Complete Guide To Buying A Private Integrated Shield Plan

This article first appeared on DollarsAndSense.sg

When it comes to health insurance, one of the most important health insurance policies that all Singaporeans and Permanent Residents (PRs) should consider getting is a private integrated shield plan.

A private integrated shield plan (IP) helps policyholders cover any potential cost that may be incurred if they are hospitalised, either in public or private hospitals.

A private integrated shield plan comprises of two components. The first is MediShield Life. All Singaporeans and PRs are automatically covered under MediShield Life, Singapore’s basic health insurance plan. Coverage is provided regardless of age or pre-existing conditions.

The main limitation with MediShield Life is that coverage provided will be pegged to the expected treatment cost in Class B2 or C wards in public hospital. What this means is that if a patient chooses to be admitted to a higher-class ward in a public hospital, or in a private hospital, the pay-out provided by MediShield Life is likely to only be a fraction of the total bill.

To ensure coverage is provided for higher-class public hospital wards or at private hospitals, Singapore residents can choose to upgrade their existing MediShield Life to an Integrated Shield Plan.

Different Types Of Integrated Shield Plan

Coverage for integrated shield plans can be grouped into three different types.

Standard Integrated Shield Plan (Standard IP)

Standard IP provides coverage for policyholders for Class B1 wards at public hospitals. Benefits provided by the Standard IP are identical across all IP insurers.

Class A Plans

Class A plans provide coverage for policyholders for Class A wards at public hospitals. Benefits provided by the plan may differ from insurers.

Private Hospital Plans

Private hospital plans provide coverage for policyholders at private hospitals. Similar to Class A plans, benefits provided may differ from insurers.

Coverage Provided By Integrated Shield Plan

As mentioned above, benefits provided by Standard IP plans are identical across all insurers while benefits provided for private hospitals and Class A plans may differ among insurers.

In general, here are the different types of coverage one can expect.

Inpatient & Day Surgery: This includes daily ward, treatment cost and surgery

Outpatient Treatment: This includes treatment for kidney dialysis, cancer treatment and chemotherapy

Pre & Post Hospital Treatment: This covers the cost of any related treatments that are incurred before or after the hospitalisation stay.

* To find out more about the benefits provided by the Standard IP, please refer to MOH comparison here.

** To find out more about the benefits provided for Class A wards, please refer to MOH comparison here.

*** To find out more about the benefits provided for Private Hospital plans, please refer to MOH comparison here.

Who Are The Different Insurers?

As the name suggests, private integrated shield plans are offered by private insurers. Today, there are a total of six insurers that offer these private insurance plans. They are:

AIA: AIA HealthShield Gold Max

Aviva: Aviva MyShield

AXA: AXA Shield

Great Eastern: Supreme Health

Income: IncomeShield

Prudential: PruShield

Except for Standard IPs, exact benefits and premiums across the various private insurers differ slightly.

Besides choosing the plan which provides you with the most extensive coverage, policyholders should also be mindful about the premiums that they will be paying. This applies not just to what they are paying today, but also its affordability over the long-term.

Paying For Your Integrated Shield Plans Premiums

Similar to MediShield Life, annual premiums for your private integrated shield plans can be paid for using your Medisave.

However, unlike MediShield Life premiums, which can be paid fully using your Medisave, there is a cap to how much Singapore residents can use from their Medisave account to pay for the premium for their private integrated shield plan.

The amount they are able to use from their Medisave to pay for their private integrated shield plan, also known as the Additional Withdrawal Limits, are as follows.

However, do take note of the withdrawals limits.

Medishield withdrawal limit

For example, if the premium for the private integrated shield plan is $375 and the individual is 35 years old, he will be able to use $300 from his Medisave to pay for his premiums and will need a cash outlay of just $75.

As a person grows older, annual premiums for private integrated shield plans will naturally increase. This increase reflects the situation that older people are more likely to require hospitalisation and treatment as compared to younger folks.

Buying A Rider

Similar to MediShield Life, coverage provided at higher-class wards does not mean hospitalisation bills are fully paid for. All integrated shield plans still include deductibles and co-insurance.

In the past, if you want complete coverage so that you do not have to pay for any deductibles and co-insurance, you have the option of purchasing a separate rider that can fully cover all hospitalisation bills incurred.

In March 2018, the Ministry of Health announced that all new integrated shield plan riders will have to incorporate a co-payment of at least 5%. However, this applies only to new integrated shield plan riders. Existing integrated shield plan with full riders will not be affected.

Moving forward, riders will have a minimum co-payment of 5% but are likely subjected to an annual cap of $3,000.

For example, if you incur a hospitalisation bill of $15,000, a 5% co-payment will mean having to fork out $750, with the remaining $14,250 being covered by the private integrated shield plan.

To find out more about the changes to shield plan riders, you can read this article about 5 facts about the latest integrated shield plan changes that Singaporeans need to know about.

DollarsAndSense.sg is a personal finance website that aim to help Singaporeans make better financial decision.

Been doing lots of research, but not sure who to engage to take the final step? Look no further! fundMyLife connects you to credible and incredible financial advisers privately and anonymously, based on the financial planning questions that you ask. We aim to empower Singaporeans to make financial decisions confidently.

Follow us on our fundMyLife Facebook page to get exciting updates and your dose of finance knowledge! Alternatively, the Insurance Discussion SG Facebook group is a good place to discuss insurance-related topics with fellow Singaporeans.

