MEDISHIELD LIFE SCHEME (AMENDMENT) BILL 2ND READING – OPENING SPEECH BY MDM RAHAYU MAHZAM, MINISTER OF STATE, MINISTRY OF HEALTH

Introduction

1. Mr Deputy Speaker, on behalf of the Minister for Health, I beg to move, “That the Bill be now read a second time.”

2. MediShield Life, our national health insurance scheme, was launched in 2015 and is an integral part of Singapore’s “S+3Ms” healthcare financing framework – comprising Subsidies, MediShield Life, MediSave and MediFund. MediShield Life protects all Singaporeans against large healthcare bills for life, regardless of pre-existing health conditions. This ensures that no Singaporean is denied appropriate healthcare due to an inability to pay.

3. The MediShield Life Scheme Act 2015 — or the Act, was enacted in 2015 to support the establishment, governance and administration of MediShield Life. The Act has not been amended since it was passed.

4. Since then, two key developments have taken place, which warrant amendments to the Act.

5. First, the landscape for healthcare delivery has evolved since MediShield Life’s launch in 2015.

a. The centre of gravity for healthcare delivery has been shifting to the outpatient, community and home settings, because not all patients require care in a hospital for their treatment. With this shift, more patients can benefit from easier access to necessary care.

6. To support this, MediShield Life coverage has been gradually expanded to more types of treatments beyond the acute inpatient setting.

a. For example, in 2020, we expanded MediShield Life to cover inpatient palliative care within community hospitals and inpatient hospices.

b. We are continuing our efforts to do more to support care outside of the acute inpatient setting, in the community and at home.

c. Last month, the Ministry of Health announced that MediShield Life’s coverage would be expanded to new outpatient treatments and home-based medical care. One example is the Home Ventilation and Respiratory Support Service (HVRSS), which provides mechanical-assisted ventilation to persons with breathing insufficiency, in the comfort of their homes.

7. We need to amend the Act to allow MediShield Life to cover the increasing number of treatments that are now being delivered beyond the hospital setting as well as new care models that may emerge in the future.

8. Second, over the last nine years since its launch, the Government has gained more experience in administering MediShield Life. We have identified issues that have limited our ability to administer it effectively and efficiently.

9. A key area to be covered in this regard is premium recovery.

a. When MediShield Life was made universal in 2015, it became mandatory for all Singapore Citizens and Permanent Residents to pay their premiums and contribute to the national risk pool.

b. This also means that we must recover premiums from those who are able but evade making payments.

10. Having had nine years of experience administering this, we have identified areas where the Act needs to be strengthened to better support premium recovery and improve scheme administration.

11. In view of these developments, the MediShield Life Scheme (Amendment) Bill, or Bill for short, seeks to amend the Act to achieve three objectives:

a. Support expansion of coverage to new models of care;

b. Strengthen provisions to support premium recovery efforts; and

c. Improve scheme administration.

12. Allow me to elaborate.

Expanding coverage to new models of care

13. Our first objective is to support the expansion of MediShield Life coverage to new models of care received outside the physical premises of healthcare providers.

14. This requires amendments in two areas.

15. First, we will amend the Act to redefine where treatments or services can be received.

16. Today, section 3(1) of the Act requires the insured to receive treatment or services in an approved medical institution.

17. However, going forward, clause 3 of the Bill amends section 3(1) to enable MediShield Life to cover medical treatment or services received by the insured, as long as it is from an approved medical institution.

18. This means that the scheme will be able to cover care that is received entirely outside the premises of a medical institution and provides flexibility to cover newer care models that may develop in the future.

19. Second, we will set out a clearer and more robust governance framework that allows scoped approvals, and suspensions and revocations of such approvals, of medical institutions in respect of approved medical treatment or services they provide under MediShield Life.

20. This will allow MediShield Life to support patient access to new models of care whilst ensuring appropriate use of MediShield Life Fund monies.

21. Therefore, clause 4 of the Bill introduces the new sections 3A and 3B which set out the framework for scoped approvals, and suspensions and revocations of such approvals. Under the framework, the Minister for Health can approve providers to be approved medical institutions in respect of (i) specific approved medical treatment or services and/or (ii) specific delivery modes for the purposes of MediShield Life.

a. Additionally, where a “medical institution” has been granted more than one licence under the Healthcare Services Act 2020 to provide “licensable healthcare services”, the Minister has the prerogative to approve all, or only one or some of such licensable healthcare services provided by the approved medical institution for the purposes of MediShield Life.

b. We will also introduce provisions to enable the Minister to impose conditions of approval, and to suspend or revoke the approvals given.

