Medishield Healthcare Scheme

IMPORTANT NOTE – MediShield Life has replaced MediShield starting from November 1, 2015.

What was MediShield?

MediShield was a basic insurance scheme that was introduced by the CPF for the payment of large hospital bills.

Using MediShield:

The best way to use MediShield was for the payment of hospital expenses in Cass A and B1 wards in restructured hospitals because this was a basic medical insurance scheme.

If you wanted to use the MediShield cover in private hospitals, you needed to additionally purchase IPs or Integrated Shield Plans which were approved by Medisave. An IP or Integrated Shield Plan consists of 2 components – the first consisting of MediShield (now replaced by MediShield Life) and the second is an enhancement plan consisting of private insurance. This plan will provide a wider range of cover and can be then used for treatment in higher wards in private hospitals.

How did MediShield work?

The MediShield scheme comprised of two features – the Co-insurance and the Deductible features which you needed to first pay using the savings in your Medisave Account (MA) before you claimed the rest from MediShield.

Deductible feature – this was the amount that you needed to pay initially for the claim/s you made in the policy year before receiving any payouts from the MediShield scheme.

Co-insurance feature – this referred to the percentage of claim you needed to pay above the deductible portion of the claim. It typically ranged between 10% and 20% of the amount claimable based on how large the hospital bill was.

Waiting Period for MediShield:

The waiting period for a MediShield claim was approximately 2 months after approval. During this period, you could not make any claims until the commencement of the cover.

Also, during the waiting period, if there were changes in the status of your health condition, you had to inform the CPF Board regarding the same. The CPF Board did not approve claims based on pre-existing conditions that you were diagnosed with before your MediShield commenced if you had not disclosed the same to CPF.

The health declaration of pre-existing conditions did not apply to newborns as they were covered under this scheme (now MediShield Life) from the date of their birth.

What did MediShield Cover?

MediShield primarily provided cover for hospitalization expenses and select outpatient treatments including radiotherapy/chemotherapy for treating cancer, kidney dialysis etc.

Find below the benefits and claim limits under MediShield:

  • Inpatient and/or Day Surgeries
    • Treatment charges and daily ward charges that included charges for meals, investigations, professional and miscellaneous charges:
      • Normal ward – S$450 for each day.
      • ICU ward – S$900 for each day.
      • Community Hospital – S$250 for each day.
      • Psychiatric – S$100 for each day up to 35 days for a policy year.
    • Surgical Procedures that were classified as per complexity levels increasing from Table 1 and up to Table 7 that includes more complex procedures:
      • Table 1 (least complex procedures) – S$150.
      • Table 2 – S$360.
      • Table 3 – S$720.
      • Table 4 – S$800.
      • Table 5 – S$840.
      • Table 6 – S$960.
      • Table 7 – S$1,100.
      • Implants (includes intravascular electrodes for electrophysiological procedures and PTCA Balloons) – S$7,000 for each treatment.
      • Radiosurgery (includes Gamma Knife treatment and Novalis radiosurgery) – S$4,800 for each procedure.
  • Outpatient Treatments:
    • Chemotherapy for treating Cancer:
      • For each treatment cycle of 7 days – S$270.
      • For each treatment cycle of 21 or 28 days – S$1,240.
    • Stereotactic Radiotherapy for treating Cancer – S$1,800 for each treatment.
    • Radiotherapy for treating Cancer:
      • Superficial/External – S$80 for each treatment day.
      • Brachytherapy with/without external – S$160 for each treatment day.
    • Kidney Dialysis – S$1,000 for each month.
    • Immunosuppressant in case of Organ Transplant – S$200 for each month.
    • Erythropoietin treatment for Chronic Kidney Failure – S$200 for each month.

Claim Limits under MediShield:

The maximum amount that you could claim under the MediShield scheme is as follows:

  • Each Policy Year – S$70,000.
  • For a Lifetime – S$300,000.
  • Maximum Age Cover – 92 years.

MediShield Payment

The premiums to be paid for MediShield increased depending on your age.

