by Leong Sze Hian
I refer to Goh Poh Kheng’s letter “Stumped by low MediShield payout” (ST, Mar 7).
To help Ms Goh and readers understand the use of Medisave and MediShield claims, I would like explain some of the queries raised by her. I shall also try to put all the relevant information in this article, as they seem to be all over the place – in various parts of the MOH and CPF web sites.
What is “pro-ration”?
Ms Goh wrote:
“I called the NUH billing department about it but they had no clue and advised me to call the Central Provident Fund (CPF) Board, which told me the amount to be calculated for the MediShield claim was not the full $2,300 submitted by NUH, but a sum after ‘pro-ration’, which came to $1,500.
I asked what this ‘pro-ration’ was and I was told it was calculated through means testing and for further details, I should call NUH.
I called the NUH patient service department and was told they would check with the CPF Board and get back to me. But, till now, no one has responded.
Who should I call now?
I wish such matters could be made more simple and transparent. A check on both the CPF Board and Ministry of Health (MOH) websites has left me none the wiser”
Actually, pro-ration (means testing) is explained in the MOH web site.
Briefly, if her father’s monthly income is more than $3,200, the 80 per cent subsidy will gradually reduce to 65 per cent when income exceeds $5,201.
For example, at $5,201, the patient would have to pay 75 per cent more than a patient whose income is below $3,200.
MediShield
MediShield may also not cover 100 per cent of the medical fees, as there are various claim limits, such as Inpatient/Day Surgery rangng from $250 to $900 per day, depending on whether its a normal, ICU or Communiy Hospital ward; the type of Surgical Operations ranging from $150 (Table 1) to $1,100 (Table 7), etc.
For Outpatient Treatments, only the following types of treatment are covered, subject to the claim limits:-
- Chemotherapy for Cancer/Certain Benign
- Neoplasms - Per 7-day treatment cycle – $270; Per 21- or 28-day treatment cycle – $1240
- Stereotactic Radiotherapy for Cancer $1,800 per treatment
- Radiotherapy for Cancer
- External or Superficial – $80 per treatment day
- Brachytherapy with or without external – $160 per treatment day
- Kidney Dialysis – $1,000 per month
- Immunosuppressant drugs for organ transplant $200 per month
- Erythropoietin drug for chronic kidney failure $200 per month
Out-patient treatments that do not fall into the above definitions, or other illnesses, other that those listed above are not covered.
Medisave
However, Medisave can be used for out-patient treatment of the following chronic illnesses, subject to withdrawal limits:-
- Diabetes
- Hypertension, Lipid disorders (e.g. high cholesterol) and Stroke
- Asthma and Chronic Obstructive Pulmonary Disease (COPD)
- Mental illness (schizophrenia and major depression)
Medisave savings can be used for the following hospital charges:
- Daily ward charges
- Doctor’s fees
- Surgical operations including the use of operating theatres; and
- In-patient charges for medical treatment, investigations, medicines, rehabilitation services, medical supplies, implants and prostheses introduced during surgery
So, in summary, generally, out-patient treatment pre and post hospitalisation may not be covered for MediShield, and Medisave may also not be used for out-patient treatment unless they fall within the seven approved chronic illnesses.
Deductible
The Deductible (Per Policy Year) which can be paid with Medisave or cash is as follows:-
Day Surgery
- Members aged 80 years old and below – Class C $1000 Class B2 and above $1500
- Members aged between 81 – 85 years old – Class C $2000 Class B2 and above $3000
You can see that older patients aged between 81 to 85 years old have to pay double the deductible, which I find rather puzzling, as it is likely that more people may not be able to afford to pay at that advanced age.
Co-insurance
The Co-insurance Amount is as follows:-
- Class C – $1001 – $3000 : 20%
- $3001 – $5000 : 15%
- Above $5000 : 10%
- Class B2 and above – $1501 – $3000 : 20%
- $3001 – $5000 : 15%
- Above $5000 : 10%
According to life expectancy tables, about 40 per cent of females and 20 per cent of males are expected to be alive at age 85. Therefore, the termination of MediShield cover at age 85, may mean that Singaporeans will have no cover when they need it most.
In addition, drugs and treatments that are non-subsidised items, will result in patients paying more out-of-pocket medical costs.
If it is an accident at work, public hospitals do not apply the usual subsidies. For example, a Class C patient may be charged up to five times more, and under the Workmen Injury Act, the employer is only resposible for up to $25,000 of medical expenses. In contrast, employers are required to insure foreign workers for $15,000, but have unlimited liability for their medical expenses.
