CLOSING SPEECH BY DR KOH POH KOON, SENIOR MINISTER OF STATE, FOR THE SECOND READING OF THE CARESHIELD LIFE AND LONG-TERM CARE (AMENDMENT) BILL

1                 Mr Speaker, sir, I thank the Members who have spoken for their unanimous support for the amendments proposed in this Bill. I thank them also for the thoughtful questions and useful suggestions they have given. I have touched on some of these in my opening speech, so I will now elaborate more on those other areas that were raised by Members on three different areas:

                 a.     One, supporting Singaporeans with long-term care needs;

                 b.     Two, keeping CareShield Life affordable and sustainable; and

                 c.     Three, simplifying processes and improving access to financial support.

Supporting Singaporeans with Long-Term Care Needs

2                 First, on supporting Singaporeans with long-term care needs.

3                 I have already explained this earlier, but I think it is worth re-emphasising that CareShield Life cannot be seen in isolation.

                 a.     It must be viewed alongside other layers of long-term care support such as subsidies and grants, healthcare savings, and social safety nets.

                 b.     Mr Ng Chee Meng and Ms Yeo Wan Ling will be heartened to know that the Government has been progressively enhancing these layers of support. We enhanced the Caregivers Training Grant last year to better support individuals undergoing caregiver training.

                 c.     From next year, long-term care recipients and their caregivers will also enjoy further support for long-term care, through enhancements to the Home Caregiving Grant and long-term care subsidies. Together, these enhancements to financing mechanisms complement each other to ensure that Singaporeans can access affordable long-term care when they need it most.

3        We recognise that Singaporeans have different long-term care needs and preferences. As earlier mentioned, this is why we have made CareShield Life optional for existing SCs and PRs, born in 1979 and earlier. As for new SC and PRs, they are required to join CareShield Life as part of the compact of becoming a new SC or PR. And this is made known to them at the point of application to be a citizen or a PR.

4                 Mr Ng Chee Meng asked how the Government will ensure that CareShield Life payouts remain meaningful and adequate.

                 a.     The CareShield Life Council had recommended doubling the payout growth rate from 2% to 4% per annum, to allow payouts to more meaningfully cushion against rising long-term care costs.

                 b.     The Council considered whether to make further enhancements to payouts, but was careful to balance benefit enhancements with premium affordability for policyholders. As part of the review, the Council consulted the public on a range of enhancement options through focus group discussions, including a higher payout growth rate. However, ultimately, there was recognition that premium affordability must remain a priority for a national scheme designed to provide basic coverage.

                 c.     The Council’s recommendation therefore balanced the need for meaningful support while keeping CareShield Life accessible for all Singaporeans.

                 d.     Nevertheless, those seeking more comprehensive coverage on top of CareShield Life, and who are willing to pay higher premiums for this, can consider privately offered supplement products. The premiums for these can also be paid for using MediSave, up to the annual withdrawal limits.

                 e.     I would like to preface that the Activities of Daily Living, or the ADL construct, is recognised internationally for disability assessments by entities such as the World Health Organization and the European Union. It is also commonly used by insurers. This is because the ADL construct is an objective measure of the level of caregiving assistance that a patient requires, regardless of the underlying condition. For the purpose of CareShield Life, the loss of three ADLs remains an appropriate threshold to indicate severe disability and higher care needs.

5                 Mr Alex Yam, Dr Wan Rizal, and Dr Hamid Razak asked how CareShield Life supports those with cognitive disabilities and impairments, such as dementia patients, as they too have significant care needs.

                 a.     MOH’s severe disability assessment framework does consider the impact of cognitive impairments on one’s ability to independently perform an activity of daily living.

                 b.     For example, a person with severe dementia may physically be able to chew and swallow the food, but may not remember how to do it without supervision. This individual would be assessed to be unable to perform this ADL due to his cognitive impairment.

                 c.     And you can imagine the same patient with dementia who may not be able to remember how to feed himself or herself, could well also not remember how to dress himself or herself, and may also have problems managing his or her toileting functions. And in which case, they would have crossed the threshold of three ADLs to qualify for payouts. Such individuals therefore can qualify for CareShield Life payouts when they are unable to perform three ADLs.

