MediShield Life: Answers to 101 frequently asked questions

By Linette Lai

MediShield Life, which replaces MediShield, will take effect on November 1, 2015. The compulsory all-inclusive health insurance scheme provides lifetime coverage for all Singaporeans and permanent residents, regardless of age or pre-existing health conditions. Reporter Linette Lai, with help from the Ministry of Health, puts together a comprehensive guide to the new scheme. Here are the answers to 101 frequently asked questions.

The Basics



It is a new compulsory basic health insurance scheme administered by the Government's Central Provident Fund Board. It will help you pay your hospitalisation bills. It is basic because it is sized for subsidised treatment in the public hospitals. 
All Singaporeans from the time they are born to when they die, as well as permanent residents.
MediShield is the current basic Government health insurance plan. It provides coverage up to age 92. Some people are not covered because they are too old, opted out, or were excluded based on pre-existing conditions. MediShield will be replaced by MediShield Life.

These are the key differences between the two:

  • MediShield Life offers higher claim limits for hospital bills and outpatient cancer treatments like chemotherapy.
  • There is no lifetime claim limit for MediShield Life, meaning you are covered until death.
  • It covers pre-existing medical conditions like congenital problems or HIV.
  • All Singapore Citizens will receive Transitional Subsidies over four years to help with the premium increases under MediShield Life. Members of the Pioneer Generation will receive Pioneer Generation Subsidies for life. Two in three Singaporeans will also receive Premium Subsidies for lower to middle-income families.
    Medisave is one of the accounts in your Central Provident Fund. It is meant to pay for your medical needs. MediShield Life premiums will be paid from your Medisave account.
    No. The scheme is compulsory. Under MediShield Life, Singaporeans will remain insured and receive lifelong protection for large hospital bills. It is in line with our move to a more inclusive society with stronger collective responsibility.
    You do not have to do anything. The scheme has been automatically rolled out to everyone since Nov 1. 
    It depends on your age, monthly income per person in your household, and the annual value of your residence. Your residence refers to the address on your NRIC. You can get an estimate at www.MediShieldlife.sg/calculator
    Yes you do. All Singaporeans will receive life-long MediShield Life protection from large bills. The benefits will be supported by the premiums. Premiums will generally get higher as you grow older. However, you will get premium rebates to help offset this increase. There will also be subsidies for your MediShield Life premiums, as long as you are eligible.
    Yes. However, the claim limits for MediShield Life are based on what you would be charged in a B2/C class ward. You will have to pay anything above that on your own.
    Deductibles are the amounts you must pay before you can start making claims under MediShield Life.

    They range from $1,500 to $3,000, depending on your age and class of hospital ward you choose. Here's an example:
    If your hospital bill is $1,400, you will not be able to claim under MediShield Life if your deductible is $1,500.
    However, you only need to pay the deductible once every policy year

    So, if you are warded multiple times in a year and are charged $1,500 every time, you would be able to claim from MediShield Life after that first hospital stay.

    It is the money that you have to pay on top of the deductible, and is calculated as a percentage of the bill.

    Under MediShield Life, the co-insurance rate is between 3 and 10 per cent, depending on the size of your bill.

    No. But if you have a private integrated shield policy, most private insurers offer various kinds of riders.
    This is in line with the principle of universal coverage.

    But PRs won't get any "transitional subsidies" - that is, the subsidies that Singaporeans get in the first four years of MediShield Life's implementation which will help them ease into the scheme. PRs will also get only half the permanent subsidies that Singaporeans get.

    Making Claims



    MediShield Life covers hospital bills and certain outpatient treatments for conditions like cancer or kidney failure. It does not cover the cost of seeing a GP or a doctor at polyclinics or specialised outpatient clinics, or the medicine they prescribe.

    Generally, MediShield Life will cover more of big hospital bills - including both surgery and ward charges - than MediShield currently does.

    For example, it will cover more of the cost of chemotherapy and radiotherapy. It also covers things like implants and kidney dialysis.
    Here goes:

    You are a 60-year-old who was warded in a B2 ward for 10 days after a heart attack. Your bill is $8,100.
    You will have to pay $2,000 in deductibles and a further $455 in co-insurance.
    The total that you pay is $2,455.
    The total that MediShield Life pays is $5,645.
    Under MediShield, your co-insurance would be higher, at $605. Claim limits are also lower, so you would end up paying $4,655.
    MediShield would pay $3,445.

