When it comes to health insurance, one of the most important health insurance policies that all Singaporeans and Permanent Residents (PRs) should consider getting is a private integrated shield plan (IP).
Private integrated shield plans help policyholders cover any potential cost that may be incurred if they are hospitalised, either in public or private hospitals.
A private integrated shield plan comprises two components. The first is MediShield Life. All Singaporeans and PRs are automatically covered under MediShield Life, Singapore’s basic health insurance plan. Coverage is provided regardless of age or pre-existing conditions.
The main limitation with MediShield Life is that the coverage provided will be pegged to the expected treatment cost in Class B2 or C wards in public hospitals. What this means is that if a patient chooses to be admitted to a higher-class ward in a public hospital, or in a private hospital, the payout provided by MediShield Life is likely to only be a fraction of the total bill.
To ensure coverage is provided for higher-class public hospital wards or at private hospitals, Singapore residents can choose to upgrade their existing MediShield Life to an integrated shield plan.
Find Out More:
- Different Types Of Integrated Shield Plan
- Coverage Provided By Integrated Shield Plan
- Who Are The Different Insurers?
- Paying For Your Integrated Shield Plans Premiums
- Buying A Rider
- The Claims Process Is Important
- Insurers Are Starting To Implement Claims-Based Pricing
- Tussle Between Insurers And Doctors
Different Types Of Integrated Shield Plans
Coverage for integrated shield plans can be grouped into three different types.
Standard Integrated Shield Plan (Standard IP): Standard IP provides coverage for policyholders for Class B1 wards at public hospitals. Benefits provided by the Standard IP are identical across all IP insurers.
Class A Plans: Class A plans provide coverage for policyholders for Class A wards at public hospitals. Benefits provided by the plan may differ from insurers.
Private Hospital Plans: Private hospital plans provide coverage for policyholders at private hospitals. Similar to Class A plans, benefits provided may differ from insurers.
Coverage Provided By Integrated Shield Plan
As mentioned above, benefits provided by Standard IP plans are identical across all insurers while benefits provided for private hospitals and Class A plans may differ among insurers.
In general, here are the different types of coverage one can expect.
Inpatient & Day Surgery: This includes daily ward, treatment cost and surgery
Outpatient Treatment: This includes treatment for kidney dialysis, cancer treatment and chemotherapy
Pre & Post Hospital Treatment: This covers the cost of any related treatments that are incurred before or after the hospitalisation stay.
* To find out more about the benefits provided by the Standard IP, please refer to the MOH comparison here.
** To find out more about the benefits provided for Class A wards, please refer to the MOH comparison here.
*** To find out more about the benefits provided for Private Hospital plans, please refer to the MOH comparison here.
Who Are The Different Insurers?
As the name suggests, private integrated shield plans are offered by private insurers. Today, there are a total of seven insurers that offer these private insurance plans. They are:
Aviva: Aviva MyShield
AXA: AXA Shield
Great Eastern: Supreme Health
Income: IncomeShield *
Raffles Health Insurance: Raffles Shield
Except for Standard IPs, exact benefits and premiums across the various private insurers differ slightly.
Besides choosing the plan that provides you with the most extensive coverage, policyholders should also be mindful of the premiums that they will be paying. This applies not just to what they are paying today, but also its affordability over the long term.
Paying For Your Integrated Shield Plans Premiums
Similar to MediShield Life, annual premiums for your private integrated shield plans can be paid for using your Medisave.
However, unlike MediShield Life premiums, which can be paid fully using your Medisave, there is a cap to how much Singapore residents can use from their Medisave account to pay for their private integrated shield plan premiums.
The amount they are able to use from their MediSave to pay for their private integrated shield plan, also known as the Additional Withdrawal Limits, are as follows.
|Age||Additional Withdrawal Limit|
|40 and below||$300|
|41 to 70||$600|
|71 and above||$900|
For example, if the premium for the private integrated shield plan is $375 and the individual is 35 years old, he will be able to use $300 from his Medisave to pay for his premiums and will need a cash outlay of just $75.
As a person grows older, annual premiums for private integrated shield plans will naturally increase. This increase reflects the situation that older people are more likely to require hospitalisation and treatment as compared to younger folks.