6                 Mr Melvin Yong asked if the CareShield Life mandatory enrolment age can be lowered from age 30 to 21, with an optional enrolment application for those age 16 and above.

                 a.     CareShield Life policyholders pay premiums during their working years, for protection against severe disability, which occurs mostly at older ages. Mandatory coverage begins at age 30 as most Singaporeans would have started work by then and have some income and savings in their MediSave accounts, so they can use these Medisave savings to pay for their premiums. So it is a design feature of CareShield Life to make sure that it is something that is affordable, that those who have begun working for some time would be able to service their premiums.

                 b.     If we extend CareShield Life coverage to those age 16 and above on an optional basis, this will lead to adverse selection where those who are more likely to make claims are more likely to opt in. This will push up premiums for everyone else in that cohort. There is a clear trade off here, and such a move needs to be considered very carefully.

                 c.     I would like to assure Members that young Singaporeans with disability requiring assistance to perform their activities of daily living, can access other government schemes besides CareShield Life. These include long-term care subsidies and grants such as the Home Caregiving Grant as well as safety nets such as MediFund. We will make sure that care is affordable and accessible to everyone.

Keeping CareShield Life Affordable and Sustainable

7                 Second, on keeping CareShield Life affordable and sustainable.

Keeping premiums affordable

8                 Members would appreciate that for any insurance scheme to be sustainable, enhancements in benefits must be accompanied by a corresponding adjustment in premiums.

                 a.     Several members who spoke earlier made this point as well. To support the increase in payout growth rate, there needs to be a one-step increase in premiums in 2026, followed by 4% increase per annum thereafter.

                 b.     Given that the one-step increase is something that may be of concern to policyholders, we are providing an additional $570 million in premium support to cushion the increase for all policyholders. This includes transitional premium support to spread out and slowly phase in the increase over the next five years. With this support, annual premium increases from 2026 to 2030 are moderated to $38 on average, and no more than $75.

                 c.     Lower- and middle-income policyholders will see even lower premium increases, as they will enjoy further subsidies.

9                 Mr Ng Chee Meng, Ms Joan Pereira, and Dr Choo Pei Ling asked how we can keep premiums affordable even after this transitional support ends.

                 a.     Beyond the transitional support, MOH will continue to provide means-tested premium subsidies for lower- and middle-income policyholders. This will offset up to 30% of their premiums.

                 b.     Premiums will also continue to be fully payable by MediSave, with additional support provided to those with lower MediSave balances. Recently in July 2025, the Government provided MediSave top-ups of about $320 million to 600,000 Singaporeans. The Government will also be introducing the Matched MediSave Scheme from 2026, with 1:1 Government matching for voluntary cash top-ups of up to $1,000 per year, for those with lower MediSave balances.

                 c.     Lastly, there is also the Additional Premium Support for policyholders which Associate Professor Jamus Lim asked about. We will extend invitations to policyholders who are unable to afford their CareShield Life premiums even after subsidies and family support to apply for this additional premium support.

                 d.     I would like to assure this House and reiterate once again that no one will lose CareShield Life coverage due to an inability to afford premiums.

10             Ms Jessica Tan and Dr Wan Rizal have asked about the means-testing framework. In particular, concerns have been raised on whether the current approach towards considering property Annual Value (AV) disadvantages some policyholders, such as in a scenario in which policyholders receive less subsidies after retirement, when they no longer earn an income.

                 a.     Let me first recap that CareShield Life premiums are typically paid through MediSave contributions during one’s working years. In general, policyholders from lower-income households receive more premium subsidies than those from higher income households.

                 b.     For most policyholders, there will be no more premium payments after retirement, as CareShield Life premium payments currently end at age 67. This is pegged to the re-employment age in 2020 when the scheme was launched. So the issue of a retiree living in a private property with high AV is not really relevant here. Most of them by that age would have stopped paying premiums.

                 c.     Only a small group of individuals in the Optional Cohort, who had chosen to opt-in at older ages, would have to pay premiums beyond age 67. We likewise support eligible individuals through premium subsidies. In addition, those who joined before 31 December 2024 would also have been receiving additional participation incentives of up to $4,000 in total, to offset their premiums.

                 d.     Should anyone still face difficulty paying premiums after subsidies and other support, the Government will provide Additional Premium Support to fully cover their premiums. This is why I keep saying to Members that no one will lose CareShield Life coverage due to an inability to pay their premiums.