Table 1: MediShield Premium Payments (including 7% GST) based on Age Next Birthday

Age Yearly Premium
1 year – 20 years S$50
21 years -30 years S$66
31 years – 40 years S$105
41 years – 50 years S$220
51 years – 60 years S$345
61 years – 65 years S$455
66 years – 70 years S$540
71 years – 73 years S$560
74 years – 75 years S$646
76 years – 78 years S$775
79 years – 80 years S$865
81 years – 83 years S$1,123
84 years – 85 years S$1,150
86 years – 92 years S$1,190

The premiums due would be deducted from your Medisave Account (MA) every year for the renewal of your policy under this scheme. If your MA did not have sufficient funds for the renewal, the CPF Board would write you a notification letter asking you to top-up your MA. If you were unable to make these payments, you could request your family members to take over the payments by using their own MA savings.

MediShield Scheme Exclusions

The following were NOT covered under MediShield Scheme:

  • Any expenses you had incurred before your MediShield cover commenced.
  • Any expenses you had incurred during your entire hospital stay upon being admitted before your MediShield cover commenced.
  • Any pre-existing medical conditions/impairments/diseases you had been suffering from before your MediShield cover commenced with the exception of conditions/impairments/diseases that the CPF Board accepted in writing.
  • Cosmetic surgery expenses.
  • Ambulance fees.
  • Charges for private nursing.
  • Maternity charges or abortions (this includes Caesarean operations).
  • Charges for sex change operations.
  • Any dental work expenses with the exception of dental work requirements resulting out accidental injuries.
  • Any medical treatment that occurred overseas.
  • Sub-fertility/infertility, any assisted conception/contraceptive operation.
  • Purchasing any machines for kidney dialysis.
  • Purchasing iron-lung or any other special appliances.
  • Any treatment for which you had already received full reimbursement any form of insurance cover or Workmen’s Compensation cover.
  • Treatment of disability/illness/injury/other conditions as a result of HIV or AIDS.
  • Treatment for alcoholism/drug addiction.
  • Treating injuries that had resulted from a nuclear fallout/war or any related risks.
  • Treating injuries that had occurred from your direct participation in riot/strike/civil commotion.
  • Treatment for self-inflicted injuries (including suicide attempts).
  • Treatment for hereditary conditions/disorders and congenital anomalies diagnosed before March 1, 2013 or after the commencement of your MediShield cover, depending on whichever of the 2 occurs later.
  • Vaccination.
  • Personality disorders or mental illness diagnosed before March 1, 2013 or after the commencement of your MediShield cover, depending on whichever of the 2 occurs later.

Claiming for MediShield

To claim your MediShield cover, you first needed to inform the hospital where you were insured under this scheme. The hospital would then submit your MediShield claim to the CPF Board. After the amount that was payable from MediShield was determined, the Board would directly pay the hospital. If your MediShield did not cover all the expenses, the balance could be paid using the savings in your Medisave Account (MA) and/or by cash.

You could claim for MediShield for expenses occurring from:

  • Any restructured hospitals.
  • Any approved private hospitals.
  • Any approved medical institutions.

Note the following:

  • You could not use MediShield to cover the hospital expenses of your dependents. This was because all CPF members were covered by this scheme individually.
  • Claims for hospitalization could be made even after a member’s death as long as they were insured under MediShield before their demise. The hospital could still submit their claim for processing.

Claiming for MediShield from stay at a community hospital –

You could only claim MediShield cover for stays at a community hospital if your attending doctor had referred you for further treatment as an inpatient at a community hospital and only after you had been discharged as an inpatient from another hospital.

You could not claim for MediShield cover for being admitted in a community hospital for respite care or for social reasons.

Submitting MediShield Claims:

MediShield claims were generally submitted by the medical institution where you were insured and hospitalized. The institution submitted the claims approximately 2 weeks after the patient was discharged.

MediShield claims had to be electronically submitted by the medical institutions, hence you could not claim this insurance directly from the CPF Board. You had to inform the institution that you wanted to use your MediShield and they would submit the claim to the Board. The CPF Board would only make the payment directly to the medical institution and not to you even if you had settled the bill. However, if there was any excess paid by you, the same would be reimbursed to you by the medical institution after the CPF Board made the payment.

Claiming MediShield in addition to having/claiming other medical insurance:

You could claim for MediShield even if you had another medical insurance. But you must note that the final amount that you claimed from your other medical insurance (including any medical benefits provided by your employer) + MediShield could not exceed the total hospital bill.

MediShield Life replaced MediShield starting from November 1, 2015. You can visit the MediShield Life page to know more about this enhanced scheme and the benefits it has to offer.

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