Sharing Information on Structure and Workflow in Singapore's Public Healthcare Clusters with Integrated Shield Plan Insurers to Facilitate Disbursements of Claims by Patients for Care Received

Dr Tan Wu Meng asked the Minister for Health whether Integrated Shield Plan insurers receive information and guidance on the structure and workflow of Singapore's public healthcare clusters so that patients at public hospitals do not encounter unnecessary administrative hurdles to receiving reimbursement for care across departments and institutions within the same public healthcare cluster.

The inpatient claims process at our public healthcare institutions have been integrated and streamlined for both MediShield Life (MSHL) and Integrated Shield Plans (IPs). Claims are submitted directly by public healthcare institutions (PHIs) through the MediClaim system, without the need for the patient to file any claims.

In the outpatient settings, IPs may provide additional coverage beyond MSHL such as pre- and post-hospitalisation benefits, and the exact coverage may differ across insurers. These claims are filed directly by patients with their insurers and may require the submission of supporting documents such as referral letters.

Once the claims are filed, public healthcare institutions or patients are reimbursed directly by the Central Provident Fund Board (CPFB), or by IP insurers for patients with IP coverage.

MOH and the CPFB work closely with the insurers and public healthcare institutions in resolving any claims filing and reimbursement issues, especially for appeals or complex cases. We also ensure that insurers are informed about any changes to claim processes. We will continue to partner all stakeholders to explore opportunities to further streamline the claim processes, especially where there are referrals across institutions as part of clinical protocol and routine treatment requirements.