Healthcare

CPF MediShield Life in Singapore – Guide To Everything You Need To Understand And Use It

CPF MediShield Life in Singapore

Joanne Poh

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When you fall sick, what’s the first thing you do? Complain about how expensive healthcare is in Singapore? Well, after doing that, the next thing you should do is to see how MediShield Life can help you.

But what the heck is MediShield Life anyway? How do you benefit from it? And why do you need it when part of your CPF contributions already have to go into your Medisave account? These questions and more will be answered right here.

 

Contents

  1. What on earth is MediShield Life?
  2. Who is eligible?
  3. What benefits does MediShield Life give you and how has it improved from the previous MediShield?
  4. What are the exclusions?
  5. What is the deductible and how much must you pay?
  6. What is the co-insurance portion and how much must you pay?
  7. How do you make a MediShield Life claim?
  8. What happens if you have a pre-existing condition?
  9. How much are MediShield Life premiums?
  10. What subsidies will you get?
  11. Updates to MediShield Life
  12. What is an Integrated Shield Plan and how does it work with MediShield Life?

 

What on earth is MediShield Life?

Have you ever been told that you’ll go bankrupt if you fall seriously ill and don’t have medical insurance?

Well, guess what, even if you’ve never spoken to an insurance agent or purchased a single insurance policy in your life, you actually are covered by medical insurance, and that’s MediShield Life.

MediShield Life is a basic medical insurance plan which all Singaporeans and PRs are automatically enrolled in.

It works in the same way as other types of health insurance. Basically, you can make a claim for certain types of medical bills, including hospitalisation and certain types of outpatient treatment.

The catch is that, being a very basic plan, there are strict limits as to how much you can claim and what is covered.

For instance, if you get hospitalised, your MediShield Life payouts will only able to cover the cost of Class C or Class B2 wards at public hospitals.

If you want to stay in a Class B2 or Class A ward or go to a private hospital, you’ll have to pay the difference on your own if you do not have a private medical insurance policy that can enable you make a bigger claim.

To give you an idea of the difference in price, at Singapore General Hospital (a public hospital), a Class C ward contains 9 beds and prices start from $35 a day. A Class B2 ward contains 5 or 6 beds and costs from $79 a day. On the other hand, a Class B1 ward with 4 beds costs from $251.45 a day, while prices for a Class A ward with a single room start at $466.52 a day. Big difference!

For private patients, bills are pro-rated before the claims under MediShield Life are tabulated. MediShield Life will cover Class B1/A wards in both private and public hospitals but at a smaller proportion. Patients can top up the remaining amounts by cash or Medisave. If you have an Integrated Shield Plan, you can get higher coverage for costs incurred in Class B1/A wards.

If you are a PR, it’s important to note that the amount of subsidies you receive at public hospitals will be lower than what Singapore citizens receive. This is likely to result in your having to pay higher out-of-pocket charges.

Before 15 July November 2018, MediShield Life covered community hospital stays only for patients transferred from an acute hospital. In the new MediShield Life update, patients who are directly admitted to community hospitals from the emergency department of public hospitals will be able to claim up to $350 a day from MediShield Life.

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Who is eligible?

All Singapore citizens and PRs are automatically granted lifetime protection by MediShield Life.

You cannot opt out of MediShield Life, and have to continue paying the premiums over your lifetime unless you live overseas and have no intention of returning.

You enjoy lifetime coverage regardless of any pre-existing medical conditions.

What is MediShield Life?

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What benefits does MediShield Life give you and how has it improved from the previous MediShield?

You might be asking yourself when MediShield started becoming known as MediShield Life.

Well, that happened on 1 November 2015, when MediShield Life replaced the previous MediShield scheme.

We should be glad it did, because MediShield Life is more generous than the previous MediShield in terms of coverage and payout ceilings. The co-insurance portion, otherwise known as the amount of money you have to pay out of pocket when you make a claim (as a % of the amount claimed) is also lower.

Here’s a comparison of the previous MediShield benefits, and how they measure up to the current MediShield Life benefits.

