SINGAPORE - When Mr S. Kalleychelbon had a heart attack, his health was not his only worry.
After heart bypass surgery and two weeks of recovering in a B2-class ward in 2010, he racked up a hospital bill of about $20,000.
The operations manager had no insurance coverage - not even the basic MediShield.
His wife, a childcare teacher, and daughter, who was about to graduate from university, had to chip in to pay the amount in full.
"At that time, we really never thought of insurance," the 57-year-old lamented. "My daughter was still schooling, so we had a lot of other things to think about."
However, when MediShield Life kicks in next year, someone in Mr Kalleychelbon's shoes will bear a lighter burden.
All Singaporeans will be covered by the scheme for life, leaving no one without at least basic insurance coverage.
Patients will also be able to make larger claims than before, cushioning the blow of large hospital bills arising from common conditions like stroke or cancer.
Such bills are major concerns for many, said principal medical social worker Tan Boon Cheng, who works for the National Heart Centre Singapore.
"Some patients may not be financially prepared to cope with the hospital bill," she said, adding that many may run out of money in their Medisave accounts or reach the maximum withdrawal limit. "That is when they have to make cash payments, and some may find it hard to manage."
The cost of outpatient chemotherapy and radiotherapy treatments, for example, can run into the thousands.
Ms Anna Li, 40, paid nearly $15,000 in total for both treatments after she was diagnosed with breast cancer last year.
This was in addition to bills for doctors' consultations and tests to ascertain the right treatment.
The majority of her bills were paid for by Medisave and Medifund, or were claimable under MediShield.
Common questions answered
"I am very lucky that I got medical assistance and, so far, I have not forked out any cash," Ms Li said. "But not all patients have managed to get that."
Under MediShield Life, cancer patients undergoing these treatments could pay less than half what they are paying now.
But better coverage means premiums will go up, although two in three Singaporean households will be eligible for subsidies to help with the increase.
The MediShield Life Review Committee also proposed that premium increases should be capped at 3 per cent for those currently insured under MediShield.
One man looking forward to next year's changes is Mr Jag Kuo, whose 74-year-old father was recently diagnosed with lung cancer.
Last year, his father was also warded for a lung infection for nearly a month and ran up a final bill of close to $10,000. Most of this was paid for using his father's Medisave funds.
"The bill for us was manageable," said the bank compliance officer. "But it was still a substantial amount."
Mr Kuo, 35, knows premiums will increase, but still welcomes the additional coverage.
"After all, everything comes with a price," he said.
Common questions answered
I am confused: How much of my hospital bill does MediShield cover?
MediShield claims are based on all the hospital bills you get in an entire policy year. All claims are first subject to a maximum (called the "claim limit") that you can claim for different services - for example, no more than $450 a day in a normal ward, but up to $900 a day in intensive care.
Of this amount below the claim limit, you first have to pay what is known as the "deductible", which ranges between $1,500 and $3,000.
Of the amount above this deductible, you co-pay 10 per cent to 20 per cent. This is sometimes referred to as "co-insurance".
MediShield then pays the rest of the 80 per cent to 90 per cent. In the diagram (top), the area in grey is the portion you pay and green is what the insurance pays.
So, what will change with MediShield Life?
Your share of big bills - in grey - goes down (graphic below).
I am on an integrated shield plan. Will I be entitled to the government subsidies?
The Government will give subsidies to middle- and lower-income households, roughly those whose total family income divided by the number of people in the family is $2,600 or less.
If you qualify, you will get the subsidy, regardless of the type of medical insurance you have.
That aside, everyone will receive four years of subsidies once MediShield Life begins next year.
If you are in the pioneer generation, you will also get the pioneer generation subsidies, regardless of your income or type of insurance coverage.
I was not eligible for MediShield before. How do I sign up for the new scheme?
If you were excluded for medical reasons (for example, former cancer patient or diabetic), you would need to pay 30 per cent more in premiums every year for the next 10 years, but you will be able to claim against the insurance as soon as you are signed up.
You will be automatically included when MediShield Life starts.
If MediShield Life gives such good medical coverage, should people give up their integrated shield plans with their higher premiums?
Integrated shield plans are policies that provide additional benefits beyond MediShield Life coverage.
Whether you want to keep your integrated shield plans with higher premiums depends on the hospital ward you are likely to choose.
If you plan to go private, then you will need such a plan catering to private hospitals or private wards in a public hospital.
But if you plan to go for subsidised hospital services, then MediShield Life should be sufficient.
If I have only MediShield Life and stay in an A-class ward, will I be covered?
MediShield Life will cover the amount it would for a B2 patient. With MediShield Life, the coverage will be higher than now - but will not be able to pay the bulk of your bill.
If you plan to use A-class service, it is best to get an integrated shield plan for that class.
As MediShield Life will cover most of the hospital costs, and government subsidies will help pay the premiums, is it not pointless to have so much in Medisave?
Aside from premiums, you would still need to pay the deductible of $1,500 to $3,000 a year.
If, for some reason, you need to be in and out of hospitals every year for 10 years, it would mean $15,000 to $30,000 just in deductibles alone.
There is also the co-payment of 3 per cent to 10 per cent.
On top of that, you are allowed to draw up to $400 a year from your Medisave account to control chronic ailments, vaccination and basic health screening.
While healthy people might not need that much, the majority are likely to need it. Studies show that 80 per cent of health-care expenditure is usually spent in the last years of life.
For more information on MediShield Life, go to www.moh.gov.sg/content/moh_web/medishield-life.html
For comparison of MediShield and the various integrated plans, go to www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidie...
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