Ask fML Advisers: What Are The Most Common Questions On Integrated Shield Plans?

fML advisers share the most common questions on integrated shield plans

[5 min read]

MediShield Life is a national health insurance scheme that protects all citizens and PRs regardless of economic status and health to cope with large hospital bills. They can also purchase Integrated Shield Plans as an upgrade to their basic plan to stay in higher class wards. We had the impression that there is plenty to add on top of our previous piece on the most common misconceptions about Integrated Shield Plans. As such, in this article fundMyLife asks another three of its financial advisers – Michelle Ngiam from Great Eastern, Roshan Belani from AIA, and Melvin Liu from Manulife – about the most common questions on Integrated Shield Plans.

Michelle Ngiam, Great Eastern

Michelle Ngiam, Great Eastern
Michelle Ngiam, Great Eastern

#1 Do I still have to pay for MediShield Life when I purchase an Integrated Shield Plan?

Yes, an Integrated Shield Plan is an upgrade of MediShield Life. Therefore, MSHL is still embedded within the IP. By paying the premium to the private insurer, you are actually paying for 2 components – MediShield Life premium and private insurance company premium. CPF still deducts the MSHL premium from your payment.

#2 I already have MediShield Life. Why do I need to purchase an Integrated Shield Plan?

MediShield Life will provide coverage for your large hospital bills in Class B2/C wards in government hospitals. If you prefer to seek treatment in Class A/B1 or in private hospitals, MediShield Life will not be able to cover the bill fully, leading to you forking out more from your MediSave account or cash.

Therefore, by upgrading your MSHL with an Integrated Shield Plan, you have the choice to cover all the way up to private hospitals. This allows you to have the option to go to any ward of your choice.

#3 Will the premiums increase once I purchase an Integrated Shield Plan?

Yes, generally premiums will increase as you get older. However, there are also a few factors at play here.

Firstly, it depends on how the insurance companies price their premiums. Most insurers also use an age-band premium scheme like MediShield Life. For example, if you are 35 years old, you will be paying the same premium as the rest of the people insured within the same age band of 31 to 40 years old. The premium will increase once you enter the next age band (in this example, 41 to 50 years old).

Secondly, they are affected by government policies regarding health insurance in Singapore. In 2015 when the government upgraded MediShield to MediShield Life (MSHL), the premiums were also increased with added benefits. With the upgrade of MSHL, insurance companies had to reprice their plans to cover the new premiums of MSHL, with enhanced benefits for better overall coverage.

Lastly, how the claims experience for the insurer has been like. In recent years, many insurers have faced rising claims and it has affected the premiums leading to premium hikes. The increases were largely focused on plans covering private hospital treatments and stays.

Roshan Belani, AIA

Roshan from AIA
Roshan Belani, AIA

#1 Am I covered for overseas treatment?

The answer is both yes and no. For most integrated shield plans, overseas treatment is only covered if it is deemed to be an emergency. At best, even if a plan allows for general overseas coverage, the benefit payable is still limited to the level of Reasonable and Customary charges in a Singapore private hospital. With this limit, say if a surgery in the US cost $20,000, had the same surgery been performed in a private hospital in Singapore at $10,000, then the claimable amount would only be based on the customary charges in Singapore, which is $10,000 in this example.

As such, it is important to determine whether overseas coverage is necessary. For most who are working in Singapore, shield plans generally provide good level of coverage for the individual based here. However, for those who are working or studying overseas, having a global plan or even a plan that is available in that country will be a great complement to the shield plan. The shield plan should still be active in case the individual decides to come home to Singapore for various reasons such as finding a job, starting a family or even retirement.

#2 Am I covered for pregnancy?

This is a question commonly asked by first-time mothers as they prepare themselves for the cost of pregnancy. To be very clear from the beginning, a pregnancy without complications with straight forward procedures will not be covered under a integrated shield plan. This is because there was no ‘risk’ or incident that required protection from per se and thus, the bill would not be reimbursed. However, should pregnancy complications arise during the pregnancy, and if it falls within the definitions as stated in the integrated shield plan, the bill would be reimbursed accordingly.

Of course there are maternity insurance plans out there that provide cover for even normal deliveries and prenatal consultations. However, they are in addition to the integrated shield plan and generally cost much higher premiums.

#3 Does the plan cover me for outpatient treatments?

Again, the answer is yes and no. For outpatient treatments, they are claimable only under two conditions: 1) Treatments and consultations eventually lead to confinement in the Hospital for hospitalisation or a surgery being done and 2) falls within the allowed number of days for pre & post hospitalisation benefit. Both conditions must be met and if either one fails, the outpatient treatments is not claimable.

To give an example of how condition 1) might not be met, an individual who fractured his foot was referred to a specialist but was told that no hospitalisation or surgery was necessary. Consultations and treatment costs for its healing would not be covered since the individual did not have to stay in the hospital or require a surgery.

To give an example of how condition 2) might not be met, an individual recalled having seen a specialist about 4 months (120 days) from his hospitalisation. His integrated shield plan only allowed for 100 days for pre-hospitalisation treatment. As the number of days exceeded the allowable limit (120>100), the consultation and treatment that day would not be reimbursed.

Melvin Liu, Manulife

Melvin Liu's picture
Melvin Liu, Manulife

#1 Can my hospital plan cover me for scope procedures (eg. colonscopy / endoscopy etc)?

