ENSURING THE SUSTAINABILITY OF PRIVATE HEALTHCARE INSURANCE

NOTICE PAPER NO. 44 

NOTICE OF QUESTION FOR ORAL ANSWER 

FOR THE SITTING OF PARLIAMENT ON 22 SEPTEMBER 2025 

Name and Constituency of Member of Parliament 

Mr Fadli Fawzi 

MP for Aljunied GRC 

Question No. 299 

To ask the Minister for Health (a) whether the Government has any plans to disallow Integrated Shield Plan (IP) insurers from offering "as-charged" or no-limit coverage for non-cancer treatments; and (b) if not, why not. 

NOTICE PAPER NO. 44 

NOTICE OF QUESTION FOR ORAL ANSWER 

FOR THE SITTING OF PARLIAMENT ON 22 SEPTEMBER 2025 

Name and Constituency of Member of Parliament 

Mr Fadli Fawzi 

MP for Aljunied GRC 

Question No. 300 

To ask the Minister for Health (a) whether existing laws preventing profiteering and anti-competitive behaviours such as collusion and price-fixing among healthcare service providers and private insurers are sufficient; and (b) how does our regulatory framework compare to other developed countries. 

NOTICE PAPER NO. 44 

NOTICE OF QUESTION FOR ORAL ANSWER 

FOR THE SITTING OF PARLIAMENT ON 22 SEPTEMBER 2025 

Name and Constituency of Member of Parliament 

Mr Fadli Fawzi 

MP for Aljunied GRC 

Question No. 301 

To ask the Minister for Health (a) whether the Government has any plans to further regulate the use of panel specialists by Integrated Shield Plan (IP) insurers, such as by mandating a minimum number of specialists per medical specialty or the contract durations of panel specialists; and (b) if not, why not. 

NOTICE PAPER NO. 6 

NOTICE OF QUESTION FOR ORAL ANSWER 

FOR THE SITTING OF PARLIAMENT ON 24 SEPTEMBER 2025 

Name and Constituency of Member of Parliament 

Mr Yip Hon Weng 

MP for Yio Chu Kang SMC 

Question No. 33 

To ask the Minister for Health given recent unilateral changes by Integrated Shield Plan insurers, such as new pre-authorisation rules for existing policyholders (a) whether the Government will consider a dedicated healthcare insurance law to protect consumers and establish a mandatory dispute resolution platform; and (b) whether there are regulations to prevent insurers from influencing healthcare decisions against policyholders’ best interests. 

NOTICE PAPER NO. 17 

NOTICE OF QUESTION FOR ORAL ANSWER 

FOR THE SITTING OF PARLIAMENT ON 24 SEPTEMBER 2025 

Name and Constituency of Member of Parliament 

Dr Hamid Razak 

MP for West Coast-Jurong West GRC 

Question No. 134 

To ask the Minister for Health given that pre-authorisation helps ensure that policyholders have access to non-panel doctors and receive cost-effective treatments, whether the Ministry will implement measures to ensure that policyholders continue to have access to the full benefits of their Integrated Shield Plan should an insurer stop issuing pre-authorisation certificates. 

NOTICE PAPER NO. 27 

NOTICE OF QUESTION FOR ORAL ANSWER 

FOR THE SITTING OF PARLIAMENT ON 24 SEPTEMBER 2025 

Name and Constituency of Member of Parliament 

Ms Mariam Jaafar 

MP for Sembawang GRC 

Question No. 198 

To ask the Minister for Health given Integrated Shield Plans are primarily healthcare financing tools, whether the Government will consider reviewing the regulatory framework for Integrated Shield Plans to give greater regulatory oversight to the Ministry, or adopting a stronger dual or co-regulation model, to ensure better alignment with national healthcare priorities and patient protection. 

NOTICE PAPER NO. 40 

NOTICE OF QUESTION FOR ORAL ANSWER 

FOR THE SITTING OF PARLIAMENT ON 24 SEPTEMBER 2025 

Name and Constituency of Member of Parliament 

Mr Vikram Nair 

MP for Sembawang GRC 

Question No. 295 

To ask the Minister for Health what are the measures the Ministry intends to take to address the issues of escalating private healthcare costs, insurance premiums and insurers refusing pre-authorisation certificates at certain hospitals. 

Answer

1             Mr Speaker, may I have your permission to answer Questions 1 to 4 together? My response will also address oral questions 73 to 75 from the order paper on 22 September 2025.  

2             Allow me to begin by putting the issue into perspective. The Ministry of Health (MOH) has previously explained the current state of private healthcare and insurance. Insurers, private hospitals, and providers have got themselves tied up in a knot, resulting in escalating private hospital bills, rising premiums, and more safeguards introduced to the claims process. The concerns raised by Members point back to this deeper issue. 

