Claims Rejected Under Integrated Shield Plan but Successfully Processed Under Medishield Life Cover

Name and Constituency of Member of Parliament
Dr Tan Wu Meng
MP for Jurong GRC

Question No. 137

To ask the Minister for Health in the last one year (a) how many patients with an Integrated Shield Plan had their claims rejected by the insurer despite the claims being made for medically necessary treatments; (b) how many of these cases were later processed for the coverage component provided under MediShield Life (MSHL); and (c) what proportion of these MSHL requests were (i) patient-initiated and (ii) insurer-initiated.

Answer

1        Over 90% of the claims processed by Integrated Shield Plans (IPs) insurers in 2019 were approved.  The remaining rejected claims were mostly for treatments or medication not covered by the IPs, such as for pre-existing medical conditions excluded by the IP or for medication not approved by the Health Science Authority.  We do not have data on the medical necessity of IPs’ rejected claims.

2        As MediShield Life (MSHL) is an integral component of IPs, all IP claims will be processed by the Central Provident Fund Board for claims under MSHL component regardless of the IP’s decision on the claims.