As part of an ongoing review of MediShield Life benefits and premiums, the MediShield Life Council will conduct a public consultation to seek views from the public on the preliminary recommendations and suggestions for enhancements to the scheme. The public consultation will be held from 29 September to 20 October 2020.
Keeping healthcare affordable for Singaporeans
2. MediShield Life is a basic health insurance plan launched in November 2015 to protect all Singaporeans against large medical bills regardless of pre-existing conditions, for life. The MediShield Life Council was appointed by the Minister for Health to provide recommendations on the policy and scheme parameters of MediShield Life, and to review its administration. This is the first major review of the scheme since its launch, and the changes are expected to be implemented in early 2021.
3. Mrs Fang Ai Lian, Chairman of the MediShield Life Council said, “MediShield Life plays a key role in ensuring our healthcare services remain affordable and gives Singaporeans greater peace of mind. We have to periodically review and update the scheme benefits and premiums to keep pace with evolving medical practice, healthcare cost inflation and actual claims experience, so that it continues to provide assurance for Singaporeans while remaining sustainable. As the Council undertakes the review, we invite Singaporeans to share their ideas and views through the public consultation so that MediShield Life will continue to benefit policyholders.”
Preliminary recommendations from the MediShield Life Council
4. MediShield Life was designed based on two key considerations: (a) provide better protection to Singaporeans, while (b) keeping premiums affordable. These considerations must be balanced carefully, as payouts are ultimately funded through premiums to ensure that MediShield Life remains sustainable.
5. Guided by these considerations, the MediShield Life Council has identified preliminary enhancements in three broad areas:
(a) Refreshing and refining claim limits to provide better coverage
6. MediShield Life claim limits should be refreshed to cover 9 in 10 subsidised bills, and should be reviewed more regularly to ensure that they offer adequate protection in light of inflation and medical advancements. In addition, the Council proposes the following refinements:
i. Introduce treatment-specific claim limits for community hospital care and outpatient radiotherapy to improve coverage for patients receiving sub-acute care [1] or costlier outpatient radiotherapy.
ii. Raise the policy year claim limit from $100,000 to $150,000, to better protect Singaporeans against exceptionally large bills arising from long or multiple periods of hospitalisation during the year.
(b) Enhancements to support larger healthcare transformation
7. In line with larger healthcare transformation efforts to keep healthcare costs sustainable, the MediShield Life Council recommends enhancements to better support Singaporeans who can be more appropriately cared for in the community or at home, to reduce the need for expensive hospital care:
i. Introduce higher claim limits for daily ward and treatment charges for the first two days of acute hospital stay, as higher charges tend to be incurred during the first two days due to diagnostic tests and investigations. This is to better support patients who can be discharged home earlier.
ii. Lower the deductible [2] for day surgeries for older patients, so that they are not discouraged from choosing a day surgery over an inpatient stay.
(c) Other proposed enhancements
8. The MediShield Life Council also proposes other enhancements:
i. Lower the pro-ration factor [3] for private hospitals to 25%, to better reflect the actual charges and ensure greater parity in payouts between subsidised and private patients.
ii. Remove the standard exclusions for treatments arising from attempted suicide, intentional self-injury, drug addiction and alcoholism, as treatment plays an increasingly important part in the support and recovery of these patients.
Review of premiums and premium affordability
9. 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. In particular, MediShield Life payouts have increased by close to 40% over the last four years, and the number of claimants has increased by almost 30%. The MediShield Life Council recommends adjusting the premiums this round as proposed by the actuary to ensure that the scheme continues to be sustainable.
10. As MediShield Life premiums had been kept constant for the first five years in line with the Government’s commitment, premiums were not adjusted when several benefit enhancements were implemented from 2018 to 2020. This round of adjustments will also take these enhancements into account.
11. Premium subsidies and support will continue to be extended to lower- and middle-income households, Merdeka Generation and Pioneer Generation seniors. Premiums will continue to be fully payable through MediSave. Total household premiums after subsidies will be within annual MediSave contributions and inflows for most typical households.
12. Nonetheless, the Council notes that some Singaporeans may face greater challenges with their premiums given the impact of COVID-19, and has asked the Ministry of Health (MOH) to consider providing additional assistance during this exceptional period. The Council is pleased to note that MOH has committed additional support for Singaporeans over the next two years. No one will lose MediShield Life coverage due to financial difficulties.
13. Please refer to Annex A for additional details on the preliminary recommendations, and Annex B for illustrations of how the preliminary recommendations can improve coverage for patients.
Details on Public Consultation
14. The MediShield Life Council would like to invite the public to contribute their views and feedback on the preliminary recommendations. The Council will carefully consider the feedback received from the public consultation before making the final recommendations by end 2020. The public consultation paper with details on the preliminary recommendations can be viewed at http://www.moh.gov.sg/e-consultation/mshl2020.
15. All feedback can be submitted from 6.00pm, 29 September to 6.00pm, 20 October 2020 via the online feedback form at http://www.moh.gov.sg/e-consultation/mshl2020, or mailed to the following address: Quality Service, Ministry of Health, 16 College Road, College of Medicine Building, Singapore 169854. All responses received by the closing date will be carefully considered.
MINISTRY OF HEALTH
29 SEPTEMBER 2020
[1] Sub-acute care at community hospitals is for complicated medical conditions that require additional medical and nursing care, but at a lower intensity compared to acute hospitals.
[2] Amount patient pays once every policy year before MediShield Life payout starts. Ranges from $1,500 to $3,000, depending on age and ward.
[3] MediShield Life payouts are pegged at subsidised bills at public hospitals, which are generally much lower than private hospital bills. The pro-ration factor is applied on a private hospital bill to adjust it down to the equivalent level of a subsidised bill, before the payout is computed.