Latest update by MOH: New rider policyholders must pay 5% of the hospital bill, Existing policyholders are NOT affected at this point in time. Read the latest news here.
Do you have private Integrated Shield Plans (IPs) with riders that can cover your entire hospital bill?
Soon, you won’t have this privilege anymore.
Six insurance companies selling MediShield Life-linked health insurance have appealed to Ministry of Health (MOH) to make it mandatory for policyholders to pay a part of their hospital bills.
This includes existing and new policyholders.
Paying part of your hospital bills
The Health Insurance Task Force (HITF) suggested that patients should pay part of their hospital bills to prevent claims for escalating too quickly.
Insurance companies said that patients with full riders are making more claims and their claims are 20 to 25 per cent higher than people who pay a part of their bills.
These large claims are causing premiums to increase for everyone.
1 in 2 people in Singapore (1.3 million people out of 2.7 million people) are covered by private Integrated Shield Plans (IPs) with riders – they pay very little or almost nothing for their hospital bills.
The insurers have asked MOH to make patients with full riders to pay a small portion of their hospital bills.
It’s understood that patients may need to pay 5 to 8 per cent of their bills. However, there will be a safety net to protect patients against very large bills.
The task force recommended that all patients have to co-pay part of their bills to encourage prudent spending.
When patients have to pay, they would likely question if they would require certain lab tests or consumables recommended by the private hospitals and doctors.
Cases of over-consumption/over-prescription
For example, a patient with stomach and chest pains was admitted to hospital and did gastroscopy and colonoscopy procedures to check on his stomach and intestines. He was also referred to a heart doctor, dermatologist for skin rash and an ophthalmologist for blurred vision.
His total bill for one-day stay in hospital was $14,000.
Here’s another example of questionable claim by a patient with full rider treated in private hospital.
A 40-year-old man with pain and swelling in his big toe, requested to be admitted into hospital and chalked up $6,000 for being hospitalised for four days.
The doctor said the treatment would usually be done in the clinic and the patient’s hospital bill was eventually rejected by the insurer.
Another common example would be cataract surgery.
A patient could have done it as a day procedure that would only take approx. one hour or so but he opted to be hospitalised since he was covered by rider.
In the end, his one-day stay each time for each eye cost him a total bill of $21,000.
The average cost for cataract surgery of one eye in private hospitals is $5,000.
That means, the hospitalisation cost alone was approximately $11,000 ($21k-$5k) and it’s borne by the insurer.
Insurance companies losing money
All six insurance companies clocked underwriting losses in 2016 and turned to MOH for help.
However, as observed by the HITF in its report, there are private insurance product features and riders that provide policyholders with 100% coverage without any co-payment. The absence of any co-payment may encourage over-consumption by some patients and over-servicing or over-charging by some healthcare providers which will eventually increase healthcare costs and insurance premiums for all Singaporeans.
MOH has been working with insurers on the implementation of the task force recommendations and will be sharing more details soon.