Integrated Shield Plan (IP) with full rider

For the longest time, I wanted to blog about Integrated Shield Plan (IP) but have been putting it off due to various reasons. The impetus for this article is due to a recent request by a lifetime member. He is seeking my views on the recent saga between the medical professionals and the insurers over the Integrated Shield Plan (IP).

The latest sparring between Singapore Medical Association (SMA) and insurers came after Ministry of Health (MOH) banned the sale of new Integrated Shield Plan (IP) with full rider on 7 March 2018. What riled many Singaporeans was the manner in which the policy was implemented. To prevent people from rushing to buy full riders, those buying a rider from 8 March 2018 had to switch to the new scheme by 1 April 2021 at the latest. Back then, MOH has not mandated any change to the 1.1 million policyholders who have full riders.

I am one of the 1.1 million policyholders who have full riders. When MOH announced that new Integrated Shield Plan (IP) must come with the co-payment feature, I feared that the insurers would do the same for existing policyholders. Indeed, my worst fear came true on 18 February 2021 when NTUC Income emailed me changes applicable to my Plus Rider.

My Integrated Shield Plan (IP) is Enhanced Incomeshield Preferred. Under this plan, I am entitled to a standard room in private hospital or private medical institution. The policy limit is $1.5 million. I have bought similar plan for my family as well. As Enhanced Incomeshield Preferred is basically an Integrated Shield Plan for private hospital stays, I have purchased Plus Riders for my family (including myself). The idea is to avoid paying the co-payment portion for medical bills arising from private hospital stays.

With this new co-payment feature, I will have to co-pay 5% of the claimable amount. The total amount of co-pay will be capped at $3,000 for each policy year. To rub salt into injury, the cap of $3,000 will only apply if I select the medical specialists from Income’s list of panels. Otherwise, the 5% co-payment will apply.

Please note that the information contained in this article is not meant to be a form of financial advice. If you have any queries pertaining to Integrated Shield Plan (IP), please seek financial advice from a licensed financial consultant.

Panel of medical specialists

The rationale for my purchasing of Integrated Shield Plan (IP) covering private hospital charges is essentially to buy a piece of mind. My thinking is that since public hospitals do not allow patients to choose their desired doctors, then it would make sense to seek treatments from private hospitals which allowed us to choose doctors.

Obviously, you would not want to take chances when it comes to selecting doctors for treatment of critical illnesses. You would want to select the best doctors for treatments. This is especially so when it comes to seeking medical treatments for your loved ones.

However, with the panel of medical specialists, my options would be severely restricted. If the doctor is not in the list of medical specialists in Income panel, then I would have to pay the 5% co-payment.

The changes made to my Integrated Shield Plan totally defeated the purpose of my intent of buying a private health insurance plan. It is true that Income has softened the impact by lowering the premiums for my Plus Rider by 37% and capping the co-payment fee to $3000. But there is absolutely no assurance that the premium will remain the same for the next few years. The cap can also be raised as and when Income thinks its justifiable. In fact, the premiums for my Integrated Shield Plan (IP) and rider had been rising for the past few years.

Furthermore, there is a lack of transparency of how the insurers select the medical specialists to be included in the list of panels. If the basis of selection is the fees charged by the medical practitioners, then surely the insurers would choose those doctors who tend to charge lower fee tiers in exchange for higher volume of patients? In my opinion, renowned doctors who are experts in their own fields would likely to charge a premium. Thus, it is likely that they would be excluded from this pool.

My proposals

MOH’s ban on the sale of new Integrated Shield Plans that come with full riders in 2018 created a conundrum for the stakeholders. Although the policy intent is to ensure a sustainable and affordable healthcare system, the move by MOH could lead to an uneven playing field between policyholders and insurers. With support from the government, insurers are even more aggressive in adjusting the terms and conditions of their Integrated Shield Plans.

In addition, I don’t think it is fair to attribute the losses incurred by the insurers solely to overconsumption by the policyholders or overcharging by doctors. In any case, I am not sure whether MOH has conducted an extensive investigation on whether the losses suffered by IP insurers are solely due to IP claims. Would it be more reasonable to expect the MOH to require insurers to first reduce their operating costs, such as the commission costs or management fees? Regardless, I hope to see the following changes would happen for Integrated Shield Plan:

• Removal of deductible and co-payment. I don’t see the need for these features as the Integrated Shield Plan should have covered the hospital bills in the first place. And they are also confusing from the perspective of consumers. Without them, there will be no need for consumers to buy expensive riders.
• The moves by SMA to rank insurers and set up a complaints committee to flag out issues relating to Integrated Shield Plan claims are commendable. However, these initiatives lack backing from the authorities. My take is that SMA should collaborate with MOH and MAS to regularise these initiatives, thereby sending a strong message to the insurers.
• Integrated Shield Plans (IP) are inelastic products. This means that the demands will remain largely unchanged even if insurers raised the premiums several folds. To resolve this, MOH should consider innovative solutions to make the supply and demand more elastic. One way could be to allow consumers to own more than one shield plans and allow co-sharing of claims among insurers. Another idea could be allowing the portability of shield plans.
• Apart from blaming policyholders for overtreatments and doctors for overcharging, authorities should also check the proportion of costs incurred by insurers in the course of processing the claim. To provide transparency, the costs should be made public for consumers to make informed decision.
• MOH should remove the lower limits for the medical treatment costs and just set the upper limit. This will prevent insurers from choosing doctors who charge just the minimum, thereby making the panel of doctors more inclusive.
• Reward policy owners of Integrated Shield Plan (IP) who did not make any claims annually by offering premiums rebate. It is unfair to keep charging increasing annual premiums to those who did not make any claims at all.

Conclusion

It is a fact that medical costs are rising in recent years. But is it solely due to the “buffet syndrome” of policyholders or doctors overcharging? I feel it is too onerous for the authorities to slap a ban on full riders based on the several black sheep cases. Is it a widespread issue that really warrant an outright ban? Honestly, only the authorities would know best as they have the full data supplied by the insurers.

From the perspective of a policyholder, I have been responsible and did not even make a single insurance claim for the past twenty years. My wife had made a claim for her eye surgery a few years ago but we did not seek other treatments unrelated to her medical problem.

At the end of the day, I just hope that the interests of policyholders will be more looked after. After all, I don’t work in the medical or financial industry. I am sure most policyholders face the same situation like me. We all look over to the authorities to ensure an affordable and sustainable healthcare system.