Wednesday, November 19, 2008

Medishield Changes wef 1st Dec 2008

From 1 December 2008, MediShield will be enhanced to increase payouts of up to 80% of large class B2 and C bills, up from 60% previously. This will be achieved through raising the MediShield claim limits.

The main changes are as follows:
1) Daily Room and Board charges raised from $250/day to $450/day and ICU from $500 to $900/day.
2) Surgical Procedure limits increased for Table 2, 3 and 4 Operations
3) Implants and Medical Consumables increased from $2k per treatment to $7k
4) Chemotheraphy limits increased from $700 to $1,240 for a 21/28 days cycle treatment
5) Stereotactic Radiotherapy for Cancer increased from $1k to $1.8k per treatment
6) Deductible increased for those above 80 yrs old from $1k to $2k for Class C wards and from $1.5k to $3k for Class B2 wards.
7) Premium increased by as low as just $3/yr for those 30yrs and below to $418/yr for the highest age band of 84-85yrs old.
8) For those 81 years old and above, withdrawal limit for premiums will be increased to $1,150 per insured person

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My comments:
Its great news especially for those with existing health problems. The most significant improvements are the increased limits for Daily R&B, Medical Consumable and Chemotheraphy treatments. I've been helping my clients with medical claims over the years and I know these are the areas that the current Medishield are seriously lacking.

However, I'm quite disappointed that they had doubled the deductible for those 80 years and above. This is the most vulnerable group of people but logically forms the lowest group of Medishield Policyholders. This increase is very drastic as they are very likely not having sufficient savings to pay that $2k or $3k treatments. I find it unnecessary to double the deductible for them at this stage.

It seems to me that the government is all out to make sure Medishield generate profits for all age groups. I'm not sure if they had taken the effort by passing part of the profits from the younger groups to cover part of the loss in the older groups.

11 comments:

Derek said...

Hi Adrian,

Do you know where I can find the
Table of Surgical Procedures under the Medisave Scheme operated by MOH?

My aunt just went for an emergency surgery to stop aorta leakage using a new stent procedure. We were told that medisave does not cover the surgery.

Btw, nice new look.

Khiat Han Hwee Adrian said...

Actually, I do not have an answer for you but there are probably too many operations to properly classify all of them into each Surgical Tables.

I do have a classification table for about 120+ procedures which I got it from a fellow colleague in 2005. Not sure if it had changed much.

wilfredling said...

Derek,

I believe you are looking for this:

http://www.moh.gov.sg/mohcorp/hcfinancing.aspx?id=324

You'll need to search really deep into the Surgical Tables one by one. If you cannot find "Stent" then maybe Medisave really does not cover.

Wilfred Ling

Khiat Han Hwee Adrian said...

Hi Wilfred,

Thanks for the info...

Derek said...

Hi Adrian and Wilfred,

Thanks for the info. It sure is a long list.

Since my aunt is operated under a new procedure, it may not yet be included in the list provided by MOH. Under such circumstances, am I right to say that the insurer may not have to pay for the surgery?

I'm just curious because the same thing might befall my parents or me.

wilfredling said...

Derek,

As to whether the insurer will pay or not depends on the policy terms itself. There is no standard answer for this.

Also you'll need to distinguish between Medisave, Medishield and the private "enhanced" shield plans. While Medisave (which is actually the CPF member's own money) cannot be use for certain procedures, it does not mean the same applies for Medishield and the private shield plan.

Moreover, even if the Medishield is claimable, it does not mean the private "enhanced" plan is claimable as there can be exclusion at the "enhanced" part.

It is best that you consult a competent adviser like Adrian to help you.

Anonymous said...

Hi Adrian

I have few questions on this, hope you do not mind

1) Is current medishield payout inadequate?

e.g. if the current 250/day is no longer valid[enough]? Does that mean all SG hospitals have increased their charges above 250 a day? Let's say if the charges are 270 a day what is the use of liit 450 a day , will I get 450-270 = 180 dollars in my pocket? I guess not.

same way about the other increased charges.

Now unless we have the exact daily charges and compare it with this enhanced limit items one by one, I really do not know what is going on?

2) Is insurance company suggesting us to upgrade to this package as they believe there will be increase in medical costs and the existing plan will be inadequate? I sthere any indication from MOH or hospitals that they will be increasing the various charges e.g. ward charges from 250 to 450 etc?

I am confused. why is this plan created and what is the need?

Hope you can give us some insight.

Regards
Paddy

Khiat Han Hwee Adrian said...

The Medishield is meant more for Restructured Hospital B2 and C wards. $250/day may indeed be insufficient and thats why they increased it to $450/day.

A lot of people mistaken the Room and Board Charges as the Bed charges and argue that the bed don't cost that much in B2 and C wards. The R&B charges actually consist of many other medical related services such as scannings, diagnostic tests, medicines, doctor attendance fees, pre-post hospitalisation, etc...

When they says $450/day, its the limit that you can claim for the R&B charges, not the amount you be getting in cash.

Generally, if you think you have any chance of going beyond the B2 or C ward, I'll advice you to upgrade your Medishield plan to an Integrated one.

Derek said...

Hi Wilfred and Adrian,

Thank you for your answers.

Khiat Han Hwee Adrian said...

Hi Derek,

For very rare cases where the surgical technique is in its experimental stage or if the medical device are not approved by the review board, it may not be covered. Its better to check with insurer if in doubt. I'm not sure how the insurer will view your aunt's case.

btw, did she manage to claim from her insurance eventually?

Derek said...

Hi Adrian,

I'm not sure if she manage to claim but fortunately for them, money is not a major issue.

I'll update you if I manage to talk to my cousins.