22. To support the framework, clause 2(c) of the Bill amends section 2(1) by introducing a new concept of “claimable medical treatment or services”. This ensures that the scheme only covers medical treatments or services provided by approved medical institutions according to the scope of their approval. Under the new amendments, Minister is also empowered to grant approvals to medical institutions.

a. For example, while HVRSS will be an approved medical service from late 2025 onwards, it does not follow automatically that all providers will be able to make MediShield Life claims for it. MediShield Life will only cover HVRSS where a medical institution has been approved in respect of the service for the purposes of MediShield Life, and if the service is provided in accordance with the conditions of that medical institution’s approval.

23. Taken together, the amendments will allow MediShield Life to be responsive to emerging models of care. It will also enable the Act to be more targeted in its approvals, and suspension and revocation of the approval of providers and their claimable medical treatment or services. This will strengthen the accountability of approved medical institutions and ensure compliance with the claim guidelines for MediShield Life.

Strengthening provisions to support premium recovery efforts

24. Now, let me move on to the second objective: Amending the Act to strengthen our premium recovery efforts.

25. MediShield Life is a universal scheme which relies on collective responsibility through risk-pooling, to provide all Singapore Citizens and Permanent Residents peace of mind in affording large, unexpected healthcare bills throughout their lives.

26. All policyholders must play their part by paying their premiums. This ensures that MediShield Life can continue to meet its obligations and support those of us who fall ill and need to make a claim.

27. At the same time, we recognise the need to keep premiums affordable, especially for vulnerable groups. This is why the Government provides strong support in the form of premium subsidies for lower and middle-income households, Pioneer Generation and Merdeka Generation subsidies, and additional MediSave top-ups.

28. We also have a comprehensive set of measures to facilitate the payment of premiums.

a. For example, for those who have missed premium payment due to insufficient MediSave balances, we remind them to top up MediSave and facilitate the process for immediate family members to take over premium payment.

b. For those who need further help with their premiums even after subsidies and MediSave use, and have limited family support, we will assess their eligibility for Additional Premium Support.

29. However, there are some individuals who do not pay their premiums despite these measures and become defaulters. In such cases, premium recovery and enforcement is needed. Any owed premiums that cannot be recovered will affect the MediShield Life Fund’s sustainability, and ultimately affect MediShield Life’s ability to meet its claims. If left unrecovered, these debts will have to be shouldered by other policyholders in the form of higher premiums.

Introducing provisions relating to service of documents

30. A key enabler of this premium recovery process is the service of a demand note. Today, a demand note needs to be served before recovery measures, such as the appointment of an agent to recover outstanding premiums, and the imposition of interest and penalties for late payments can commence. The note may be served by prescribed recovery bodies under the Act – the Central Provident Fund Board (CPF Board) and the Inland Revenue Authority of Singapore (IRAS). It notifies defaulters of their owed premiums and of the time by which these must be paid before further measures are taken.

31. We will amend the Act to recognise the different modes through which demand notes and other documents, are served on a defaulter.

32. At present, demand notes are only deemed served if sent by registered post to i) a person’s residential address provided in accordance with section 31 of the Act or ii) any correspondence address provided by the person under certain prescribed circumstances. This is pursuant to regulations made under the limited scope provided by section 34(2)(k) of the Act.

33. However, this has impeded the recovery of outstanding premiums, such as in cases where no valid address information on the defaulter is available or service at an overseas address is required.

34. Clause 10 of the Bill inserts the new sections 33A and 33B. The new sections provide how demand notes and other documents permitted or required by or under the Act to be served may be effectively served. With those new sections, section 34(2)(k) of the Act is no longer necessary and will be deleted by clause 11.

35. This would include serving them through additional modalities such as digital means, which will improve operational efficiency and streamline premium recovery actions for the recovery bodies.

a. For example, a demand note may be served by sending it to an email address of a person where there is deemed consent to such service in accordance with the new section 33B(3)(b).

b. The Minister is also empowered to make regulations to allow a demand note to be served via an existing electronic service such as CPF Board’s my cpf portal or IRAS’ myTax Portal by applying the requirements set out in existing laws regarding these electronic services to the service of demand notes by CPF Board or IRAS respectively.

