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Navigating the complexities of MediShield and Medisave

Published

14 years ago

on

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:

  1. Entire stay in hospital if the member was admitted to the hospital before he was insured by MediShield
  2. 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.

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Current Affairs

TJC issued 3rd POFMA order under Minister K Shanmugam for alleged falsehoods

The Transformative Justice Collective (TJC) was issued its third POFMA correction order on 5 October 2024 under the direction of Minister K Shanmugam for alleged falsehoods about death penalty processes. TJC has rejected the government’s claims, describing POFMA as a tool to suppress dissent.

Published

18 hours ago

on

6 October 2024

By

The Transformative Justice Collective (TJC), an advocacy group opposed to the death penalty, was issued its third Protection from Online Falsehoods and Manipulation Act (POFMA) correction direction on 5 October 2024.

The correction was ordered by Minister for Home Affairs and Law, K Shanmugam, following TJC’s publication of what the Ministry of Home Affairs (MHA) alleges to be false information regarding Singapore’s death row procedures and the prosecution of drug trafficking cases.

These statements were made on TJC’s website and across its social media platforms, including Facebook, Instagram, TikTok, and X (formerly Twitter).

In addition to TJC, civil activist Kokila Annamalai was also issued a correction direction by the minister over posts she made on Facebook and X between 4 and 5 October 2024.

According to MHA, these posts echoed similar views on the death penalty and the legal procedures for drug-related offences, and contained statements that the ministry claims are false concerning the treatment of death row prisoners and the state’s legal responsibilities in drug trafficking cases.

MHA stated that the posts suggested the government schedules and stays executions arbitrarily, without due regard to legal processes, and that the state does not bear the burden of proving drug trafficking charges.

However, these alleged falsehoods are contested by MHA, which maintains that the government strictly follows legal procedures, scheduling executions only after all legal avenues have been exhausted, and that the state always carries the burden of proof in such cases.

In its official release, MHA emphasised, “The prosecution always bears the legal burden of proving its case beyond a reasonable doubt, and this applies to all criminal offences, including drug trafficking.”

It also pointed to an article on the government fact-checking site Factually to provide further clarification on the issues raised.

As a result of these allegations, both TJC and Annamalai are now required to post correction notices. TJC must display these corrections on its website and social media platforms, while Annamalai is required to carry similar notices on her Facebook and X posts.

TikTok has also been issued a targeted correction direction, requiring the platform to communicate the correction to all Singapore-based users who viewed the related TJC post.

In a statement following the issuance of the correction direction, TJC strongly rejected the government’s claims. The group criticised the POFMA law, calling it a “political weapon used to crush dissent,” and argued that the order was more about the exercise of state power than the pursuit of truth. “We have put up the Correction Directions not because we accept any of what the government asserts, but because of the grossly unjust terms of the POFMA law,” TJC stated.

TJC further argued that the government’s control over Singapore’s media landscape enables it to push pro-death penalty views without opposition. The group also stated that it would not engage in prolonged legal battles over the POFMA correction orders, opting to focus on its abolitionist work instead.

This marks the third time TJC has been subject to a POFMA correction direction in recent months.

The group was previously issued two orders in August 2024 for making similar statements concerning death row prisoners.

In its latest statement, MHA noted that despite being corrected previously, TJC had repeated what the ministry views as falsehoods.

MHA also criticised TJC for presenting the perspective of a convicted drug trafficker without acknowledging the harm caused to victims of drug abuse.

Annamalai, a prominent civil rights activist, is also known for her involvement in various social justice campaigns. She was charged in June 2024 for her participation in a pro-Palestinian procession near the Istana. Her posts, now subject to correction, contained information similar to those presented by TJC regarding death penalty procedures and drug-related cases.

POFMA, which was introduced in 2019, allows the government to issue correction directions when it deems falsehoods are being spread online.

Critics of the law argue that it can be used to suppress dissent, while the government asserts that it is a necessary tool for combating misinformation. The law has been frequently invoked against opposition politicians and activists.

