A speeding ambulance with its horns blaring on the expressway, and cars steering away to make space for it.
It’s an emergency.
But that’s just one half of the picture.
Hospital and surgical costs are expensive and ever-increasing.
Can the injured afford the hospital bill that comes after?
That’s the second part.
In this ultimate guide, I’ll cover all there is to know about the national healthcare scheme, MediShield Life.
So, read on!
- The Big Picture of Singaporeans’ Health
- Death Might Not Be the Heaviest Financial Burden
- Healthcare in Singapore Can Be Expensive
- How Much Is the Typical Hospital Bill?
- The Cost of Treating Various Critical Illnesses
- What is MediShield Life?
- 5 Key Features of MediShield Life
- What Does MediShield Life Cover?
- What Doesn’t MediShield Life Cover?
- There Will Be Deductible and Co-insurance
- The Premiums of MediShield Life
- Premium Subsidies Are Available
- How to Make a Claim
- The 3 Limitations of MediShield Life
- Covering for Hospitalisation Is Just the Start
- What’s Next?
The Big Picture of Singaporeans’ Health
To start off, here are some facts and figures to get a glimpse of how healthy Singaporeans are.
In 2019, the total population in Singapore is 5,703,600. Out of which, 4,026,200 are Singapore residents (citizens and permanent residents).
As for life expectancy, the average is 83.2 years (both genders).
To add on, Singapore’s average life expectancy places the small red dot at the 3rd of global rankings, with Japan and Switzerland topping the charts. And it’s expected to hit 85.4 by 2040.
Based on the data, it seems like Singaporeans can live to a healthy old age.
But is it entirely true?
Well, although longevity is lengthening, Singaporeans are spending more time in ill health.
Currently, an average of 8 years is spent in ill health. That’s roughly 10% of an average lifetime.
Not only that, it creates a burden on not just yourself but those around you.
Let’s take a deeper dive.
Death Might Not Be the Heaviest Financial Burden
The fear of death is real.
We’re naturally afraid that one day we won’t be around, especially when it’s unexpected.
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 fully experience life.
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).
It usually doesn’t happen suddenly, and something has to happen first.
Here are the top 10 causes of death in 2018:
|Causes of Death||% of Total Deaths|
|3||Ischaemic heart diseases||18.1|
|4||Cerebrovascular diseases (including stroke)||6.0|
|5||External causes of morbidity and mortality||4.3|
|6||Hypertensive diseases (including hypertensive heart disease)||3.0|
|7||Nephritis, nephrotic sydrome & nephrosis||3.0|
|8||Other heart diseases||2.1|
|9||Urinary tract infection||2.0|
|10||Chronic obstructive lung diseases||1.3|
The hard truth is this:
Death is not the most painful part. It’s the period one has to go through before it 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”.
Treatments can be very expensive and if you’re unable to seal the financial wound, it can be hard on everybody.
From the list, you can see what type of health problems plague Singaporeans.
Cancer is the top cause of death which accounts for almost one-third of all death cases. 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 imply?
Treating of these illnesses will require money.
And most of the time, if you were to have a health problem, the hospital is the first place to be at.
Healthcare in Singapore Can Be Expensive
Medical costs are constantly increasing.
In 2018, the inflation rate for medical costs is 10% per year. And it’s expected to be 10.1% in 2019.
What does it mean?
A simple way to portray this: if a surgery costs $10,000 in 2017, it would cost $11,000 in 2018.
But that’s just for one year, if you compound it throughout the years, the costs can be very significant.
In contrast, the general inflation rate in 2018 is only 1%.
So in all, can the rise (if any) in your income match a 10% inflation rate?
Which is also a reason why the government spends a lot on healthcare these days.
They’re spending $10 billion yearly and in 2020, it’s expected to be $13 billion.
But the government views this as unsustainable so the best way is to encourage Singaporeans to be healthy by creating awareness.
This can reduce potential health problems which leads to lower healthcare costs.
But unfortunate events still do happen.
That’s why it’s good to be covered for hospitalisation costs.
How Much Is the Typical Hospital Bill?
The hospital is the start of everything.
Whether it’s diagnosing an illness, going for treatments, accidents, etc, it’s the first place to be at.
Finding out how much it’ll cost is the concern of every patient.
Here’s an average of hospital bill sizes:
The average bill size of medical specialties:
- Public hospitals: $1,012 to 7,876
- Private hospitals: $3,906 to $24,687
The average bill size of surgical specialties:
- Public hospitals: $1,638 to 10,541
- Private hospitals: $8,109 to $18,993
But those are just averages.
Let’s look at some specific examples.
The Cost of Treating Various Critical Illnesses
There are only 5 critical illnesses (CI) that make up more than 90% of all CI claims.
