Insurance Coverage for Persons with Autism and Mental Health Issues

Mr Chong Kee Hiong asked the Prime Minister (a) how does the extent of insurance coverage for persons with autism and mental health issues compare against that for the general population; (b) what are the main reasons for rejection or reduced insurance coverage purchases by this group; and (c) whether standardised risk assessment criteria can be implemented across all insurance companies for greater transparency.

Under our national insurance schemes, there is no difference in coverage between persons with autism and/or mental health conditions, and those without. MediShield Life provides basic health insurance coverage for life for all Singapore Residents, regardless of pre-existing health conditions. CareShield Life, which provides basic financial support in the event of severe disability, covers all Singapore Residents born in 1980 or later. When the scheme is launched for older cohorts, they can all join if they are not severely disabled.

Private insurers offer optional coverage on top of the national insurance schemes. Insurers apply the same underwriting approach to all customers, which does mean that they take into consideration their customers’ medical history, health condition and health risks arising from the condition. This is consistent with international practice. Insurers may accept or decline an application or adjust the premiums or coverage to appropriately reflect the customer’s health risk relative to those of others in the insurance pool. This ensures the insurance pool is sustainable, with sufficient funds to pay the anticipated claims.

Private insurers have to base such assessments on the evidence. International research has shown that autistic persons often experience co-occurring conditions and that hospitalisation rates among them are typically higher.

MAS, together with the MSF, is engaging insurers and other stakeholders on ways to improve autistic persons’ access to insurance coverage. We understand the motivation behind the suggestion to require insurers to apply standardised risk assessment criteria. But this could have unintended consequences. For example, restricting the ability of insurers to adjust coverage and premiums for higher-risk individuals could lead to higher premiums for policyholders who are of lower-risk.

MAS expects insurers to deal fairly with all customers, which means assessing all applications carefully and clearly communicating underwriting outcomes to them. The Life Insurance Association is developing a consumer guide to raise awareness and enhance transparency of insurers’ risk assessment approach towards health insurance underwriting.