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Commonwealth Health Partnerships 2015

MediShield Life will cover people with pre-existing conditions, who were not included in the old MediShield scheme Additional insurance coverage may be purchased from a private insurer as a Medisave-approved Integrated Shield Plan (ISP), an add-on to MediShield, the premiums for which are payable using Medisave funds. Those who have purchased ISPs could be understood as paying higher premiums in order to obtain higher payout, better class of stay in hospitals and higher coverage. Almost a third of the current insured have subscribed to ISPs. Similarly, ElderShield Supplements may be purchased from private insurers to enhance disability benefits coverage. However, a number of treatment items, procedures, conditions, activities and their related complications are not covered by MediShield and cannot be claimed. These include any pre-existing illnesses, diseases or impairments from which the insured member was suffering prior to the commencement of his MediShield cover, except where such conditions have been accepted by the Central Provident Fund (the administrator of the national social security plan) in writing, and treatment of any condition arising from or due to HIV/AIDS. MediShield was not without its share of criticisms and three major ones have been documented recently (ibid: pp. 70–75). First, the non-coverage of certain population groups greatly increased the financial burden of the uninsured and their families. Most evident was the initial exclusion of newborns with congenital diseases, as they were also excluded from coverage for downstream complications arising from their pre-existing illnesses. Second, the actuarial practices of MediShield were regarded as too ‘commercial’. Premiums are computed (and risk-pooled) by age U n i v e r s a l h e a l t h c o v e r a g e i n S i n g a p o r e bands, with the result that the elderly were faced with the highest premiums. Third, an open-ended co-insurance meant that there is no limit to out-of-pocket payment for a substantial hospital bill. From MediShield to MediShield Life The MediShield Life Review Committee (MLRC) was established in November 2013 to review and study the proposed parameters for MediShield Life, an initiative that was first announced by Prime Minister Lee Hsien Loong at the National Day Rally in 2013 to provide lifetime health insurance coverage for all Singapore residents.2 Since its establishment, the MLRC has held more than 30 public meetings. It reached a consensus on the need to strike a balance between higher premiums and affordability on the one hand, and sufficient coverage for all citizens over their lifetime on the other. Generally speaking, the MLRC has identified three responses to a number of concerns relating to increasing health care costs: 1. Existing benefits should be enhanced in terms of an increase in payout in order to reduce out-of-pocket payment 2. Coverage should be for life, making health care more affordable for the elderly 3. Coverage should apply to all Singaporeans and eligible permanent residents, including those living overseas Preliminary recommendations on the benefits parameters of MediShield Life were made by the MLRC in January 2014. The Commonwealth Health Partnerships 2015 119 Imtmphoto / Shutterstock.com


Commonwealth Health Partnerships 2015
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