Previous MediShield benefits Current MediShield Life benefits
Inpatient treatment/Day surgery claim limits
Daily ward and treatment charges

Normal Ward

$450 per day $700 per day
Intensive Care Unit Ward $900 per day $1,200 per day
Community Hospital $250 per day $350 per day
Surgical Procedures $150 to $1,100 $200 to $2,000
Psychiatric Ward $100 per day $100 per day
Outpatient Treatment
Chemotherapy for Cancer $1,240 per 21/28 day cycle $3,000 per month
Radiotherapy (External or Superficial) $80 per treatment session $140 per treatment session
Radiotherapy (Brachytherapy) $160 treatment session $500 per treatment session
Stereotactic radiotherapy $1,800 per treatment session $1,800 per treatment session
Maximum Claim Limits
Per Policy Year $70,000 $100,000
Lifetime $300,000 No Limit
Maximum Coverage Age 92 (age on next birthday) No maximum age
Co-Insurance
Claimable Amount

$0 to $3,000

20% 10%
$3,001 to $5,000 15% 10%
$5,001 to $10,000 10% 5%
> $10,000 10% 3%
Outpatient treatments 20% 10%

Here are the biggest takeaways from the comparison:

  • The claim limits in all categories have risen (except for Psychiatric Ward and Stereotactic Radiotherapy). That means you can get more money out of MediShield Life than you could for MediShield.
  • The co-payment portions have also fallen. That means each time you make a claim, the cash portion you need to fork out is smaller.
  • While people were previously protected by MediShield until the age of 92, MediShield Life protects you for an entire lifetime, so assuming you live past 92, you won’t have to worry about losing protection.

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What are the exclusions?

There are certain things you can’t use MediShield Life to pay for, such as the following.

  • Ambulance services
  • Cosmetic surgery
  • Maternity charges (including Caesaren operations) or abortions
  • Dental work (except due to accidental injuries)
  • Infertility, sub-fertility, assisted conception or any contraceptive operations
  • Sex change operations
  • Optional items which are outside the scope of medical treatment
  • Overseas medical treatment
  • Private nursing charges
  • Purchase of kidney dialysis machines, iron-lung and other special appliances
  • Surgical interventions for Trisomy 13, Bilateral Renal Agenesis, Bart’s Hydrops and Anecephaly
    (Update: MediShield Life has been updated since 1 November to cover surgical interventions for Trisomy 18 and Alobar Holoprosencephaly)
  • Treatment which has received full reimbursement from Workmen’s Compensation and other forms of insurance coverage
  • Treatment for drug addiction or alcoholism
  • Treatment of injuries arising directly or indirectly from nuclear fallout, war and related risk
  • Treatment of injuries arising from direction participation in civil commotion, riot or strike
  • Treatment of intentional self-injury or injuries resulting suicide
  • Vaccination

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What is the deductible and how much must you pay?

So, you might have read above that there is a deductible for MediShield Life. Before you make your first MediShield Life claim each year, you will have to pay the deductible before you can get at that claims money.

As the deductible is chargeable only once a policy year, you will only have to pay it once even if you make multiple claims in a year.

Deductible in the policy year
Age 80 and under Age 81 and over
Class C $1,500 $2,000
Class B2 and above $2,000 $3,000
Day surgery $1,500 $3,000

Example:

You get hospitalised twice in a year, and in both cases you get warded in a Class B2 ward. Your first medical bill is $8,000 and the second is $4,000, making a total of $12,000.

Being under 81 years old, you would thus pay a deductible of $2,000 after your first hospital visit. As deductibles are only payable once a policy year, you would not have to pay any deductible when making a claim for your second visit.

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What is the Deductible?

What is the co-insurance portion and how much must you pay?

The deductible isn’t the only money you need to fork out in order to make a MediShield Life claim.

You will also have to pay co-insurance, which is calculated as a percentage of the amount you’re trying to claim. While the deductible is charged only once a policy year, co-insurance must be paid each time you make a claim.

The amount of co-insurance you must pay varies according to the size of your bill.

Amount being claimed Co-insurance
$0 to $3,000 10%
$3,001 to $5,000 10%
$5,001 to $10,000 5%
> $10,000 3%

Example: Let’s take the example in the previous section, where you incurred two hospital bills worth $8,000 and $4,000 respectively, and paid a deductible of $2,000 after the first hospital visit.

After paying your deductible, you’ve still got $10,000 worth of expenses.

After the first hospital visit, which cost $8,000, you paid a deductible of $2,000. You would then submit a claim for $6,000. The co-insurance portion for that sum is 10% of the first $3,000 and 5% of the next $3000, so you would pay $450 and claim the remaining $5,550.

