MediShield Life is as close to universal healthcare
that Singapore has ever had. It is the
basic health insurance administered by the CPF Board. It is a replacement for MediShield, the low-cost basic medical insurance introduced in 1990.
MediShield and MediShield Life coverage is for
subsidised treatment in Class B2 and C wards of public hospitals. It is the bare basic coverage. Staying in a B1 or A class ward, or in a private
hospital, you are still covered by MediShield but because the bills are higher since
there is minimal government subsidy. If
people can afford it, it is advisable for them to get an integrated plan.
Features
MediShield Life began replacing MediShield coverage
from November 2015. The new premiums are
in force from the next premium anniversary.
It has the following features, distinct from MediShield.
It covers all Singaporeans and Permanent
Residents. The current MediShield does
not. This coverage is automatic. There is no need to apply for it.
It is specific for B2 / C class wards. There is another plan to be introduced in
2017 for B1 wards.
It covers pre-existing conditions. The current MediShield does not. This coverage for pre-existing conditions is
provided even if you have previously been rejected for that exact same
condition. This coverage does not extend
to the private insurance portion of an integrated plan.
Covering pre-existing conditions for all Singaporeans
and Permanent Residents is expensive.
Those with pre-existing conditions pay 30% extra for their premiums for
the next decade. The government stressed
that this does not reflect the actual cost of coverage. Additionally, insurance companies have
pledged not to raise their premiums for one year. As to what constitutes a pre-existing
condition serious enough to warrant this extra 30% loading, MoH will release
that at a later date.
Younger people will pay a slightly higher premium to
compensate for a lower premium in their old age.
The coverage is for the entire natural life. The current MediShield terminates at age 92
next birthday.
All of the MediShield Life premiums are now payable by
Medisave. Previously, there were claim
limits ranging from $800 to $1,400.
The policy year claim limit has been raised to
$100,000. Previously, it stood at
$70,000 per policy year.
The lifetime claim limits have been removed. Previously, the maximum lifetime claim limit was
$300,000.
The daily claim limits for normal wards and Intensive
Care Units have been raised by up to 55%.
There is an increase in the claim limits for surgical
procedures by between 25% and 93%.
There is an increase the daily claim limit for
Community Hospitals by 40% from $250 to $350.
There is an increase in the claim limits for
outpatient chemotherapy and radiotherapy treatments. This covers more of the cost of subsidised
cancer treatment.
The co-insurance rates have been lowered from the
current 10 to 20%, to 3 to 10%. This
means MediShield Life can be used to cover a larger proportion of the medical
bill.
Premium rebates are supposed to begin from age 66 next
birthday, instead of the previous age 71.
Subsidies
There are four types of premium subsidies. This is needed because in some cases, the
premiums go up substantially.
The first type is the Pioneer Generation Subsidies. Their subsidies are between 40-60% regardless
of their household per capita income or the Annual Value of their home. After the subsidies and top-ups, Pioneers pay
lower premiums for MediShield Life than they would have paid under MediShield. Pioneers will receive $200 to $800 a year in
Medisave top-ups for the rest of their life. This will be used to pay for their MediShield
Life premiums.
The second type is the Transitional Subsidies. This is for all Singapore Citizens whose net
premiums, after Pioneer Generation Subsidies or Premium Subsidies, increase
after the introduction of MediShield Life, regardless of their household income
or the Annual Value of their home. It is
only available for the first 4 years of MediShield Life.
In the first year, the Government pays 90% of the net
increase in MediShield Life premiums, less other premium subsidies, above
MediShield premiums. This means that we
pay 10% of the net increase in premium for the first year. The subsidy decreases to 70%, 40% and 20% of
the net premium increase in the second, third and fourth years of MediShield
Life respectively.
The third type is Premium Subsidies for lower- to
middle-income families. They must have a
household monthly income of $2,600 and below per person, and living in
residences with an Annual Value of $21,000 and below. Simply getting enough people such as your
parents to stay with you will do this. Those
eligible can receive subsidies of up to 50% of their premiums. Permanent Residents receive half the subsidy
rate applicable to citizens. This is a
permanent feature of the Scheme.
The final type is the Additional Premium Support for
families who require assistance with their premiums even after the above
subsidies and Medisave use.
Analysis
It is estimated that covering pre-existing illnesses
will cost just over $1 billion in the next five years. Insurance companies will see the claim
history for a year before deciding how much to raise the premium of the integrated
portion of their respective Shield Plans.
The 30% loading over the next 10 years is definitely not enough to cover
the cost. As such, the government has to
raise that funds elsewhere. That would
likely be found in an increase in the GST.
Based on data on deductible, withdrawal and co-insurance
breakdown, the pay out of the plan as a percentage of the hospital bill is
about 44%. In contrast, the average
increase in premium is close to 90%.
This is double the percentage pay out.
This is very high for a national health insurance.