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Calculating the claimable amount under Medishield is complex
20 Feb 2016 (606 views)

It is complicated to calculate the claimable amount under Medishield due to the following:

a) Deductible, which applies differently for those below and above 80 years 
b) Class of stay - proration has to be applied when the patient goes to higher class wards
c) Co-insurance, which applies in different tranches 
d) Level of subsidy provided by the government

The detailed working is shown here:  This is complicated, even for an insurance expert like me.

There is a need to simplify the system. Here are some suggestions:

a) Remove the Deductible. It is not necessary for an in-hospital plan.
b) Use a level co-insurance. 15% will be suitable.
c) When a patient is treated in a higher class ward, the claimable amount will be reduced by some specified percentages (i.e. the pro-ration factors) and that should be spelled out.
d) Offer options for the public to be insured under Medishield for the higher class wards  rather than require them to buy an "integrated plan" from a private insurer.

Tan Kin Lian
 

 

 

 



Calculating the claimable amount under Medishield is complex
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It is complicated to calculate the claimable amount under Medishield due to the following:

a) Deductible, which applies differently for those below and above 80 years 
b) Class of stay - proration has to be applied when the patient goes to higher class wards
c) Co-insurance, which applies in different tranches 
d) Level of subsidy provided by the government

The detailed working is shown here:  This is complicated, even for an insurance expert like me.

There is a need to simplify the system. Here are some suggestions:

a) Remove the Deductible. It is not necessary for an in-hospital plan.
b) Use a level co-insurance. 15% will be suitable.
c) When a patient is treated in a higher class ward, the claimable amount will be reduced by some specified percentages (i.e. the pro-ration factors) and that should be spelled out.
d) Offer options for the public to be insured under Medishield for the higher class wards  rather than require them to buy an "integrated plan" from a private insurer.

Tan Kin Lian