3             A significant root factor is the design of private health insurance. Insurers know that policyholders are worried about unexpected large hospital bills, so they offer plans with generous coverage and benefits through Integrated Shield Plans (IPs) and riders, covering almost to the last dollar with little copayment. 

4             But when someone else – in this case, insurers – pays for almost the entire bill, the dynamic between patients and providers changes. There is tendency for over-servicing and unnecessary treatments. This is backed by data. The likelihood of a patient with a private hospital rider making a claim is 1.4 times that of a patient without a rider. The size of the claim is also on average about 1.4 times that of a patient without a rider. 

5             Rising private hospital claims put a strain on insurance. For IP portfolios to be sustainable, insurers raise premiums to cover claims – policyholders have seen sharp increases in premiums for private hospital plans, namely IPs and riders. They also introduce more safeguards to manage claim costs, which helps insurers to moderate premium growth to some extent. 

6             So in response to the Member’s question, Mr Fadli Fawzi is right that features such as ‘as charged’ expands coverage and contributes towards weakening the discipline of insurance claims. There are other features too, such as covering deductibles and co-payment, which also need to be looked at. 

7             But private healthcare insurance is in its current unsustainable state not because of collusion or anti-competitive behaviour. That usually leads to supernormal profits by market players at the expense of consumers. Here, insurers are either making losses or barely breaking even on their health portfolios. The situation is due to excessive competition that has gone wrong – another type of market failure. 

8             Mr Yip Hon Weng and Ms Mariam Jaafar asked if there could be new laws for stronger regulatory oversight. We already have a Competition Act to proscribe collusion and anti-competitive behaviour. If we strengthen regulatory oversight, it should be to correct the market failures arising from unsustainable and self-harming competition that have taken place today. Regulations to prevent insurers from correcting the current problem will likely exacerbate the situation, make private insurance even more unsustainable, with no market correction mechanism. 

9             Should there be disputes over specific claims, policyholders can take it to the Financial Industry Disputes Resolution Centre (FIDReC), an independent and impartial institution that assists with insurance-related disputes. The Monetary Authority of Singapore (MAS) will also take action against insurers if they do not pay claims in accordance with policy terms and conditions or have unfair claims handling practices. 

10             MOH will continue to work with MAS to exercise regulatory oversight over IP insurers and products. 

11             Members also asked about the practice of pre-authorisation. Pre-authorisation is an administrative arrangement – not a contractual benefit – offered by insurers. It enables insurers to review and approve medical treatments and associated fees, to make sure that they are medically necessary and covered by the policy, before they occur. This arrangement also gives patients assurance about what will be covered. Today, five of the seven IP insurers provide pre-authorisation. Regardless of pre-authorisation, IP policyholders enjoy their full contractual benefits, and can still make claims for their treatments according to the terms and conditions of their policy. 

12             Panels are another means that insurers use to manage claim costs, by ensuring that doctors on the panel adhere to fee ranges set by the insurer. Seeing a panel doctor typically allows policyholders to enjoy more favourable co-payment terms. All policyholders remain entitled to their full contractual benefits, even if they seek care from a non-panel doctor. 

13             Most insurers have at least 600 private specialists on their panels. MOH monitors insurers’ practices and works with them to ensure adequate panel coverage at the overall and speciality level. With Extended Panels, most IP insurers also allow policyholders to access doctors on other IP insurers’ panels, subject to review. 

14             The trends we see – escalating costs, premiums, tightening claims management practices – are consequences and symptoms of the knot that insurers, doctors, hospitals and policyholders are caught in. 

15             Regulation will not loosen this knot; it will make it worse. If we restrict insurers’ claims management practices, we will likely see even larger premium increases. And if we cap premium increases, products will become unviable, which will hurt policyholders. 

16             So we need to loosen and untie this knot, step by step. Every stakeholder needs to do its part, and MOH will facilitate the process. 

17             We have urged the insurance industry to relook their overly-generous policy design, such as minimal rider co-payment. Insurers will need to balance between providing assurance and protection, and encouraging prudent consumption and servicing. 

18             We will do more to educate consumers on choosing the appropriate health insurance coverage for their needs. We are in fact launching a public education campaign soon. 

19             To rein in sector cost increases, MOH has developed and published over 2,800 fee benchmarks, which providers and insurers reference to set fees and review reimbursements respectively. We will study what more can be done to guide fee setting by private hospitals. 

20             MOH will also continue to work through the Multilateral Healthcare Insurance Committee (MHIC), which brings together key stakeholders from healthcare providers, medical professionals, insurers and consumer representatives, to address these issues collaboratively.