Medical Expense Insurance


Medical expense insurance pays for certain medical expenses incurred because of an accident or illness. Medical expenses can arise from any of the following medical treatments or procedures:

  • in-patient medical treatment or surgery,
  • day surgery,
  • consultations with specialists before, during and after the hospital stay,
  • X-rays and laboratory tests.

‘Major’ medical expense insurance will pay expenses for longer hospital stays due to a major illness like cancer or for major surgery such as heart bypass surgery or organ transplant.

Do note that:

  • The policy may not fully pay for actual medical expenses incurred.
  • The policy will usually include limits for each illness, disability, by policy year or lifetime.
  • Certain conditions and pre-existing conditions may be excluded from cover. Treatment that is not for medical reasons may also be excluded.
  • Investigative procedures such as tests / biopsies for diagnosis purposes, for example to detect a specific illness or medical condition may or may not be included.
  • Waiting periods may also apply. If so, expenses will not be paid during the waiting period.
  • Some policies may also have ‘deductible’ and ‘co-insurance’ features. Read more here.
  • With medical expense insurance, the total reimbursement you will get from all your policies is limited to your actual expenses. So buying additional medical expense insurance policies does not necessarily provide extra benefits.

MediShield Life

All Singaporeans and Singapore Permanent Residents are covered by MediShield Life from 1 November 2015. MediShield Life is a basic medical expense insurance. It is the national healthcare insurance scheme run by the CPF Board and can help you with medical expenses from major illnesses and prolonged hospital stays at the Class B2/C level.

MediShield Life replaced MediShield in end-2015, and covers all Singapore Citizens and Permanent Residents for life, even for pre-existing conditions, in line with the principle of universal coverage.

You can use your funds in your Medisave account to fully pay for MediShield Life premiums. Your Medisave account is debited to pay for premiums for your newborns. The deduction may be from either parent’s account.

Do note that:

  • If you are a Singapore Citizen or Permanent Resident, you will be automatically covered under MediShield Life from 1 November 2015. There is no need to apply for MediShield Life.
  • Coverage under MediShield Life is for life, and there is no age limit for entry into the scheme.
  • MediShield Life has claims limits, and operates on a deductibles and co-insurance basis. See more on deductibles and co-insurance.
  • Even if you incur bills in Class A, B1 or B2+ wards in public hospitals, or in private hospitals, you will still be able to claim from MediShield Life, but the claim will be adjusted to the equivalent Class B2/C bills and then subject to MediShield Life claim limits.
  • Those with serious pre-existing conditions may have to pay Additional Premiums (of 30% of standard MediShield Life premiums) for 10 years. The Additional Premiums do not reflect the actual costs of their coverage, as the bulk of the costs of covering those with serious pre-existing conditions will be taken up by the Government.
  • You will not lose your MediShield Life coverage even if you have financial difficulties. The Government will provide premium subsidies to keep MediShield Life premiums affordable. Those who are unable to afford premiums even after Government subsidies will also receive assistance.

For more information on MediShield Life, visit the MediShield Life website.

Is MediShield Life enough?

MediShield Life is sized to cover subsidised treatment in Class B2/C wards of public hospitals.

If you want the privileges of Class B1 or higher ward classes (like your choice of doctor) which are non-subsidised, you should expect to pay more. If this is the case, you may wish to consider additional health insurance coverage such as an Integrated Shield Plan and / or a comprehensive personal health insurance policy to help with the expected higher healthcare costs. (You should note that if you get a private health insurance policy that is not an Integrated Shield Plan, you may experience some duplication of coverage with MediShield Life.)

Read more on the MediShield Life website.

Integrated Shield Plans

If you plan to use Class B1 or Class A wards or private hospitals or expect to receive lower subsidies due to means-testing, and can afford higher premiums in the long run, you could consider applying for increased coverage under a Medisave-approved Integrated Shield Plan.

All Integrated Shield Plan holders already have MediShield Life. Integrated Shield Plans are made up of two components: (i) MediShield Life, run by CPF Board, and (ii) additional private insurance coverage, typically to cover Class A/B1 wards in public hospitals or private hospitals, run by private insurers.

Similarly, Integrated Shield Plan premiums are made up of the premium for the MediShield Life component and the premium for the additional private insurance component. Policyholders pay one combined premium for coverage under the Integrated Shield Plan. There is no duplication of coverage and premiums between MediShield Life and Integrated Shield Plans.


Do note that while MediShield Life will cover pre-existing conditions, the additional private insurance coverage portion of your Integrated Shield Plan may not. You should check with your insurer what you are covered for, and make an informed decision about which ward class you would like to be admitted to, in the event that you require treatment.

Which Integrated Shield Plan should I get?

