Is it a smart move to change insurers for shield plans?

SINGAPORE - My last column on why the recent premium hikes for Singapore's health-care insurance plans deserve closer scrutiny seems to have struck a chord with many.

I have received numerous e-mails that have raised a host of thoughtful points on this topic.

Just to recap, I wrote about how, beyond the surge in claims, other factors such as inflated doctors' fees and hospital charges were also contributing factors to the hikes.

I added that I was prepared to change insurers owing to the significant difference in premiums in the various integrated shield plans each one offers.

Some of those who wrote to me wanted to share their personal experiences of being billed inflated amounts at private clinics, while others offered solutions. There were also some who gave their views on changing insurers, which I feel deserve an airing.

One reader, Gek, wrote about how a private clinic she went to recently charged a different rate depending on whether the patient was covered by insurance.

"When queried about the high charges, the private doctor relented and the whole thing became negotiable depending on how much is claimable from the insurance company," she said, questioning the "flexi-rates" charged by doctors.

Others, such as Renee, said she felt that the Ministry of Health is not doing enough to regulate the fees charged by private practices.

She said: "Many have no choice but to turn to private hospitals because of the hospital bed shortage. (But) many doctors have also subtly become sales promoters of hospital services such as MRI or CT scans, or unnecessary day surgery, which forms part of their additional income when they book the operating theatre."

She recounted how her husband recently fell and incurred a minor thumb injury but was put through X-rays, magnetic resonance imaging scans and eventually day surgery, which they felt was unnecessary and eventually cost them more than $10,000.

The entire amount was paid out by their insurer, she said, but they could not help but wonder about the "unnecessary medical treatment and wastage".

She suggested that any doctors' fees or hospitalisation charges that are claimed through integrated shield plans should be limited to a cap not exceeding a certain percentage above government hospital fees - something I think is worth looking into.

Private hospitals have the discretion to charge differently, she acknowledged, but when the reimbursement is from a national health insurance scheme, there should be a degree of regulation, she said.

Another reader, Colin, questioned if the "as charged" feature for integrated shield plans makes it an "easy target for abuse by doctors". He also asked if it needed to be reviewed.

Another reader related how in recent years, he has often heard doctors say: "Don't worry, I can help you claim."

He added that even though patients seeking treatment are happy that they do not have to foot the bill, in the long run, everyone pays when premiums go up and the only beneficiary is the doctor.

Some readers also asked me which insurers they should go with, given the difference in premiums that each of the five - AIA, Great Eastern, Prudential, Aviva and NTUC Income - offer.

Besides doing a direct comparison of the premiums, some other factors to consider include your age and existing health condition. For the young and healthy, switching to an insurer with a more competitive pricing plan is an option worth considering if the premium savings are hefty. For example, if my husband and I make a switch, we could save more than $300 annually in premiums.

But as one insurance adviser who wrote in said, if we switched insurers, we take the risk that the new insurer will not cover pre-existing illnesses, regardless of whether we know if we have any illnesses or not.

So, if I switched from A to B this year, and in a year's time, I find out that I had an illness that developed two years ago, insurer B is within its rights to reject claims related to this as it is considered a pre-existing illness. I would have avoided this situation if I did not make the switch as insurer A would have no right to reject the claim.

It comes down to how confident you are about your own health. I would probably have no qualms switching insurers for myself and my 18-month-old son, given our age and health condition.

My husband also has no known existing medical condition but at age 40, it is riskier for him to make the switch as there is a higher likelihood that he may have a pre-existing condition that will not be covered by the new insurer.

One other adviser I spoke to recently also pointed out that over the years, the fees of insurers vary greatly.

Prudential, for example, used to be more expensive relative to the other insurers but their premiums today are one of the most attractive in the market.

The reverse is true for Great Eastern. In the long term, it's hard to say whose premium will be cheaper, and you, the policyholder, might end up taking risks and doing lots of unnecessary paperwork "chasing" the cheapest insurer.

If the difference in premium is less than $100, he said, it is safer and less of a hassle to stick to your current insurer.

One reader, May, said you can keep changing insurers but if in the end, the premium hikes remain unregulated, "it's back to square one" for consumers.

I'd like to end with some food for thought from a reader, Chee Peng, who said "the only way to get out of this trap of ever-rising health and insurance costs is to stop giving power away to doctors and hospitals, and take responsibility for our own health".

In other words, being healthy should remain our top priority - doing so would give you the confidence to go for the most affordable health-care option and help avoid incurring hefty medical bills you can't afford.

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