Exclusions
The following is the List of Excluded Treatments & Medical Expenses :-
Generally, the following expenses are outside the scope of MediShield and cannot be claimed:
- Entire stay in hospital if the member was admitted to the hospital before he was insured by MediShield
- Treatment of any of the following categories of pre-existing illnesses or any other serious illnesses for which the patient had received medical treatment during the 12 months before the start of MediShield cover:
- Blood disorder
- Cancer
- Cerebrovascular accidents (stroke)
- Chronic liver cirrhosis
- Chronic obstructive lung disease
- Chronic renal disease, including renal failure
- Coronary artery disease
- Degenerative disease
- Ischaemic heart disease
- Rheumatic heart disease
- Systemic lupus erythematosus
- Ambulance fees
- Congenital anomalies, hereditary conditions and disorders e.g. hole-in-heart, hare-lip
- Cosmetic Surgery
- Maternity charges (including Caesarean operations) or abortions
- Dental work (except due to accidental injuries)
- Infertility, sub-fertility, assisted conception or any contraceptive operation
- Sex change operations
- Mental illness and personality disorders
- Optional items which are outside the scope of treatment
- Overseas medical treatment
- Private nursing charges
- Purchase of kidney dialysis machines, iron- lung and other special appliances
- Treatment for which the insured person received reimbursement from Workmen’s Compensation and other forms of insurance coverage
- Treatment of any illness, disability, injury or any condition arising from or due to the
- Acquired Immune Deficiency Syndrome (AIDS) virus
- Treatment for drug addiction or alcoholism
- Treatment of injuries arising directly or indirectly from nuclear fallout, war and related risk
- Treatment of injuries arising from direct participation in civil commotion, riot or strike
- Treatment of self-inflicted injuries or injuries resulting from attempted suicide
- Vaccination
Finally, the last available statistic reported in the media a few years ago, was that about 750,000 people in Singapore, did not have any form of medical insurance.
Support TOC! Buy Leong Sze Hian’s book here!
HELP keep the voice of TOC alive!
If you like this article, please consider a small donation to help theonlinecitizen.com stay alive. Please note that we can only accept donations from Singaporeans. Thank you for your assistance.Do you have a flair for writing? Volunteer with us. Email us your full name and contact details to theonlinecitizen@gmail.com
Mr Leong, by writing this and many other economic analyses, you are doing all commoners a great service here. I thank you for that.
I just wonder how did the Health Minister managed to pay only $8 for his major surgery?
All the govt. initiated schemes, like Eldershield, medishield, CPF life, come with so many bells and whistles that they are no different from structured investment products like the Lehman minibonds, etc.
Hi RC,
I believe it was possible through the various Ms, and a comprehensive hospitalisation insurance cover that ordinary folks will not be able to afford.
Our CPF schemes are getting so numerous and ridiculous that CPF staff cannot explain it and have to cross reference you to the various dept within CPF board. I am speaking from personal encounter with them.
Simplicity is beauty and effective. Our CPF schemes gotten so complicated over the years only show that they are not well thought out. The govt cover up pot holes as and when they see them appearing. Apparently plenty of shortcomings have surfaced over the years. This resulted in the ridiculously completed and ineffective schemes we are burden with.
sorry, typo error.
Last sentence the word should be ‘complicated’ and not ‘completed’
@RC, Kris is correct. According to my insurance friends, Khaw has got his own private medical insurance that covers majority of the operation bills for him. So he need to pay only $8 out of his pocket. But the medical insurance premium should be very expensive for common people, obviously it is not expensive for him. 8 months bonus coming up….
To add insult to injury, the appointed nurse-in-charge of such claims procedure will even explain to you in detail that the 1st deductible is imposed only for the 1st time for each year but if you are hospitalised again for any subsequent visit within the same year, the deductible will be subsequently waived.
Hope to be warded for subsequent visit to make full use of the deductible, anyone ?
“Maternity charges (including Caesarean operations) or abortions
”
“Infertility, sub-fertility, assisted conception or any contraceptive operation
”
why Excluded all these?
Sg has fertility issue making it one of the least fertile country in the world if not the most infertile country in the world.
So, I hope a new ruling party change all these.
Good old Mr. Leong Sze Hian for his dedicated work to serve Singaporeans.
May Almighty God bless him and his family.
Always looking forward to his articles.
Mr leong ,u may want to contest Sembawang GRC
My thanks to Mr. Leong for this consolidation of information.
However, the CPF system is still ridiculously complex. I may be slow, but there are still many aspect that I don’t understand at all.
This is uniquely Singapore. Can’t they simplify things, or is the system intended to confuse.
