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18 Feb 2020
SOURCE: CPF Board
You might know that MediShield Life is a basic medical insurance scheme to help Singaporeans cope with large hospital bills and selected costly outpatient treatments. But are you familiar with the components of a medical bill and what you can claim under MediShield Life?
The claimable amount for a bill is determined by adjusting the bill based on the pro-ration factor and applying the claim limits. As MediShield Life benefits are designed to cover subsidised bills incurred by Singaporeans at public hospitals, bills that receive less or no subsidy are pro-rated. Claim limits are then applied to the pro-rated bill. Claim limits depend on the number of days you stay in the hospital and the type of treatment or surgery you undergo.
MediShield Life will cover the claimable amount, less co-payment features, which are the deductible and co-insurance.
Here’s an overview of the various components of your hospital bill:
To better understand how MediShield Life claims work, let’s take a look at Pamela, a 48-year-old Singapore Citizen who had a uterus operation and was hospitalised in a normal C ward for five days. Her total bill came up to $17,600.
In this instance, Pamela’s bill payable is $4,000, after government subsidy. As she is a Singapore Citizen who stayed in C ward, the MediShield Life claim is not pro-rated.
Here’s a breakdown of Pamela’s claim from the bill payable.
|Hospital Bill Payable||MediShield Life Claim Computation|
|Daily ward and treatment charges (Five days in a normal ward)||$2,400||$2,400
Claim limit for Daily Ward & Treatment Charges is $700 per day. As Pamela is warded for 5 days, her total claim limit is $3,500. The bill payable of $2,400 is below the claim limit, meaning that it is fully claimable from MediShield Life.
|Uterus operation under
Table 5C of Table of Surgical Procedures
Claim limit for Table 5C procedures is $2,180. The bill payable of $1,600 is below the claim limit, meaning that it is fully claimable.
|Total claimable amount||$4,000
As Pamela is under 80 years old, there will be a deductible of $1,500 for her stay in a C ward in a public hospital. A co-insurance component1 also applies.
|MediShield Life Claim Computation|
|Total claimable amount||$4,000|
|Claimable (less deductible)||$2,500|
|MediShield Life payout||$2,250
The deductible and co-insurance totalling $1,750 can be paid using MediSave and/or cash.
Here’s an overview of Pamela’s bill, subsidies received, and her MediShield Life payout:
|Total bill (before subsidy)||$17,600|
|Total bill (after subsidy)||$4,000|
|MediShield Life payout||($2,250)|
|Patient co-payment||$1,750 (can be paid by MediSave and/or cash)
1 The co-insurance is applied to the claimable amount above the deductible. The co-insurance rate is 10% for the first $5,000 of the claimable amount (inclusive of the deductible). It decreases to 5% when the claimable amount increases to between $5,001 to $10,000 and decreases further to 3% for claimable amounts above $10,000.
Information updated as at 8/3/2021