IPs may not cover all outpatient cancer treatments from 2023
Coverage to be limited to 150 clinically proven, cost-effective drugs on MOH list
Sign up now: Get ST's newsletters delivered to your inbox
Currently, many Integrated Shield Plans cover outpatient cancer treatments on an as-charged basis. With the change, coverage will be limited to the roughly 150 drugs that are on the Ministry of Health's approved list. Claims cannot be made for drugs that are not on the list.
TNP FILE PHOTO
DeeperDive is a beta AI feature. Refer to full articles for the facts.
People who have bought Integrated Shield Plans (IPs) from private insurers may not be able to claim for certain drugs used in outpatient cancer treatments from April 2023.
The Ministry of Health (MOH) has come up with a list of clinically proven and cost-effective cancer drug treatments that can be covered by MediShield Life insurance from September next year.
The same list will apply to coverage by all IPs sold or renewed from April 2023, MOH announced yesterday.
Currently, many IPs cover outpatient cancer treatments on an as-charged basis. This means that treatment costs are capped only by the overall annual limit of the insurance plan, which could exceed $2 million.
With the change, coverage will be limited to the roughly 150 drugs that are on MOH's approved list. Claims cannot be made for drugs that are not on the list.
This coverage for outpatient cancer treatments will also be capped, though the cap can vary depending on the drug used.
The Life Insurance Association of Singapore said: "IP insurers will study the changes and bring their plans into alignment with the direction from MOH."
This new requirement, however, does not apply to coverage by riders, which IP policyholders pay out of pocket to cover the bulk of their share of medical bills. Premiums for IPs are paid with MediSave.
This means that the eight insurers can continue to fully cover the cost of treatment for the more than 1.7 million policyholders who have bought riders.
The Government requires patients with IPs to pay a deductible of up to $3,500 a year before insurance kicks in, and a co-payment of 10 per cent of the rest of the bill.
Prior to 2018, riders could pay for the patient's entire portion of the bill. However, those who bought riders from March 8, 2018, have to pay 5 per cent of the bill, up to a minimum cap of $3,000 a year.
MOH made the change to riders to curb rising healthcare costs, as it found that people who do not pay a cent for their treatment have bills that were 60 per cent higher than patients who did not have riders.
As it stands, unless insurers change the conditions of rider coverage, should a patient with a rider get non-approved outpatient cancer treatment, the rider will pay for all but 5 per cent of the bill.
Associate Professor Jeremy Lim from the National University of Singapore's Saw Swee Hock School of Public Health pointed out that there are two parts to the term "cost-effective". Drugs not on the list might be effective, but may not meet MOH's cost requirement.
He said: "I do hope there is a system for appeal and consideration of exceptions for individual patients, as there won't be a 'one size fits all' for everyone."