    In most public hospitals, all you have to do is tell the staff member handling your admission that you wish to claim from MediShield. The hospital will take care of the rest.
    Yes. MediShield Life is targeted at large hospital bills. However, the Health Ministry has said that it may consider providing coverage for outpatient treatment in the future - for example, if new treatments are developed and there is sufficient evidence that they are effective.
    It is supposed to be a basic health insurance scheme. If you want better coverage, you can buy a private Integrated Shield Plan which will cover you for higher ward classes.
    Yes, they can. But those who earn more will get a lower subsidy.
    No, so as not to encourage such behaviour. But the Health Ministry will take a case-by-case approach if the injuries came about as a result of mental illness.

    Pre-existing conditions



    A pre-existing condition is a medical condition or illness that an individual already has before he is covered under an insurance plan. If your health condition developed after the start of your insurance cover with MediShield or an Integrated Shield Plan, you will not be considered to have a pre-existing condition.

    Yes. They will pay 30 per cent higher premiums, for the next 10 years of MediShield Life. However, the Government will only charge those with serious pre-existing conditions higher premiums. For example, if you have well-managed high blood pressure, you will not be charged extra.
    Cancer, stroke, chronic conditions with serious complications (e.g. hypertensive heart disease), stroke, degenerative disorders (e.g. Parkinson's disease).

    However, note that if this health condition developed after the start of your insurance cover with MediShield or an Integrated Shield Plan, you will not be considered to have a pre-existing condition.

    Click here for details.

    This is to fund part of their coverage, and also because they pose a higher risk to the pool of those insured. If they cannot afford it, they will get help.
    The Health Ministry says that those with serious pre-existing conditions would have to pay a lot more than 30 per cent if the Government didn’t bear most of the costs.

    Subsidies are also applicable to the additional 30 per cent premium to be applied for those with serious pre-existing conditions. This includes the Premium Subsidies for the lower- to middle-income, Pioneer Generation Subsidies and Transitional Subsidies. For the needy, on a case by case basis, the Government will provide Additional Premium Support.

    Only 6 per cent of Singaporeans are not insured under MediShield. About 23,000 people in this group will have to pay higher premiums because of serious pre-existing conditions.

    Of those covered under MediShield or Integrated Plans but with exclusions on certain conditions, around 2,000 will have to pay higher premiums.

    No. It will check your health records to assess your condition.
    They are those which require intensive medical intervention to treat or manage, or have a high risk of future complications or recurrence and may therefore require prolonged treatment. Within the broad categories, whether individuals will have to pay more premiums depends on the specific nature and severity of their own condition.
    You will get a letter from the Government by October 2015.
    No, as long as the disorder doesn’t mean that the person is likely to have to be hospitalised for prolonged periods or undergo expensive outpatient treatments in the future.

    Subsidies



    If you belong to the lower- or middle-income group, you will get permanent subsidies to offset your premiums. This applies to both Singaporeans and PRs.
    This is defined as households where the per capita monthly income is $2,600 or lower, and who live in properties whose annual value is $21,000 or less. The Health Ministry has said that this means two out of three people will get these permanent subsidies.
    If you are a Singaporean, you will also get transitional subsidies spread over four years to help ease you into the scheme. You will get these regardless of your income or residence.
    Those in the Pioneer Generation will also get special subsidies of between 40 to 60 per cent, depending on their age. This is on top of the other subsidies.
    According to SingStat, 67 per cent of residents live in households with this or lower income level.
    A working couple with two kids and an elderly parent, earning a total of $12,000 a month, would qualify, as their monthly income per person would be $2,400.
    It is a simple and administratively practical way of assessing households’ relative means, says the Government.

    Those with a home of a higher annual value would, generally speaking, be better off. For those who find it hard to afford premiums but do not qualify for subsidies due to their home’s annual value, additional help may be made available on a case-by-case basis, depending on a person’s family circumstances.

