Integrated Shield Plans (Health Insurance) in Singapore: 2019’s Guide

Integrated Shield Plans (Health Insurance) in Singapore: 2019’s Guide

Integrated Shield Plans Medical Insurance

All of us should be familiar with this image...

A speeding ambulance with its horns blaring on the expressway, and cars steering away to make space for it.

It's an emergency.

But it's just one half of the picture.

Can the injured afford the bill that comes after?

That's the second part.

In this ultimate guide, I'll cover all there is to know about Integrated Shield Plans in Singapore.

Hospital and surgical costs are expensive and ever-increasing.

Are you sufficiently covered? What can a private health/medical insurance provide?

... and I'll also touch on the recent industry changes that affect these plans.

So, read on!

More...


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Singapore's Healthcare Statistics: The Big Picture

medical insurance singapore

To start off, here are some facts and figures to give a glimpse of how healthy Singaporeans are.

In 2018, the total population in Singapore is 5,638,700. Out of which, there are 3,994,300 Singapore residents (citizens and permanent residents).

For life expectancy, males are expected to live till 80.7, and females till 85.2.

Yes...

It shouldn't come as a surprise that females live longer than males (insurance companies do take into account this fact).

To add on, based on 2016's data, Singapore's average lifespan of 83.3 places the small red dot at the 3rd of global rankings, with Japan and Switzerland topping the charts. And it is expected that the average lifespan in Singapore will hit 85.4 in 2040.

Ain't it surprising?

Based on these data, it seems like Singaporeans can live to a healthy old age.

Is it really true?

Perhaps not entirely...

Although longevity is lengthening, Singaporeans are getting more ill.

Currently, an average of 8 years is spent in ill health. That's 10% of your life and is a very long time.

Not only that, it creates a burden on not just yourself but those whom you love.

Let's take a deeper dive.

The Top 10 Causes of Death in Singapore

The fear of death is real.

We're naturally afraid that one day we're not around.

Unfortunately, it messes our minds up - it can either propel us forward or hold us back.

Knowing that today may be our last day will enable us to take some risks and experience life fuller.

But on the other hand, when the fear is too strong, it makes us afraid to take do things even remotely "risky".

Know this though...

Death is something that can't be controlled (just don't go looking for it).

When we accept that it can happen at anytime, I believe we can live a more fruitful life.

(enough digressing)

Death doesn't just happen at the snap of the finger (yes, Marvel). Usually, something needs to happen first which then leads to it.

So here are the top 10 causes of death in 2017:

Causes of Death

% of Total Deaths

1

Cancer

29.1

2

Pneumonia

20.1

3

Ischaemic heart diseases

18.5

4

Cerebrovascular diseases (including stroke)

6.3

5

External causes of morbidity and mortality

4.0

6

Hypertensive diseases (including hypertensive heart disease)

3.4

7

Nephritis, nephrotic sydrome & nephrosis

2.4

8

Urinary tract infection

1.9

9

Other heart diseases

1.9

10

Diabetes mellitus

1.5

10

Chronic obstructive lung diseases

1.5

The hard truth is this though...

Death is not the most painful part.

It's the period one has to go through before the inevitable happens.

Aside from the physical pain, there will be financial battles.

As the saying goes: "it's cheaper to die than to fall sick in Singapore".

Treatment can be very expensive and if there are no concessions to seal the financial wound, it can be hard on everybody.

From the list, you can see what type of health problems plagued Singaporeans.

Cancer is at the top and almost 1/3 of all death cases come from it. We'll talk more about this later on...

Diabetes is also in the list and is the latest hot topic.

In 2017's National Day Rally, Prime Minister Lee Hsien Loong deemed the problem of diabetes "very serious"

Till this day, there are still many advertisements everywhere educating the public about it.

How serious is it?

  • 1 in 9 Singaporeans has diabetes
  • 3 in 10 over the age of 60 have it
  • Singapore is the no. 2 nation with the most diabetics

It can lead to blindness, heart failure, and kidney failure. And some patients may need to go through amputation (about 1,200 diabetics every year).

What do all these say?

Money is needed to be spent on treatments.

Most of the time, if one has a health problem, the hospital is the first place to be at.

Let's take a further look at the various reasons why Singaporeans are admitted into the hospital.

The Top 10 Causes of Hospital Admissions in Singapore

Anything can happen.

And the hospital is usually the first place to be at.

Think about it...

Be it death, some form of disability, illnesses, accidents, etc, one would almost definitely be seen at the hospital first.