36. This facilitates recovery bodies in their recovery efforts, especially in relation to individuals whom they were previously unable to serve the demand notes and documents on by registered post.

Enabling access to means information for premium recovery efforts

37. While we have a strong set of recovery measures to ensure the sustainability of the scheme, we should take a calibrated approach based on the means of defaulters.

a. For example, some defaulters may come from lower-income households with complex circumstances. We should be more empathetic towards such groups of people and provide them a longer time to pay their outstanding premiums.

b. On the other hand, premium recovery should proceed along the normal timelines for those with more means to pay their outstanding premiums, such as individuals from higher-income households.

38. To support this, clause 9 of the Bill amends section 28 to broaden the scope for access and use of means information to assess whether premium recovery and enforcement measures under Part 3 of the Act should be exercised on premium defaulters with lesser means.

Improving administration of the scheme

39. Finally, let me touch on the last objective: Amendments to improve the administration of the scheme, which aim to streamline, clarify and strengthen existing processes.

Enabling premiums to be specified on MOH’s website instead of legislation

40. First, we will specify MediShield Life premiums in a manner that is more accessible, such as on the Ministry of Health’s website, instead of legislation.

41. Currently, MediShield Life premiums must be prescribed in regulations. There is scope to enable premium amounts to be more conveniently accessed by Singaporeans as well as to streamline the administrative process of reflecting premium revisions for operational efficiency.

42. Therefore, going forward, clause 5 will amend section 4 to allow the amount of premiums payable for each insurance period to be specified in a prescribed manner, including a website, with consequential amendments made by clause 11 to section 34(2). This mirrors the practice adopted for CareShield Life, our national long-term care insurance scheme.

Provisions relating to persons with unknown birth dates or born on a leap day

43. Second, we will make clear the date when a person is taken to attain a particular age for the purposes of calculating their MediShield Life premiums.

44. This is achieved through the amendment to section 2(4) of the Act by clause 2(f).

45. For most Singaporeans, their age is taken to be on their birth anniversary.

46. However, there is a small group of individuals whose birth date and/or month cannot be ascertained.

a. Currently, our practice is to take their birth date to be on the first day of the month in which the individual was born, if their birth date cannot be ascertained; and their birth month to be in January, if their birth month cannot be ascertained.

b. This is not currently set out in the legislation. The proposed amendment to section 2(4) will clarify this.

47. There is another group of individuals who are born on a leap day.

a. For them, MediShield Life starts on 29 February in the year they are born and in subsequent years, their birth anniversary is taken to be on 1 March.

b. Going forward, the birth anniversary for these individuals will be taken to be on 1 March in non-leap years, and on 29 February in leap years.

c. This mirrors the approach taken by CareShield Life today and ensures consistency across our schemes.

d. This amendment will not impact these individuals’ MediShield Life cover or premiums, as there will not be any breaks in their coverage and premiums continue to be calculated based on their age over the insurance period.

Enhancing scope of offences arising out of false or misleading information provided under the Act

48. Lastly, we will expand the scope of offences arising out of false or misleading information provided under the Act.

49. Today, section 19 makes it an offence where a person knowingly provides material information which is false or misleading and knowing that the information will be included in a health declaration, means declaration or claim application. However, such information may also impact the payment of benefits under MediShield Life, as well as the disbursement of premium subsidies or Additional Premium Support.

50. Therefore, the scope of such offences will be expanded to include cases where the information provided may affect the amount of grants, subsidies or benefits to be paid or given to an individual. The amendments by clause 6 to section19 provide for this.

51. The amendments will enable us to take a stricter stance against such offenders and ensure the proper payment of claims as well as the disbursement of grants and subsidies, to protect the interest of Singaporeans.

Conclusion

52. Mr Deputy Speaker, let me conclude.

53. The Act serves as the fundamental legislative framework that enables the implementation and operation of MediShield Life, an important component of our S+3Ms healthcare financing framework.

54. This Bill ensures that coverage of MediShield Life keeps pace with changes to our healthcare landscape whilst allowing the Government to more effectively and efficiently administer the scheme.

55. Mr Deputy Speaker, I beg to move.