11             Ms Yeo Wan Ling, Ms He Ting Ru, and Dr Wan Rizal raised concerns about premium affordability for women. This was also discussed extensively in this House in 2019 when CareShield Life was first introduced.

                 a.     In general, within any insurance risk-pool, premiums are actuarially priced such that the premiums collected can pay out for expected claims. This is the case for both men and women.

                 b.     Now here, gender is a relevant factor for CareShield Life as the key parameters that affect long-term care insurance claims such as lifespans and duration and likelihood of disability, do vary between men and women. Women tend to live longer than men and are more likely to develop severe disability and therefore are more likely to stay in disability for a longer period.

                 c.     This has remained the case in the past few years too. It will mean that in the event of severe disability, a woman will typically receive CareShield Life payouts for a longer duration.

                 d.     Support is available for women in lower income households through existing support schemes, including premium subsidies and Additional Premium Support.

12             Beyond these measures to ensure premium affordability for those who need more support, there is also a need to ensure that the long-term trajectory for CareShield Life premiums remains sustainable and affordable for all policyholders.

13             As I listened to Ms He Ting Ru’s speech, I got sense that she has not quite grasped the features of CareShield Life. There are two distinct features in CareShield Life, that are quite different from all other insurance schemes. The first is that this is a cohort-based risk-pooling. In other words, the risk-pooling happens in your age cohort. It is not whole population risk-pooling, it is risk-pooling among those who are born in the same birth year. So it means that the burden of any premium that needs to go up is borne by a lesser number of people just in that age cohort alone.

14             The second feature is that this is a pre-funded scheme, with limited premium contribution duration, but has a lifelong payout, as long as the person remains in disability. So these are two unique features. Now, as I said earlier, women do live longer and reach older ages, where severe disability becomes more likely. The average life expectancy for women is 85.6 years in 2024, compared to 81.2 years for men. And we can all understand that as one ages, at older ages, women are 10% more likely than men to enter severe disability at a given age. This is not about discriminating against women, this is just biology. It is just the way science is – as you get older, as you live longer, you are just at higher risk of many other health problems. Women are at higher risk of osteoporosis compared to men, they are therefore more likely to get severe hip fractures when they sustain a fall, and they may remain disabled for a far longer period of time.

15             If I can just contrast the design of CareShield Life with MediShield Life, which will hopefully illustrate why there is a gender differentiation in the premiums. Medishield Life policyholders pay premiums for life, as opposed to CareShield Life where you stop paying when you reach age 67. This means that in MediShield Life, there is no need to insure against the different life expectancies across genders, because the premiums are payable for every year of coverage. If you live longer, you just pay more premiums. Every year you live, you pay.

16             CareShield Life, as I said, one of the features is that it is pre-funded, for a limited duration while one is working. So over a lifetime, while women may make more claims due to a longer life expectancy, they will also have to pay more for their premiums, because that is the fair principle – if you are going to claim more and claim for longer, one pays more during the contribution years. It is about being fair to both genders, it is not about discriminating against women or being unfair to women, it is also about being fair to men. Remember, this is about risk-pooling within one cohort with a limited number of people sharing the risk, and therefore maintaining the payouts for the cohort that needs to claim.

Adjustments to the underwriting criteria

17             A key change that we are introducing through this Bill is intended to safeguard the sustainability and affordability of CareShield Life. By restoring the underwriting criteria for the scheme, we will lower premiums for older Optional Cohort policyholders, who today pay higher annual premiums than the Mandatory Cohort policyholders, who joined the scheme at a younger age.

18              I hear Ms Elysa Chen, Ms Jessica Tan, and Dr Hamid Razak’s concerns over whether reinstating underwriting criteria would make the scheme less inclusive.

                 a.     Now let me take the opportunity to emphasise that for all Singapore Citizens (SCs) and Permanent Residents (PRs) born in 1980 and later, CareShield Life coverage is universal, regardless of any pre-existing disability.

                 b.     This means that a younger person in the Mandatory Cohort with pre-existing disability will still be auto-enrolled when he turns 30 years old. He will pay the premiums for his age once, on enrolment, and if he is determined upon Disability Assessment to meet the three ADL threshold for severe disability, he will be eligible for claims for life thereafter, and stop paying further premiums. So this is how we make sure that the scheme is inclusive and take care of those in need.

