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 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.
- What is MediShield Life?
- Am I eligible?
- MediShield Life Coverage & Benefits
- MediShield Life Exclusions
- What is deductible?
- What is co-insurance?
- MediShield Life Claim
- Does MediShield cover pre-existing condition?
- MediShield Life Premium
- MediShield Life Subsidies
- Updates to MediShield Life
- Integrated Shield Plan vs MediShield Life
1. What 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 the Ministry of Health’s medical insurance, MediShield Life.
MediShield Life is a basic medical insurance plan which all Singaporeans and Permanent Residents (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.
To give you an idea of the difference in price, here are the median hospital bills from MOH for a complex knee joint replacement surgery at the various wards:
|Ward class||Total hospital bill|
|Public hospital: Ward C||$6,436 (subsidised)|
|Public hospital: Ward B2||$7,753 (subsidised)|
|Public hospital: Ward B1||$21,586|
|Public hospital: Ward A||$24,899|
|Private hospital||$10,220 – $14,400|
For public hospitals alone, the moment you upgrade from Class B2/C to Class B1/A, prices more than triple. Big difference!
So if you want to stay in a higher class ward or go to a private hospital, MediShield Life won’t be enough. You’ll need to supplement your plan with an Integrated Shield plan (more on that below) for higher coverage, and/or top up the remainder in cash or Medisave.
2. Am I eligible for MediShield Life?
All Singapore citizens and PRs are automatically granted lifetime protection by MediShield Life.
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.
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. Then you can apply to opt out.
You enjoy lifetime coverage regardless of any pre-existing medical conditions.
3. MediShield Life Coverage & Benefits
Here’s a quick look at the current MediShield Life benefits (i.e. how much you can claim). Table taken from the Ministry of Health:
|MediShield Life Coverage (Inpatient)||Claim Limits|
|Daily Ward and Treatment Charges|
|Intensive Care Unit Ward||$2,200/day|
|Psychiatric (up to 60 days/year)||$160/day|
|Community Hospital (Rehabilitative)||$350/day|
|Community Hospital (Sub-Acute)||$430/day|
|Inpatient Palliative Care Service (General)||$250/day|
|Inpatient Palliative Care Service (Specialised)||$350/day|
If you’re getting hospitalised for a surgery, there’s a very comprehensive table of surgical procedures on the Ministry of Health‘s website that you can refer to. Find your exact surgery from that table, and then you will be able to match the cost of it here:
|MediShield Life Coverage (Inpatient)||Claim Limits|
|Table 1 A/B/C (less complex procedures)||A $240, B $340, C $340|
|Table 2 A/B/C||A $580, B $760, C $760|
|Table 3 A/B/C||A $1,060, B $1,160, C $1,280|
|Table 4 A/B/C||A $1,540, B $1,580, C $1,640|
|Table 5 A/B/C||A $1,800, B $2,180, C $2,180|
|Table 6 A/B/C||A $2,360, B $2,360, C $2,360|
|Table 7 A/B/C (more complex procedures)||A $2,600, B $2,600, C $2,600|
|Continuation of Autologous Bone Marrow Transplant Treatment for Multiple Myeloma||$6,000/treatment|
Finally, if you’re going to the hospital for treatment as an outpatient (not getting hospitalised there), here are the benefits and claim limits:
|MediShield Life Coverage (Outpatient)||Claim Limits|
|Chemotherapy for Cancer||$3,000/month|
|Radiotherapy for Cancer|
|External (Except Hemi-Body)||$300/treatment|
|Immunosuppressants for Organ Transplant||$550/month|
|Erythropoietin for Chronic Kidney Failure||$200/month|
|Long-term Parenteral Nutrition||$1,700/month|
Extra $1,200/year for Cancer Outpatient Costs from September 2022
Speaking of cancer outpatient treatments, there was much talk around the low MediSave withdrawal limit ($600/year) for cancer patients to use for their on cancer-related MRI, CT, and other scans. View MediSave withdrawal limits here.
While the MediSave withdrawal limit won’t be increased, cancer patients will be able to claim an additional $1,200/year for scans as part of their cancer treatment from September 2022. Radiotherapy cancer patients will be able to claim from the MediShield Life radiotherapy section, too.
Approved Outpatient Cancer Drugs from September 2022
Other important news to note about claiming for cancer from MediShield Life is this – from September 2022, the outpatient cancer drugs that you use in cancer treatment have to be in the official MediShield Life Cancer Drug List to be claimable.
To see if your cancer drug is claimable and subsidised under MediShield Life, check this Ministry of Health Drug Subsidies List.
What are the claim limits for MediShield Life? You can claim up to $150,000 per policy year, but there’s no cap on how much you can claim in your entire lifetime.
|MediShield Life Maximum Claim Limit|
|Per Policy Year||$150,000|
4. MediShield Life exclusions
There are certain things you can’t use MediShield Life to pay for, such as the following.
