PUBLISHED ONFebruary 27, 2014 12:00 AM
SINGAPORE - A second insurer has been taken to task by the Ministry of Health (MOH) over reduced payouts to policyholders on dialysis.
Two months ago, MOH asked insurer AIA not to reduce payouts to such policyholders, whose benefits shrank when they were moved to a different health plan. About 20 end-stage kidney failure patients on dialysis were affected.
Now, it has told Aviva not to short-change similar patients.
The moves follow queries by The Straits Times to MOH about the reduced payouts.
Aviva reduced the amount of payout for dialysis under two of its integrated MediShield plans in March last year, when the basic MediShield package was enhanced. At the same time, it raised premiums.
Payouts for dialysis were cut from 65 per cent of the dialysis fees to 50 per cent of the cost under its public hospital Class A plan, resulting in patients having to top up more in cash themselves despite having insurance coverage.
And under its Class B1 plan, only 30 per cent of the cost of dialysis became covered, down from 50 per cent.
The integrated MediShield plans, for which Medisave can be used to pay the premiums, offer plans pegged at the rates of private hospitals and A and B1 class wards at public hospitals. The basic MediShield covers people for subsidised care.
Some integrated MediShield plans pegged at the rates of A and B1 class wards continue to pay out as charged for dialysis, subject to a monthly or annual cap.
Unlike for most types of medical treatment here, where there is private, public and subsidised care, for dialysis, there are no centres in the public sector. Most are run by voluntary welfare organisations such as the National Kidney Foundation, and patients are means-tested. The rest are privately run.
So, someone who has enough money to be unable to qualify for subsidised dialysis at one of the means-tested centres has to go to a private one.
Dialysis is for life, and costs vary from $2,500 to more than $4,000 a month at private centres.
Following MOH's intervention, Mr Daniel Lum, Aviva's director of product and marketing, said it is now contacting its three affected policyholders about giving them the payouts they had enjoyed previously. They will also be reimbursed the difference between the previous payout and the reduced one dating back to March last year.
Although MOH had approved the changes to Aviva's plans as it felt that pro-rating the payout would "help to ensure that policyholders also take responsibility for their health-care needs and help to curb unnecessary claims", its spokesman said, the change was not meant to affect those already claiming the benefit.
The spokesman added: "MOH understands that some policyholders may have been adversely affected by these changes and has requested Aviva to look into the matter."
Aviva's Mr Lum said: "This is an interim measure to help with the current crunch that the dialysis centres are facing. It's not meant to encourage all customers who bought plans for government hospitals to opt for private treatments and drive up the claims, which will ultimately impact premiums for everybody."
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