MOH admits MediShield Life claim limits fall short of the targets that were set when it was launched

6278
Health Minister Gan Kim Yong / YT screencapture

The Ministry of Health has revealed that MediShield Life claim limits have fallen short of the targets that were set when the national health insurance scheme was launched.

In a forum letter to the national broadsheet, MOH’s Director of Corporate Communications, Ms Lim Siok Peng, revealed that MOH had targeted that the caps on claims should cover 9 out of 10 subsidised bills when MediShield Life was launched in 2015.

Over three years later, Ms Lim admitted that the Ministry’s latest figures show that only 8 out of 10 subsidised bills fall within the claim limits imposed MediShield Life:

“When MediShield Life was launched in 2015, the claim limits were set to cover nine out of 10 subsidised bills. Based on latest available figures, eight in 10 subsidised bills were within the MediShield Life claim limits, and nine in 10 were within $230 of the claim limits.”

Ms Lim added: “The remaining bills tend to be those of a more complex nature or were cases which involved higher income patients who received lower means-tested subsidies.”

The MOH’s forum letter comes on the heels of the recent revelation that MediShield Life only paid out $4.50 of an elderly patient’s over $4,477 post-subsidy bill for cataracts surgery.

The national health insurance scheme said that it imposes a cap of $2,800 on the cataracts procedure the 82-year-old underwent. This, combined with the actual wards fees of $205, means that the patient can only claim $3,005 out of the $4,477.

Perhaps even more curiously, MediShield Life said that the first $3,000 of the bill has to come out of the Medisave savings in the elderly patient’s CPF account. Thus, MediShield Life only paid out 90 per cent or $4.50 of the remaining $5 that is claimable.

This left the 82-year-old with a hefty $1,472.50 that he had to pay out of pocket.

His plight sparked outrage among many Singaporeans who have opined that the authorities should release their CPF savings to them so that they can have freedom to use their own savings for their medical expenses as they see fit, instead of being subject to the caps and limits MediShield Life and Medisave impose.

In the MOH forum letter published yesterday, the Ministry’s representative Ms Lim asserted that:

“Overall, MediShield Life provides Singaporeans with protection against large bills, with affordable premiums. In particular, having a deductible for each year and a co-insurance borne by the patient, ensures that MediShield Life remains sustainable, and premiums kept affordable.
“Even with the co-payment, MediShield Life, in tandem with Medisave, allows for eight in 10 subsidised hospital bills to be paid with $100 or less in cash, and seven in 10 are fully paid without any additional cash outlay by the patient. In some cases, however, the patient’s co-payment can be high.”

Ms Lim further assured that “There is an ongoing review of claim limits, and the consequential impact on premiums, to ensure that MediShield Life’s coverage remains broad-based and sustainable,” and that this review will be completed by the end of 2020.

She added: “In the meantime, patients who face financial difficulties can apply for assistance such as Medifund to ensure that healthcare remains affordable.”

Read the forum letter in full here.