                 c.     For the Optional Cohort, those born in 1979 and earlier, we had provided a time-limited concession for those with mild or moderate disabilities to join the scheme.

                 d.     This concession, as I said earlier, was originally intended to be for two years, up to 2023. After two years, we extended this concession to enable more to join in. The extension enabled us to redouble our outreach efforts in the post-Covid-19 period. We also extended the duration of participation incentives, and conducted extensive outreach to seniors to encourage them to join.

                 e.     So in fact, the concession period has lasted for about four years in total. As of June 2025, about 900,000 individuals in the Optional Cohort, or about half of the cohort, have enrolled in CareShield Life. If we were to include those who choose to remain on ElderShield, about 7 in 10 older Singaporeans are enrolled in our national long-term care insurance schemes. So the coverage is not bad.

                 f.       As shared in my opening speech, new CareShield Life applications from the Optional Cohort have decreased by almost 90%, compared to when the scheme was first launched. Most Optional Cohort individuals who wanted to join CareShield Life would have already done so by now. 

                 g.     Hence, the CareShield Life Council has assessed that it is timely to reinstate the planned underwriting criteria from 1 January 2026 onwards. This will moderate the premium impact for all Optional Cohort policyholders, keeping the scheme fair and sustainable. To keep the scheme fair, this approach will be taken for new SCs and PRs of the same age groups as well.

19             Ms Mariam Jaafar, Ms He Ting Ru, Ms Joan Pereira and Ms Elysa Chen asked whether there have been sufficient provisions made for those in the Optional Cohorts who may have chosen not to enrol in CareShield Life.

                 a.     As mentioned in my opening remarks, there are different layers of financial support for those who require long-term care.

                 b.     Individuals may have chosen to prepare for and pay for their long-term care in other ways, such as through personal savings or private insurance.

                 c.     For those who are not enrolled in CareShield Life, there continues to be other layers of support, such as subsidies and grants, which have been significantly enhanced recently, so I hope this addresses Ms He Ting Ru’s concerns. MOH will continually review our financing schemes to ensure that long-term care costs remain affordable.

Strengthening provisions to support premium recovery efforts

20             Another change we are making through this Bill is to strengthen our provisions for premium recovery.

                 a.     Specifically, the provisions in the Bill enable us to serve important documents to policyholders through additional modalities, including electronic means.

                 b.     Now let me explain that this is on top of existing modalities, not replacing existing modes. I want to assure Mr Alex Yam and Mr Yip Hon Weng that physical notifications will continue to be sent to all policyholders, where necessary, including those who are less tech savvy.

21             More broadly, the changes are necessary to equip our administering agencies with tools to recover premiums that are due.

                 a.     Without such tools, premiums owed by wilful defaulters will become bad debt, which will be borne as higher premiums by other policyholders in that cohort.

                 b.     This is unfair to those who have been responsibly paying their premiums.

Ensuring sustainability

22              Members have rightly observed that an ageing population and rising costs of care could present challenges to premium affordability over the long run.

                 a.     We agree with Ms Mariam Jaafar that sustained investment in prevention and wellbeing is crucial. The Government is paying close attention to these trends and has embarked on national strategies to address this.

                 b.     This includes Healthier SG and Age Well SG, which aim to empower Singaporeans to live healthy and active lives.

                 c.     By staying in good health, we not only minimise the cost of care, but importantly, enable every Singaporean to live their lives to the fullest. That in itself should be the biggest benefit to Singaporeans, although there are also other subsidies and incentives in place to promote preventive health. 

23             Dr Choo Pei Ling suggested offering CareShield Life premium discounts for those who lead healthier lifestyles.

                 a.     At the heart of Dr Choo’s question and suggestion is the principle that prevention is better than cure, and we fully agree with that. I had earlier shared the strategies the Government has rolled out to support healthy and active living.

                 b.     And premium discounts are an extension of this. MOH had rolled out a premium discount pilot for MediShield Life just last month. Eligible Singaporeans participating in healthy lifestyle programmes and challenges will be rewarded with discounts of up to $580 off their MediShield Life premiums per year.

                 c.     Unlike MediShield Life, CareShield Life is still a nascent scheme with just a few years of claims experience. This is especially since onset of severe disability typically takes place only at older ages, and most CareShield Life policyholders are still young today. Therefore, there is only limited data, including on how healthy behaviours translate to lower claims for severe disability. When more claims data is available, we can consider if similar premium discounts can be considered in future.