Here are the top 10 reasons for being warded in a hospital (most recently published data):

2014 (%)

2015 (%)

2016 (%)

Accident, poisoning and violence

8.4

8.2

8.3

Cancer

6.0

6.0

5.9

Pneumonia

2.8

3.0

3.2

Ischaemic heart diseases

3.3

3.1

3.1

Intestinal infectious diseases

2.8

2.6

2.8

Other heart diseases

2.7

2.7

2.5

Infections of the skin and subcutaneous tissue

1.9

2.0

2.1

Acute upper respiratory infections

1.6

1.6

1.9

Cerebrovascular diseases (including stroke)

1.9

1.9

1.8

Obstetric complications affecting foetus and newborn

2.1

2.0

1.7

If you add up the percentages of these incidents in 2016, it amounts to only 33.3%.

There's still a 66.7% of reasons not indicated in the table.

Meaning?

There's a variety of reasons - big or small - on why you would end up in the hospital.

So if you ever find yourself in a clinically smelling place of a hospital (touch wood), then one thing's for sure.

"How much do I need to pay?"

The Statistics of Singapore’s Healthcare Medical Costs

hospital plan singapore

"Can I afford it?"

That's the question in every patient's mind.

Although the information on the average hospital bill in Singapore is not readily available, it takes some digging and research (the following idea came from Seedly).

The hospital costs can be broken down into 2 distinct sections: public hospitals (and the different classes) and private ones. And in each hospital, it's further broken down to medical and surgical specialties.

Although the following data is from 2015, that's the latest information that was published.


Public hospitals


Cost of Medical specialties for Public hospitals
* Exclude KK and National Heart Centre due to outliers

Class

Avg Cost/Day

Avg Bill

Top 10% Paid More Than

Top 5% Paid More Than

A

$1,142 - $1,412

$3,844 - $7,459

$6,626 - $15,464

$11,485 - $24,873

B1

$780 - $1,094

$2,830 - $7,876

$6,176 - $18,334

$10,867 - $28,041

B2

$192 - $439

$1,178 - $3,380

$2,354 - $6,494

$3,434 - $10,389

C

$129 - $319

$1,012 - $2,599

$1,988 - $5,478

$2,973 - $8,466


Cost of Surgical specialties for Public hospitals 
* Exclude KK and National Heart Centre due to outliers

Class

Avg Cost/Day

Avg Bill

Top 10% Paid More Than

Top 5% Paid More Than

A

$1,372 - $2,788

$5,044 - $10,541

$10,114 - $22,290

$14,923 - $30,292

B1

$1,268 - $2,509

$4,629 - $9,922

$10,096 - $20,242

$15,846 - $28,153

B2

$529 - $760

$1,824 - $3,393

$4,358 - $6,962

$5,845 - $9,819

C

$357 - $523

$1,638 - $3,775

$3,716 - $8,200

$5,222 - $12,684


Private hospitals 


Cost of Medical specialties for Private hospitals 
*Exclude John Hopkins due to outlier

Class

Avg Cost/Day

Avg Bill

Top 10% Paid More Than

Top 5% Paid More Than

Private

$1,327 - $5,310

$3,906 - $24,687

$7,670 - $38,811

$9,521 - $73,287


Cost of Surgical specialties for Private hospitals 
*Exclude John Hopkins due to outlier

Class

Avg Cost/Day

Avg Bill

Top 10% Paid More Than

Top 5% Paid More Than

Private

$3,340 - $7,053

$8,109 - $18,993

$12,626 - $36,147

$14,749 - $46,194


Now what you're seeing is the broader picture of the average cost in the different types of hospitals. If you wish to see for a more cost detailed breakdown by treatment, you can visit MOH's website here.

Note that these are data from 2015... medical costs may have increased now. 

In fact, the inflation rate for medical costs is much higher than the general inflation rate in Singapore.

From a study done by AON, the gross medical inflation rate for 2017 and 2018 is at 10%, which exceeds the global medical inflation rate of 8.4%.

But why are medical costs skyrocketing?

There are a few reasons behind this.

In a report by Channel News Asia, hospitalisation costs, especially inpatient costs contributed to this high inflation rate.

Medical fees such as surgery charges form the bulk of all inpatient costs.

Moreover, insurers dealing with the private healthcare space experienced a claims incidence rate more than double of the public system and the average bill size ballooned.

