Higher and More Granular Claim Limits for MediShield Life

        The Ministry of Health (MOH) will enhance MediShield Life by increasing and introducing more granular claim limits for surgical procedures to improve coverage for more complex surgical procedures and better protect Singaporeans against large medical bills. Around 90,000 patients per year are expected to benefit from higher MediShield Life payouts with the implementation of the new claim limits, which will take effect for patients admitted for surgeries from 1 January 2020.

2.     The enhancement was recommended by the MediShield Life Council (MLC), as part of their ongoing review of MediShield Life benefits and premiums, which is expected to be completed by end 2020. There will be no premium adjustments at this point, in line with the government’s commitment to keep premiums constant for five years when the scheme was launched in November 2015. As part of its overall review of the scheme, the MLC will also assess adjustments to premiums accordingly, after factoring in enhancements to the scheme and actual claims experience.

Claim Limits for Surgical Procedures

3.      Patients undergoing surgical procedures listed in the Table of Surgical Procedures (TOSP) can claim from MediShield Life and tap on their MediSave to pay for their surgical bills, subject to the MediShield Life claim limits and MediSave withdrawal limits respectively. Currently there are seven different MediShield Life tiers of claim limits to cater to surgical procedures of different complexities under the TOSP.

4.      From 1 January 2020, the number of tiers will triple to 21. The introduction of more granular and higher tiers will provide better coverage for more complex surgical procedures, which tend to be costlier. In addition, the claim limits have also been adjusted to keep pace with increased healthcare cost since the last revision in 2015.

5.      With the new claim limits, patients will be able to claim more from MediShield Life, and pay less through MediSave or cash. Please refer to ANNEX A for the current and new claim limits, and ANNEX B for illustrations of the MediShield Life claims for different surgical procedures under the current and new claim limits.

6.      Mr Edwin Tong, Senior Minister of State, Ministry of Law and Ministry of Health, said, “The new claim limits will improve MediShield Life coverage for more complex surgical procedures and better protect Singaporeans against large hospital bills. Even as the MediShield Life Council undertakes their review, which will be completed by end 2020, we will start off by implementing the new claim limits for surgical procedures so that patients can benefit earlier from this enhancement. We will continue our efforts to keep healthcare costs sustainable and affordable for all Singaporeans.”

7.     No action is needed on the part of patients. The new claim limits will be automatically applied to MediShield Life claims for patients admitted for surgeries from 1 January 2020.

MediShield Life Review

8.      In 2018, MOH and the MLC started a review of the MediShield Life benefits and premiums, to ensure that the coverage of MediShield Life remain broad-based and sustainable. The MLC will gather views and feedback through stakeholder and public engagements in the coming months.

9.     The MLC and MOH regularly review MediShield Life benefits to ensure that it provides protection for Singaporeans against large hospitalisation bills and selected costly outpatient treatments, in keeping with developments in medical care.

i) In 2018, we extended MediShield Life coverage to direct admissions from emergency departments of public hospitals to community hospitals, home parenteral nutrition, and surgical intervention for two rare congenital conditions – trisomy 18 and alobar holoprosencephaly.

ii) In 2019, MediShield Life coverage was extended to inpatient treatment for serious pregnancy and delivery-related complications, as well as the continuation of autologous bone marrow transplant treatment for multiple myeloma in the outpatient setting.

10.    The Government provides significant subsidies of up to 80 per cent to keep healthcare costs low, and all Singaporeans are protected against large healthcare bills through MediShield Life. Patients can pay for the co-payment part of their bills with their MediSave. MediFund and various forms of financial assistance at our public institutions are also available for those in need. No Singaporean will be denied appropriate healthcare due to an inability to pay.

MINISTRY OF HEALTH
27 DECEMBER 2019