

“This will ensure that patients are not discouraged from choosing a day surgery over an inpatient stay, as they will be subject to the same deductible regardless of their choice,” said the council.

LOWER PRO-RATION FACTOR FOR PRIVATE HOSPITALS

The MediShield Life Council suggested lowering the pro-ration factor for private hospitals from 35 per cent to 25 per cent.

Before their MediShield Life payouts are calculated, patients from private hospitals will have their bills pro-rated by 35 per cent to make the bills comparable to those from a public hospital. This ensures that private hospital patients do not receive a larger payout.

About 15 per cent of MediShield claims per year are private hospital claims.

“Lowering the pro-ration factor to 25 per cent will better reflect the actual bill differences and ensure more similar payouts between private hospital and subsidised patients,” said the council.

REMOVAL OF EXCLUSIONS

In addition, the council recommended extending coverage to treatments for attempted suicide, intentional self-injury, drug addiction and alcoholism. 

It is estimated to help 300 more people per year for attempted suicide and intentional self-harm, and an additional 1,000 people every year for those with alcoholism and drug addiction.

“There is increasing recognition that proper treatment is the appropriate approach towards self-harm,” it said, noting that the American Society of Addiction Medicine recognises addiction as a chronic medical disease, with prevention efforts and treatment approaches generally as successful as those for chronic diseases.

READ: MediShield Life coverage extended to three new areas 

Said Minister for Health Gan Kim Yong: "I want to assure Singaporeans that the Government will continue to help you with your premiums. No one will lose MediShield Life coverage because of financial difficulties."

Views on the recommendations can be submitted through an online feedback form or mailed to the Ministry of Health.