As of October 2024, Minister K Shanmugam has issued 17 POFMA directions, more than any other minister. Shanmugam, who was instrumental in introducing POFMA, is followed by National Development Minister Desmond Lee, who has issued 10 POFMA directions.

Major media outlets, including The Straits Times, Channel News Asia, and Mothership, have covered the POFMA directions. However, as of the time of writing, none have included TJC’s response rejecting the government’s allegations.

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Current Affairs

Hotel Properties Limited suspends trading ahead of Ong Beng Seng’s court hearing

Hotel Properties Limited (HPL), co-founded by Mr Ong Beng Seng, has halted trading ahead of his court appearance today (4 October). The announcement was made by HPL’s company secretary at about 7.45am, citing a pending release of an announcement. Mr Ong faces one charge of abetting a public servant in obtaining gifts and another charge of obstruction of justice. He is due in court at 2.30pm.

Published

3 days ago

on

4 October 2024

By

SINGAPORE: Hotel Properties Limited (HPL), the property and hotel developer co-founded by Mr Ong Beng Seng, has requested a trading halt ahead of the Singapore tycoon’s scheduled court appearance today (4 October) afternoon.

This announcement was made by HPL’s company secretary at approximately 7.45am, stating that the halt was due to a pending release of an announcement.

Mr Ong, who serves as HPL’s managing director and controlling shareholder, faces one charge under Section 165, accused of abetting a public servant in obtaining gifts, as well as one charge of obstruction of justice.

He is set to appear in court at 2.30pm on 4 October.

Ong’s charges stem from his involvement in a high-profile corruption case linked to former Singaporean transport minister S Iswaran.

The 80-year-old businessman was named in Iswaran’s initial graft charges earlier this year.

These charges alleged that Iswaran had corruptly received valuable gifts from Ong, including tickets to the 2022 Singapore Formula 1 Grand Prix, flights, and a hotel stay in Doha.

These gifts were allegedly provided to advance Ong’s business interests, particularly in securing contracts with the Singapore Tourism Board for the Singapore GP and the ABBA Voyage virtual concert.

Although Iswaran no longer faces the original corruption charges, the prosecution amended them to lesser charges under Section 165.

Iswaran pleaded guilty on 24 September, 2024, to four counts under this section, which covered over S$400,000 worth of gifts, including flight tickets, sports event access, and luxury items like whisky and wines.

Additionally, he faced one count of obstructing justice for repaying Ong for a Doha-Singapore flight shortly before the Corrupt Practices Investigation Bureau (CPIB) became involved.

On 3 October, Iswaran was sentenced to one year in jail by presiding judge Justice Vincent Hoong.

The prosecution had sought a sentence of six to seven months for all charges, while the defence had asked for a significantly reduced sentence of no more than eight weeks.

Ong, a Malaysian national based in Singapore, was arrested by CPIB in July 2023 and released on bail shortly thereafter. Although no charges were initially filed against him, Ong’s involvement in the case intensified following Iswaran’s guilty plea.

The Attorney-General’s Chambers (AGC) had earlier indicated that it would soon make a decision regarding Ong’s legal standing, which has now led to the current charges.

According to the statement of facts read during Iswaran’s conviction, Ong’s case came to light as part of a broader investigation into his associates, which revealed Iswaran’s use of Ong’s private jet for a flight from Singapore to Doha in December 2022.

CPIB investigators uncovered the flight manifest and seized the document.

Upon learning that the flight records had been obtained, Ong contacted Iswaran, advising him to arrange for Singapore GP to bill him for the flight.

Iswaran subsequently paid Singapore GP S$5,700 for the Doha-Singapore business class flight in May 2023, forming the basis of his obstruction of justice charge.

Mr Ong is recognised as the figure who brought Formula One to Singapore in 2008, marking the first night race in the sport’s history.

He holds the rights to the Singapore Grand Prix. Iswaran was the chairman of the F1 steering committee and acted as the chief negotiator with Singapore GP on business matters concerning the race.

 

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