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.

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.

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:

You can get more information on parts of the bill you can claim and find out how you can make MediShield Life claims. Do also check out this calculator for estimates on how much you can claim from MediShield Life and MediSave.

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