And they are:
- Major Cancers
- Heart Attack of Specified Severity
- Coronary Artery By-pass Surgery
- Kidney Failure
By far, cancer is the most important as it makes up the majority of the CI claims.
And its prevalence is strong: the lifetime risk of getting cancer is 1 in every 4-5 Singaporeans.
Cost of Treating Cancer
Different treatments are required to treat cancer.
It’s usually a combination of surgery, chemotherapy radiation therapy. And they required for the longer term.
As such, late-stage cancer treatments can cost $100,000 to $200,000 yearly.
Cost of Treating Heart-Related Conditions
|Type of Treatment||Type of Hospital||Average Bill Size|
Cost of Treating Stroke
|Type of Treatment||Type of Hospital||Average Bill Size|
The costs are high.
Right now, do you have excess cash for such treatments?
Which is why health insurance is important as it can substantially cover such medical bills.
The government knows this and that’s why MediShield Life is introduced.
What is MediShield Life?
For the longest time, there was only MediShield.
Then, MediShield Life came along and replaced it on 1 November 2015.
MediShield Life, administered by the Central Provident Fund (CPF) is one of the national healthcare schemes. Its aim is to provide basic medical insurance to help Singaporeans pay for large hospital bills and selected outpatient treatments.
The other national healthcare schemes are ElderShield and CareShield Life (replaced ElderShield). Both are meant to provide long term care support in the form of monthly payouts if at least 3 out of 6 basic activities of living can’t be done.
5 Key Features of MediShield Life
1) Protect Against Large Medical Bills for Life
When something unfortunate happens, and you end in the hospital, the bills you would’ve to pay can be hefty.
One of the biggest benefits of MediShield Life is that you’re able to claim for eligible hospitalisation costs – be it as an inpatient or an outpatient.
And this coverage is available to you for life, hence the name. There’s no limit to the maximum coverage age.
2) Automatic Coverage for Singapore Citizens and Permanent Residents
If you’re a Singapore Citizen or Permanent Resident, MediShield Life is automatically enrolled.
This is to ensure that everyone has some form of protection, and not to be left out.
This coverage is compulsory and you wouldn’t be able to opt out, even though you may have your own medical insurance.
3) Targets B2/C Class Public Wards
MediShield Life is only a basic health insurance.
One of the reasons why this is so is because it’s sized for subsidised treatments in the public hospitals – particularly B2/C wards which are 5-9 bedders.
Why doesn’t it have better coverage?
In my opinion, national policies cater to the masses. At least the basic form of protection has to be made first.
And that’s why you’re allowed to upgrade this MediShield Life with an Integrated Shield Plan if you need a more comprehensive cover.
4) Covers Pre-Existing Conditions
Rarely do insurance companies offer any form of coverage for pre-existing conditions.
However, for MediShield Life, they’re able to cover such cases.
This comes with a cost for those who have more serious conditions:
|Broad categories||Indicative examples (not exhaustive)|
|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, Human Immunodeficiency Virus/ Acquired Immune Deficiency Syndrome (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 condition with serious complications||Hypertensive heart disease, Hypertensive kidney disease, Diabetes with kidney complications, Diabetes with eye complications|
For those who are deemed to have such serious conditions, they would be required to pay an additional 30%, for a period of 10 years.
But they’ll be able to claim from MediShield Life if they were incur medical costs because of their pre-existing conditions.
5) Premiums Are Fully Payable by MediSave
One of the enticing factors about MediShield Life is that premiums can be fully payable by your MediSave balance, at all ages.
When the usage of your MediSave balance is limited, this point comes in very handy.
To enjoy some form of health insurance, you need not use your hard-earned cash.
I’ll cover more on premiums later.
What Does MediShield Life Cover?
The main benefit of MediShield Life is the ability to claim.
Here’s the coverage:
What Doesn’t MediShield Life Cover?
It doesn’t mean that everything that happens in the medical institution can be covered.
Here are some exclusions:
- Ambulance fees
- Cosmetic surgery
- Maternity charges (including Caesarean operations) or abortions, except treatments for serious complications related to pregnancy and childbirth.
- Dental work (except due to accidental injuries)
- Infertility, sub-fertility, assisted conception or any contraceptive operation
- Sex change operations
- 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
- 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 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
- Treatment of self-inflicted injuries or injuries resulting from attempted suicide
- Surgical interventions for the following rare congenital conditions which are severe and fatal by nature: Trisomy 13, Bilateral Renal Agenesis, Bart’s Hydrops and Anecephaly.
Such costs are not eligible for claims.
There Will Be Deductible and Co-insurance
Typical medical plans have these elements and MediShield Life is no different.
Let’s look at how both of them work and then an example.
