Law passed to expand MediShield Life coverage to new care models
Amendments to the law were necessary to cover the increasing number of treatments being delivered beyond hospital settings, as well as new care models that may emerge in the future, said Minister of State for Health Rahayu Mahzam.
A view of the College of Medicine Building, the Ministry of Health's headquarters. (Image: Google Street View)
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SINGAPORE: MediShield Life coverage is set to expand with parliament passing a law on Monday (Nov 11) to include new models of care received outside the physical premises of healthcare providers within the insurance scheme.
This comes after the government accepted recommendations from the MediShield Life Council last month to better protect Singaporeans against large medical bills and expanded coverage to help patients afford new types of care and treatments.
Among the council’s recommendations, it proposed the inclusion of new benefits to cover additional outpatient treatments including mental health, community, and home-care treatments as well as increased claim limits.
WHAT THE BILL PROPOSED
The MediShield Life Scheme (Amendment) Bill sought to expand the scheme’s coverage to new models of care, strengthen provisions to support premium recovery efforts and improve the scheme’s administration.
Currently, the MediShield Life Scheme Act requires treatment or services covered under the scheme to be carried out in an approved medical institution.
The Bill proposed to redefine MediShield Life to cover any medical treatment or service as long as it is provided by an approved medical institution.
This change will be complemented by a “more robust governance framework” allowing “scoped approvals, and suspensions and revocations of such approvals”, that are given to medical institutions under the scheme.
This will ensure the continued appropriate use of MediShield Life Fund monies, Minister of State for Health Rahayu Mahzam told the House.
For instance, to be approved, the medical institution must have a valid licence under the Healthcare Services Act 2020.
In addition, a new concept of “claimable medical treatment or services” is aimed at ensuring that the scheme only covers medical treatments or services provided by approved medical institutions according to the scope of their approval.
The Bill also sought to refine provisions to support premium recovery efforts, such as by serving demand notes through other means like email.
Among other proposed changes were to specify MediShield Life premiums in a more accessible manner, such as on the Ministry of Health’s website, in a bid to improve the administration of the scheme.
WHY IT MATTERS
Madam Rahayu said the shifts in healthcare delivery to outpatient, community and home settings as well as a need to improve scheme administration warranted amendments to existing legislation.
Taken together, the amendments will allow MediShield Life to be responsive to emerging models of care, while enabling more “targeted” approvals as well as suspensions and revocations of approvals for providers and their claimable medical treatments and services.
“This will strengthen the accountability of approved medical institutions and ensure compliance with the claim guidelines for MediShield Life,” said Mdm Rahayu.
On premium recovery, Mdm Rahayu said any owed premiums that cannot be recovered will affect the MediShield Life Fund’s sustainability, and ultimately affect the scheme’s ability to meet its claims.
If left unrecovered, these debts will have to be shouldered by other policyholders in the form of higher premiums, she said.
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WHAT MEMBERS OF PARLIAMENT SAID
While the Bill focused on the implementation details of expanding MediShield Life coverage, questions from members of parliament regarding it were mostly about the impact of the changes to the scheme that were announced last month.
With higher claim limits and the expansion of coverage, premiums could increase by as much as 35 per cent, the MediShield Life Council had said previously. The increases will be phased in evenly over three years from April next year to March 2028.
MP Ng Ling Ling (PAP-Ang Mo Kio) and MP Jessica Tan (PAP-East Coast) expressed concern that the introduction of a new outpatient deductible as well as increases in the inpatient deductible could result in an increased out-of-pocket cashflow burden for those who may not have sufficient Medisave balances.
Meanwhile, with the Bill proposing an expansion of means-testing powers, MP Gerald Giam (WP-Aljunied) and MP Yip Hong Weng (PAP-Yio Chu Kang) asked how this will impact residents who are asset-rich but cash-poor, such as some retirees.
Without clear guidelines and robust oversight, Mr Yip said there is a real risk of denying subsidies to deserving individuals based on overly strict interpretations of their financial situations.
Mr Giam urged the government to consider removing residential property annual values as a means-testing criteria.
Ms Tan also asked whether the increased claim limits and expansion of coverage and benefits of MediShield Life coverage will be enough for some to give up their Integrated Shield Plans (IPs).
IPs are offered by private insurers as optional health coverage on top of MediShield Life. This typically covers stays in A- or B1-type wards in public hospitals or in private hospitals.
Ms Tan noted that it was reported that half of patients with IPs for private hospitals still end up using subsidised care at public hospitals.
MOH’S RESPONSE TO MPS’ CONCERNS
Responding to MPs’ concerns about the impact of the deductible changes on lower-income patients, Mdm Rahayu provided assurance that Singaporeans who face difficulty affording their bills after subsidies, MediSave and MediShield Life can apply for forms of financial assistance such as MediFund support.
She also reiterated that, for more than nine in 10 Singaporeans, government support measures will more than offset premium increases for the next three years. These measures were announced last month along with the MediShield Life scheme changes.
“No one will be denied access to appropriate healthcare due to an inability to pay,” she said.
Turning to concerns about how lower-income individuals who reside or own properties with high annual values (AV) will be supported, she said the government periodically reviews the eligibility criteria for subsidies, adding that the AV thresholds were recently raised earlier this year.
She added that those who need more help or are facing extenuating circumstances may appeal for more assistance, which will be assessed on a case-by-case basis.
