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Lesson4: Insurance and Employee Medical Benefit (Private Medical Insurance…
Lesson4: Insurance and Employee Medical Benefit
Common types of health insurance
Catastrophic Medical Insurance
Cover major illnesses where the associated medical cost is substantial
Cover in-patient and outpatient benefits, and certain expensive and prolonged treatments like kidneys dialysis and cancer treatment
Together with the basic hospital and surgical insurance, some insurers refer to it as comprehensive major medical expense insurance
Usually have deductible and co-insurance elements
Example would be Medishield Life
Long-term care insurance
Pays a fixed monthly amount for long term nursing treatment upon the insured's inability to perform a number of "activities of daily living" (ADLs)
Activities of daily living: bathing, dressing, feeding, going to the toilet and moving around
Example would be Eldershield
Limitations (Co-ordination of benefits clause)
Medical insurance policies has Coordination of Benefits clause
If person is covered under more than one healthcare insurance policy: total claims made by the insured would always be equal to the total medical expenses incurred
Original or duplicate bill label is printed on the invoice (claims processing need original bill)
There will always be only one original bill, and the subsequent reprints will be duplicate bills
Various insurance terms
Deductible
avoid first-dollar coverage and help Medishield target only large bills
initial amount an insured members needs to pay for claim (s) made in a policy year before any payout from Medishield Limit
Co-insurance
to guard against over-consumption
percentage of the claim that an insured member needs to pay, on the portion of the claim above the Deductible
Claim limits
eg. daily ward limit, policy year limit, lifetime limit
address excessive claims
Medishield Life
basic health insurance plan helping patients cope with large hospital bills and selected costly outpatient treatments
designed to cover medical expenses (including deductible and co-insurance) for stay in Class B2/C wards at public hospitals
Offers:
better protection and higher payouts (patients pay less Medisave/cash for large hospital bills)
protection for all Singapore Citizens and PR, including the very old and those who have pre-existing conditions
protection for life
cover Singapore Citizens and Permanent Residents who were previously not covered under Medishield
Elements of Medishield Life philosophy is discerned:
provide peace of mind for patients if they fall ill, covering them through their lives, to take advantage of risk-pooling
avoid "buffet syndrome" (patients over-consume healthcare because insurance policy pays, by setting limits on payouts and requiring patient co-payment (coinsurance)
have affordable premiums, due to it being self-sustaining, not-for-profit scheme. Working-age members pay ahead of their needs and receive debates when they are older to ease their cost
co-payment and deductibles can be paid using Medisave or cash but not for payment of riders
Private Medical Insurance
Private insurance plans for hospitalisation in the form of Integrated Shield Plans (IPs)
AIA HealthShield (Gold Max)
Aviva (MyShield)
AXA (AXA Shield)
Great Eastern (SupremeHealth)
NTUC Income (IncomeShield)
Prudential (PruShield)
IPs has 2 components: Medishield Life; Private Medical Insurance Coverage
Provide additional benefits and coverage to patients when they opt for Class A and B1 wards in public hospitals, or private hospitalisation
Can use Medisave to pay for premiums, subject to withdrawal limits applied to Integrated Shield Plans
Premiums in excess of the Integrated Shield Plan withdrawal limits would need to paid via cash
Those with IPs have Additional Withdrawal Limits, enabling Singaporeans to use Medisave, up to a cap, to pay the additional premiums for the private insurance portions of IPs
Employer Medical Benefit Scheme
Employed Singaporeans have medical insurance coverage provided by their employers
Some think that they are adequately insured, so they are not inclined to purchase further medical coverage
Employee hospitalisation and surgical insurance does not provide long-term coverage
Disadvantages of relying solely:
pre-existing illness (change job: coverage exclude all pre-existing illnesses or medical condition at inception and typically for the 12 months thereafter)
retirement/unemployment (does not insure one after retirement or unemployment --> exposing one to financial risk when they need it most after retirement
Retired or Unemployed
Medishield Life (subsidised class)
Medisave-approved private shield plan (private patients in restricted hospital or patients in a private hospital)
Enhanced Medisave-approved private shield plan with riders (can be added to cover deductible and co-insurance)
those who are ill or unable to work due to illness: Eldershield can help (only if they are insured under Eldershield and meet the requirements to receive payout)
Letter of Guarantee
Official document issued on an episodic or corporate basis by a business entity to undertake the medical bills of patient (s)
Long termed Letter of Guarantee on a corporate basis in the form of a contract is termed the Hospitalisation Identity Card (HIC) Scheme
Usually printed with company's letter head (logo and address)
Civil Service Medical Benefits
Comprehensive Co-payment Scheme (CCS): for civil servants appointed before 1 jan 1994
No additional Medisave contribution to employee
Officer will co-pay 15% on all items of medical expenses in a public hospital (co-payment rate by his dependants is 40%)
Officer and dependants co-pay (15% and 40% respectively) subsidised treatment at public outpatient dispensaries, SOCs and A&E
No maximum subsidy
Medisave-cum-Subsidised Outpatient Scheme (MSO): civil servants appointed from 1 jan 1994 onwards
Government pays an additional 1% CPF contribution on total monthly salary for paying hospitalisation or buying approved medical insurance (Medishield) for employee and his family
Does not cover hospitalisation
Officer and dependants co-pay (15% and 40% respectively) subsidised treatment at public outpatient dispensaries, SOCs and A&E
Maximum subsidy (inclusive of dependants): $350 per calendar year
Co-payment on Ward Charges Scheme (CPW)
No additional Medisave contribution to employee
Officer pay co-pay 20% only onward charges in public hospital; does not need to pay all other fees (surgical investigations, treatment and medicine); co-payment rate by dependants on ward charges is 50%
Officer or dependant will not have to pay for subsidised outpatient treatment at public hospital (excluding private referrals)
No maximum subsidy
CPW tends to be the most generous scheme, followed by CSC then MSO