    Just like those who live in residences with an annual value of more than $21,000, those who own multiple properties will not get permanent subsidies.
    Yes, you do. You can update your NRIC address at police posts or the Immigration and Checkpoints Authority, with supporting documents.
    You do not have to do anything, apart from making sure that your address is up-to-date.

    Premiums



    Money can be deducted from the Medisave accounts of your immediate family members – including your spouse or children – to pay premiums on your behalf.
    No, but you can top-up your Medisave account with cash.
    No, they will not take the money from these accounts as they are set aside to help with other needs, such as retirement. There will be Premium Subsidies for the lower- to middle income, Pioneer Generation Subsidies and Transitional Subsidies. For the needy, on a case by case basis, the Government will provide Additional Premium Support.
    Yes, you will get multiple reminder letters. You will not be penalised unless you deliberately default on your payments.
    No, they will not. No single individual will pay more than everyone else in the same age band simply because he has made more claims.

    However, if everyone in your age band makes many claims, premiums may go up the next time the Health Ministry reviews this group.

    You are responsible for your children’s premiums. Payments for other people will be handled on a case-by-case basis. Or you can give them the money and they can top up their Medisave accounts.
    Yes. You will be notified before the money is deducted, and will be able to cancel the arrangement.

    In line with the principle of insurance, premiums are risk pooled and used to support payouts for policyholders who fall ill and make claims. While some members may die earlier, the contributed premiums will continue to support the rest of the pool. For those who die without making a claim, premiums that they had contributed in the past will have gone towards supporting the claims payouts and commitments for the Scheme.

    If a member dies through the premium year, the premium will be pro-rated and refunded to the member’s Medisave account, according to the number of months left in the premium year. These Medisave monies will be distributed to the family members, along with other Medisave monies.

    MediShield Life premiums increase with age. This reflects the higher incidence of hospitalisation among the older age groups, and the higher bills incurred.
    According to the Health Ministry, premiums went up that year to reflect the claims and improvements made under MediShield.

    As MediShield Life provides better coverage, higher premiums are to be expected.

    You will be sent multiple reminder letters. There will be checks to see if any family member can help you pay, and you will also be alerted if you are eligible for additional financial help.
    No. The Government has said it will treat with flexibility those who need help because of unique or sudden unfortunate circumstances.
    No. However, if you have outstanding premiums, you may be warned that you are not to leave Singapore until they are paid.

    If you still leave or try to do so, you may be jailed up to a year, fined up to $5,000, or both.

    It is possible that your bank or your employer may be directed to pay the outstanding premiums from your savings or your salary.
    You may have to pay up to 17 per cent of outstanding premiums and interest on late premiums.
    The Inland Revenue Authority of Singapore and the CPF Board.
    You could get your family members to pay for you using their Medisave accounts. If they cannot help you, you can apply for help from the Government.

    Data Privacy



    It will look at records available in Government databases, such as those used to process claims submitted by private and public medical institutions.
    These are records that have already been submitted to the Government, such as details on CPF contributions.

    The Government will not be looking at private or commercial data, including bank accounts or credit records.

    It will ensure that as many Singaporeans as possible are able to benefit from the subsidies. This is particularly important for the vulnerable and needy who may find it more challenging to put together the necessary forms and documents that are normally needed to access government subsidies.

    You may choose to deny the Government access to your information. However, you will not get any Premium Subsidies as there is insufficient information to assess your eligibility.

    This is because the Government will be unable to ascertain whether or not you have a pre-existing condition. It will also ensure that all members will be treated fairly, as other Singaporeans would have gone through the check for pre-existing conditions and would pay the higher premiums if they are identified to have serious pre-existing conditions.
    Details on how to decline access will be released later.
    If you do not want to pay higher premiums, you can choose to submit a statutory health declaration or other documentary proof of your health status.
    Only authorised persons will be allowed to access, use, or disclose this information.
    Those who violate this rule can be jailed up to a year, fine up to $5,000, or both.
    The Government will facilitate the extension of Premium Subsidies by making the process as convenient as possible for the public. There is no need for the public to submit any application forms or income documents. MOH will use information in Government records to check and compute the MediShield Life Premium Subsidies for each individual. The public are encouraged to verify their household composition, to ensure that their information is updated and accurate.

