Integrated Shield Plan revamped to include Claims-Adjusted Pricing
Co-payment and Claims-adjusted pricing helps encourage the prudent consumption of healthcare services as well as rewarding policyholders who maintain a healthy lifestyle.
There is increased awareness on the importance of having our own private hospitalisation insurance as it helps to supplement MediShield Life, a basic national healthcare insurance plan. However, not many are aware how each component interacts with each other.
Furthermore, a recent change by private insurers includes the introduction of the Claims-Adjusted Pricing (‘CAP’) framework. This was probably in response to policyholders’ requests that less premiums should be paid for those who consume less healthcare services so that healthcare costs can be kept affordable for all stakeholders. Indeed, Great Eastern is one of the few insurers who has incorporated such framework into its suite of hospitalisation insurance plans.
Let us find out the wide range of plan types offered by Great Eastern to suit your hospitalisation needs and how the newly introduced CAP framework rewards policyholders for leading a healthier lifestyle.
What is GREAT SupremeHealth?
GREAT SupremeHealth (‘GSH’) is a MediSave-approved Integrated Shield plan that covers hospitalisations in private hospitals and Class A/B1 wards at restructured hospitals. It adds on to the coverage provided by MediShield Life, the national health insurance policy that is compulsory for Singaporeans and Permanent Residents. Key benefits include coverage on pre and post hospitalisation, high annual coverage of up to $1.5 million as well as guaranteed lifetime coverage and renewability.
The complete suite of hospitalisation coverage by Great Eastern is shown in Diagram 1.
Diagram 1: Complete Hospitalisation Coverage with Great Eastern (Source: Great Eastern)
Further enhance your hospitalisation coverage with GREAT TotalCare
It is possible to enhance your hospitalisation coverage further with GREAT TotalCare (‘GTC’) supplementary plan, which covers the deductible and co-insurance under GREAT SupremeHealth, subject to co-payment. Co-payment is a mainstay as it encourages prudent consumption of healthcare services. There are 2 classes of GTC Supplementary plans, Elite and Classic. Note that for both classes of supplementary plans, there are a further 3 different categories to cater to different demands for the level of care desired:
- Private and Restructured Hospitals
- Class A and below in Restructured Hospitals
- Class B1 and below in Restructured Hospitals
The various permutations are shown in Diagram 2.
Diagram 2: Various permutations of Great TotalCare supplementary plans
When paired with GREAT SupremeHealth you can enjoy coverage of up to 95% of your total bill. The key difference between GTC (Elite-P) and GTC (Classic-P) is the co-payment required. To illustrate how GTC works with GSH, it is best to depict various scenarios with the following assumptions made:
- Policyholder has an IP plan pegged to a private hospital i.e. GREAT SupremeHealth P Plus
- Policyholder purchased GREAT TotalCare (Classic-P) or (Elite-P) to supplement his/her GREAT SupremeHealth P Plus
- Diagram 3 shows the step-by-step calculation to derive the final bill split between policyholder and insurer when visiting a Private Hospital under 5 scenarios.
Diagram 3: Various scenarios illustrating how GREAT SupremeHealth and GREAT TotalCare works
- If the policyholder chooses the GSH P Plus plan (Scenario 1) and incurs an eligible medical bill of $65,000, he/she must bear both the deductible and co-insurance, which amounts to $9,650.
- However, if the policyholder prefers to reduce his/her out-of-pocket expenses for any medical treatments and enjoy premium savings over the years, he/she can opt for GSH P Plus with GTC (Classic-P). Assuming that the policyholder does not seek pre-authorisation from GREAT Eastern before hospitalisation (Scenario 2), his/her co-payment would be the higher of 5% of the eligible medical bill or deductible. In this case, as the deductible ($3,500) is higher than 5% of the eligible medical bill ($3,250), his/her co-payment will be $3,500. With pre-authorisation (Scenario 3), the co-payment is capped at $3,000.
- For the most comprehensive coverage coupled with options to consult his/her own specialist and ward type, the policyholder can choose to go with GSH P Plus and GTC (Elite-P). For an eligible bill size of $65k, he/she will only co-pay $3,250 (5% of the total eligible bill- Scenario 4). With pre-authorisation (Scenario 5), the co-payment is also capped at $3,000.
- In fact, by choosing GTC (Classic-P), you can enjoy medical treatments at private hospitals with lower premiums as the co-payment with pre-authorisation is identical to GTC (Elite-P) (Scenarios 3 & 5).
- Did you know? – The GREAT TotalCare Classic-P has one of the most comprehensive list of benefits in the market at an affordable premium, making it one of the most value for money health plans.
