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SINGAPORE: MediShield Life premiums may increase by as much as 35 percent in the coming years, ahead of subsidies, as MediShield Life Council seeks to enhance the benefits of Singapore’s national health insurance plan.
“The MediShield Life Council has made preliminary recommendations to improve MediShield Life benefits and for premiums to be adjusted accordingly,” the Ministry of Health (MOH) said on Tuesday (September 29).
This is the first major review of MediShield Life since its launch in 2015.
Recommendations include increasing the claim limit per policy year, introducing higher claim limits for daily ward and treatment charges, as well as eliminating standard exclusions for treatment arising from suicide attempts, drug addiction and alcoholism.
A public consultation on the recommendations will take place from Tuesday until 6 pm on October 20.
Authorities expect to implement the changes in early 2021.
HIGHER PREMIUMS
According to the recommendations, people 61 and older will experience the largest increase in premiums of about 35 percent, before subsidies.
But the net increase for all Singaporeans will remain at around 10 percent in the first year, after factoring in existing and additional subsidies, including a one-time COVID-19 subsidy announced on Tuesday.
The COVID-19 subsidy will cover 70 percent of the net increase in premiums in the first year and 30 percent in the second year.
READ: Singaporeans Will Receive COVID-19 Subsidy To Offset Proposed Increase In MediShield Life Premiums
MediShield’s Life Council said that while premiums have remained constant so far, MediShield’s Life payments have increased about 40 percent in the last four years, and the number of claimants has increased by nearly 30 percent.
He also noted that the premiums were not adjusted when the improvements were implemented starting in 2018.
READ: More Singaporeans Will Benefit From Higher Health Care Subsidies Under Revised Income Criteria
“This round of adjustments will also take into account these improvements,” the council said.
“Premiums need to be adjusted periodically to support improvements that provide better coverage and higher payments, and to keep up with health care cost inflation and actual claims experience.”
Low- and middle-income households, as well as Merdeka and Pioneer Generation seniors, will continue to receive premium subsidies and support.
Premiums will continue to be paid in full through MediSave, the council said, adding that total household premiums should remain within MediSave’s annual contributions and receipts for most typical households.
HIGHER ANNUAL CLAIM LIMITS
Claims limits should be “updated” to cover nine out of 10 subsidized bills, and claims limits should be reviewed every three years, the council said.
The MediShield Life Council recommended increasing the claims limit per policy year from S $ 100,000 to S $ 150,000. This would give Singaporeans better protection against exceptionally high bills for long or multiple hospitalizations throughout the year, it said in its public consultation document.
Citing a case in which an eight-year-old Singaporean had to be hospitalized for 147 days, including more than 80 days in the intensive care unit, for epilepsy and underwent five surgical procedures during his stay, the council noted that the bill The child’s total medical bill came to S $ 546,500.
Although the family received government grants and additional support from MediFund, they could only claim up to S $ 100,000 from MediShield Life. This meant that they had to use their MediSave to pay the last S $ 1,400 of their bill.
The proposed higher MediShield life policy year claim limit would provide more support for such patients.
READ: Higher MediShield Life Claims Limits As of January 1, 2020
HIGHER CLAIM LIMITS FOR UNDER ACUTE CARE
Another recommendation is treatment-specific claim limits for community hospital care and outpatient radiation therapy.
Both rehabilitation and subacute care in community hospitals are currently subject to the same claim limit of S $ 350 per day. However, subacute care is approximately 20% more expensive than rehabilitation care.
The council raised the case of a 60-year-old Singaporean who underwent subacute care in a community hospital for 25 days due to a bone infection. The total bill was S $ 17,300.
Although the patient received government subsidies and a MediShield Life payment, his bill exceeded the MediShield Life claimable amount. This meant that the patient had to pay the remaining S $ 2,212 with MediSave.
“Introducing separate claim limits for subacute care and rehabilitative care will ensure that both groups of patients enjoy similar levels of coverage with MediShield Life,” the council said.
Those treatment-specific claim limits should also apply to outpatient radiation therapy, to improve coverage of more expensive treatments, he added.
HIGHER DAILY CLAIM LIMITS
Patients with short hospital stays could receive more support, as the council proposed increasing claim limits for daily room and treatment charges during the first two days of acute hospital stays.
Ward and treatment charges for patients in acute hospitals have a claim limit of S $ 700 per day for normal wards and S $ 1,200 per day for intensive care unit wards.
However, patients tend to incur higher charges during the early part of their stay due to expensive tests and research to diagnose their conditions. Patients with longer stays benefit the most, as the aggregate claim limit on a longer hospital stay is enough to cover the high initial charges, the council said.
Higher claims limits for the first two days of hospitalization “would better cover short stays,” the council said.
READ: MediShield Life coverage extends to severe pregnancies and delivery-related complications
LOWER DEDUCTIBLE FOR DAY SURGERY
To encourage older patients to undergo outpatient surgery, the council recommended lowering the deductible for outpatient surgery patients over the age of 80 from S $ 3,000 to S $ 2,000. This will match the amount payable for inpatient stays in class C rooms.
“This will ensure that patients are not discouraged from choosing an outpatient surgery over a hospital stay, as they will be subject to the same deductible regardless of their choice,” the council said.
LOWER PRORATION FACTOR FOR PRIVATE HOSPITALS
The MediShield Life Council suggested lowering the proration factor for private hospitals from 35% to 25%.
Before their MediShield Life payments are calculated, private hospital patients will have their bills prorated by 35 percent so that the bills are comparable to those of a public hospital. This ensures that private hospital patients do not receive a higher payment.
Approximately 15 percent of MediShield claims per year are private hospital claims.
“Lowering the apportionment factor to 25 percent will better reflect real differences in bills and ensure more similar payments between the private hospital and subsidized patients,” the council said.
ELIMINATION OF EXCLUSIONS
In addition, the council recommended extending coverage to treatment for suicide attempt, intentional self-harm, drug addiction, and alcoholism.
It is estimated to help 300 more people per year for attempted suicide and intentional self-harm, and 1,000 more people per year for those with alcoholism and drug addiction.
“There is growing recognition that proper treatment is the proper approach to self-harm,” he said, noting that the American Society for Addiction Medicine recognizes addiction as a chronic medical disease, with prevention efforts and approaches to treatment generally as successful as those for chronic diseases. diseases.
READ: MediShield Life coverage expanded to three new areas
Health Minister Gan Kim Yong said: “I want to assure Singaporeans that the government will continue to help them with their premiums. No one will lose MediShield Life coverage due to financial difficulties.”
Opinions on the recommendations can be submitted via an online comment form or mailed to the Ministry of Health.