    Integrated Shield Plans



    It is a private insurance plan that builds on what MediShield - and later, MediShield Life - has to offer. You can pay premiums to your private insurer using your Medisave account, subject to a certain limit.
    You can check your yearly CPF Statement of Account or check online on the CPF website.
    There are five Integrated Shield Plan providers - Aviva, AIA, NTUC Income, Great Eastern, and Prudential.
    No. MediShield Life will be the foundation on which Integrated Shield Plans are built. If you have an Integrated Shield Plan, you will pay one single premium directly to your private insurer. The MediShield Life portion will be sorted out at the back-end by your insurer and the CPF Board.
    No. They function as one policy. You submit your claim to your private insurer. The part of the claim that MediShield Life will cover will be provided by the CPF Board to your insurer.
    That depends on what you are looking for in your insurance plan. If you want to stay in a private ward and choose your own doctor, you should keep it. If you think you might not be able to afford the premiums, you should consider cancelling it.
    Yes, you will. You do not need to downgrade. Any subsidies that you get will be based on the MediShield Life component of your private plan.
    The Health Ministry is working with the Monetary Authority of Singapore to ensure that insurers present their products more transparently and accurately.
    This will help people make more informed decisions about buying such plans.
    Yes. About two-thirds of Singaporeans and PRs have such plans.
    In that case, the best thing to do is to hang on to your current plan for one more year, says the Health Ministry. When MediShield Life is launched, the overall IP premiums will be revised. By early next year, the picture will be clearer and you can then decide on the best scheme for you and your family.
    It will most likely be introduced in the first half of next year, after the rollout of MediShield Life.

    More Questions



    No. This is because there are already other avenues of Government support for pregnancy, such as the Marriage and Parenthood package.
    You can read the MediShield Life Review Committee report. The full list of excluded conditions is in Annex F.
    The report can be found at www.moh.gov.sg/content/moh_web/MediShield-life/mlrc-report.html
    There is a need to balance premium affordability with the range of benefits provided, says the Health Ministry. It feels that palliative care is generally affordable after Government subsidies and Medisave use.
    If you are a pensioner, you will continue to receive the same post-retirement medical benefits even when MediShield Life is introduced. There are no changes.

    To ensure that pensioners will not be worse off with the introduction of MediShield Life, the Government will help pensioners with their MediShield Life premiums. The Government has written directly to all affected pensioners.

    The Health Ministry was concerned that people may delay treatment to maintain the no-claim bonus. In addition, some people - like those born with congenital conditions or who get into accidents - may take good care of themselves, but still need to make claims. It is not fair to penalise them for things that they cannot help.
    No. Last year, Health Minister Gan Kim Yong said that no increase in taxes is planned to pay for MediShield Life subsidies.
    Healthcare coverage from employers is rarely guaranteed for life. Employees with healthcare coverage from their employers may lose such coverage when they leave employment or retire, and may not be able to re-apply for coverage thereafter if they have already developed some health conditions.

    MediShield Life ensures that all Singaporeans will have assurance against large healthcare bills for life regardless of your employment status, e.g. in between jobs or after retirement.

    The reason people have to pay up to 10 per cent in co-insurance is so that doctors don’t over-service, just because “the patient has insurance”.
    When it comes to treatments, the Government is also urging doctors and patients to keep in mind cost-effectiveness, and that expensive does not always mean better.
    It will cost about $1.1 billion in the first five years. This is because those with pre-existing conditions are more likely to incur medical costs to treat these conditions.
    No. The Government is bearing about 75 per cent of the cost, or around $850 million. Those with pre-existing conditions will also pay higher premiums.
    However, Singaporeans will co-share part of this cost as part of collective responsibility.
    No, she cannot. The Health Ministry’s rationale is that people may wish to come back to Singapore for medical treatment in the future, and if they do so, they will be covered by MediShield Life. Under MediShield Life, Singaporeans will remain insured and receive lifelong protection for large hospital bills. It is in line with our move to a more inclusive society with stronger collective responsibility. 
    He can top up his Medisave account with cash. You can also help him pay his premiums.
    No. Non-payment of premiums is not a criminal offence.