CNA Explains: Changes to Integrated Shield Plans and how it will affect cancer patients

All Integrated Shield Plans that are purchased or renewed from Apr 1 will only cover treatments on an approved cancer drug list.

By Vanessa Lim

SINGAPORE: From Saturday (Apr 1), Integrated Shield Plans in Singapore will only cover cancer drugs on a government-approved list.

The change is part of efforts to slow the rising cost of cancer treatments here and obtain better drug prices, the government said in announcing the decision in August 2021.

It comes after a major review of MediShield Life, Singapore's basic health insurance scheme, which found that the country's spending on cancer drugs grew 20 per cent annually from 2016 to 2019.

If the current trajectory continues, the expenditure is projected to reach S$2.7 billion (US$2 billion) by the end of this decade.

What are the changes?

All Integrated Shield Plans (IPs) from private insurers that are purchased or renewed from Apr 1 will only cover treatments on an approved cancer drug list.

MediShield Life and MediSave, the national medical savings scheme, both implemented the change in September last year.

The number of treatments in the cancer drug list has increased from 270 when it was first published in August 2021 to 340 as of February this year. This covers about 90 per cent of all cancer treatments approved by the Health Sciences Authority.

The remaining treatments are not on the MOH list because "the prices do not yet justify the effectiveness and suppliers are not willing to moderate their prices", Health Minister Ong Ye Kung said in a written parliamentary reply on Feb 23.

"But we will continue to work with them in good faith and try to expand the list," he said.

What does this mean for IP holders who need cancer drugs not on the list?

Singapore has seven insurers that offer IPs – AIA, Prudential, Income Insurance, HSBC, Great Eastern, Raffles Health Insurance and Singlife.

All insurers will maintain the current IP coverage of policyholders at least until Sep 30 this year, Mr Ong said.

Beyond Sep 30, cancer patients whose treatments are not on the MOH list may still be covered by IP riders or other insurance plans they have. If not, they would have to shift to treatments that are already on the list.

Those who require treatments not on the list and are unable to pay can opt for subsidised care at public healthcare institutions, where they may apply for financial assistance.

How else will IP coverage change for cancer patients?

Currently, most IPs cover outpatient cancer drug treatments "as charged", excluding the deductible and co-payments borne by patients.

From Apr 1, IPs will only pay up to five times the MediShield Life claim limit for cancer treatment. This means that the coverage for most policyholders will be lower.

The MediShield Life claim limit for cancer treatment depends on the drug used, but could range from S$200 to S$9,600.

To reduce their out-of-pocket expenses for medical bills, cancer patients who are IP holders will most likely have to opt for insurance riders, which are add-ons to their basic policy.

How much more coverage do riders provide?

Ahead of the changes, the seven insurers have either introduced or revised rider policies to provide additional coverage for cancer treatment.

Currently, the three insurers that give the best cancer coverage are AIA, Prudential and Great Eastern.

AIA has introduced a new Cancer Care Booster that offers coverage of 16 times the amount provided by MediShield Life for cancer drug treatments on the MOH-approved list, on top of the main policy.

Prudential and Great Eastern’s riders offer 15 and 18 times the Medishield Life claim limit respectively. This is on top of the main policy’s limit.

As for the remaining insurers, nearly all offer coverage that is at least double the main IP policy. This typically covers treatments on the cancer drug list and costs such as consultation fees, tests and supportive medication.

The exception is Singlife, whose rider plan does not specify whether it provides additional coverage for drugs on the MOH list.

For drugs not on the MOH list, Great Eastern offers the highest annual claim limit (S$250,000), followed by AIA (S$200,000) and Prudential (S$150,000).

The other insurers offer a monthly claim limit of between S$15,000 (Income Insurance) and S$30,000 (HSBC), or S$30,000 per policy year (Singlife).

How much do riders cost?

It is unclear whether premiums for IP riders will increase after Apr 1, as most insurers have not released the information.

As of Mar 31, only Singlife appears to have revised premium rates for policies starting or renewed from Apr 1.

According to its website, annual premiums start at S$27 and go up to S$4,132 for those aged 75, depending on the type of plan. Those above the age of 75 can only renew their policies and not buy new ones.

AIA said it is offering a one-time waiver of underwriting for existing policyholders of its private hospital plan who wish to take up the new booster. This is provided they take it up within six months of their policy renewal between Apr 1 and Mar 31 next year.

The booster comes with an additional premium that starts from S$22.70 and goes up to S$934.90 for those aged above 100.

As for those who currently have riders for their AIA private hospital plan, the booster will automatically be included in their main policy but policyholders may terminate the booster if they do not want to pay the extra premium.

For the other five insurers, annual premiums for their riders currently range between S$44 and S$12,560, depending on the age of the policyholder and the type of plan purchased.

Editor’s note: Great Eastern’s cancer coverage for its rider has been updated in this article after the insurer announced changes to its policy.

This article has also been updated to correctly reflect details of MediShield Life claim limits for cancer treatments. We apologise for the error.

This article was first published in CNA on 31 March 2023.