Strait Times also pointed out that one reason to why this may be happening are that doctors may be overcharging and over-treating. These brought the bill up to more than what's required, especially when one is on an Integrated Shield Plan (ISP) with a full rider attached.

This sparked an industry wide change as insurers struggle to cope with more frequent and bigger claims that proved to be unsustainable.

I'll touch more on the new changes further down in the article.

But for now, know that hospital bills are not cheap and will continue to get more expensive going forward.

Let's zoom in now to the cost of one of the most common health issues in Singapore.

Example: Cost of Cancer Treatments in Singapore

cost of cancer treatments singapore

What are the statistics of the cost of cancer treatments in Singapore?

First, let's start off with how common it is.

37 people are delivered the bad news... every day.

Here are the top 10 types of cancers being diagnosed in Singapore:

Top Cancers Diagnosed Singapore

And every day, 16 people die because of it (the no. 1 cause of death in Singapore).

If you're not convinced by why cancer (and critical illness) is so crucial, take a look at the real life insurance claims statistics put up by NTUC Income. I've written more on this in my article on early critical illness insurance.

Basically you can see that cancer is a common reason for not only critical illness claims but for death claims as well. And also for critical illness claims.

Anyways...

The costs for cancer treatments can vary greatly and is mainly dependent on the stage and type of cancer one has.

Seedly has estimated that the cost needed for a late stage cancer treatment to be from $8,000 to $17,000 per month ($100,000 to $200,000 yearly). For a more detailed cost breakdown, see here.

That's a lot of money.

Right now, do you have excess money to go for treatments?

That's why a medical plan is so important.

It can substantially cover the hospital bill.

It's just half of the picture though...

When you're back home to recover, would you be able to work? If not, who's going to cover your loss of income?

This loss of income can be "replaced" by having either a early critical illness insurance or a term insurance.

The moral of the story is this...

The thought of getting cancer is frightening.

But the nightmare gets darker thinking about the cost of treatments without sufficient insurance.

The Healthcare System in Singapore: How Does It Fare?

How does the government deal with these healthcare issues then?

In the Financial Year 2017, the government spent $10,700,000,000 ($10.7 billion) on healthcare. And the finance minister, Heng Swee Keat expects the spending to go up by at least $3 billion by year 2020.

So what are they spending on?

Singapore's healthcare spending:

  • Infrastructure
    • With an aging population, more hospitals are needed
    • It also makes up for the increased demand for hospital beds
  • Manpower
    • Additional 30,000 healthcare workers are needed between 2015 to 2020 to support the increased need for healthcare services
  • Technology
    • For example, the introduction of bed transporters reduces the no. of ppl needed to move a bed with a patient in it bringing up overall productivity
    • An electronic device for patients to easily show vital signs
  • Medical Safety Needs
    • More financial help to support the lower and middle income 
    • Initiatives like the community health assistance scheme (Chas)
    • MediShield life to help Singaporeans pay hospital bills

How do these current and past healthcare policies affect the system?

A global healthcare ranking will show that.

In a recent Bloomberg report, a study of 56 countries shows that Singapore ranks number 2 in the world for healthcare efficiency, second only to Hong Kong.

These are all broader views of the healthcare landscape in Singapore..

Do all these matter to you?

Probably not.

The only thing we care about is ourselves and the people around us.

That brings us to the one thing WE can do about our healthcare needs and the high costs of hospitalisation...

...MediShield Life.

What is CPF MediShield Life?

cpf medishield life

For the longest time, there was only MediShield.

Then, MediShield Life came along and replaced it on 1 November 2015.

MediShield Life is a basic health insurance plan meant to help pay for large hospital bills and selected outpatient treatments.

The reason why it's considered basic is because it's sized for subsidised treatments in the public hospitals - particularly B2/C wards which are 5-9 bedders. Basically, if you choose to stay in a private hospital, the MediShield life only covers the costs similar to a B2/C ward and you'll need to top up the excess.

It's provided to all Singapore Citizens and Permanent Residents.

Is MediShield life compulsory? Yes, it is and you're not able to opt out from it.

The good thing is that you can pay the premiums fully from the Medisave (although premiums increase with age band). And since its introduction, there were heavy subsidies given.

It also offers coverage to the very old and people with pre-existing conditions.

The question is this...

Is it enough for your needs?

Sometimes, there may not be a choice.

If you're in a fatal accident at Orchard Road and need immediate attention, where do you think you want to go? The nearest one, right? That'll be Gleneagles or Mount Elizabeth. Even if you're unconscious, you'll still likely to be sent there anyways.