Colonscopy/endoscopy (and similar procedures) are considered as a day surgery procedure and  will be covered under shield plans. However, it’s important to note that this will depend on whether its a routine check-up or whether it is ordered by your doctor during a consultation. It may not be covered if it is simply a health screening.

#2 Can my shield plan cover me if I am hospitalized overseas?

Overseas cover generally apply to emergency hospitalization, and for some insurers, benefits may allow for pre-arranged overseas inpatient treatment which is pre-approved by the insurer. It is best to buy additional travel insurance if going overseas.

[Editor note: We wrote something about personal accident plans when you travel overseas, so you should check that out too]

#3 I recall I have bought a hospital plan, but I can’t remember which insurance company I bought from or what plan I bought. How do I check?

You can login to your CPF account under: My Messages > Healthcare > MediShield Life/ Integrated Shield Plan. From there you should be able to see which company is your insurer. You can contact your insurer to find out the details of your plan.

fundMyLife Summary

Michelle provided the rundown on common consumer concerns on getting Integrated Shield Plans, such as what it is and whether premiums will increase. Roshan explained that Integrated Shield Plans do not cover normal pregnancies, but will kick into effect when there are complications that occur during pregnancy. He also shared that Integrated Shield Plan claims for outpatient treatments can be a bit complicated, as it depends on whether the outpatient treatment results in hospitalization/surgery and that the outpatient treatment fell within a stipulated time frame from hospitalization. Both Roshan and Melvin wrote about whether Integrated Shield Plans will help when the consumer is overseas – they both recommend that it’s wiser to get travel insurance when travelling. Melvin cautions that endoscope procedures is covered if it is ordered by a doctor, but a routine checkup is not covered. He also gave advice on how to check which company the consumer bought the Integrated Shield Plan, by going to the CPF website.

Conclusion

That’s all folks! We hope this article shed a bit more light into the most commonly asked questions on Integrated Shield Plans. If you’ve more queries on the plan or are considering to get insurance but don’t know who to ask, head on to our main site and ask our curated pool of financial advisers! Alternatively, if you’d like to connect with either  Michelle Ngiam from Great Eastern, Roshan Belani from AIA, or Melvin Liu from Manulife, just click on the link in their names and you can ask them questions directly from their profile pages.

Been doing lots of research, but not sure who to engage to take the final step? Look no further! fundMyLife connects you to credible and incredible financial advisers privately and anonymously, based on the financial planning questions that you ask. We aim to empower Singaporeans to make financial decisions confidently.

Follow us on our fundMyLife Facebook page to get exciting updates and your dose of finance knowledge! Alternatively, the Insurance Discussion SG Facebook group is a good place to discuss insurance-related topics with fellow Singaporeans.

Top 9 Reasons Why Singaporeans Land In Hospitals

Top reasons why Singaporeans land in hospitals

Have you ever wondered why Singaporeans land in hospitals? We can look to data for that. However, medical data in many countries can be sparse at best, opaque at worst. Fortunately for us Singaporeans, data is plenty and often available readily. We here over at fundMyLife love data, and what better to explore this passion by going through the hospital bill data provided by the Ministry of Health?

In the handy Excel sheet from the MOH website, there are a total of 155 condition/procedures in the list, capturing hospital bills between 2016 and 2017. While immensely useful, it can be somewhat overwhelming, chock full of data. In this article, fundMyLife distills the list and examines the top 7 reasons (in no particular order) why Singaporeans land in hospitals.

#1 Anus, Surgical removal of haemorrhoids (Haemorrhoidectomy) – 10,180 cases

We start this list with the end. Of our bodies, that is. Haemorrhoids, also known as piles, are swollen veins in the rectum and/or anus. Haemorrhoids are a literal pain in the ass, causing plenty of discomfort when you sit or when you’re pooing. In the worst case scenario, the swell results in a visible clot that requires surgery for removal. Most cases are mild, and can be treated without surgery. To prevent this, make sure you eat plenty of fibre so that you have soft stools and don’t need to strain during bowel movements.

#2 Childbirth – 40,157 cases

In the list, we found two different reasons for hospitalization under the category of Childbirth. There’s antenatal care (6,548), where a mother is admitted into the hospital due to problems during pregnancy. For example, abnormal bleeding or tests and monitoring that requires an overnight stay. The second reason is the childbirth itself, where mothers either do it naturally (22,628) and Caesarean (10,981). We note that twice the number of mothers choose natural childbirth rather than Caesarean (ouch).

#3 Newborn, Normal Baby – 25,391 cases

According to the list, almost 2/3 of the children born in hospitals require hospital stay, assuming each case in #2 results in one child. Even if the child is healthy, they sometimes require observation overnight (15,202). There are many reasons for this. If the baby releases his/her bowels before birth, he/she will be swimming in amniotic fluid with the stool. While most babies are ok despite that, they are observed for any possible infection for 24 hours.

Mothers who carry Group B Streptococcus in their vagina receive antibiotics childbirth, but the baby will undergo observation for any possible infection. In addition, if the mother’s water broke longer than 24 hours before the child’s birth, the baby is at risk of developing infection in the lungs which requires observation. If the baby’s weight is lower than average, the baby may require observation for possible health concerns.

