The days of claiming insurance for your full hospitalisation fees are all but over

No more buffet for those hospital-stay lovers.

By Martino Tan |Jonathan Lim | March 7, 2018

Planning to purchase a hospitalisation insurance plan with a rider that allows you to pay nothing for hospitalisation fees?

Well, that would no longer be possible, from March 8, 2018 onwards.

Patients with new Integrated Shield Plan (ISP) riders will still have to foot some of their healthcare costs, Health Minister Gan Kim Yong announced during the Committee of Supply debates today.

For those Singaporeans who do not understand what ISP is, or what riders are (they are not cyclists!), please read on. The details below are very important for you, your family, your grandparents and all your closed ones.

I don’t get it? Bear some healthcare costs? 

Essentially, new hospitalisation insurance plans will require policy holders to co-pay at least 5% of their hospitalisation bills, even if they purchase a rider.

The co-payment amount can be capped at $3,000 or more depending on how individual private insurance companies want to structure their new plans.

ZOMG. How about people on existing plans with riders that covers the co-payment portion of the bill?

MOH does not require insurance companies to change existing policies. The decision to change the terms of existing policies is up to the insurance companies themselves.

Insurance companies can anyhowly change policy terms of existing policyholders meh? How can dis B allow?! 

You sign on your policy document that time never read the fine print ah?

More often than not, insurance companies will spell out specifically that they reserve the right to change the terms and conditions of their policies. They can even change the premium charged. If you’re not happy, please don’t cancel your insurance policy before securing proper coverage with another company.

Oh no. I am meeting my insurance agent tomorrow.

On the bright side, insurers can continue selling their existing rider plans.

But insurers have to let the new policyholders know that they will transit to new riders with co-payment from April 1, 2021.

Wah lau eh, why are they requiring us to co-pay for our hospistalisation? Like that pay for the rider for what?! 

According to Minister Gan, co-payment “plays an important role in ensuring our healthcare system is sustainable: by emphasising personal responsibility in healthcare, by encouraging service providers to focus on appropriate interventions, and nudging patients to make prudent decisions in healthcare services.”

Why no co-payment = not sustainable? 

Chee Hong Tat, Senior Minister of Health, said that “the current zero co-payment feature of these full riders has resulted in a ‘buffet syndrome’, leading to over-consumption, over-servicing and over-charging of healthcare services.”

In other words, a patient will opt for unnecessary treatments, or doctors who over-charge and over-service patients. This increases healthcare costs – “never mind mah, insurance can cover, so I charge more for this treatment. Too bad for other plebeians who cannot afford insurance, so they cannot get this treatment lor”.

With healthcare costs and insurance claims spiraling upwards, insurance companies (MediShield included) will have no choice but to increase premiums. It may eventually make hospitalisation insurance too expensive for some people.

Overall, everyone loses as the zero co-payment feature of riders pushes up healthcare costs in Singapore.

Eh don’t bluff la, people really anyhow claim meh? 

Don’t know leh, but statistics show otherwise.

Chee said that in 2016 the average medical bill size for full rider policyholders was about 60% higher than the average bill size for those without riders, even though rider policyholders are younger and generally in better health.

In 2016, the average cumulative bill size for a full-rider policyholder on a private hospital plan was $9,975. It was $6,270 for policyholders without a rider.

MOH also shared that full-rider policyholders have higher claims incidence. In 2016, 9.1% of private hospital full-rider policyholders made claims, versus 5.9% of policyholders without a rider.

Currently, 29% of Singapore residents are full-rider policyholders.

Are there any stories to share?

Chee shared a few stories in parliament, below are two examples.

Example 1: A full rider policyholder made claims for 12 nose scopes in a year, without clear medical need.

Example 2: Another full rider policyholder underwent an expensive surgery for a small breast lump removal that costs $70,000 in doctor fees alone, when there was an equally effective alternative procedure which costs only $5,000.

Sigh. Why these people spoil market? But how come it is 5 per cent co-payment?

MOH said that “the guideline was set taking into account the range of views on rider co-payment rates from IP insurers, claims data and potential impact on policyholders”.

In other words, the guideline of five per cent co-payment for new rider policies aims to strike a balance between allowing Singaporeans to buy additional coverage and peace of mind, and ensuring some level of co-payment.

These people damn spoiler. Then why Gahmen never whack all the doctors that suka suka give expensive treatments first, instead of taking away the rider perk? Why never punish those super kiasu and kiasee Singaporeans who every small thing also go hospital and get warded? Feelings get hurt also go hospital kind? Why? Tell me!

This one ah… we also dunno =/

About Martino Tan

Martino’s parents named him after an Italian priest, Vatican's 1st ambassador to S’pore. He's inspired by the lives of Robert Kennedy & D. Bonhoeffer, the words of G.Orwell & T.Sorensen, & the music of the Beatles.

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