askST: Do you really need an Integrated Shield Plan? Which one should you choose? (2024)

SINGAPORE - A July 1 report in The Straits Times on how much people can expect to pay for Integrated Shield Plans (IPs) over their lifetime has resulted in queries from readers on whether they really need an IP, and, if so, how to choose one that suits them best. AskST looks at some common questions posed.

Q: Do I need an IP?

A: That depends on the hospital ward class you would choose should you require serious medical treatment, since IPs are meant to provide coverage on top of the basic MediShield Life to pay for treatment as a private patient.

So if your answer is a subsidised Class C or B2 ward, then MediShield Life should be enough, as the compulsory national insurance plan is pegged to cover subsidised care in public hospitals.

However, if you want private care – either as a private patient at a public hospital or as a private hospital patient – then yes, your best bet is to have an IP. Otherwise, you might have to fork out quite a bit of cash to foot the hospital bill.

There are three levels of IPs: The top tier covers treatment in private hospitals, while the second and third tiers see to the care of Class A and Class B1 patients, respectively, in public hospitals.Choose your IP based on the ward class you are likely to go to.

Do remember that the IP can pay for only 90 per cent of the bill – after the initial deductible that ranges from $1,500 to $5,200 each year, depending on the ward class and your age. This deductible has to be paid before insurance coverage will kick in.

Take, for example, stenting to treat a blocked artery, which thousands of people in Singapore undergo each year: Based on the Ministry of Health’s (MOH) typical bill size, that for a patient in Class B1 is $15,889; for someone in Class A, it is $17,733; and at a private hospital, it is $37,357.

Assume your deductible has already been paid. Your 10 per cent share of the bill will be $1,589, $1,773 and $3,736.

MediSave can be used to pay for part of it, but the rest will need to be paid for in cash.

Q: Do I still need an IP if my company provides me with health coverage?

A: If your company provides you with hospitalisation coverage, you probably do not need an IP. The question to ask yourself is what happens after you stop work.

If you want to be treated as a private patient, then you need to have an IP. But it will likely be too late to buy an IP at that time. That is because by that time, you will likely have pre-existing conditions. Such conditions generally start surfacing when one is between 40 and 50 years old.

That will make it difficult for you to buy an IP as insurers will either reject your application, or exclude coverage of conditions you are more likely to suffer from – which defeats the purpose of having an IP in the first place.

You need to buy your IP while your health is still in tip-top form. So, should you want an IP after you retire, you will probably need to buy one while you are working – even if your company pays for your hospital treatment.

Q: How do I choose an IP?

A: MOH has calculated the premiums you need to pay for the various IPs now on the market. Use that as a first gauge, but remember, premiums will go up in future. And there is no guarantee that an IP that is cheaper today will remain so in time to come.

But cost should not be the only factor you look at. Insurers charge different premiums but also provide different coverage. Some continue to cover treatment costs after discharge, for varying lengths of time.

An insurer also provides better coverage for its private hospital IP if you seek treatment from a doctor on its panel. So do look into that, too. This does not apply to IPs that cover Class A and B2 treatment in public hospitals, as all public-sector specialists are automatically on the list.

Other factors, such as how fast an insurer pays and how often it disputes claims, are also important. According to MOH, five insurers process 75 per cent of claims within one day, while Raffles takes four days and Prudential takes six.

The Singapore Medical Association asked its members to rank IPs, so that might help. But do note that the responses used came from 210 doctors for 2021, and 152 for 2022 – which means the ranking is based on the views of less than 10 per cent of private-sector specialists.

If you are not sure what to get, and you are very young, it might make sense to buy a higher-level IP as premiums are relatively low. For people aged 30 and younger, the premium for a private hospital IP comes to less than $600 a year.

It is easy to downgrade but much harder to upgrade.

However, if your decision is to eventually downgrade, then you should not wait till you are priced out by the premiums before doing so, since you will be wasting your money on higher premiums than necessary. Premiums that are paid for with MediSave are still your money, which earns 4 per cent interest if left untouched.

MOH said that between 2020 and 2023, 2.2 per cent of people aged 60 and older gave up their IP in favour of just MediShield Life.

For those who decide to buy an IP for Class B1 treatment, do note that six insurers have their own B1 plans with varying coverage, but all seven also offer a Standard B1 IP. Coverage provided by this standard plan is identical across all insurers, so the deciding factor here should be cost.

Look at this website for information on the coverage provided and premiums charged for all IPs: https://www.moh.gov.sg/healthcare-schemes-subsidies/medishield-life/comparison-of-integrated-shield-plans

Q: Looking at MOH’s calculations, keeping my current IP is going to be expensive. What are my options?

A: If you already have a serious medical condition and are getting treatment and insurance coverage for it, you might want to stay with your existing IP, since premiums will likely be much cheaper than the cost of treatment.

However, half or more of people who have IPs choose a lower ward class than is covered by their insurance when they need hospital care.

There are various reasons why people do this.

It could be because they fear that the portion of their bill might be high, and so they opt for a lower class with a cheaper bill. Or that they think they will likely need long-term outpatient treatment that will not be covered by their IP, and, hence, they choose a subsidised ward for cheaper outpatient cost.

If you are likely to do the same, then you might want to downgrade your IP to one that meets your needs and has more affordable premiums.

If you want to keep the class of treatment – for example, continue with a private hospital plan – but choose an insurer that charges a lower total lifetime premium, you could apply for coverage.

But if the insurer is willing to accept you only with certain exclusions, it is better to stick with your current insurer and either bite the bullet and pay the higher premium, or downgrade to a lower coverage.

This is because health insurance with exclusions does not provide you with comprehensive coverage, which is important, especially as you age and might suffer from multiple medical conditions.

Downgrading with your existing insurer will ensure that there are no additional conditions to your coverage.

Q: Do I need to buy a rider if I have an IP, since my share of the bill might be higher than what I can afford?

A: The ministry has mandated that MediShield Life and IPs must have a deductible and a co-payment element.

Insurers sell riders to take care of this. Prior to March 2018, insurers were allowed to sell riders that covered 100 per cent of the patient’s portion of the bill. Since then, customers buying new riders have to pay 5 per cent of the bill, but this can be capped at $3,000 a year.

The premiums for riders have to be paid in cash, and, like IPs, they go up with age. You need to assess if you can afford to pay those premiums into your old age.

Furthermore, while riders are supposed to pay only the deductible and 10 per cent of the bill, some have premiums that are higher than those of IPs that cover 90 per cent of the bill.

With the introduction of the Cancer Drug List in 2022, IPs can cover only cancer treatments on the list. Riders, however, can also cover treatments not on the list. So getting a rider could provide you with better cancer coverage.

But again, you should do your research as riders do not cover all cancer treatments not on the list, with coverage varying from insurer to insurer.