Update on Service Indicators for Medisave-Approved Integrated Plans

15 Nov 2006

On 15th August 2006, MOH started to publish on a quarterly basis three insurance service indicators on Medisave-approved Integrated Plans: i) Claims returns rate, ii) Provision of letter of guarantee, and iii) Absorption of costs for obtaining medical records. The objective is to provide service data information to the public to support consumer choice and enhance market competition.

The latest quarterly update of these service indicators are provided in Annex A.

The claims return rate has improved across the board for all insurers and more policyholders are getting their claims settled much faster. The median number of days taken to process claims has decreased by between one to ten days. In addition, the percentage of claims processed within one week has increased by between 6% to 26%. All these improvements will benefit policyholders as it would mean more timely reimbursements for medical expenses covered by insurance.

MOH will continue to facilitate greater disclosure and transparency so as to foster an efficient private medical insurance industry and improve the service standards of insurers.

Annex A

(I) Claims Return Rate

Under the "Claims Return Rate" category, we publish:

(a) The percentage of claims processed by insurers for cases with positive payouts, within one week, two weeks and a month (called cumulative claims return rate);

(b) The median number of days it takes for each insurer to process claims with payouts.

After insurers complete claims assessment, the claim is forwarded to CPF Board, who typically takes one additional day to finalise claims assessment. Payment is subsequently made to the claimant through the hospital.

Table 1: Claims return rate ⁽¹⁾

 (From July to Sept 2006.  Figures in brackets show change from 15th August publication)

Note (1): The number of days insurers take to process claims includes the time it takes to obtain medical records from claimants or medical institutions.

Note (2): Insufficient claims in the time period for statistically significant results

(II) Letter of Guarantee

(III) Absorption of Cost of Medical Records

The letter of guarantee, provided by insurers to hospitals, is an assurance of payment on behalf of the patient for the portion of the hospital bill covered by insurance. It alleviates the financial burden on patients by reducing the amount that patients have to pay upfront to hospitals.

Medical records can be requested from medical institutions by either the insurer or claimant. Medical institutions levy a charge for medical records due to the administrative costs of retrieving and collating medical information.

(As of 15 November 2006)

Note (1): Insurers who are shown to absorb the cost of obtaining medical records do so in the majority (more than 90%) of cases. There might still exist situations where the claimant is requested to pay for medical records.