| BASIC MEDISHIELD MEMBERS | |
| 1. I am currently covered under MediShield. | |
| a. How do the changes affect me? | |
| You will be able to enjoy higher payouts from MediShield
for large hospital bills in B2/C ward. This is done through the lowering
of co-payment and raising of the claim limits under the reformed MediShield.
But there will be an increase in the deductibles and premium for the reformed MediShield to match the improved benefits. The increase in deductibles is necessary as MediShield is designed to cover large bills only. You may use your Medisave to pay for your smaller hospital bills. |
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| b. Do I have to apply to be covered under the reformed MediShield? | |
| You do not need to apply for coverage under the reformed MediShield scheme. If you are covered under MediShield, you will be automatically migrated to the reformed MediShield scheme on 1 July 2005. If your cover
is due for renewal in July 2005, you will start paying the new premiums.
If you the renewal of your cover falls in any other month, you will
need to pay a pro-rated premium for the remaining period of your
cover to enjoy the higher benefits. This pro-rated premium will
be deducted from your Medisave account in July 05. |
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| c. Can I opt to continue my cover under the existing MediShield plan, paying the old premium for the old benefits? | |
| The existing MediShield scheme has been reformed so that all insured persons will enjoy higher benefits for large bills from July 05 onwards. The premiums have to be raised to match the better benefits. The old premiums
and benefits are only applicable till 30 June 2005. Thus, your MediShield
cover could only be continued under the revised premiums and benefits.
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| 2. If I have opted-out of the scheme previously, can I re-join MediShield? | |
| Those who have opted-out are encouraged to rejoin the MediShield scheme. However, to be fair to existing policyholders who had stayed with and contributed to MediShield all these years, all new applications will be subject to health declaration and underwriting to determine whether one is eligible to be insured under MediShield. If you suffer from a serious or chronic illness, you may not be allowed to join; or you may join, but will not be insured for this illness. |
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| 3. How do I apply or re-join? | |
| If you wish to rejoin the scheme, please submit your request through our CPF website at www.cpf.gov.sg by accessing My Request. Alternatively, you can download the application form from our website and send the application to us. | |
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| 4. How can I insure my family members under the scheme? | |
| You can download the application form from our website and send in the application to us. The application will be subject to underwriting to determine whether they are eligible to be insured under MediShield. |
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| 5. What are the changes under the reformed MediShield? | |
| 5.1 Higher Benefits | |
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* Inclusive of meal charges,
prescriptions, professional charges, investigations and other miscellaneous
charges. # Surgical operations are classified according to their level of complexity, which increases from Table 1 to Table 7. Please refer to our website www.cpf.gov.sg for details. |
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a)
When do the new benefits apply? |
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The
new claim limits will take effect from 1 July 2005. Patients who
are admitted to MediShield-approved medical institutions on or after
1 July 05, or who received treatments at MediShield-approved outpatient
clinics on or after 1 July 05, can claim under the new claim limits.
For patients who are
admitted before 1 July 05 but discharged on or after 1 July 05,
the old limits will apply for the entire hospitalisation episode.
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b)
Will the age limit for MSH coverage be extended beyond age 80? |
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MediShield
will continue to cover up to a maximum age of 80 for now. MOH is
currently reviewing the maximum coverage age for MediShield and
it is likely to be raised in the near future. Details would be made
public when ready. |
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5.2
New Premium Rates |
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a)
Premium Rates Table |
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* For members who join MediShield before age 60, there is a 10% premium discount for every ten years of coverage. |
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b)
What if I do not have sufficient Medisave to pay the increased premium?
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The Government will be topping up the Medisave Accounts of Singaporeans in July 2005 to help them adjust to the new MediShield premiums. Singaporeans who are aged 21 and above on 1 January 2005 will qualify for this top up. The amount of top-up will depend on your age, as shown in the table. It will be enough to pay the increase in MediShield premium for at least two years. Please see the table below for the top-up amount.
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c)
What is the benefit if I stay on with the scheme? |
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To ease the impact of the increase of premiums on the elderly, the MOH has extended the loyalty discount scheme from the existing age band of 71-75 years to those aged 76 to 80, where the elderly can enjoy up to a discount of 40% as an incentive for joining the scheme early. Elderly members who are aged 71 – 75 will also enjoy higher premium discount compared to the current MediShield.
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5.3
Higher Deductible |
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a)
What are the deductibles under the reformed MediShield scheme? |
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b)
What is deductible and when do I have to pay for it? |
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Deductible is the minimum amount that you would need to pay when you make a claim. You only need to pay the deductible once in a policy year. For example, if you are a C-class patient who is hospitalised twice in one policy year, with a bill of $2,000 each time, you only need to pay the $1,000 deductible the first time. There will be no deductible for the second bill. But if you are hospitalised again the following policy year, you will have to pay the deductible again. *A policy year is a period of one year, beginning from the start date of the insurance policy. Different policyholders have different start dates for their policies, depending on when they applied for their coverage. |
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c)
Can I use my CPF to pay the deductible? |
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Yes,
the deductible can be paid with your Medisave. You can also use
the Medisave of your immediate family members (such as parents,
spouse, or children) to pay for the deductible. |
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d)
Is the deductible applicable to outpatient treatments? |
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No. The deductible is waived if your claim is for outpatient treatments. |
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5.4
Lower Co-insurance |
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a)
What is co-insurance? |
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After paying the deductible, you will need to pay a portion of the claimable amount, known as the co-insurance. The co-insurance is usually a percentage of the claimable amount (as shown in the table below).