Another main reason for a normal baby requiring overnight stay is neonatal jaundice (10,189), caused by high levels of bilirubin – broken red blood cells that causes yellowing in eyes and skin. During the stay, the baby undergoes phototherapy, a treatment that exposes him/her to florescent light that the skin absorbs to help break down bilirubin to a more harmless form.

#4 Eye, Cataract Surgery – 46,142 cases

As you age, there is a chance of your lens clouding up that turns your lens opaque. Symptoms of cataracts involve generally poor vision and trouble with seeing light, which really reduces your quality of life. Diabetics and smokers are more likely to develop cataracts. At over 46,000 cases in a year, it’s indeed one of the more common ailments people face in Singapore. The only way to treat this is to remove the cloudy lens and replacing it with artificial lens to restore vision.

#5 Intestine/Stomach, Gastroenteritis (Diarrhoea) – 14,857 cases

Did you know that you can get hospitalized for shitting too much? Neither did we, until a very good friend of one of our members was warded for non-stop diarrhea. While it sounds funny, we assure you that it is anything but. Gastroenteritis refers to the inflammation of the intestine and stomach, usually caused by bacterial toxins or viral infection. Symptoms typically involve expulsion of liquid from your body via non-stop vomiting and/or diarrhea. This is often accompanied by fever and dehydration. Fortunately, mortality in Singapore for severe diarrhea is low, requiring constant hydration.

#6 Intestine/Stomach, Endoscopy for gastrointestinal bleeding (Day Surgery) – 45,006 cases

Endoscopy is a commonly performed procedure to examine your upper digestive system, i.e. oesophagus, stomach and small intestine. It involves putting a long tube with a camera attached to one end called an endoscope into your mouth, where it will travel through your body. We lumped two procedures together, 1) Intestine/Stomach, Endoscopy for gastrointestinal bleeding (25,547) with 2) Stomach, Gastroscopy (Day Surgery) (19,459) since they are similar procedures but for different parts of the body.

Endoscopy helps to image parts of your insides to discover causes for symptoms such as nausea, vomiting, pain in the abdomen, and gastrointestinal bleeding. It’s a day surgery because doctors will give you anesthesia before the endoscope inside your mouth.

#8 Intestine, Colonoscopy (Day Surgery) – 20,747

While the scope went in through the mouth for endoscopy, in colonoscopy the doctor inserts the scope from the opposite end. Doctors use colonoscopy to diagnose possible colon cancer and bowel diseases like Crohn’s disease, polyps, and ulcerative colitis.

#9 Respiratory Tract, Upper respiratory tract infections (URTI) – 29,824

URTI refers to the infections of upper respiratory tract, including middle ear infections and allergic rhinitis. It is a very broad category as the respiratory tract involves several body parts, e.g., nose, nasal cavity, pharynx, and larynx. Common symptoms include nasal discharge, congestion, sneezing, sore throat. Sounds familiar? It’s the ordinary cold and cases like allergy. However, sometimes the cold can so bad that the patient checks him/herself into the ward for observation. Interestingly, a large number of the cases come from KKH, implying that most of these patients are relatively young.

Conclusion

That’s all folks! That was a lot of cases of hospitalization in one year. We hope this article was informative, and you found the reasons why Singaporeans land in hospitals useful in anticipating future possible ailments (touch wood). If you have any more questions on MediShield Life and Integrated Shield Plans, why not ask our curated pool of trusted financial advisers?

Been doing lots of research, but not sure who to engage to take the final step? Look no further! fundMyLife connects you to credible and incredible financial advisers privately and anonymously, based on the financial planning questions that you ask. We aim to empower Singaporeans to make financial decisions confidently.

Follow us on our fundMyLife Facebook page to get exciting updates and your dose of finance knowledge! Alternatively, the Insurance Discussion SG Facebook group is a good place to discuss insurance-related topics with fellow Singaporeans.

Ask fML Advisers: What Are The Common Misconceptions About Integrated Shield Plans?

Financial advisers of fundMyLife share some common misconceptions about integrated shield plans

[5 min read]

According to the Ministry of Health, the MediShield Life is a national health insurance scheme that provides lifelong protection against large hospital bills. On top of MediShield Life, locals and PRs can purchase Integrated Shield Plans from six insurance companies, which provides additional coverage for higher hospital class wards. While MediShield Life is relatively straightforward, Integrated Shield Plans can be quite a tricky matter.

In the past, we wrote about the considerations to make before purchasing Integrated Shield Plans. However, we also realize that there might be clarification required before embarking on buying these plans. Who better to clarify possible misconceptions, but our very own financial advisers of fundMyLife? In this article, we ask three of our fundMyLife financial advisers – Winifred Tan, Jonathon Han from Prudential, and Ryan Teo from AXA – about the common misconceptions about Integrated Shield Plans.

Winifred Tan

Winifred Tan, Great Eastern
Winifred Tan

#1 “IP plans are the same as CPF Medishield Life plans”

Firstly, Medishield Life (MSHL) and IP plans are not exactly the same although they have some overlapping similarities. Both MSHL policies and IP policies are payable by CPF. MSHL is a compulsory hospital/surgical insurance for all Singaporeans and PRs which covers only basic hospital stays, e.g., daily room and board benefits, and basic surgeries, but with limitations on claim amount and also on type of hospital that the user can stay in (up to only public B2 ward, 6-bedder ward).