For the second hospital visit, there is no deductible, so you can submit a claim for the entire bill of $4,000. The co-insurance portion is 5% for the first $2,000 and 3% for the next $2,000 so you would pay co-insurance of $160, and then receive $3,840 worth of MediShield Life payouts.

In this scenario, your total medical bill of $12,000 is broken down as follows:

MediShield Life payout $9,390
Deductible (paid by you) $2,000
Co-insurance (paid by you) $610
Total medical bills: $12,000

As you can see, to cover your medical bills totalling $12,000, you would have to fork out $2,610, and the rest would be paid by MediShield.

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How do you make a MediShield Life claim?

The claims process differs depending on whether you have purchased an Integrated Shield Plan (ie. a private health insurance policy that works in tandem with MediShield Life), or whether you will be relying solely on MediShield Life.

If you don’t have an Integrated Shield Plan

You’re probably wishing you had an Integrated Shield Plan right now. The good news, if we can call it that, is that the paperwork for your MediShield Life claim will be handled by the staff at your hospital or other healthcare provider.

Once you are admitted, inform the staff that you wish to make a MediShield Life claim to pay part of your bills. The medical institution will submit your claim on your behalf after receiving your authorisation.

The MediShield Life payouts will be computed based on the relevant benefits and claim limits, taking into account the deductible. You can then use your Medisave or cash to make the payment for the co-payment amount.

The MediShield Life payout will be released to the medical institutions by the CPF Board after the claim has been processed.

If you have an Integrated Shield Plan (IP)

Contact your insurer or agent immediately when you know you’re going to be admitted to hospital. Also inform hospital staff that you wish to pay your bill using your IP.

MediShield Life is included in all IPs. IPs comprise of 2 components, where the MediShield Life components are run by CPF board and the additional private insurance coverage component is run by the insurance company.

Your insurer will process your claim and send payment to the hospital or other medical institution on your behalf. They will also handle the documentation for your MediShield Life claim, and the portion of your bill being paid by MediShield Life will automatically be sent to the medical institution.

Obviously, whether you have an IP or not, any sums on your bill that cannot be covered by MediShield Life or your IP will be dutifully billed to you.

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What happens if you have a pre-existing condition?

Those who had a pre-existing condition classified as “serious” by MOH before MediShield Life kicked in on 1 Nov 2015, or who joined with pre-existing conditions (eg. in the case of PRs) will need to pay 30% Additional Premiums for 10 years.

After the 10 year period, you will no longer have to go pay the Additional Premiums.

Here are the broad categories of pre-existing conditions classified as serious, that will require the payment of Additional Premiums.

Broad categories Examples
Cancer Lung cancer, colorectal cancer, breast cancer, stomach cancer
Blood disorders Aplastic anaemia, thalassemia major
Degenerative diseases Parkinson’s disease, muscular dystrophy, amyotrophic lateral sclerosis (ALS)
Heart or other circulatory system diseases Heart attack, coronary artery disease, chronic ischaemic heart disease
Cerebrovascular diseases Stroke
Respiratory diseases Chronic obstructive pulmonary disease
Liver diseases Alcoholic liver disease, chronic hepatitis, fibrosis or cirrhosis of liver
Autoimmune / Immune System diseases Systemic lupus erythematosus, HIV,  AIDS
Renal diseases Chronic renal disease, chronic renal failure, chronic nephritic syndrome
Serious congenital conditions Congenital heart disease, congenital renal disease biliary atresia
Psychiatric conditions Schizophrenia
Chronic conditions with serious complications Hypertensive heart disease, hypertensive kidney disease, diabetes with kidney complications, diabetes with eye complications

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How much are MediShield Life premiums?

Of course, somebody’s got to pay for MediShield Life. And that person’s going to be you (or an immediate family member).

You will have to pay MediShield Life premiums annually, and these premiums will rise as you age. And yes, you will pay more than you had to for the previous MediShield.

The good news is that you can pay 100% of your MediShield Life premiums using Medisave. Your premiums will be automatically deducted from your Medisave account if you have enough. Or, your immediate family members may pay your premium using their Medisave.