++Co-insurance for outpatient treatments is 20% regardless of claimable amount. |
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b)
Why is there a 3-tier co-insurance instead of a single co-insurance
rate? |
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MediShield
Basic is primarily meant for large bills at the subsidized class
(B2/C) wards. The three-tier co-insurance rate will help to reduce
the payout on larger bills as the co-payment percentage decreases
as the bill size increases. |
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c)
How does the co-insurance work under the reformed MediShield? |
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For example, if you are a C-class patient with an $8,000 amount eligible for claim*, you will first pay the deductible of $1,000.You then pay 20 per cent on the next $2,000 ($400); 15 per cent of the subsequent $2,000 ($300), and 10 per cent of the rest of the bill ($300). This works out to $2,000 that you have to pay, with MediShield paying the other $6,000. The $2,000 can be paid using your Medisave. *The amount eligible for claim is computed as the lower of either the actual patient bill, or the sum of the claimable limits (e.g. $250 a day).
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d)
Can I use my Medisave to pay the co-insurance? |
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Yes,
you can use your Medisave to pay the co-insurance. You can also
use the Medisave of your immediate family members (such as parents,
spouse, or children) to pay for the co-insurance. |
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5.5
Claims for Hospital Bills in Class B2+ and above |
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a)
Can I claim under MediShield Basic if I am warded in a Class B2+
and above ward? |
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Yes,
you will still be able to claim under MediShield Basic. However,
as MediShield Basic is meant to pay large bills at the B2/C class
wards, your MediShield claim will be calculated based on a percentage
of your actual hospital bill.
Members who want and can afford private hospitals or Class B1/A facilities should purchase private enhancement plans for additional benefits on top of MediShield Basic. |
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b)
What is the percentage that will be applied to my hospital bill?
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For example, if you stay in an A class ward, we will calculate the claimable amount based on 35% of your bill. Please refer to 6(b) for an example on the detailed claims computation. |
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c)
Will the percentage be applied for my outpatient treatment? |
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No. |
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d)
Will the percentage be applied to the hospital bill for my community
hospital stay? |
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No. |
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| 6. Claims Examples | |
| a) What is the payout like comparing current MediShield to the Reformed MediShield? | |
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Ward class: B2 |
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| b) How will the claim be payable if I stay in a higher class ward? | |
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class: A Length of stay: 18 Days Hospital Procedure Performed: Hip Replacement As the patient stayed in an A class ward, we will calculate the claimable amount based on 35% of his bill. |
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| 1 Claimable
amount for Daily Treatment & Treatment Charges = ($250 X 18 days)
= $4,500 or $2,625, whichever is lower 2 Claimable amount for surgical procedure = $840 or $1,750, whichever is lower 3 Co-insurance = ($1,500 X 20%) + ($1,865 X 15%) = $580 |
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| MEDISHIELD PLUS MEMBERS | |
| 1. I am a MediShield Plus member. How will the reform affect me? | |
The MediShield Plus plans will be restructured into integrated
plans which offer additional benefits on top of the reformed MediShield.
These plans will be transferred to a private insurer through a competitive
tender in the third quarter of 2005. | |
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| 2. When would I be informed of the transfer of my MediShield Plus cover to the appointed private insurer? | |
| You will be informed of the details in September 2005. |
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| 3. Can I choose to remain insured with the Board instead of the appointed private insurer? | |
| The existing MediShield Plus scheme will be privatized through a competitive tender to allow all insured persons to enjoy higher benefits. As the Board will no longer be administering the plans, your MediShield Plus cover can only be continued under the appointed private insurer. |
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| 4. If I do not wish to be insured with the appointed private insurer, can I switch to another insurer? | |
| If you do not wish to be covered under the existing plan with the appointed insurer, you can apply directly to the private insurer of your preference for a new plan. The acceptance of your application will be subject to underwriting by the private insurer. | |
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| EXISTING PMI MEMBERS | |
| 1. What will happen to these schemes after the reform? | |
| Private insurers will restructure their PMIS as enhancement plans to complement MediShield Basic. These enhancement plans will offer benefits above those provided by MediShield Basic, such as coverage for stays in Class A/B1 and private wards. Policyholders can use Medisave to pay for the premiums of these new enhancement plans. | |
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| 2. If I buy an enhancement plan, does it mean that I will have to file 2 separate claims with the Board and the insurer? | |
| The private insurers will design their enhancement plans to integrate with the reformed MediShield as an integrated plan. This means policyholders will only need to be concerned with a single product which already incorporates both sets of benefits. Policyholders who take up the new enhancement plans will not need to file two separate claims to the private insurer and the Board. Policyholders will only need to file one claim to their private insurer, who will provide a single point of contact and service. The private insurer will also administer all payouts to policyholders, including any payouts due under the reformed MediShield. Settlement between private insurer and CPFB will be done at the back-end. |
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| 3. Can I choose to stay with the existing PMI plan instead of applying to the new integrated plan that my insurer offers? | |
| Yes, you can choose to remain covered under the existing PMI plan that you have applied. However, you will need to pay the premium in cash after June 2007 as they will no longer be Medisave-approved plans. You can check with your insurer directly if you wish to know more about the integrated plan. |
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| 4. What benefits can I expect if I am insured under an integrated plan? | |
| First, once you switch to the new integrated plans, you will be insured with both your private insurer and the board (as operator of the reformed MediShield). You will receive all benefits of MediShield membership, including loyalty discounts on premiums, in addition to the benefits promised by the private insurer. The new integrated plans will also allow you to make claims at the B2/C level (as you will be insured under MediShield), should you choose to be warded in a B2/C ward. Currently, most of the PMIS plans have deductible levels that may be too high to activate payment by the private insurer when a policyholder decides to stay in a B2/C class wards. | |
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