Data on Doctor Representation, Claim Rules and Premium Charges of Integrated Shield Insurance Plans

Mr Yip Hon Weng asked the Minister for Health with regard to Integrated Shield Plans (a) what are the considerations on whether to expand claim rules to include more medical specialties and diagnostic tests for common conditions; (b) whether the Ministry will mandate a minimum co-payment for new private insurance policies to moderate healthcare costs; and (c) what measures will be taken to safeguard policyholders' access to necessary care and ensure insurance companies do not wield excessive influence in deciding what tests and procedures are claimable.

Mr Yip Hon Weng asked the Minister for Health (a) whether there are plans to expand the scope of the Claims Management Office (CMO) as well as the Clinical Claims Resolution Process (CCRP) to handle claims on private insurance policies; and (b) in light of concerns regarding insurance companies delaying or cancelling payouts after policyholders make claims, what avenues of recourse do policyholders currently have; and (b) what penalties will be imposed on insurance companies engaging in such practices to ensure fairness and timely resolution for policyholders.

Ms Mariam Jaafar asked the Minister for Health (a) whether the Ministry will continue to publish updated information and comparison of Integrated Shield Plan insurers' premiums and coverage regularly; and (b) if so, at what frequency.

Ms Jessica Tan Soon Neo asked the Minister for Health whether measures will be in place to ensure that any increases to premiums for Integrated Shield Plans (IP) are fair and sustainable for policyholders, given that the two-year period where premiums for IPs remained unchanged to support policyholders amid implementation of the Cancer Drug List will end on 31 August 2024.

My response will also cover the matters raised in the written question by Mr Yip Hon Weng1 which is scheduled for today's Sitting.

Before addressing the specific queries, let me reiterate the current health insurance situation, as explained in my public speech last month.

Our assessment is that the health insurance industry is very competitive, so much so that insurance companies are offering very generous terms to compete for market share. It is only human nature that when terms are too generous and someone else is paying the bill, the behaviour between patients and doctors changes and a buffet syndrome is created. The health insurance industry is at risk of becoming a race to the bottom. Claims and, in turn, premiums, are rising fast and the system is in danger of becoming unsustainable.

The questions raised by Members reflect this deeper issue. Embedded in the questions are many requests to make claims easier, coverage better and premiums lower. We all wish for such better deals. But we also know it is highly impossible. They will probably make the system even more unsustainable and the current problem even deeper. To be more specific:

First, there is a question on whether the Ministry of Health (MOH) can ensure premium increases are fair. Indeed, as claims escalate, insurance companies are under pressure to raise premiums. For national health insurance, namely, MediShield Life, we can increase premium subsidies or provide MediSave top-ups to make premiums affordable. However, private health insurance is commercially offered in a free market. What MOH can do is to continue to publish premiums and coverage annually to facilitate policyholders making the right choices.

Second, is the request to expand doctor panels. To contain costs, insurance companies introduced panels, comprising doctors who charge responsibly. Due to public feedback, insurance companies have expanded the panels somewhat. But expansion beyond a certain point will likely mean less ability to contain costs. Since each insurer publishes their list of panel doctors on their websites, it will be better for policyholders to enquire from their agents or seek out the latest information on the insurance companies’ websites than for MOH to publicise the information.

Third, and in a similar vein, it will be better for consumer groups to establish platforms and fora for sharing of insurance experiences, not different from how such fora are set up for various services, from retail and restaurants to hotels and point-to-point private transport.

Fourth, there are questions on whether MOH can ensure policyholders have access to necessary care, control coverage for private health insurance and set up avenues of recourse for private insurance claims disputes. As mentioned, private insurance policies are commercial contracts that policyholders enter into with insurance companies. It is very important for policyholders to know what treatments are covered and what are not, before they enter into the contracts. If they are looking for something with very wide coverage, it will most likely fetch higher premiums. The Monetary Authority of Singapore and MOH require insurance companies to uphold their contractual obligations and process claims in a fair manner. Insurance companies that fail to do this can be subject to penalties, such as warnings, offers of compositions and sanctions. Policyholders who wish to dispute a private health insurance claim outcome may appeal to their insurer. If they are still not satisfied with the outcome, they may tap on the Clinical Claims Resolution Process for Integrated Shield Plan (IP) claims disputes of a clinical nature and the Financial Industry Disputes Resolution Centre (FIDReC) of a contractual nature. The Claims Management Office set up by MOH also uses complaints on unreasonable medical bills as a basis to identify cases for potential claims adjudication. These cases usually comprise hospital bills covered by private insurance. The Claims Management Office also develops claims rules to guide doctors in making appropriate MediShield Life claims for common procedures or those more susceptible to complaints. While claims rules are developed to govern MediShield Life claims, private health insurers also reference them when assessing IP claims.

It is also useful to remember that regardless of any disputes with insurance companies, all policyholders will be able to access subsidised care in public hospitals. Our public hospitals may vary subsidies based on means-testing but will not deny access to care. So, the request to restrict private insurance policyholders to unsubsidised or private care is not consistent with our fundamental policy of ensuring universal accessibility to healthcare.

It is natural for policyholders to want better coverage, greater access to care, more choices of doctors and lower premiums. But in today’s situation that MOH has explained, these are not likely achievable. We need to break the current cycle of overly generous terms, over-charging and over-utilisation, leading to rising hospital bills, escalating claims, higher premiums, which then result in policyholders demanding better terms.

Members have put forth questions that may be part of the solution. First is education. We can do more to help consumers better understand insurance, how a hospital bill is covered by subsidy, MediShield Life, MediSave and private insurance, so that they know what they are paying for and can make better choices.

Co-payment instils discipline in the system and keeps the inflation of hospital bills and insurance premiums in check. Today, there is already co-payment. However, those who bought riders can minimise their co-payment to 5% of the hospital bill, up to a limit of $3,000. These are parameters we have to constantly review.

There are complex interdependencies across the healthcare system, the private insurance industry, as well as all of us, as patients and policyholders. If we are to break the vicious cycle of runaway healthcare costs, unaffordable premiums and increasing anxiety, all stakeholders must play their part to treat, insure and consume responsibly. MOH will have to carefully consider appropriate interventions.