Higher claim limits, new tiers under MediShield Life to help with cost of complex surgeries

SINGAPORE — MediShield Life, the basic hospitalisation insurance scheme covering all citizens and permanent residents, will have higher claim limits and new tiers of claim limits from Jan 1, to better help Singaporeans with large medical bills.

The claim limits have been adjusted to keep pace with increased healthcare costs, while the number of tiers of claim limits will be tripled from seven to 21, the Ministry of Health (MOH) said on Friday (Dec 27), adding that these moves are aimed at providing better coverage for more complex surgical procedures, which tend to be costlier.

Currently, patients undergoing surgical procedures listed in MOH’s Table of Surgical Procedures (TOSP) can claim from MediShield Life and MediSave to help with the cost of their medical bills.

The full list of over 2,000 surgical procedures under TOSP can be found on the MOH website.

With the changes, patients will be able to claim more from MediShield Life and pay less from MediSave or by cash.

Around 90,000 patients a year are expected to benefit from higher Medishield Life payouts with the implementation of the new claim limits, said MOH.

One such beneficiary is Ms How Pei Fen.

Her one-year-old son, Bryler, will be undergoing a cleft palate repair surgery next month at KK Women’s and Children’s Hospital, and Ms How intends to use MediShield Life to offset the cost of the surgery.

After the new claim limits kick in, Ms How, 27, will be able to claim up to S$2,180 for the procedure, an increase from the current claim limit of S$1,400.

In all, the medical bills for Bryler are estimated to be about S$15,000, before government subsidies. Ms How told TODAY that before the new claim limits, she was concerned that she had insufficient funds both in her MediSave account and by cash to pay the outstanding balance.

“Having the new scheme will allow us to be less worried about out-of-pocket payments,” she said.

From Jan 1, the new claim limits will be automatically applied to MediShield Life claims for patients admitted for surgeries. No action is needed on their part.

The claim limits were enhanced as part of the MediShield Life Council’s (MLC) ongoing review of MediShield Life benefits and premiums, which is expected to be completed by the end of 2020.

In 2018, MediShield Life was extended to patients admitted directly from the accident and emergency departments of public hospitals to community hospitals. It was also expanded to cover two other groups of patients — those who need long-term intravenous nutrition, and children born with the rare congenital conditions of Trisomy 18 and alobar holoprosencephaly who need surgery.

Earlier this year, the national insurance scheme was also extended to inpatient treatment for serious pregnancy and delivery-related complications, as well as for patients who receive outpatient autologous bone marrow transplant treatment for multiple myeloma.