When it comes to health insurance in Singapore, both Singaporeans and PRs are covered by the MediShield Life plan. You can choose to add on to this basic plan with an Integrated Shield Plan (IP), which gives you the option of being treated in better wards or private hospitals.

Recently, there have been some changes made to the Integrated Plans, and the Integrated Plans used on top of your basic insurance. One main factor is that with some IPs, you are only able to consult with doctors on your insurer’s panel without any extra costs.

Additionally, various changes have been made to what is and is not covered by your insurer. The Straits Times recently brought to light that diagnostic endoscopies, while medically necessary for certain procedures such as the detection of cancer, were not covered by all insurers until earlier this month.

We will explore how this affects your medical benefits and seeking the necessary treatment from your preferred doctor within this article.

Two main things have come of these changes to health insurance in Singapore. That is, some doctors have opted out of insurance panels, and it has come to light that insurance companies are limiting the number of doctors allowed on their panels. What does this mean for you as a patient? Are you still in control of your treatment and medical plan?

In this article, we explore some of the reasons doctors are choosing to opt out of insurance panels, what can be done if your preferred doctor is not on the panel, and some questions you should be asking your insurance agent.

What Integrated Shield Plans Exist Today?

To begin, let us first take a look at the plans available in Singapore. To date, seven IPs exist.

They are:

1. AIA HealthShield GoldMax
2. Aviva MyShield
3. AXA Shield
4. Great Eastern SupremeHealth
5. NTUC IncomeShield
6. Prudential PruShield
7. Raffles Health Insurance

Paying for an additional IP on top of your MediShield Life plans gives you the advantage of several things. These are, higher class wards, higher claim limits, claims for pre and post-hospitalisation, and claims done by your agent meaning you don’t have to deal with paperwork.

What are the Downsides to Many Popular Integrated Plans?

Therefore, with so much information thrown your way when choosing between Integrated Plans and health insurance in Singapore, it is easy to feel overwhelmed. This can lead to you forgetting some questions that you should be asking your insurance agent before signing any additional premiums.

After all, you want to ensure that when you are paying for premiums, you know what you are paying for.

Here are some questions that you can ask your insurance agent:

• Can I go to any Doctor in any Hospital?

When buying premiums from your insurance agent, you should be asking them which hospitals and doctors are included on their panels. Your preferred doctor might not be included on the list of panel doctors that are covered by your insurance.

Unfortunately, this means that you might not be able to see your regular doctor under your insurance plan. Or you can, but you are not insured for this. Alternatively, you may need to make a copayment with a reduced pre and post treatment coverage period.

For example, with AIA’s Vita Health A plan, if you seek treatment from a non-panel doctor without prior authorisation from your insurer, you must make a co-payment of 5% of the total bill.

On the other hand, if you do not have a preferred doctor and you make an appointment at a hospital, can you be sure that the doctor you are referred to under your insurance plan is the best doctor for your treatment?

• What does My Plan Cover?

Most Integrated Plans will cover emergency services (A&E), hospitalisation, and surgeries. Depending on the price of your premium, you may be eligible for higher class wards and treatment in private hospitals. Remember to ask your insurance agent for more details.

• Are Routine Examinations Covered by My Integrated Plan?

Preventative measures and examinations such as mammograms, routine health checks, and pap smears are not typically covered by Integrated Plans.

• Which Insurance Companies Impose Penalties for Using Non-Panel Doctors?

As mentioned, there are insurers that require you to make a co-payment on your bill should you visit a doctor off the panel with or without pre-authorisation from the insurer. Aside from AIA, Aviva and Raffles Shield also charge a 5% co-payment on the total bill for visits to a non-panel doctor.

However, AIA has a cap on the co-payment at S$3000, neither Aviva and Raffles Shield have a cap to the 5% co-payment.

Why is My Doctor not Covered by My Insurance

Many doctors and clinics are choosing to opt-out of being on the panel of many of the popular health insurance plans in Singapore. This means visits to your preferred doctor may not be covered under your specific insurance plan.

Doctors and clinics are choosing to opt-out of the panel as their fees are determined by the insurer. This means that the insurers are deciding what fees are being paid to the doctors on the panel. Oftentimes, the fees being paid to the doctors are falling below the benchmark that has been set by the Ministry of Health (MOH).

Meaning that your doctor may be underpaid for his or her time and services if they opt to remain on your insurer’s panel of doctors. Further, many insurers are reluctant to state what criteria has gone into the selection of doctors on their panel.

Additionally, many insurers are not willing to take on more doctors onto their panels. This limits your choice of doctors that you can visit if you want your insurance plan to cover you.

So, what happens when your choice of doctor is limited is that as a patient? You are letting your insurer decide the fate of your treatment. You are not given the option of selecting the doctor you want to care for you. Your healthcare should be tailored to you and by you. As opposed to a generated result of what is available. In a sense, you may be shortchanged by your insurer if you are not fully aware of these terms.