Thank you Mr. Leong, for exposing the sly exploitation of the poor and average Singaporean by the PAP govt. The people are made to feel that the PAP govt. is a very caring govt. by its very efficient propaganda machine, but in reality, if we analyze the figures carefully, like what Mr. Leong has been doing for us, we realize that we’ve been screwed from the rear over and over again without our knowledge, and we actually turn around and say “Thank you sir, the PAP govt., for taking care (screwing) of us
@Kris, Ahboy… thanks for explaining. In other words his low $8 bill has got nothing to do with our current medical system or benefits regime, right? It is all attributed to his ability to pay hefty medical insurance, yes? So why did he brag about it in public is beyond me.
“You can see that older patients aged between 81 to 85 years old have to pay double the deductible, which I find rather puzzling, as it is likely that more people may not be able to afford to pay at that advanced age.”
I hate to say this but all Insurance policy no matter which country has a cut off age limit where people can no longer get insurance or be charged very high premiums because it is accepted that they are no longer able to live much longer and medical bills will be far higher than insurance premiums can pay for. Not to compare apples to oranges, but similar calculations are done for car damages for example. When your car is damaged beyond repair, it is considered a write off because the repair will be more expensive then the value of the vehicle itself. Sounds awful to apply said calculations for human beings i know but that is how insurance calculations work. And yes i am aware that unlike cars that can be replaced, a human being cannot be replaced. Nevertheless, speak to any person that works in the insurance industry and they will tell you the same thing.
Otherwise, good job Mr leong for summarizing these points for us on Medisave and Medishield. I should bookmark or copy this article for future references. I also like to clarify the list of exclusions. Medishield does not cover AIDS virus no matter whether you got it before or even after Medishield kicks in. There is simply no government support for AIDS patients at all in Singapore.
Watch this old Al Jazeera news story on HIV in Singapore shortly before Al Jazeera got dropped from Singapore cable TV. http://www.youtube.com/watch?v=V7WTbmPG0Qc
navigatin from/for what?
before you dropped dead..you still don’t see a cent returned to you whatever medics H I T the cpf/dr khaw is sinkin and singin…
when/if you dropped dead..you still OWED them your organs..non-negotiateble as well…
to me FKUC this medic thinggy…
Er…how to just pay $8 for a heart bypass? The other terms are mind boggling and gives me a headache.
Simply put, $8 is what Khaw Boon Wan paid in cash to the hospital for his surgery and what he wants the public to know so that they think our healthcare remains “affordable”. He simply neglected to tell us the inconvenient, hard truths that the bulk was paid by his private comprehensive shield plan (with high annual premiums that the average person either simply cannot afford or finds it finds heart-wrenching to pay), and the balance was deducted from his Medisave (which would blow a hole in the ordinary citizen’s Medisave account), with the remaining $8 to be paid in cash.
So complicated . Why the govt use such complicated method to charge. Why cant make it simpler. Why medishield, medicare, means testing, &%$# shit.? Need so many nonsense method of charging ah? If you cant convince them, confuse them….more like it.
I wish to challenge the point raised by a few people that private medical insurance is very expensive.
Before I begin, I disclaim that I am a financial adviser (though independent and not tied to a single insurance company and its interests) and that I am supportive of local opposition parties.
Mr. Khaw paid $8 in cash because he has a private Shield plan which likely covers most of the bill, and the remaining was paid by his Medisave, and hence resulting in only $8 of out-of-pocket expenses. He did not get a discounted bill on account of his ministerial status (I’m making an intelligent guess).
For a man in his 50s, a private Shield plan can cost as cheap as $340 a year which is payable by Medisave. He can then top it up with a rider costing $163 a year payable by cash. The insured will only have to pay 10% of his hospitalisation expenses up to a maximum of $3,000, of which Medisave can be used as well. (Eg. $2,000 bill -> $200 payable, $100,000 bill -> $3,000 payable)
This works out to $13.58 of premiums every month by cash. The premiums for younger people are much cheaper. An even cheaper plan with less features can be picked. I worry for the people who believe medical insurance to be expensive as they probably have not done proper financial planning before, or have met up with insurance agents only interested in peddling high commission policies and expensive medical plans.
It is the fact of life in Singapore that hospitalisation expenses are high. Since we do not like the government being a nanny, I believe we should be taking care of certain things, and medical insurance happens to be something that most of us are able to take care of in a cost-effective manner (if you meet up with the right financial adviser).
I understand that there are those who have pre-existing problems. There are plans that will cover for some of such conditions (accordingly, they are more expensive). This also emphasizes the importance of getting cover when young.
At this point, I wish to reiterate my vested interests as I earn commissions. Recently, I closed a Shield plan for a 40-year-old man, and the commissions (one-off, not recurring) barely pays for my cab fare home (which is why I take bus/MRT rain or shine). Today I closed another for a 22-year-old person which will earn me enough to pay for 2 to 3 cups of my favourite bubble tea.