The deductible is a fixed amount and what the insured needs to pay first in a policy year before there are any payouts from MediShield Life. If there is more than 1 claim in the year, the deductible paid can be accumulated.
It also means that if your bill is small size, the claimable amounts from MediShield Life would not be great. Deductibles are there to sieve out the smaller bills from the bigger ones.
Here are the deductibles:
For co-insurance, it’s also something that you’ll need to fork out, on top of the deductible. It’s a percentage of the claimable amount.
Here’s the co-insurance:
|Claimable Amount for Inpatient & Day Surgery||Co-insurance (Percentage of Claimable Amount)|
|$0 – $3,000||10%|
|$3,001 – $5,000||10%|
|$5,001 – $10,000||5%|
|Co-insurance for all Outpatient Treatments||10%|
Mr Tommy incurred a bill of $10,000 (within the claim limits of MediShield Life).
He first has to pay a deductible of $2,000 (B2 Class ward).
Calculating the co-insurance:
$2,001 to $5,000: 10% of $3,000 = $300
$5,001 to $10,000: 5% of $5,000 = $250
Total co-insurance = $550 (300 + 250).
So, Mr Tommy has to pay the sum of the deductible and co-insurance which works out to be $2,550. And MediShield Life will pay out the rest.
This ensures that when the bill size grows, MediShield Life will pay out a bigger portion of it.
The Premiums of MediShield Life
As mentioned previously, premiums for MediShield Life can be fully payable using MediSave.
What if you don’t have enough? Cash will be needed.
However, you’re able to use your own MediSave to pay premiums for your immediate family, and vice versa.
Here are the annual premiums before any subsidies:
|Age Next Birthday||Annual MediShield Life Premiums before Subsidy ($)|
Do note that the premiums increase with age-band. It gets more costly as you get older.
For those who require more help in paying the premiums, there are several subsidies available.
Premium Subsidies Are Available
To help those who may have difficulties in paying the premiums, there are several subsidies available:
- Lower Income to Middle Income
- Pioneer Generation Subsidies
- Merdeka Generation Subsidies
- Additional Premium Support
As Singapore strives to provide universal coverage for healthcare, these subsidies come in handy for all those who are older and those who require more financial assistance.
This way the basic safety net for all residents is met, and a group of people will not be left out because they can’t cope with the premiums.
How to Make a Claim
Claiming is everything about a hospital plan.
The claim process is simple as everything can be done electronically.
You’ll just need to inform the medical institution and they’ll do the rest.
If there is an eligible payout, CPF will make the payment to the medical institution on your behalf.
If you have an Integrated Shield Plan, the process is still similar. The only change is that the insurance company will handle everything else.
The 3 Limitations of MediShield Life
The goal of MediShield Life is provide a basic and universal health insurance for ALL Singapore residents.
While it’s a good initiative, it can’t cater to everyones’ specific needs.
Here are some of the main disadvantages:
1) Limited coverage
If you refer to the MediShield Life coverage at the top, you would’ve seen that the benefits are fairly short.
Only just a few things are covered.
On top of that, there are claim limits.
Claim limits on the particular type of treatment and ward charges.
And a limit to how much you can claim in a year.
2) No coverage for pre and post hospitalisation
Usually, you don’t visit a hospital just to get warded.
Prior to admission, you would’ve gone for several consultations and tests.
Even after admission, there are follow up treatments.
These aren’t covered under the MediShield Life, and will increase your out-of-pocket expenses. It also doesn’t cover other areas too.
3) Pegged to B2/C wards
Like mentioned, the claims are pegged to B2/C class wards.
It doesn’t mean that you can’t go to a private hospital or choose a government A class ward. It just means MediShield Life will pay out the costs of a B2/C ward equivalent. You’ll need to top up the rest.
And “the rest” of the bill can be huge.
This will limit your desired choice of hospital, the type of ward and doctor.
Covering for Hospitalisation Is Just the Start
By far, hospitalisation coverage is the most important aspect in planning your finances.
It has a higher probability of happening and the costs can be great.
Having said that, we shouldn’t neglect the other part – protecting your income.
What happens if you’re back home and suffer from a permanent disability or a critical illness?
No more income.
But there are still a lot of financial commitments and liabilities to pay.
Which is why you should consider having adequate life insurance coverage too. Not sure how much is enough? Estimate how much life insurance cover you need with our calculator now.
Hopefully by now, you’ve understood what MediShield Life is all about.
It is an important element in financial planning as hospitalisation forms the foundation.
Without proper coverage according to your needs, no matter how much you save or invest, there will always be leaks.
So then, the question is this: do you think MediShield Life on its own is enough?
It is as per designed – basic.
If you have the capacity, consider upgrading it. Learn more about Integrated Shield Plans now.