- Ambulance fees
- Cosmetic surgery
- Dental work (except due to accidental injuries)
- Infertility, sub-fertility, assisted conception or any contraceptive operation
- Sex change operations, including their related complications
- Maternity charges (including Caesarean operations) or abortions, including their related complications, except treatments for serious complications related to pregnancy and childbirth
- Treatment for injuries arising from the insured’s criminal act
- Treatment of injuries arising directly or indirectly from nuclear fallout, war and related risk
- Treatment of injuries arising from direct participation in civil commotion, riot or strike
- Expenses incurred after the 7th calendar day from being certified to be medically fit for discharge from inpatient treatment and assessed to have a feasible discharge option by a medical practitioner
- Surgical interventions, including related complications, for the following rare congenital conditions which are severe and fatal by nature: Trisomy 13, Bilateral Renal Agenesis, Bart’s Hydrops and Anecephaly
- Optional items which are outside the scope of treatment
- Overseas medical treatment
- Private nursing charges
- Purchase of kidney dialysis machines, iron-lung and other special appliances
- Treatment which has received reimbursement from Workmen’s Compensation and other forms of insurance coverage
5. What is deductible in MediShield Life?
So, you might have read that there is a “deductible” for MediShield Life. The deductible is the amount of money you have to pay before you can make your first MediShield Life claim each year, and it depends on which ward you stay in.
|MediShield Life Deductible|
|Age 80 and under||Age 81 and over|
|Ward Class C||$1,500||$2,000|
|Ward Class B2 and above||$2,000||$3,000|
You will only have to pay the deductible once a year, even if you make multiple claims in that year.
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.
6. What is co-insurance?
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%|
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.
7. How to 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.
8. Does MediShield Life cover pre-existing condition?
Unlike most kinds of health insurance, MediShield Life covers all pre-existing medical conditions.
If you joined MediShield Life with one of the below pre-existing conditions (e.g. in the case of PRs) you will need to pay 30% additional premiums for 10 years.
|Pre-Existing Conditions||Some 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|
|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|
|Chronic conditions with serious complications||Hypertensive heart disease, hypertensive kidney disease, diabetes with kidney complications, diabetes with eye complications|
After 10 years, your premiums go back to normal. Additional premiums are Medisave-payable.
9. MediShield Life Premiums
Of course, somebody’s got to pay for MediShield Life. You will have to pay MediShield Life premiums annually, and these premiums will rise as you age.
|Age Next Birthday||Annual MediShield Life Premiums|
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.
10. Can I get MediShield Life premium subsidies?
Yes, there are MediShield Life premium subsidies for lower, middle, and upper income groups. You can get discounted premiums ranging from 15% to 50%, depending on your income level.
Here are the MediShield Life subsidy for lower-income families ($0 to $1,200 household monthly income per person):
|Age Next Birthday||MediShield Life Subsidy|
|1 – 40||25%|
|41 – 60||30%|
|61 – 75||35%|
|76 – 85||40%|
|86 – 90||45%|
Here are the MediShield Life subsidy for lower to middle-income families ($1,201 to $2,000 household monthly income per person):
|Age Next Birthday||MediShield Life Subsidy|
|1 – 40||20%|
|41 – 60||25%|
|61 – 75||30%|
|76 – 85||35%|
|86 – 90||40%|
Here are the MediShield Life subsidy for middle to upper-income families ($2,001 – $2,800 household monthly income per person):
|Age Next Birthday||MediShield Life Subsidy|
|1 – 40||15%|
|41 – 60||20%|
|61 – 75||25%|
|76 – 85||30%|
|86 – 90||35%|
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%.
What is a property’s annual value? In layman terms, it’s the basic rental price and income your house can fetch if you rented it out.
Oh yes, and those who are part of the Pioneer Generation get 40% to 60% in MediShield Life premium subsidies from age 66 onwards.
Meanwhile, the Merdeka Generation gets 5% premium subsidy from age 60 to 75, and 10% subsidy from age 76 onwards.
11. MediShield Life Updates (2021)
Healthcare being a major government priority, MediShield Life does undergo a certain amount of scrutiny by the higher-ups, and does get tweaked from time to time to meet coverage gaps.
But in 2021, there will be a major review of the MediShield Life scheme. Due to healthcare inflation, the current benefits are now lagging behind the actual cost of healthcare and need to be revised upwards.
The proposed changes include:
- Revising the annual claim limit from $100,000 to $150,000
- Higher claim limits for the first 2 days of hospitalisation, which is when most diagnostics and tests happen
- Higher claim limits for intensive care, dialysis, and psychiatric care
- Higher coverage for sub-acute care at community hospitals
- Coverage for attempted suicide, self-harm, substance abuse and alcoholism
- More affordable day surgery for the elderly — so they do not need to be warded to claim
- Private hospital claims will be capped at 25% down from 35%
However, these enhancements would also mean up to 35% increase in MediShield Life premiums. Yikes.
12. What is an Integrated Shield Plan? Difference between IP Plan vs MediShield Life
You’ve already heard that you can’t rely solely on MediShield Life because of how basic it is.
But the solution is pretty easy: Upgrade your coverage is to opt for an Integrated Shield Plan (IP), which can be paid for with Medisave. There are 7 insurers that provide IPs in Singapore.
Integrated Shield plans comprise the MediShield Life base plan + additional private insurance provided by the insurance company. So there’s no duplicate here.
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, with the possibility of shorter queues and wait times. You can also buy riders for your IP to receive even greater coverage.
The downside is obviously that you’ll be paying higher premiums if you have an IP, and there may 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.
For more details, check out our Integrated Shield plan comparison.
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