IP plans are composed of MSHL as its foundation and an additional private insurance on top of it from either of the six insurers in SG to remove all the category limits and allow users to even insure themselves for better types of hospital services e.g. Private hospital, or Public A ward (1-bedder). It is thus essential to get an Integrated Shield Plan if one has enough CPF-Medisave to afford it as it would really help when bills incurred are large, as in most cases MSHL only covers 10-20% of a bill!

#2 “Why must I get the rider? I’m still young and don’t want to waste my own cash to buy a rider which I would probably wouldn’t claim anyway”

Whether you are young or not, every hospital/surgical bill incurred will first subtract off the Deductibles and 10% co-insurance – essentially you have to co-pay this part – before you can claim using the main IP plan paid by CPF. It’s not an easy part to explain, so you can either ask me directly or drop me a message on my Facebook page. In terms of probability of going into hospitals, perhaps things like critical illnesses are rarer among younger people but what about the possibility of being active in sports or at work that you injure yourself and require a say, surgery e.g. ACL tear/burns/fractures? How about Congenital illnesses that may out of a sudden, strike in a young adult? These are the probabilities we need to guard against and having the entire package (basic main IP plan + rider) would really help you mitigate such financial risks

#3 “I have a hospital-cash/hospital-income benefit rider in my whole life plan! It’s so much cheaper than the rider of the IP plan so why should I waste money to get this when I can claim through the whole life rider?”

Firstly, the coverage is entirely different in the hospital-cash rider of the whole life plan vs a full IP package. The former only gives a small payout, i.e. $30 a day when you’re hospitalized and warded to help replace your possible income loss during the time you’re hospitalized. They do not normally pay for surgeries/outpatient treatments/followups as well. The latter really covers all of your hospital bills as well as surgery/outpatient/followups/pre-admission tests from the first dollar onwards. The latter is also more of a reimbursement of bill instead of extra payout for income-loss. Bills often can be as high as $1,000 even for minor surgeries or hospital stays. Thus, what we have to focus on, is to ensure the bills are covered for, and then work on getting the extra hospital-cash for some income replacement during the time that you’re unfit for work!

Jonathon Han, Prudential

Jonathon Han's picture
Jonathon Han, Prudential

#1 Buying an ISP means anything to do with hospitals can be claimed

ISP are hospitalization plans. What this means is that the customer must be HOSPITALIZED in order for the plan to take effect. Should the client see a specialist – even with a referral letter – without staying in the hospital, they will not be covered for the medical bills. However, if their specialist check-up requires them to be warded for observation or medical treatment, then yes the bills will be covered.

Special circumstances can be made for customers to claim their ISP without being hospitalized, and these include A&E treatment and follow-up specialist treatment from previous hospitalization stays.

#2 Having a company insurance means I don’t need to buy an ISP

Not true. Why?

Firstly, a majority of company insurance is not as comprehensive as personal insurance. Personal health insurance can protect individuals from medical bills of up to $1.5 million a year, whereas a lot of company insurance barely crosses the $20k of medical coverage per individual per a year.

Secondly, company insurance is non-transferable. What this means is that the moment you leave the company, your coverage will stop. Some of my clients had to leave the company due to their inability to work, and leaving the company means that they no longer are covered under the corporate insurance. At this point of time, if we don’t have an ISP, we are left exposed to the mercy of the bills.

Ryan Teo, AXA

Ryan Teo's picture
Ryan Teo, AXA

 

#1 Integrated Shield Plans payment is separate from MediShield.

When you sign up for an Integrated Shield Plan, you’re still paying for the MediShield component as well. This is because Integrated Shield Plans are not separate coverage, as it is an additional top up coverage to MediShield.

#2 It is a minor matter to switch Integrated Shield Plans

Before you switch providers, you need to weigh the options that the other provider gives, especially if there was a previous surgery or pre-existing illness. Cost-wise or benefits may seem better, especially as plans improve; however, you may not enjoy the same protection you previously enjoyed for existing medical conditions. In fact, under your old plan, you may potentially pay more for the same level of coverage.

#3 No need to pay a single cent if I have full rider coverage by Integrated Shield Plans

Actually, it is not really true. You may still need to pay a cash deposit if it’s required by the hospital. Therefore, it’s useful if possible to have a letter of guarantee (LOG) as an assurance of payment offered by insurers before any hospital admission.  It can help to waive any cash deposit required by the hospital or bill payment. However, it’s still up to the discretion of the hospital to accept the letter. You may still need to fork out your own money first before applying for a claim.

fundMyLife Summary

Winifred clarified the differences and similarities between Medishield and Integrated Shield Plans. Ryan also expressed similar sentiments – it seems that consumers do mistake MediShield and Integrated Shield Plans as separate kinds of plans, when the former is a sub-component of the latter. No wonder this necessitates clarification on the MOH website. Winifred also emphasized the importance of riders, and explained the differences between hospital-cash rider of the whole life plan and the rider of a full IP package. Jonathon cautioned that not everything hospital related is claimable using Integrated Shield Plans and stressed the importance of not relying on company insurance. Ryan also debunked the myth that it is a small matter to switch insurers for Integrated Shield Plans, and talked about cash deposits during hospitalization and how Letter of Guarantees can alleviate the financial pressure.

Conclusion

We hope this article was helpful in addressing the common misconceptions about Integrated Shield Plans! If you’ve more questions on the plan or any other insurance plans, head on to our main site and ask our curated pool of financial advisers! Alternatively, if you’d like to connect with either Winifred Tan from Great Eastern, Jonathon from Prudential, or Ryan Teo from AXA, just click on the link in their names and you can ask them questions directly from their profile pages.

