Forum: All have part to play in keeping health insurance affordable

We refer to recent letters and Dr Wong Chiang Yin's op-ed on Integrated Shield Plans (IPs) (Who is minding the gap on health in health insurance?, Sept 17).

Dr Wong raised concerns that Aviva had removed its IP coverage for medically necessary diagnostic endoscopies and asked if there were gaps in oversight of IP insurers.

Medically necessary diagnostic procedures are covered by IP insurers. The Monetary Authority of Singapore (MAS) has engaged Aviva, which clarified that it did not change its IP terms and conditions.

It had tightened its claims assessments, having observed a trend of questionable claims. However, this tightening resulted in claims being rejected despite being medically necessary.

Aviva has since revised its assessment approach and undertaken to approve such claims.

The Ministry of Health (MOH) and the MAS work closely together in exercising regulatory oversight over IP insurers. They have to seek approval from MOH for changing IP terms and conditions.

MAS will act against insurers if they do not pay claims in accordance with the policy terms or have unfair claims handling practices.

MOH and MAS will enhance our surveillance efforts so that inappropriate practices can be identified and dealt with more expeditiously.

We will also look into:

• providing guidance on determining the medical necessity for specific procedures;

• requiring insurers incorporate this guidance into their claims assessment.

Dr Wong's comment that an IP policyholder can be worse off than someone covered only by MediShield Life is incorrect.

IPs provide additional coverage above the MediShield Life component. As the Central Provident Fund Board assesses all claims for that component of IPs, a person with an IP would not receive a lower payout than a person with only MediShield Life.

All stakeholders - patients, insurers and medical practitioners - have a role in ensuring health insurance remains affordable.

Patients should refrain from over-consuming healthcare; doctors should prescribe only treatments that are medically necessary; and insurers should assess claims carefully to minimise over-consumption without compromising necessary healthcare.

MOH and MAS will step up engagement with clinicians and insurers to strengthen good practices that will help ensure appropriate and affordable care.

Cham Dao Song

Director, Finance Policy

Ministry of Health

Daniel Wang

Executive Director, Insurance,

Monetary Authority of Singapore

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