Buying A Rider
Similar to MediShield Life, coverage provided at higher-class wards does not mean hospitalisation bills are fully paid for. All integrated shield plans include deductibles and co-insurance.
In the past, if you want complete coverage so that you do not have to pay for any deductibles and co-insurance, you had the option of purchasing a separate full rider that can fully cover all hospitalisation bills incurred.
With effect from 1 April 2019, all new integrated shield plan riders will have to incorporate a co-payment of at least 5%, subject to an annual cap of $3,000 (though insurers are allowed to set higher thresholds). For example, if you incur a hospitalisation bill of $15,000, a 5% co-payment will mean having to fork out $750, with the remaining $14,250 being covered by the private integrated shield plan.
To find out more about the changes to shield plan riders, you can read this article about 5 facts about the integrated shield plan changes that Singaporeans need to know about
This regulation only applies to new integrated shield plan riders. Existing integrated shield plans with full riders are not affected. However, existing policyholders are still affected by the insurers’ decisions to continue the renewal of existing full riders. Indeed, in February 2021, NTUC Income announced the decision to renew full riders (regardless of whether they are purchased before or after the April 2018 regulation) with a co-payment component from 1 April 2021 onwards.
For existing policyholders with full riders, we go through the implications of this change in our article: Buying A Private Integrated Shield Plan: Should You Opt In For Co-Payment Rider?
What’s critical to note is that unless your existing insurer has notified you of changes (i.e. NTUC Income), existing policyholders with full riders will still enjoy the full coverage of full riders.
The Claims Process Is Important
For new buyers of integrated shield plans, what is more pertinent is perhaps how and what you can claim.
According to MOH, most claims are processed by the insurer within 2 days. These durations are for Integrated Shield Plan claims and do not include rider claims.
It is assuring to know that all insurers are speedy in processing the claims. However, these statistics also don’t tell us about the difficulty of making a claim. Much of the claim process may have been expedited by the fact that IP policyholders are seeking treatment with panel specialists and already prepared with a Letter of Guarantee.
Insurers Are Starting To Implement Claims-Based Pricing
In recent years, insurers have also been moving towards claims-based pricing. Policyholders who do not make a claim will enjoy a discount off their rider premiums. This will range between 20% to 25%, depending on the insurer. Whereas those who do make a claim of at least $1,000 or $2,000 are likely to face a hike in rider premium in the subsequent year.
Currently, Prudential has claims-based pricing in place since 2017. Great Eastern and AIA will launch claims-based pricing in April. Aviva has indicated plans to launch this in 2022.
While this appears to benefit healthy policyholders, it could become detrimental when we eventually fall ill. Once that happens, our rider premiums will escalate and we may end up in a no-win situation where we have to handle both escalating healthcare costs and premium costs.
Tussle Between Insurers And Doctors
Currently, all insurers have introduced panels of doctors that are preapproved by the insurer. Policyholders who choose to seek treatment with panel doctors may enjoy some benefit enhancements such as being able to have a co-payment cap without needing to do pre-authorisation, having lower deductibles, or a longer period of pre- and post-hospitalisation cover.
This leads to the current tussle between insurers represented by the Life Insurance Association (LIA) and the Singapore Medical Association (SMA) which represents most doctors. The SMA’s position statement takes issue with 1. the exclusivity of IP panels, 2. the lack of transparency as to how these IP doctors are selected, and 3. the low reimbursement by insurers who mostly reimburse the lower limits of MOH’s fee benchmarks. Whereas LIA counters that insurers have been expanding their panels and that panel doctors have been essential to counter cost escalation.
For us consumers, this tussle could mean higher premiums, fewer choices in choosing our doctors, or a combination of benefits reduction. MOH will appoint a committee to mediate between insurers and doctors and we can expect a review on Integrated Shield Plans in the future.
In general, while Integrated Shield Plans help us cover the additional costs above and beyond the coverage of MediShield Life, MediShield Life itself is also undergoing changes and benefit enhancements. Thus, as buyers of IPs, we need to keep ourselves informed about the base coverage MediShield Life before determining whether we are adequately insured for our healthcare needs.