Been doing lots of research, but not sure who to engage to take the final step? Look no further! fundMyLife connects you to credible and incredible financial advisers privately and anonymously, based on the financial planning questions that you ask. We aim to empower Singaporeans to make financial decisions confidently.

Follow us on our fundMyLife Facebook page to get exciting updates and your dose of finance knowledge! Alternatively, the Insurance Discussion SG Facebook group is a good place to discuss insurance-related topics with fellow Singaporeans.

4 Things To Consider Before Buying An Integrated Shield Plan

Things to consider before getting an Integrated Shield Plan

MediShield Life is a basic health insurance plan that is administered by the Central Provident Fund to help pay hospital bills. Consumers can also opt to get Integrated Shield Plans, which is composed of Medishield Life and a second component that provides additional private insurance coverage for higher class wards in public and private hospitals. Higher class wards and private hospital wards can be quite pricey, and as such Integrated Shield Plans are very popular amongst Singaporeans – 68% of them have Integrated Shield Plans.

While Integrated Shield Plans are great, they nonetheless require more premiums per year and as such require careful thought before adding it on. In this article, fundMyLife lists the things to consider before getting an integrated shield plan.

#1 Personal preferences for treatment

MediShield Life provides enough coverage to take care of large hospital bills in B2 or C class wards in public hospitals. In B2 or C class wards in public hospitals, you share a room with 6 and 8-10 beds respectively, without any TVs. These wards have natural ventilation, i.e. no air-con, and the patients are taken care of by a team of doctors. However, in an A/B1 ward in public hospitals and wards in private hospitals, you get to have your own bed or share with less patients. The wards are air-conditioned and you’d be taken care of by individual doctors.

One of the things to consider before getting an integrated shield plan – your personal preference. Figure adapted from Central Provident Fund website.

As the diagram above shows, there is a difference between B2/C and A/B1/private wards. However, it really depends on your personal preference. You can opt for B2/C wards if you do not mind the crowd and a lack of TV – a pair of earphones and a good book solve these issues. On top of that, you’d be spending most of your time recovering and sleeping anyways.

#2 Your current and future budget

It is important to consider not just your current budget, but your future budget as well as premiums of shield plans will increase as you get older. The increases are not trivial as you age. To illustrate this, we compiled integrated shield plan premiums for private hospital from the six insurance companies that offer them. In addition, if you are curious to know more, you can either go to the companies’ website or the Ministry of Health’s website. The Ministry of Health releases regularly updated information on MediShield and Integrated Shield Plans, including premiums and benefits.

Premiums for Private Hospital Plans from different insurers
A bar chart showing the increasing premiums for private hospital plans. Plans referred to: 1) Income Enhanced IncomeShield Preferred, 2) AIA HealthShield Gold Max A, 3) AXA Shield Plan A, 4) Great Eastern Supreme Health P Plus, 5) Aviva MyShield Plan 1, 6) Prudential PruShield A Premier. Some of the plans do not have information at certain age ranges.

As the illustration shows, the premiums increase over time, and most sharply after age 40. More specifically, the premiums increase between 50-70% when you are 41, from age 40, depending on which company. While we used private hospital shield plan premiums to illustrate this, the pattern is the same for plans for lower class wards as well. Your future ability to pay the ever-increasing premiums is important because there is a limit on how much your MediSave can cover the premium, which means you’ll need to fork out cash for the rest. The ability to pay is one of the more important things to consider before getting an Integrated Shield Plan.

#3 Riders

As the name suggests, riders are add-ons to enhance existing coverage by the Integrated Shield Plans. These riders are useful, as they can assist in reducing any deductible or co-insurance portions on the consumers’ hospital bills (subject to co-payment within limits).

In addition, there are two ways to get daily cash benefits using riders. One way is to be warded in a ward that is of a lower class than you were entitled to. Another way is to get daily cash benefit riders that specifically pay out daily cash benefits for every day you are hospitalized. Other riders include coverage for children’s illnesses and international hospitalization.

#4 Hospital bill sizes

Besides knowing your coverage, we feel that it is important to understand the average bill sizes across different hospitals and wards. We visited the website in the Ministry of Health, which display the rates for various hospitals in 2015. In the list, there are nine hospitals – Alexandra Hospital (AH), Changi General Hospital (CGH), Khoo Teck Puat Hospital (KTPH), KK Women’s and Children’s Hospital (KKH), National University Hospital (NUH), Ng Teng Fong General Hospital (NTFGH), Singapore General Hospital (SGH), Tan Tock Seng Hospital (TTSH), and National Heart Center (NHC).

A comparison of average bill sizes from different hospitals. Source from Ministry of Health website.

Not surprisingly, the average bill sizes vary across different hospitals. While there is little difference between the average bill sizes between Class B2 and Class C, the difference is much more noticeable for between Class B1 and Class B2. Note that the bill sizes are on average, and do not reflect the bill for various medical conditions. For that, it is another major article topic in itself.

Conclusion

That’s all, folks! We hope that this article was useful in sharing the things to consider before getting an Integrated Shield Plan. It can be tricky to figure out what kind of coverage you need. As such, if you have any more questions on this plan, why not ask our curated pool of trusted financial advisers? They can definite advise on the things to consider before getting an integrated shield plan!

