One of the often-mentioned fears of the elderly is the fear of ill health, and particularly, the fear of high healthcare costs. This fear is not without basis: healthcare costs are increasing in Singapore. According to the Ministry of Health (MOH), the National Healthcare Expenditure increased from $12.9 billion in 2012 to $22.1 billion in 2017, or about 11% per annum.
To counter this fear of rising healthcare costs, many Singaporeans choose to buy private Integrated Shield Plans (IPs) on top of the government-mandated MediShield Life. To further limit bill shock, many also bought riders to cover the cost of the deductible and co-insurance.
Today, if you are buying an Integrated Shield Plan, your options for riders are only co-payment riders with a minimum of 5% co-payment. Full riders are no longer sold as of March 2018 due to MOH’s requirements while existing policies with full riders were allowed to continue. However, this changed as of February 2021 with NTUC Income’s decision to renew full riders with a co-payment feature from 1 April 2021 onwards.
With such changes for Integrated Shield Plan riders, the question of whether you should opt-in for a co-payment rider becomes more important.
The Link Between Full Riders And Higher Healthcare Costs
When Integrated Shield Plans was first introduced, private insurers introduced full riders that fully covered the co-payment, meaning that policyholders would not have to pay a single cent out-of-pocket.
However, in March 2018, MOH issued a new requirement that all new riders sold would have to include a 5% co-payment component. This was at the recommendations of the Health Insurance Task Force (HITF) which observed that full riders were encouraging overconsumption by patients and over-servicing and over-charging by some healthcare providers.
This is borne out in more recent statistics from MOH: between 2015 and 2020, there were more claims every year for full riders of private and restructured IPs (the claims incidence rates increased at a compound annual growth rate of 15% for full riders of private hospital IPs and about 9% for full riders of restructured hospital IPs), whereas claims incidence for co-payment riders of both private and restructured hospital IPs stayed almost the same. Not only has the number of claims increased, but the average bill size for claims from full riders is also more than 20% higher than co-payment riders for both private and restructured hospital IPs.
Buffet Syndrome Amongst Full Rider Policyholders
The main issue with full riders is that it encourages a buffet syndrome amongst the policyholders/ patients. Without the pinch of out-of-pocket costs, patients can choose to take on unnecessary treatments. Some patients may even deliberately add on procedures to ensure that they can claim additional benefits, such as choosing a full surgery (when a day surgery may suffice) in order to claim the hospitalisation benefit. This overconsumption of healthcare by a few people leads to an overall increase in healthcare costs for the entire population. Even if you are a policyholder with full rider and you choose not to overconsume healthcare, you are paying the higher premiums as if you are overconsuming healthcare services.
In a way, it is like a prisoner’s dilemma, whereby you are encouraged to overconsume because if you don’t, you would be paying for someone else’s overconsumption, even though everyone would be better off if overall consumption of healthcare is reduced.
|Age Next Birthday||Plus Rider (Full Rider)||Deluxe Care Rider (5% Co-Payment Rider)|
Premiums for NTUC Income Enhanced IncomeShield Preferred (Private Hospital IP). Compiled with information from NTUC Income.
As seen from the table above, the premiums are higher for full rider. If you start paying the premiums at 40 years old until 60 years old (without making a claim), you would have paid in premiums around $44,000 for the full rider or $26,000 for the co-payment rider. This is a difference of over $18,000. Additionally, the premiums for full rider have been increasing faster over years until the point that NTUC Income transitioned them to co-payment rider.
Should An Existing Integrated Shield Plan (IP) Policyholder With Full Rider Opt-In To Co-Payment Rider?
Given that one major private insurer (NTUC Income) has decided to discontinue full riders and transition existing full riders to co-payment riders, the odds are high that other private insurers would consider doing so.
As an existing full rider policyholder, you run the risk of being beholden to your insurer when they suddenly decide to transition to co-payment riders. At that point, you may not have the freedom of choice to choose the most suitable IP and co-payment rider because you are locked-in to your existing insurer possibly due to developing some medical conditions that a new insurer would consider as pre-existing conditions.
If you don’t have any pre-existing conditions, you should consider opting-in to a new co-payment rider while you are in good health. As shown by NTUC Income, there is no assurance that your current full rider IP would continue to be renewed and thus the guaranteed value of holding on to your full rider has been diminished. Additionally, as the prices for full rider premiums continue to inch up every year, you may eventually find yourself unwilling (or unable) to pay the premiums and having to transition to a co-payment rider.
If you do have pre-existing conditions, you may not have much of a choice to switch insurers. Instead, the choice to opt-in to co-payment rider may be between time and your financial ability. As long as you are able and willing to afford the increasing premiums of a full rider, you can always hold on to your full rider until your insurer decides to transition to a co-payment rider (if they ever do).
Co-Payment Riders Are Mandatory But You Can Also Choose To Have No Rider
While you may only purchase co-payment riders, many people may overlook the option to not purchase a rider to cover the deductible and co-insurance.
Under MediShield Life, the deductible is the portion of the bill you must pay before insurance kicks in. You only need to pay the deductible once every policy year.
|Deductible for||Age 80 and below||Above age 80|
|Ward B2 and above||$2,000||$3,000|
The co-insurance rate ranges from 10% to 3%, and decreases as your bill size increases.
|Claimable Amount for Inpatient and Day Surgery||Co-insurance
(Percentage of Claimable Amount)
|$0 – $5,000||10%|
|$5,001 – $10,000||5%|
|Co-insurance for all Outpatient Treatments||10%|
This means that potentially your hospital bill shock may not be as high as you imagine because the co-insurance actually decreases as your bill size increases. It also implies that your co-payment rider may not be covering as much as you would think it would.
Choosing not to buy a co-payment rider means that you would need to have a larger source of emergency savings to tap into. You would need to be disciplined in setting aside the savings from not buying a rider for future medical expenses. At a minimum, you would need to have sufficient savings to cover the deductible before insurance can kick in.
Nonetheless, the government has made a commitment that no Singaporean will be left behind and excluded from MediShield Life due to financial difficulties. While we can choose private hospital treatments and should pay for them accordingly from our own pockets (and through IPs and riders), the fact remains that this is a choice and a privilege that not every Singaporean has. Instead, we, who can afford IPs and riders, should recognise that our choices and how much healthcare services we consume have an impact on the less privileged.
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