Therefore, it's always good to have options and not just be limited to B2/C wards.

And that option is in a form of an upgrade...

What is an Integrated Shield Plan (IP)?

It is a private health insurance plan that can be purchased on top of MediShield Life. This provides additional benefits and more flexibility to cater to your needs.

Simply put... 

Integrated Shield Plans MediShield Life

Image Credits: CPF

Unlike MediShield life, an IP may not be fully payable by Medisave as there are withdrawal limits. The premiums payable are on top of what you're paying for MediShield Life. The withdrawal limit only applies to the additional premium of the private insurance component, and not MediShield Life.

Additional Withdraw Limits (AWL):

  • $300 if your age next birthday is 40 years old or younger
  • $600 if your age next birthday is 41 to 70 years old
  • $900 if your age next birthday is 71 years or older

Which Insurance Companies Provide Integrated Shield Plans?

There are currently 7 companies: 

  • AIA Singapore
  • Aviva
  • AXA Insurance
  • Great Eastern Life
  • NTUC Income
  • Prudential Assurance
  • Raffles Health Insurance

Take note that you can only be insured under 1 provider. If you happen to apply for another company's shield plan, it may automatically go through and your existing plan will be terminated. This can be detrimental especially if you're already covered for pre-existing conditions. 

To check whether you've upgraded before, follow these steps:

  1. Go to cpf.gov.sg
  2. Log on to my cpf Online Services
  3. Go to "My Messages"
  4. See "Insurance" section

How Do Shield Plans Work?

how do health insurance work

IPs provide additional coverage for hospitalisation and surgical costs on top of MediShield life.

Does it mean that there will be a duplicate coverage if you were to upgrade to an IP?

No.

The IP you choose will include the MediShield Life portion and the insurance company will be the single point of contact. It acts on behalf of CPF to collect premiums and assist in claims for the MediShield life component.

The additional private insurance component can be broken down further into 2 parts.

I will term them the "basic" and the "rider" portion.

Let's start with the "basic" upgrade component. 

The "Basic" Upgrade

Here are the various options for upgrading: 

  • Private
  • Government A1
  • B1
  • Standard

So let's say you want to upgrade to be covered under private hospitals, if you choose to go to a government ward, there's no issue.

However, if you're only covered with government wards, and you end up in a private hospital, you'll still need to fork out a substantial portion as the basic upgrade only covers a proportion of the private hospital bill (pro-ration factor).

That's why most people go for the private option but it's still up to your needs and budget.

To add on, if in the future you find the premiums too costly, you can always reduce your coverage to government wards and pay lesser premiums. When you want to downgrade the plan, it's not a problem.

However, if you were to start with government wards and want to upgrade in the future, a whole new round of underwriting will take place again. And if new medical conditions developed, there's a possibility that you may not be able to enjoy the higher level of cover at all.

Here are some of the major advantages by doing a basic upgrade:

1) Get your preferred type of ward

An upgrade allows you to choose what type of wards you can be covered. It'll mean that you're not limited to B2/C wards which are 5-9 bedders.

If you prefer the private space to recover when the need arises, having the option for it is valuable.

Not only that, you have more options which include your preferred hospital or a particular surgeon you think is great.

2) Higher claim limits

In MediShield life, there is a cap on how much you can claim for inpatient and outpatient treatments and you'll need to fork out the excess.

If you upgrade, the treatments are usually as charged (subject to deductibles and co-insurance).

This provides you with the peace of mind that large bills will be greatly taken care of.

3) Pre and post hospital treatments

MediShield Life does not cover this aspect.

Pre-hospital treatments include certain consultations and diagnostic costs that were incurred before you were hospitalised. They have to be related to the reason why you were warded and a pre-requisite is that you must be warded or having gone through a day surgery.

Post-hospital treatments include follow up treatments that are needed for you to recover.

The periods that are covered before and after hospitalisation may vary from company to company.

Other than these 3 main reasons, there are other additional benefits.

But... there's still something called the deductible and co-insurance. 

What is a Deductible?

If a claim arises, the deductible is a fixed amount that you would need to pay once each policy year. The amount depends on which type of ward you stayed in. The purpose of this is to filter out smaller claims to make the overall premiums of the plan affordable.

Here's an example of the deductibles for the most common wards (for age 80 years and below next birthday):

  • Class C ward - $1,500
  • Class B2/B2+ ward - $2,000
  • Class B1 ward - $2,500
  • Class a ward - $3,500
  • Private - $3,500

What is Co-insurance?