Been doing lots of research, but not sure who to engage to take the final step? Look no further! fundMyLife connects you to credible and incredible financial advisers privately and anonymously, based on the financial planning questions that you ask. We aim to empower Singaporeans to make financial decisions confidently.

Follow us on our fundMyLife Facebook page to get exciting updates and your dose of finance knowledge! Alternatively, the Insurance Discussion SG Facebook group is a good place to discuss insurance-related topics with fellow Singaporeans.

The New Rider Co-payment: Is It That Bad?

fundMyLife discusses the new rider co-payment

In the past, patients with Integrated Shield Plan riders had their hospital bills completely paid for. However, this will soon be a thing of a past. Under the new rules announced on the 8th of March 2018, riders for Integrated Shield Plans will no longer cover the entire bill. Under the rider co-payment rule, you have to pay at least 5% of the hospital bill, at a maximum of $3,000/year.

Wait, but why?

In the past, we wrote on why this phenomenon happened, and observed that cost for services increase drastically when insurance is involved. According to Ministry of Health, the average bill of someone with a rider is around 60% higher than someone without. Patients with riders tend to seek treatment in private hospitals as well, which results in the difference in average.

In addition, the asymmetry of information for medical bills allowed hospitals to charge high prices for procedures. The first response to the increasing bills was introducing the medical fee benchmark to be implemented in second half of 2018, and this forms the second major response by MOH.

What does that have to do with you, you might ask? Premiums for Integrated Shield Plans increased over the years, with higher increases affecting older policyholders and those with private hospital plans. This is bad because if the increase in premiums continue, these people won’t be able to afford the premiums later in their lives. At the risk of being reductionist, the sequence of events goes like this:

  1. High expenditure due to riders
  2. Healthcare decides to charge more – insurance companies are paying, anyways
  3. Insurance company faces loss
  4. Insurance company charges higher premiums

Inappropriate levels of health service usage lead to an overall larger healthcare expenditure. Future consumers suffer directly due to escalated premiums. All Singaporeans also suffer indirectly since healthcare expenditure affects taxes.

Financial advisers of fundMyLife share their opinion

Out of curiosity, we asked the financial advisers of fundMyLife on their opinion regarding the rider co-payment. Disclaimer: their opinions were either paraphrased for reading convenience or quoted verbatim.

Winifred Tan

Winifred believes that full coverage is the best. She sees why the Ministry of Health wanted to implement this due to rising claims and “free buffet” effect, and that there are too many people in hospitals trying to take advantage of insurance policies. However, she would rather they increase the premiums just like last year instead of co-payment.

Another point Winifred made was that it is better to, if you can afford it, buy the best of hospital plans. She shared that most people think that they won’t need it and buy cheaper riders in a bid to upgrade it in the future. However, unpredictable changes like this will happen and presumably throw people’s plans awry.

Jonathon Han, Prudential

I think people are missing the point here. The fact is that there is going to be a gradual shift from government supporting us with subsidies and schemes to a more self-reliant ecosystem whereby we pay for what we want.

There is no point crying over spilled milk and who we should blame for this episode. We shouldn’t expect a U-turn from either the insurance companies or the government for this matter.

My suggestions are objective and pragmatic:

Over few years as we progress towards an aging population, we need to scrutinize our own portfolio to see if we have enough savings. Be real with yourself you haven’t saved enough or build up enough passive income. Because with whatever changes that might happen during the coming years (I don’t think this is the end), only one thing is constant. We are going to need more money for medical and for our daily cost of living. Hence, it’s better we start our planning today.

Ryan Teo, AXA

Private medical bills are increasing about 10-15% per annum for the past few years, so it’s little surprise that this has caused insurers plenty of concern.

But from a patient’s perspective, if the patient knows there’s insurance coverage and when the doctor recommends diagnostic tests etc, we’re not really going to say no. The main priority in our minds is just to make sure everything is okay. The cost part is taken care of by the insurance.

However, with the co-payment change, will we think twice about costs of tests? I doubt so. Health is still a priority.

A a consumer, it’s frustrating to not get full coverage or if you haven’t utilized your shield and your premiums are escalating. But it’s understandable that over the longer term, co-payment is the way forward. In fact, I think we’ll all be moving towards co-payment in the long run. 

Melvin Liu, Manulife

Melvin shared that it was easier to downgrade a rider than to upgrade it as upgrading requires medical underwriting whereas the other way does not. He recommends that you buy a better plan first to have more options available to you. On doctors who benefit from charging higher fees dues to insurance, he opined that it is challenging to figure out whether it is true or otherwise, and that good ones do want to treat the patients in the best manner possible.

Melvin said that it is easy to talk about co-payment for riders when it involves outsiders. For insurance companies, it makes sense. However, he pondered whether one holds the same opinion if his/her loved ones are the ones in hospital. He also questioned if a consumer would prefer co-payment or pay as-charged.

He also thought that there should be more innovative solutions out there such as Prudential’s PruShield, where customers enjoy premium discounts when there are no claims made whereas there is premium adjustment after claims. However, while solutions such as this is in the right direction for pricing structure, first-time buyers may reconsider getting riders in consideration of the likelihood of needing to pay higher premiums after claims.

What do others think about the rider co-payment?

