I used to be very intimidated by all the acronyms, government schemes and ridiculous jargon surrounding health insurance. All that used to matter was whether I can get an MC for my hangover without needing to pay too much.
But I’m getting to the age where “health insurance” should probably mean more than just “watching my step so I don’t fall down the stairs”. You might find yourself in a similar life stage too.
So I’ve done the research to give you a crash course on the basics of health insurance in Singapore: what it is, whether it’s a scam, why you might need it, what options there are, and what’s the latest in medical insurance regulations.
Health insurance in Singapore – the TL;DR version
If you don’t have time to read, here’s a very compressed version of this article:
- All Singaporeans and PRs get basic health insurance (MediShield Life) which covers basic public hospital treatments.
- You can boost MediShield Life with an Integrated Shield Plan (IP), which gives you the option to get treated in better class wards and private hospitals.
- IPs were once offered with full riders, where patients don’t have to pay a single cent on their medical bills. But under new MOH guidelines, they will no longer be offered.
- From 1 Apr 2019, you will only be able to buy IPs with co-pay riders, where you’d have to pay at least 5% of your bill while the insurer pays the rest.
Is Singapore’s healthcare system expensive? Need health insurance meh?
If you’re asking this, count yourself lucky. It must be a Singaporean rite of passage to swallow one’s shock and dismay upon looking at your first hospital bill.
I got my first recently, when I had a gym accident and went to A&E. I was glad my face was already contorted with pain, because, oh boy, I was not prepared for a >$100 bill for an X-ray and 5-minute consultation during which the doctor just said “you’re fine” without looking up from his computer screen.
If you have to pay $100 for a 5-minute job, imagine how much hospitalisation would cost. Here are some sample costs for a major surgery and stay in a public hospital taken from government website MoneySense last year.
|3-day stay in public hospital Class A ward||$900|
|Miscellaneous hospital bills (e.g. doctor’s fees)||$3,200|
|Medical examination & lab tests||$800|
|TOTAL HOSPITAL BILL||$11,000|
So as you can see, one terrible illness or accident – even one that’s relatively quickly “fixed” as in this case – can set you back a few months’ salary. You can see more estimates of medical costs on MOH’s website.
And that’s only for public hospitals! If you want your choice of doctor or hospital, expect to pay MUCH more. Ouch indeed.
But I already have Medisave. I can use Medisave to pay, right?
Every working Singaporean would have some money in their Medisave accounts. Channelled from your CPF savings, Medisave is basically a bucket of funds which are meant for healthcare costs. You can read all about it in our handy guide to Medisave.
The short answer is: yes, you can use Medisave to defray some of the costs of your treatment (or your immediate family’s).
But there are withdrawal limits: $450 a day for hospitalisation costs + a variable amount depending on the complexity of surgery. Going back to our illustration, here’s how much of the bill you can pay with Medisave:
|Item||Cost||Pay with Medisave|
|3-day stay in public hospital Class A ward||$900||Max. $450 a day, hence 3 x $450 = $1,350|
|Miscellaneous hospital services (e.g. doctor’s fees, paid separately from the surgery)||$3,200|
|Surgery||$6,100||Assuming it’s a level 5B procedure, $3,550|
|Medical examination & lab tests||$800||N/A|
|TOTAL HOSPITAL BILL||$11,000||$4,900|
That’s still $6,100 you have to pay out of pocket. (And don’t forget that Medisave is also your money…)
Note that this is already a “best case scenario” because there are even tighter withdrawal limits on certain types of treatments, e.g. hospitalisation for psychiatric treatment is capped at $5,000. And if you’re not hospitalised you can’t use your Medisave at all.
So… Are you saying I should buy health insurance?
Based on the simple projection we went through above, there’s a compelling case for getting some form of health insurance. It would cover more of your hospital bill beyond your Medisave withdrawal limits, plus the other medical bills you can’t use Medisave on.
Hold up though – before you call up your primary schoolmate-turned-insurance agent to buy a medical insurance plan, know that every Singaporean and PR is covered with basic health insurance, called MediShield Life, administered by the CPF Board.
It’s a revamped version of the old MediShield, but unlike MediShield, you can’t opt out of MediShield Life. However, premiums are affordable (FOR NOW!) and you can use Medisave to pay them. You can calculate yours here.
Given the low premiums, MediShield Life benefits are correspondingly basic. Payouts are pegged to prices for Class B2 and C wards in public hospitals. If you stay in a Class B1 or A ward, or in a private hospital, you can still benefit from MediShield Life, but you need to top up the rest of the bill.
Also, it’s for selected serious treatments only – you definitely cannot use it to cover your “convalescence” after a cosmetic tummy tuck.
What if I don’t want to go to public hospital? What other types of health insurance can I get?
Most Singaporeans would find MediShield Life rather limiting, as if you do end up in a life-threatening condition you would want the best care and treatment you can afford. Fortunately there are several health insurance options in Singapore to enhance your coverage.
|Health insurance||Description||Can use Medisave to pay premiums?|
|MediShield Life||Basic health insurance for all Singaporeans and PRs||Yes|
|Integrated Shield Plan (IP)||MediShield Life + additional coverage by private insurer (resulting in more healthcare options and higher claim limits)||Yes|
|IP Riders||Optional add-ons (“riders”) to your IP that enhance specific types of coverage||No|
As mentioned above, MediShield Life is the most basic sort of health insurance and covers basic healthcare in public hospitals’ lower class wards.