Not too sure about TOC’s stand on comments that advertise, but I shall hereby shamelessly advertise my services to clarify matters on Medishield, Medisave, private Shield policies etc.. Hopefully they allow it since considering the commission rate, it’s almost “pro-bono”!
Seth
I wish to challenge the point raised by a few people that private medical insurance is very expensive.
I disclaim that I am a financial adviser (though independent and not tied to a single insurance company and its interests) and that I am supportive of local opposition parties.
Mr. Khaw paid $8 in cash because he has a private Shield plan which likely covers most of the bill, and the remaining was paid by his Medisave, and hence resulting in only $8 of out-of-pocket expenses. He did not get a discounted bill on account of his ministerial status (I’m making an intelligent guess).
For a man in his 50s, a private Shield plan can cost as cheap as $340 a year which is payable by Medisave. He can then top it up with a rider costing $163 a year payable by cash. The insured will only have to pay 10% of his hospitalisation expenses up to a maximum of $3,000, of which Medisave can be used as well. (Eg. $2,000 bill -> $200 payable, $100,000 bill -> $3,000 payable)
This works out to $13.58 of premiums every month by cash. The premiums for younger people are much cheaper. An even cheaper plan with less features can be picked. I worry for the people who believe medical insurance to be expensive as they probably have not done proper financial planning before, or have met up with insurance agents only interested in peddling high commission policies and expensive medical plans.
It is the fact of life in Singapore that hospitalisation expenses are high. Since we do not like the government being a nanny, I believe we should be taking care of certain things, and medical insurance happens to be something that most of us are able to take care of in a cost-effective manner (if you meet up with the right financial adviser).
I understand that there are those who have pre-existing problems. There are plans that will cover for some of such conditions (accordingly, they are more expensive). This also emphasizes the importance of getting cover when young.
At this point, I wish to reiterate my vested interests as I earn commissions. Recently, I closed a Shield plan for a 40-year-old man, and the commissions (one-off, not recurring) barely pays for my cab fare home (which is why I take bus/MRT rain or shine). Today I closed another for a 22-year-old person which will earn me enough to pay for 2 to 3 cups of my favourite bubble tea.
Seth
basically the pigs managed to show good stuff for 3m but selecting the people that goes into the pool.
Once the age/medical profile of the pool changes, the system will crack like never before.
It is
It is a cock up system.
basically the pigs managed to show good stuff for 3m but selecting the people that goes into the pool.
Once the age/medical profile of the pool changes, the system will crack like never before.
because more people take out monies than put in.
That’s why the govt had to inflate medical bills.
The cost of production is the same (since they control most hospital) but the part paid in by the contributors increase to the point that the pigs don’t have to put monies in.
with our population ageing,the govt needs to ensure that healthcare costs do not escalate to a point where more and more ‘POOR CITIZENS’ feel it is better to jump off from the upper floors of their hdb flats or dive into MRT tracks in order not to burden their families or attempt to stop their pain because they can;t afford medications.
means testing or whatever,these are all just cosmetics that attempt to duck the very substance of the real problems on hand.
to my simple mid,it is just like giving little ‘goodies’ to citizens who have been robbed off their jobs and livelihood by the FT POLICY and to whom the govt should spare no efforts in re-creating and returning jobs to them.
Simply put, the govt. should take care of the old who have contributed to the building and development of Singapore, and cut back in other areas such as the budget for the PA and other grandiose but non productive projects. Perhaps give free health care to all senior true blue citizens of age 65 and over. These are the people who truly deserve the govt.’s gratitude and assistance.
fpc
That’s why the govt had to inflate medical bills.
The cost of production is the same (since they control most hospital) but the part paid in by the contributors increase to the point that the pigs don’t have to put monies in.
………………
why dont leekingyou tell/show us his medical bill for his belated spouse who spent 24/7/365 in singapoor gen hospital under intensive care unit..
and i will show you MINE the $90 cash upfront paid for usin the A&E unit on an accidental case…
wake up lah! why govt take care of old,
they take care of themselves already rob us blind!
done enough of breaking the kitty,
robbing the people
still dare let them go on?
My problem with the strange doubling of deductible for those 81 and above is that a state-sponsored insurance scheme cannot leave the most vulnerable. I can accept a commercial health insurance scheme has such a clause; I can even accept this situation for elderly with children supporting them, but I cannot accept that there is no fall-back for the elderly above 81 when they are hospitalized. This is telling the last category to go and die before they reach 81.
My second and more serious issue: who audits the hospitals for their accounting of costs? Are there any arbitrary allocation of costs like depreciation of buildings (eg the new KTPH was built with over $1b donation, so it is not fair for the government to still charge the public depreciation costs from donated sums right?
What is their incentive to control costs?