24             The CareShield Council will also review CareShield Life regularly over time to ensure that both the benefits and premiums including the actuarial assumptions remain relevant and sustainable over time as our demographic profile evolves.

25             The Council regularly monitors the financial status of the CareShield Life and ElderShield Insurance Fund to ensure that premiums, which are set on a non-profit basis, remain adequate to sustain the scheme’s obligations to all policyholders over time. And in response to Ms He Ting Ru’s question, I want to assure her that information on the Fund, including the amount of claims and investment returns, is already publicly available in CPF Board’s annual financial statements.

Simplifying Processes and Improving Access to Financial Support

26             Third, on simplifying processes and improving access to financial support.  Now before I elaborate further, let me clarify with Associate Professor Jamus Lim that CareShield Life is administered by the CPF Board and not outsourced.

27             We fully acknowledge the challenges faced by caregivers. We are committed to improving the user journey for care recipients and caregivers, and ensuring a citizen-centric experience that allows residents to get support in a timely manner, as Ms Mariam Jaafar has shared.

                 a.     Since CareShield Life was launched, we have doubled the number of severe disability assessors island-wide from over 300 at launch to now more than 700 assessors.

                 b.     More General Practitioners (GPs) in the community, therapists and nurses are being trained, and every public hospital now has in-house assessors. We have also expanded the number of assessors who perform house calls, to improve access and convenience for policyholders.

                 c.     MOH and the Agency for Integrated Care (AIC) will press on with efforts to expand our assessor pool. I would also like to reassure Mr Yip Hon Weng as well as other Members that we will continue to ensure that assessors are rigorously trained to conduct fair and high-quality assessments. These assessment outcomes are also subject to further clinical reviews, if necessary.

28             Sir, I agree with Members that we can make our financial support schemes more seamless. 

                 a.     We now have nine AIC Link offices across the island. These serve as a one-stop resource to help connect care recipients and their caregivers to the support they need. Our Silver Generation Ambassadors also reach out to seniors to explain schemes in a clear and more personal manner.

                 b.     As Mr Melvin Yong and a number of members have noted, better awareness and insurance literacy can help families make more informed financial decisions. Community touchpoints also continue to remain an important source of help for seniors and caregivers to understand the suite of long-term care financial support schemes available. We will continue to work with AIC and community partners to reach out to families to increase awareness of the support available.

                 c.     We agree with Ms Mariam Jaafar that we can make our scheme application process more claimant friendly.

                 d.     One way we have done so is by giving residents the opportunity to be automatically assessed across various disability schemes, after having undergone a disability assessment. This reduces the administrative burden and ensures timely support for families.

                 e.     We will continue to identify areas for improvement and ensure the claims process remains efficient and responsive to policyholders’ needs.

Conclusion

29              Mr Speaker, ageing is part of life’s journey.

                 a.     While we cannot stop time, we can shape how we age. The Government is taking steps to empower Singaporeans to lead active, healthy and purposeful lives in their silver years, through national initiatives such as Age Well SG.

                 b.     Some of us may come to require more support for our activities of daily living. Our commitment to Singaporeans is that we will continue to develop our care ecosystem, through more community care services and Age Well Neighbourhoods, to enable more to age-in-place confidently.

                 c.     Financially, we have reviewed our support ecosystem to ensure that Singaporeans have access to affordable care through enhancements to long-term care subsidies and grants earlier this year.

                 d.     Now, with the enhancements to CareShield Life, Singaporeans can be assured that these insurance payouts too will continue to provide meaningful support for long-term care, should they need it. The Council will continue to review the scheme to ensure that it remains relevant to policyholders.

30             This Bill supports these enhancements by strengthening the legislative framework to ensure that the scheme remains fair and sustainable, through appropriate underwriting criteria and enhanced premium recovery mechanisms.

31             These amendments will help ensure that CareShield Life continues to provide essential financial protection when families need it most, for current and future generations of Singaporeans.

32             I thank Members for their support of this Bill.

33             Mr Speaker, sir, I beg to move.