The next step up is an Integrated Shield Plan (IP) which combines MediShield Life with additional coverage provided by private insurers. There are many variations of these, but they all basically extend the coverage of MediShield Life to cover Class B1 in public hospitals, all the way up to private hospitals. You can compare coverage here.
The 7 IPs in Singapore are:
- AIA HealthShield GoldMax
- Aviva MyShield
- AXA Shield
- Great Eastern SupremeHealth
- NTUC IncomeShield
- Prudential PruShield
- Raffles Health Insurance (NEW, from 1 Aug 2018)
Finally, if you don’t mind paying extra premiums in cash (not Medisave) you can add “riders” on to your IP to enhance your coverage. I’ll explain these in a bit.
Do a lot of Singaporeans choose to upgrade their MediShield Life to IPs?
Yup. It costs more than MediShield Life, but two-thirds of Singaporeans still opt for it. Why?
For a start, you can pay for a portion of your or your immediate family’s IP premiums with Medisave within the annual withdrawal limits: $300 (up to 40 years old), $600 (41 to 70 years old) or $900 (71 years old and up). Which is a great way to use up funds that would otherwise just sits there untouched, year after year.
Depending on the combination of plan and riders you choose, IPs can deliver the following benefits:
- Higher class wards in public hospitals
- The option of staying in private hospital
- Higher annual claim limits
- Choice of doctor
- Shorter waiting time
- Bonus benefits e.g. medical coverage outside Singapore
Plus some people like the fact that your insurance agent is your one point of contact for all things health insurance related. If you need to make a claim or check if you’re covered for this and that, no need to dig through the government website – just WhatsApp your agent.
There’s been a big fuss about “IP riders” recently. What exactly happened?
Riders are basically add-ons to your IP that you have to pay in cash, not Medisave. Nonetheless, many Singaporeans opt for these to “zhng” their health insurance plans.
Each insurer has a range of riders for you to choose from. Some popular ones are cash allowances for every day you’re hospitalised or when you get discharged. The most controversial one right now is the “full rider”, which you pay for in order for your insurer to pay 100% of your hospital bill.
These are not cheap, BTW. According to a Straits Times article last year (“premium” content behind paywall, sorry) premiums for private hospital IP + full rider range from $1,860 to $2,838 for a 50-year-old. That goes up to $7,521 to a whopping $12,183(!!) for an 80-year-old. Worse than ordering fish with your cai png! Yet 1.1 million Singaporeans have full rider IPs. We be ballin’.
Of course, this wouldn’t be an issue if everybody just paid the premiums with no intention to claim. Private insurers in particular would be damn happy. But this is Singapore lah. Naturally, everyone has been gaming the system. Patients on rider plans developed this “simi sai also claim” attitude, while doctors have been naughtily overtreating and overcharging people on such plans.
Sounds like just a bit of harmless mischief, right? Until you realise how much money private insurers are now hemorrhaging. And guess who they’re going to pass the costs on to? That’s right – us.
IP premiums have risen as much as 80% in the last 2 years, while full riders now cost as much as 225% more. The scariest thing is that this free-for-all buffet might cause premiums for basic MediShield Life to rise too, since IPs are tied to them.
OMG, please tell me the government is doing something about this!
Yeah, they have – the Ministry of Health has now outlawed full rider IPs.
Private insurers can only offer 5% co-payment riders. These are very similar to full riders, but when you make a claim, you need to co-pay at least 5% of the medical bill (instead of not paying a single cent).
This small (well, hopefully) sum you must pay out-of-pocket will hopefully discourage “insurance buffet syndrome” and help keep premiums more stable for both IPs and MediShield Life.
If you already have an IP with full rider, there is technically no change to your plan. But most insurers charge claims-based premiums. So if you claim a lot, you can expect your next premium to go up. You’ll probably also be enticed to switch to the new co-pay rider when it goes on offer.
If you buy an IP with full rider between 8 Mar 2018 and 31 Mar 2019, your full rider will turn into a co-payment rider upon renewal from 1 Apr 2021.
From 1 Apr 2019, insurers will stop offering full riders and only offer riders with a minimum 5% co-payment required on your part whenever you make a claim.
That’s some time away. In the meantime, can I milk my full rider for all its worth?
Not so fast. You might find that your insurer is not that willing to entertain your claims.
For a start, most insurers have a panel of preferred doctors whom they know will not overcharge willy-nilly, and you may be “strongly encouraged” to get treatment with them. Also, you might need to get pre-treatment approval of your upcoming medical expenses through a hotline or a form.
If (or rather, when) you get slapped with a high premium upon renewal, consider “downgrading” your plan to save money. Either switch to the co-pay rider if it’s available by then, or to a public hospital IP if you don’t absolutely need to be treated at a private one. Or, you can shop around and see if other insurers will take you on for cheaper.
Also, it’s useful to see how much your medical treatment will cost with existing MOH fee benchmarks so as to ensure that you are not overpaying.
And that’s what you need to know about health insurance in Singapore. Ready to check out how much health insurance will cost you, based on your current profile? Get quotes across the market through MoneySmart and find out what your options are.
MediShield Life, IP, or IP with riders – which would you go for? Tell us about your choice in the comments!