Co-insurance is a percentage of the of claimable amount. You'll need to pay the co-insurance on top of the deductible. The co-insurance is at 10%.

Example of how this goes:

Bill

$100,000

Deductible (Private)

$3,500


$96,500

Co-insurance (10%)

$9,650

Although with just a "basic" upgrade, you can claim a huge amount from the plan, you'll still need to fork out the deductible and co-insurance, which amounts to $13,150. 

It can still be a big amount to pay out-of-pocket.

And that's when the rider component comes in ... 

How a "Rider" Provides Even More Comprehensive Cover

shield plan riders

You can still purchase a rider on top of the "basic" upgrade and it'll provide a more comprehensive coverage.

Other than additional benefits that come along with a rider (varies with companies), you're able to cover the deductible and co-insurance portion (but not fully).

In the past, if you have a "full" rider, you were able to claim the full amount of the bill, regardless of the bill size.

But because of recent industry changes, these options are not available anymore. (More on the changes to the riders later).

There will be a 5% co-payment for new IP riders but most insurers have it capped is at $3,000/year.

This still makes a lot of sense because it protects you from needing to pay very large bills.

There may still be certain conditions to be fulfilled now like needing to obtain pre-approvals/authorization to enjoy the cap.

With that being said, the insurance companies have different ways to deal with it. It's only through comparison that you're able to identify these differences.

New Changes on the Integrated Shield Plan Riders

You can skip this section if you're not interested in the past.

Currently, about 29% of Singapore residents have these "full" riders which will allow them to claim the full bill.

This resulted in 2 implications, over-consumption and over-charging.

How?

One was able to claim for anything, and for the full amount, leading to more claims. At the same time, hospitals may over-charge knowing that the patient is under a "full" rider.

This led to a drastic increase in healthcare costs leading to insurance companies paying out more, until it became unsustainable. This explains why there were many premium revisions over the past few years.

And that's when the industry wide change came in.

A 5% co-payment.

By having to pay out of your own pocket, it can manage the costs of such hospital bills.

As of now, the insurance companies have to come up with the new rider plans by 1 Apr 2019.

There is currently no guideline on how insurance companies should manage their customers with existing plans bought before 8 March 2018.

One possible scenario is that although you may retain existing plans, the premiums of such plans with "full" riders may be jacked up, and it may make more sense to downgrade to the new riders (with the new 5% co-payment) as the premiums may be significantly lower.

As for those who purchased riders from 8 March 2018 up to 31 March 2019, they WILL need to transit to the new riders from 1 Apr 2021.

Foreigners and Shield Plans

There may be only 2 options available if one wishes to get a private medical insurance as a foreigner.

International health insurance and local health insurance.

The pros with international is well, you're covered for other countries. However, the premiums that you pay tend to be much higher. In comparison to a local health insurance like the IP, the premiums are affordable but the coverage is meant to be in Singapore. So it ultimately depends on your needs.

If you're a Singaporean or a PR, you're able to get an IP for your dependents if they have valid passes in Singapore.

You may also use your Medisave to pay for such plans.

There may be slight differences administratively, but the core benefits still stay the same. 

Company Insurance vs Private Medical Plan

The first thing is that the amount of medical benefits that your company offers may vary from one another.

There are a few things to take note...

Can you foresee being with that company forever?

If you get your own private medical plan, you'll be covered no matter what happens - either you fire your employer or your employer fires you. That also means that if along the way, even minor medical conditions pop up, you're still covered.

The opposite is not the same.

If you're just under company insurance and have conditions along the way, chances of you being accepted into a private medical plan can be severely reduced.

Some medical benefits from company insurance may not be sufficient and usually, they have a cap to how much you can be covered. Above that amount and you have to pay for the excess, however large that may be. And it may not cover comprehensively.

Ultimately, you don't own the policy... the company does. Whatever they want to do with it depends on them.

With a private plan, you own the policy. And with that, comes greater flexibility.

Which is the Best Medical Insurance in Singapore?

Hospitalisation and surgical costs are high in Singapore. And they're getting higher year on year.

Would you be able to cope financially if something adverse were to happen?

Sure, there is MediShield Life to aid, but is it enough for you?

What if you want better and more extensive cover for your medical needs?

An integrated shield plan along with a rider will give you the peace of mind and greater flexibility.

Do a comparison now to find out what kind of benefits are offered from the different companies.