Diagram 4: Total Payouts by Great Eastern under 5 scenarios for a $65k bill size
Comprehensive hospitalisation coverage for life
As demonstrated, GTC significantly reduces the out-of-pocket expenses to be borne by the policyholder especially in a big hospital bill. Moreover, seeking pre-authorisation before any hospitalisation is highly encouraged as it caps the co-payment and provides assurance to the policyholder as it guarantees the coverage of the eligible medical expenses in advance. Pre-authorisation can be conveniently obtained through Health Connect, a call-in service (6563 2233) that will put the caller in touch with more than 4,000 specialists of over 25 different medical specialties. Additionally, cash deposit upon hospital admission will be waived and the policyholder can look forward to a hassle-free discharge as the claims are settled directly with the hospital. This takes away any further stress so that the policyholder can fully focus on the recovery process.
Finally, if policyholder seeks coverage for planned medical treatment overseas, he/she can also purchase the GREAT TotalCare Plus rider. To complete the hospitalisation coverage as shown in Diagram 1, Supreme MediCash can be added on to provide daily hospital cash benefit so as to close the co-payment gap.
Having understood how Great Eastern provides complete hospitalisation coverage, let us understand how it also rewards policyholders who manage to stay healthy with its Claims-Adjusted Pricing framework.
How Claims-Adjusted Pricing works?
CAP is only applicable to policyholders who have purchased a private hospital supplementary plan; either GTC (Elite-P) or (Classic-P). As shown in Diagram 5, there are varying multipliers on the premiums payable and depending on the age of the life assured, there are 2 types of premium scale.
Diagram 5: Claims-Adjusted Framework: Premium scale for policyholders (Source: Great Eastern)
During the 1st policy year, everyone starts off at the Standard premium level. At each policy renewal, the next premium level payable on the GTC supplementary plan will be determined by any previous claims made during the Assessment Period.
In other words, the extent of the movement along the premium scale depends on whether there are any claims and how much claim amount was made during the Assessment Period. Diagram 6 depicts the “number of levels” a policyholder can move along at every policy renewal. Think of it like a rule guide in the classical board game of snakes and ladders.
Diagram 6: Claims-Adjusted Framework: Premium level movement at next policy renewal
I know this gets confusing, so it might be better to illustrate with some scenarios to show how the CAP framework works in GTC. Let’s assume John, age 30, signs up for GSH P Plus supplemented with GTC (Elite-P) on 1 April 2021.
# Applies to Restructured Hospitals and Private panel specialist with certificate of pre-authorisation.
^ Applies to both private hospital and private hospital with pre-authorisation.
Diagram 7: Hypothetical illustration of how Claims-Adjusted pricing works (Source: Great Eastern)
1 April 2021: John starts off at Standard level.
1 April 2022: John made no claims during the Assessment Period and will now move down to Preferred premium level. He will enjoy 20% savings off the Standard premium level during his first-year renewal.
1 April 2023 (Scenario 1): John is hospitalised in a Private Hospital during his 2nd policy year and ran up a hospital bill size of $100,000. As he had sought pre-authorisation, his co-payment is capped at $3,000 (This is similar to Scenario 3 of Diagram 3). As the amount Great Eastern paid for his hospital bill exceeded $2,000 and John was previously on the Preferred level, he will move up 2 levels to Level 1. At Level 1, his premiums payable is now 1.5X of the Standard premium level.
1 April 2023 (Scenario 2): John is hospitalised in a Restructured Hospital during his 2nd policy year with hospital bill size of $100,000. Because John was hospitalised in a restructured hospital, he will move up 1 level to the Standard premium level from the Preferred premium level even though the amount Great Eastern paid for his hospital bill exceeded $2,000.
As illustrated, the healthier your lifestyle, the more premium savings you will enjoy under the CAP framework. This is a win-win for both policyholder and the insurer.
Sign up and enjoy 20% off your first-year premiums for GREAT TotalCare (Elite P) and (Classic-P) plans.
The importance of private Integrated Shield plan to provide higher coverage against pre and post hospitalisation expenses cannot be understated. By introducing co-payment and Claims-adjusted pricing elements to its Integrated Shield plan (IP) rider, Great Eastern is encouraging the prudent consumption of healthcare services as well as rewarding policyholders who maintain a healthy lifestyle. Overall, this keeps healthcare costs affordable and its policies sustainable, benefitting all stakeholders.
*Disclosure: This article is written by Heartland Boy in collaboration with Great Eastern. It is for information only and reflects my opinion and not that of Great Eastern. | Age stipulated refers to age next birthday. | GREAT TotalCare and GREAT TotalCare Plus are not MediSave-approved Integrated Shield plans and premiums are not payable using MediSave. | GREAT TotalCare is designed to complement the benefits offered under GREAT SupremeHealth. GREAT TotalCare Plus is a rider that can only be attached to GREAT TotalCare to extend medical coverage worldwide. | This advertisement has not been reviewed by the Monetary Authority of Singapore. | The above is for general information only. It is not a contract of insurance. The precise terms and conditions of this insurance plan are specified in the policy contract. | Protected up to specified limits by SDIC.
Information is correct as at 30 May 2021.
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