We also browsed the Insurance Discussion SG Facebook Group, where a lively discussion took place. Both sides offered compelling argument for and against the new ruling. Of the few posts that we surveyed, there were thought-provoking comments. For example, a commenter mentioned why a doctor would order extra tests on a patient.

One of the many comments in the group that discussed the new rule. Source: Insurance Discussion SG.
Another comment in the same group. Source: Insurance Discussion SG.

Both comments brought valid points to the table. That said, who should we blame in this who affair? There truly isn’t a sole party to blame – affordable and fair healthcare requires the cooperation of various stakeholders. Consumers, insurance companies, and healthcare providers are all in it to make healthcare accessible for everyone.

How will this change things for consumers?

As of the moment of publishing, there are currently no plans to require existing policyholders to co-pay their hospital bills. However, this could change since insurance companies will come up with more competitive and innovative plans to encourage existing policyholders to switch.

Is it the end of healthcare that we know it for future policyholders? Not necessarily so. Medisave can cover some of this co-payment, and the ministry estimates that 1 out of 2 rider policyholder will pay SGD$100 or less for hospital bills across all ward types. However, financial planning in the future will probably have to include planning for rider co-payment, since riders no longer offer full cover.

Worried about this new rider co-payment rule? Fret not – head on to our site to ask our curated pool of trusted financial advisers on what your next move should be, if you have not purchased one.

fundMyLife is a platform that aims to empower Singaporeans to make financial decisions confidently. We also connect consumers to the right financial planners in a private and anonymous manner, based on their financial planning questions.

Follow us on our fundMyLife Facebook page to get exciting updates and your dose of finance knowledge! Alternatively, the Insurance Discussion SG Facebook group is a good place to discuss insurance-related topics with fellow Singaporeans.

Is An Integrated Shield Plan (Hospital Plan) All I Need?

Written by Jonathon Han, edited by Jackie Tan. The opinion series is dedicated to sharing our advisers’ thoughts and opinion on personal finances. Jonathon is a part of fundMyLife, the platform that connects financial planning questions to the right advisers. Interested to contribute? Drop us an email at jackie@fundmylife.co!

It is very Singaporean of us to have a KIASU or cost effective mindset when it comes to doing up our insurance. One of the most common questions that I am often asked is: Is just buying an integrated shield plan (ISP) sufficient?

After all, in the event of sickness, we Singaporeans always have one saying…can afford to die, cannot afford to get sick. So I presume as long as I have a Shield plan, I should be fine?

Yes it is true, hospital bills are usually the biggest INITIAL bill, however we have to factor in other unseen costs, which are often overlooked. It is not in my practice to be fear mongering, I prefer to take a rational approach to sickness while drawing from real life experiences.

What happens when we are sick?

[Seen Cost] We get hospitalized and require medical treatment (ISP covers this)

Yes, hospital bills will be covered by ISP. ISPs are designed to cover catastrophic hospital bills and costs of post-hospital treatment. Your medical bills and post-hospital treatment will be covered in according to the plan you purchased.

[Unseen Cost 1] We lose our ability to work, usually temporary (Immediate loss of income)

When we get sick, it is highly unlikely we would wish to go back to the same stressful environment that caused us to get sick in the first place. We would require a significant amount of time off based on the severity of our illness. The time ranges from 3-6 months of being out of the job for Early Critical Illnesses, to 6-24 months for advanced Critical Illnesses.

Most of us don’t get paid to stay at home to mend our bodies. Hence income replacement is important.

A critical illness plan will give a payout of a lump sum upon diagnosis of early critical illness or advanced critical illness. This money can be used as income replacement while we recover.

[Unseen Cost 2] Some of us will reprioritize our lives and choose to work at a different pace (Potential income loss)

After some of us recover from illness, we might wish to relook our lives and spend time more time with our loved ones, or spend more time enjoying and embracing life. This usually translates to committing short hours to work or changing jobs to something less intense. Most of the time, this will result in a drop in our income. Since a critical illness plan pays out a lump sum upon diagnosis of critical illness, the funds can be used to offset some of the potential loss of income when we choose to reprioritize our lives.

[Unseen Cost 3] Cost of eating healthy, with supplements and organic food (Nutrition and supplement)

Those going through illness will attest to a positive change in diet. Some of us will go to extremes as to only consume organic food while others increase their supplement intake. Adopting an organic diet and increasing our supplement intake will not come cheap. A lump sum from a critical illness payout will usually come in handy at such times.

After knowing all these hidden bills, what is the most cost-effective way to resolve it?

We should consider whole life insurance with critical illness and early critical illness coverage.

How does this complement my ISP?

In summary, the ISP is designed to cover hospitalization and medical cost, while critical illness plans are designed to pay out a lump sum to offset your unseen cost, i.e. immediate loss of income, potential income loss, & nutrition and supplement.

A small tip: I would suggest avoid using term insurance to cover against critical illness and early critical illness as the total outlay from term insurance often will be more expensive in the long run.

Jonathon Han
Professional Financial Adviser, not just another typical salesman

 

fundMyLife is a platform that aims to empower Singaporeans to make financial decisions confidently. We also connect consumers to the right financial planners in a private and anonymous manner, based on their financial planning questions.

Follow us on our fundMyLife Facebook page to get exciting updates and your dose of finance knowledge! Alternatively, the Insurance Discussion SG Facebook group is a good place to discuss insurance-related topics with fellow Singaporeans.