MediShield Life premiums in 2019/2020 for non-pioneer generation members

Age on next birthday Annual MediShield Life Premiums before Subsidy ($) 2019 MediShield Life Premiums after Subsidy
1-20 130 Lower income Lower-middle income Upper-middle income High income
1-20 130 98 104 111 130
21-30 195 146 156 166 195
31-40 310 233 248 264 310
41-50 435 305 326 348 435
51-60 630 441 473 504 630
61-65 755 491 529 566 755
66-70 815 530 571 611 815
71-73 885 575 620 664 885
74-75 975 634 683 731 975
76-78 1,130 678 735 791 1,130
79-80 1,175 705 764 823 1,175
81-83 1,250 750 813 875 1,250
84-85 1,430 858 930 1,001 1,430
86-88 1,500 825 900 975 1,500
89-90 1,500 825 900 975 1,500
>90 1,530 765 842 918 1,530

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What subsidies will you get?

Non-Pioneer Generation premium subsidies

As you can see from the above table, the government offers subsidies depending on your income level.

First, you need to figure out whether you’re classified as a lower income, lower-middle income or upper-middle income person.

  • Lower income – You have a household monthly income of $1,100 or less per person.
  • Lower-middle income – You have a household monthly income of $1,101 to $1,800 per person.
  • Upper-middle income – You have a household monthly income of $1,801 to $2,600 per person.

In addition, to receive any subsidies at all, you must live in a residence with an annual value of $13,000 or less.

If you live in a residence with an annual value of between $13,001 and $21,000, your subsidy rates will be cut by 10%.

Here’s how much you’ll receive depending on your income level.

Age on next birthday Subsidies (% of premium) for Singapore citizens (non-Pioneer generation)
Lower income Lower-middle income Upper-middle income
1-20 25% 20% 15%
21-30
31-40
41-50 30% 25% 20%
51-60
61-65 35% 30% 25%
66-70
71-73
74-75
76-78 40% 35% 30%
79-80
81-83
84-85
86-88 45% 40% 35%
89-90
>90 50% 45% 40%

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Pioneer Generation subsidies

If you’re part of the Pioneer Generation, you’ll receive subsidies regardless of your household income and the annual value of your residence. What’s more, you’ll also get Medisave top-ups of $200 to $800 a year, depending on which year you were born in.

Age on next birthday Pioneer generation subsidies (% of premiums)
66-70 40%
71-80 44% to 54%
81-90 54% to 59%
>90 60%

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Updates to MediShield Life

The MediShield Life has been updated to cover three new areas:

1. Patients directly admitted to community hospitals from the emergency department of public hospitals can now claim up to $350 a day from MediShield Life with effect from 15 July 2018.

2. Patients who require long-term parenteral nutrition, which means they need to feed intravenously, will be covered in the new update, receiving up to $200 per month from Medisave for parenteral nutrition bags and consumables with effect from 1 November 2018. See full clinical criteria to be eligible.

3. Surgical interventions for congenital conditions Trisomy 18 and Alobar Holoprosencephaly are now covered under MediShield Life with effect from 1 November 2018.

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What is an Integrated Shield Plan and how does it work with MediShield Life?

You’ve already heard that you can’t rely solely on MediShield Life because of how basic it is. MediShield Life is included in all Integrated Shield Plans (IP), which comprise of 2 components, the MSHL components run by CPF board and the additional private insurance coverage component run by the insurance company.

An Integrated Shield Plan (IP) works hand in hand with MediShield Life to give you greater coverage.

One of the biggest benefits to getting an IP is that you have the option of staying in private hospitals or upgrading to Class B1 and A wards and get covered. This also gives you the chance to choose your own doctor. One big advantage of using a private doctor is that queues and waiting times are much shorter.

You can also buy riders for your IP to receive even greater coverage. In the past, it was possible to buy full riders that would enable you to make a claim with zero co-payment. However, you should note that this is now a thing of the past, anyone signing up for new IP rider will not be able to completely avoid making co-payments.

The downside is obviously that you’ll be paying higher premiums if you have an IP, and there will be a cash portion that cannot be paid using Medisave. These premiums may be affordable when you’re young, but they’ll rise as you age and can eventually get quite hefty.

What is an Integrated Shield Plan?

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Related Articles

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With So Many Integrated Shield Plans Available, How Do You Decide Which to Choose?

3 Things You Didn’t Know About Medishield Life and Integrated Shield Plans

Here’s Why You Still Need to Buy Insurance Instead of Just Relying on MediShield Life

Have you ever made a MediShield Life claim? Share your experiences in the comments.

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Joanne Poh

In my previous life, I was a property lawyer who spent most of my time struggling to get out of bed or stuck in peak hour traffic. These days, as a freelance commercial writer, I work in bed, on the beach, in parks and at cafes, all while being really frugal. I like helping other people save money so they can stop living lives they don't like.