In June 2025, Great Eastern Life announced it would pause the issuance of pre-authorisation certificates for two hospitals – Mount Elizabeth Hospital (Orchard) and Mount Elizabeth Novena Hospital.
The insurer cited concerns over significantly higher charges at these two hospitals, compared to other private hospitals. According to Great Eastern, bills at Mount Elizabeth can be 20% to 30% more expensive on average for similar treatment or the same clinical outcomes, with some cases exceeding even that.
Read Also: Complete Guide To Buying A Private Integrated Shield Plan
What Is A Pre-Authorisation Certificate?
Pre-authorisation is offered by insurers like Great Eastern under their Integrated Shield Plans (IPs), facilitating cashless admission as the insurer settles the bill directly with the hospital. Patients still pay co-payments and non-covered services according to their IP’s terms.
The pre-authorisation certificate provides a confirmation before your treatment that the hospitalisation and related costs are covered. This includes:
– Eligible in-patient hospitalisation expenses,
– Eligible surgical expenses,
– Eligible doctor’s inpatient daily attendance fee,
– Eligible medical examinations and tests during hospitalisation, and
– Eligible outpatient treatment expenses (limited to Kidney Dialysis Treatment, Cancer Treatment, Erythropoietin, Immunosuppressants for organ transplant and Long-term Parenteral Nutrition).
Certain medical expenses that may be covered are not eligible for pre-approval, including:
– Pre and post hospitalisation bills
– Short stay ward
– Pregnancy and childbirth complication
– Accidental dental treatment
– Living donor organ transplant
– Congenital abnormalities
– Psychiatric treatment
– Inpatient Sub-acute Care, Rehabilitation Care and/or Palliative Care
– Overseas treatment
Read Also: Guide To MOH Fee Benchmarks For Private Hospital, Surgeon, And Anaesthetist Fees
Policyholders Can Still Get Pre-Authorisation For Other Private Hospitals
While this move discourages policyholders from using the two Mount Elizabeth hospitals, they can still receive treatment at the affected hospitals and all eligible and covered claims will be paid.
On the Great Eastern website, it explicitly states that pre-authorisation is still available for other private hospitals, including Farrer Park Hospital; Mount Alvernia Hospital; Thomson Medical Centre; Raffles Hospital; Gleneagles Hospital; Parkway East Hospital, and all other private day surgery centres.
Read Also: 5 Ways Singaporeans Can Avoid Overspending On Health Insurance
Private Insurers And Private Hospitals Are Tied Up In A Knot
The move to pause pre-authorisation at Mount Elizabeth was a surprise. Health Minister Ong Ye Kung responding to the situation in a Facebook post, saying “private health insurers and private hospitals have gotten themselves tied up in a knot”.
He pointed to the generous coverage under Integrated Shield Plans (IPs) that insurers designed to win over customers – who insurers know are worried about huge hospital bills. Such IP designs include ‘as-charged’ or no limit coverage, and riders that will protect almost to the last dollar.
When someone else is footing almost the entire bill, there will be a tendency to consume more than necessary. He noted that the “likelihood of a patient with rider making a claim is 1.4 times that of a patient without. The size of the claim is also on average 1.4 times that of a patient without riders”.
As claims escalate, insurers have only two paths. First, they can introduce more safeguards into the claims process. This has included panel arrangements with doctors, and now, suspending pre-authorisation for selected hospitals with higher claims. The second thing they can do is raise premiums, which is also why premiums have risen sharply in the past few years.
The end-result is that consumers are unhappier, paying more for less coverage. Healthcare providers may find it increasingly cumbersome to make claims, while insurers struggle to provide a viable product.
What This Means For Those Covered Under Integrated Shield Plans
While Singaporeans are already covered by MediShield Life, over 70% have opted to buy more comprehensive coverage under Integrated Shield Plans (IPs).
All changes to the IP coverage do not affect MediShield Life coverage. In fact, MediShield Life coverage is reviewed every 3 years to ensure it remains relevant and offers adequate coverage. Along with the enhancements to the scheme, we can also expect higher premiums. The latest enhancements came into effect in April 2025.
Read Also: How Much Your MediShield Life Premiums Will Be Going Up From April 2025
Private insurers may review their own IPs from time to time. Great Eastern’s move to pause pre-authorisation certificates for Mount Elizabeth is certainly a drastic move that has made national headlines and the Health Minister has weighed in. We can only assume it was not an easy decision.
For now, this move is contained to just Great Eastern as the only insurer to restrict pre-authorisations on the two Mount Elizabeth hospitals. As claims rise, there’s nothing to stop other insurers from making similar moves – especially if certain private hospitals are indeed charging more for similar treatments and outcomes.
Pre-Authorisations Meant To Improve Healthcare Experience
In the first place, pre-authorisation certificates are meant to simplify the healthcare experience for Singaporeans, and not meant to differentiate between hospitals that charge an acceptable fee. While not an absolute necessity, removing them will mean Singaporeans’ healthcare experience will go backwards.
For those who can no longer receive pre-authorisation certificates, the Great Eastern website notes that the “hospitals may now collect the bill amount upfront depending on their financial assessment”. Notwithstanding this, the two Mount Elizabeth hospitals can still issue an e-LOG (Letter Of Guarantee) and e-file the claims to Great Eastern. The claims will be assessed according to the terms and conditions of the relevant policy and all eligible and covered claims will be paid.
In Health Minister Ong Ye Kung’s Facebook post, he also noted that public healthcare accounts for around 80% of hospital beds in Singapore, but provides care for 90% of all inpatients.
Private hospitals should add to Singapore’s healthcare efficiency rather than work against it. If the “knot” between private insurers and private hospitals continues to tighten, the public healthcare infrastructure may come under increasing pressure.
Read Also: Beginner’s Guide To Understanding How MediShield Life Works