Why Would I Want to Opt for My Preferred Doctor?

If you’ve already bought health insurance in Singapore, you might be thinking is it really worth paying more money to see a specific doctor? What we would like to touch on is the fact that when you rely on your insurer’s panel of doctors, you may not be getting what we refer to as a sub-specialised or super specialised doctor.

What exactly does this mean? Let us put it into simpler terms. Imagine you find yourself with the uncontrollable urge to tuck into a big, juicy, cut of steak. Would you head over to a hawker centre, which serves up all kinds of delicious food, a Western stall with steak included? Or, would you take the extra trouble to go to a steakhouse that has perfected the art of cooking melt-in-your-mouth, medium-rare cuts of prime beef?

What we’re trying to say, is that your insurer’s panel doctors are often General Specialists. On the other hand, your preferred doctor might be a ‘super specialised’ doctor. If you suffer from a broken bone in your knee, under your insurer’s panel of doctors, you are likely to be sent to an orthopaedic surgeon or doctor who may also be a spine or foot specialist.

This doctor is an orthopaedic surgeon. However, as opposed to a specialist who has narrowed down their practice to knee orthopaedics, they are specialised in a different area. They may be able to perform the surgery. However, when compared to a knee specialist who handles similar procedures regularly, this doctor may only have handled it a few times in their career.

The question is, do you want tasty-enough steak from your favourite hawker, or would you prefer the creme de la creme of steaks? The same concept should be applied to your medical care.

What Can be Done if I Want to Visit My Preferred Doctor?

You might be feeling slighted if you’re only now realising that your regular doctor who you have grown familiar and comfortable with is not included in your insurance provider’s panel of doctors.

However, suppose you want to continue seeing your preferred doctor while remaining on your current insurance premium. In that case, you are still able to do so while making use of your Medisave plan or co-payment schemes, if available.

Suppose you find that your preferred doctor is not on your list of panel doctors. In that case, you can request to use your Medisave or Additional Insurance Plan (Eg. Corporate or Personal Accident Plan) where applicable to make co-payments and deductibles to cover the cost of your treatment with your chosen doctor.

Depending on the IP you have bought and the premiums you pay, there will be some differences with how much you need to pay if you want to continue seeing your preferred doctor. For most IPs, there are complex copayment plans that you might not be fully aware of.

For more information about using your Medisave to cover this fee, speak to your doctor or a member of staff at your regular clinic and your insurance agent. They should be able to walk you through the process of using your Medisave for this additional fee.

Are There Penalties Imposed on Premiums if I Make a Claim?

While not many of us are aware, some insurers impose penalties of increased premiums if you make use of your plan. This is not something that should be applied to health insurance, falling sick and needing healthcare is not something within our control.

For example, Prudential’s IPs state that should you make a claim over a certain amount, you will find yourself with an increased premium the following year. Determining factors such as the IP that you are on, your age, and the amount claimed, decide how much your premium increases the next year.

Is your Agent Giving you All the Necessary Information?

Your insurance agent may not be intentionally withholding information from you when selling an Integrated Plan to you. However, it definitely helps to come prepared with a list of questions. This way, you can be sure that you are being given all the information you need before signing on for a premium.

If you’ve already grown comfortable with a particular clinic or doctors, as many of us have, it is recommended that you check with your agent as to whether this clinic is on the panel of doctors. Additionally, ask your insurance agent what other fees need to be paid should you want to continue visiting your preferred doctor or clinic.

We’ve Put Together a Table to Help You Understand Some of Differences Between Premiums

We hope this helps clarify some of the differences we have spoken about in this article. This table highlights some of the popular insurers in Singapore and the increase in some premiums after having made a claim. Additionally, this table also compares the prices of seeing panel and non-panel doctors, with and without authorisation. Therefore, you will be able to better understand some factors that we have touched on.

In Conclusion

As a Singaporean Citizen or Permanent Resident, you are already covered by a basic MediShield Life plan for health insurance in Singapore. This is your Medishield Life plan. However, this only includes basic medical care in public hospitals. Integrated Plans offer better coverage and treatment in private hospitals.

Additionally, while your preferred doctor may not be on your insurance panel, you can still opt to be treated by them. Health insurance is important and provides a great deal of aid financially. However, you should be the one deciding who is in-charge of your care when you need it the most.

It will benefit you to be fully aware of the terms and conditions of your health insurance plan. As mentioned, you should be in charge of your medical plan, and you should not be forced to forego a necessary procedure due to a lack of coverage. Being informed as to what options are available to you is the best thing that you can do when it comes to your health and health insurance plans. We can be thankful that changes are being made to insurance policies such as the ones regarding diagnostic endoscopies.

The information provided in this article has been compiled by Cleveraa from public sources and our independent research – it does not reflect every insurance provider’s premiums and payments.