SINGAPORE - People with Integrated Shield Plan (IP) riders will have more doctors to choose from - potentially more than 1,000 specialists in the private sector - while still enjoying an annual payment cap of $3,000.
As at the end of May, the seven IP insurers had fewer than 200 to around 750 doctors on their panels.
While all the insurers have agreed to a new initiative by the Life Insurance Association Singapore (LIA) that will greatly expand the list of specialists patients can tap, the actual implementation may vary.
Called the extended panel, it was a recommendation by the Multilateral Healthcare Insurance Committee appointed by the Ministry of Health (MOH) last year to look into health insurance issues raised by concerned parties.
It is currently available to all rider policyholders, except for those with NTUC Income and Singlife with Aviva, for whom it becomes effective as their contract is renewed from April this year.
About 2.9 million people here have IPs, which sit atop the basic national health insurance, MediShield Life, to pay for non-subsidised care.
To prevent a "buffet" syndrome of excessive spending, MOH requires all IPs to have an annual deductible of $1,500 to $5,250 (based on ward class and age of patient) and a co-payment of 10 per cent of the rest of the bills.
More than 1.7 million IP holders also bought riders to take care of the portion of medical bills they have to pay.
Following studies showing that people who do not need to pay a cent of their medical bills tended to spend a lot more on treatments, MOH made it mandatory for patients who buy riders from March 8, 2018, to co-pay 5 per cent of their bill, with the rider picking up the rest.
But it allowed insurers to cap the patient's share of their bills to $3,000 a year if the treatment has either been pre-approved, or is done by specialists on the insurer's panel.
This led to complaints of limited choice by both patients and specialists in the private sector.
IP insurers had promised to increase the number of doctors on their panels - to between 250 and more than 500 by the end of last year. Most have made good on the promise.
A joint release on Friday (July 8) by LIA, the Singapore Medical Association and the Academy of Medicine Singapore said the new initiative will "give policyholders certain key panel benefits, even when seeing specialists from other insurers' panels, as long as the specialists comply with the insurers' terms, including fees".
With the move, patients with riders can enjoy a wider choice of specialists for non-emergency treatments. A private specialist who is not on the patient's insurance panel but is on the panel of another insurance company can submit a standard pre-authorisation request to the patient's insurer.
The release said: "The insurer will assess medical necessity and fee appropriateness to decide on the IP coverage and provide an assurance of payment prior to the planned treatment."
Insurers pay doctors differently for treatments. The difference in fees they are willing to pay for a similar treatment could vary significantly. Doctors on an insurer's panel have agreed to those fees.
If the request is approved, the patient's share of the bill will be capped at $3,000 a year should his total medical bill exceed $60,000.
This will potentially give patients access to 84 per cent of the 1,287 private specialists - this number excludes back-end specialists, such as pathologists, who are already on an insurer's panel.
The release said the scheme "gives a specialist who is currently not on the patient's IP insurer main panel an opportunity to establish a working relationship with the insurer".
This initiative has no impact on the more than one million people with IPs but no riders.