What ward class do you plan to stay in if you require treatment? You should take up a policy based on the hospital and ward type that you want to use. For example, if you buy a plan that caters for a class B1 ward type but eventually use class B2/C wards in a public hospital, you will end up paying higher premiums than necessary. Conversely, if you eventually use class A ward type in a private hospital, you may be exposed to high out-of-pocket payments.

From 1 May 2016, apart from their existing products, all Integrated Shield Plan insurers are required to provide the standard Integrated Shield Plan. The Standard Integrated Shield Plan is an affordable plan targeted at B1 coverage with standardised benefits across insurers.

What does your Integrated Shield Plan cover? While MediShield Life will cover pre-existing conditions, the additional private insurance coverage portion of your Integrated Shield Plan may not. You should check with your insurer what you are covered for, and make an informed decision about which ward class you would like to be admitted to, in the event that you require treatment.

What kind of benefits are important to you? While all Integrated Shield Plans minimally provide the same main benefits features as MediShield life, they differ in terms of additional benefits offered. Examples of additional benefits offered include pre- and post-hospitalisation treatment benefits, pregnancy complication benefits and final expense benefits. You may wish to consider which plan has additional benefits you value or would most likely use.

In addition, many Integrated Shield Plans are “as-charged” policies. These policies do not usually have any sub-limits except for the annual and lifetime limits. The premiums for “as-charged” policies are significantly more expensive than “non-as-charged” (plans with sub-limits) policies, especially at the older ages.

What about the deductible and co-insurance portions? All Integrated Shield Plans have deductible and co-insurance portions. Do note that you will still have to pay for the deductible and co-insurance portions unless you buy separate rider plans to cover them.

Can I afford the premiums over the longer run? Integrated Shield Plans are payable by Medisave up to a limit (see next section). Nonetheless, the higher coverage you have, the higher your premiums will be. Do consider if you can afford the premiums over the longer run, especially since premiums rise with age.

Paying for Integrated Shield Plans with Medisave

If you or your immediate family members have Integrated Shield Plans, you can use Medisave to pay for your premiums and theirs too.

The MediShield Life component of the Integrated Shield Plan premium is fully payable by Medisave. You can also use Medisave to pay for the additional private insurance component of the Integrated Shield Plan premium, up to the prevailing Additional Withdrawal Limits (AWLs).

The AWL is set per insured person per policy year, and is as follows (as of 1 November 2015):

  • Age next birthday 40 and below: $300
  • Age next birthday 41 to 70 years: $600
  • Age next birthday 71 years and above: $900

 

Depending on your age and plan, the additional private insurance component of the premiums may cost more than the AWL and you will have to pay the amount over the limit with cash.

Do note that:

  • When deciding what type of medical insurance to buy, make sure it covers what you need and you can afford to keep up with the premiums over the long term. Be prepared to adjust what you want according to what you can afford in premiums. The cost of healthcare differs greatly between private and public hospitals, and also for the different types of wards. There are different insurance policies to cater to different needs and premiums will be higher for policies which offer higher coverage. Take some time to work out what you need for you and your family, before deciding what to buy.
  • While MediShield Life will cover pre-existing conditions, the additional private insurance coverage portion of your Integrated Shield Plan may not. You should check with your insurer what you are covered for, and make an informed decision about which ward class you would like to be admitted to, in the event that you require treatment.
  • You should check how much Medisave you can use to pay for the additional private insurance component of your Integrated Shield Plan premium. Once you reach the limit, you have to pay for the amount above the limit with cash.
  • Your Integrated Shield Plan may not always pay out more than MediShield Life due to higher deductibles and co-insurance features.
  • Riders that cover co-insurance and deductibles may not be paid for using Medisave. You need to pay cash for these riders. Instead of paying for a rider, you can also consider paying for the co-insurance and deductible incurred in the event of hospitalisation via Medisave or cash.
  • If you can no longer afford, or do not wish to continue paying the premiums for your Integrated Shield Plan in future, you can downgrade your plan to a lower coverage plan within the same insurer without additional underwriting, or downgrade to basic MediShield Life without any exclusion, at any point in time.
  • In the event that you have an existing Integrated Shield Plan and you switch to a new Integrated Shield Plan with another insurer, your original Integrated Shield Plan will be automatically terminated.
  • Before you switch policies, you should know that your new policy may not cover any pre-existing conditions you develop before it takes effect. Do not change your current policy if it leaves you unprotected for important conditions.

For details on the insurers and for more information on Medisave-approved Integrated Shield Plans, please refer to the MediShield Life website.

 

The above information is prepared in collaboration with the Life Insurance Association of Singapore, Central Provident Fund Board and General Insurance Association of Singapore.