Relief after $180,000 bill worry

SINGAPORE - When her daughter-in-law gave birth to quadruplets last month, she worried about how the family was going to pay the staggering medical bills ($180,000 and counting) incurred as a result of the births.

But there is some relief after the Ministry of Health (MOH) made an exception and allowed Madam Lily Lim, 52, and her husband to use their Medisave savings to help pay their grandchildren's bills.

Madam Lim's daughter-in-law, Ms Jennifer Pan, 28 (pictured), gave birth by caesarean section at Gleneagles Hospital last month to what is believed to be Singapore's first set of quadruplets since 2008.

Ms Pan,an assistant treasury manager at acommodities trading company here, had taken fertility medication, but did not undergo in-vitro fertilisation, The Straits Times reported.

Janessa, Joelle, Jovianne and Kingsley (the only boy) were born on July 19.

In a letter to The Straits Times forum, published last Wednesday, Madam Lim said: "Having quadruplets was a joyous occasion, but it was marred by the financial hole it created."

She said the hospital bill totalled some $180,000 and explained that the babies were born premature and have to stay in the hospital for almost two months in the intensive care unit (ICU).

The ICU charges alone were reported as $1,000 for each baby a day.

The bills also include an estimated $25,000 for Ms Pan's month-long hospital stay and an obstetrician fee of $23,000.

Madam Lim added: "My husband and I wanted to help them by dipping into our Medisave account, but the Central Provident Fund blocked it with the reply that grandchildren could not use their grandparents' Medisave."

Unique circumstances

Madam Lim is the founder of a confinement nanny agency.

She and her husband have about $90,000 in their Medisave savings, Chinese newspaper Shin Min Daily News reported. The babies' father, Mr Phua Jiun Wei, 28, runs the agency.

In response to media queries, an MOH spokesman said it has "agreed to allow the grandparents to use their Medisave to help with the bills, considering their family's unique circumstances".

The spokesman said parents can use their Medisave to pay for their child's hospitalisation expenses.

But as elderly persons tend to incur more medical expenses than younger persons, grandparents cannot use their Medisave to help pay for their grandchildren's medical bills.

This is to ensure that the grandparents themselves have sufficient Medisave savings for their own hospitalisation needs, especially after retirement.

The spokesman said: "In circumstances such as in Madam Lim's case, where the grandparents have requested for their Medisave to be used, we will assess such requests on a case-by-case basis.

"We understand that the family has also appealed to Gleneagles Hospital for assistance for the babies' hospital and doctor charges."

The spokesman said that all hospitals are required to provide financial advice to their patients regarding their treatment.

"Patients are encouraged to choose a care setting most appropriate to their financial situation.

"In the restructured hospitals, Singaporeans can receive subsidies of up to 80 per cent of their total bill, and can also be assisted by Medifund or other hospital assistance schemes if they still face difficulties in settling their bill."

Ministry in touch with family

MOH understands the concerns faced by Madam Lim and her family, and has been in touch with them, the spokesman said.

When contacted, Madam Lim declined comment.

Dr Lam Pin Min, chairman of the Government Parliamentary Committee for Health, told The New Paper that he was glad to know that MOH has exercised flexibility according to the special circumstance in this particular case.

"I do understand the anxiety caused in cases where hospitalisation bills can be hefty and the helplessness in relieving the financial burden although there are significant amounts in the Medisave accounts," he said.

"The restriction on the use of Medisave needs to be reviewed regularly to commensurate with the medical needs of Singaporeans.

"However, we need to exercise caution as a too rapid liberalisation may result in premature depletion of members' Medisave savings," he said.

$14k bill shock for retiree after operation

SINGAPORE - Retired businessman Steven Choo, 60, underwent angioplasty at the Singapore General Hospital (SGH) to unclog blood vessels in his legs last November.
 
Mr Choo, who is diabetic, underwent the procedure - with "balloons" and stents used to unblock the arteries - which prevented gangrene from spreading from his toes.

But the successful operation marked the start of another round of problems for him. On the day he was discharged from hospital, he received a shock: His medical bill came up to $14,501, but Medisave and MediShield would cover only $900 and $810, respectively, or $1,710 combined.

SGH also told him he would not get his $6,620 deposit back, and that he still owed it $5,381, Mr Choo told my paper in an interview. The remaining $790 was covered by a government grant.

The Central Provident Fund (CPF) Board told him that the Medisave claim submitted by the hospital did not indicate a surgical procedure.

This meant he could not claim the full amount he should have been entitled to: $3,050.

Insurance company AIA, which handles his MediShield account, told him likewise.

Mr Choo then hand-delivered a four-page report from his doctor to the CPF Board, explaining that angioplasty is a surgical procedure. But then he got another shock.

He said: "CPF Board wrote to tell me that they're not paying because (the angioplasty) was not done in a 'proper' place."

The CPF Board's letter, dated Feb 8, read: "Only surgical procedures performed in a properly equipped operating theatre... are Medisave claimable."

The head of SGH's diagnostic radiology department, Associate Professor Tay Kiang Hiong, told my paper that Mr Choo's angioplasty had been planned to take place in an operating theatre. But his operation was moved to an angiography suite - where angioplasty is also typically conducted.

Unhappy

This was because "there were urgent and complicated cases that needed to be performed in the operating theatre", said Prof Tay.

Mr Choo then sent an e-mail message to the CPF Board arguing that he had been penalised because of where his operation was conducted.

The case remained in limbo for three months, said Mr Choo, who wrote to the CPF Board repeatedly, only to receive the same reply each time that his appeal was under review.

In May, the Ministry of Health (MOH) sent him an e-mail message informing him that his appeal had been successful.

Not long after, Mr Choo's MediShield claim was also approved.

AIA told my paper that the claim was reviewed twice because there were inaccuracies in the initial claim.

Late last month, SGH called Mr Choo to tell him that both Medisave and MediShield amounts due to him had been paid out fully.

He was also entitled to a $638 refund from his deposit.

Six months later, the problem has been resolved but it has left Mr Choo irate. He said: "If I did not fight for it, where would I get the money from?"

Mr Choo added that he hopes that others would not have to be put through the same ordeal.

An MOH spokesman told my paper that angioplasty typically takes place in operating theatres.

As Mr Choo's angioplasty took place in an angiography suite, it "was not deemed a surgical procedure".

This is why SGH did not submit a Medisave claim for the procedure, said the spokesman.

The spokesman added: "We have since clarified with SGH that an angioplasty procedure... can be submitted for Medisave claims, even if it took place in the angiography suite."

MediShield revamp: Premiums to rise but better coverage for S'poreans

The national health insurance scheme, MediShield, will soon be expanded to cover Singaporeans and permanent residents who are currently excluded.

The limits on how much can be claimed from MediShield will also be raised.

To support the enhancements, premiums for MediShield will be increased.

The majority of policyholders - those aged 65 and below - can expect to pay an additional $10 or less per month.

Yesterday, the Ministry of Health (MOH) announced these changes, which are set to take effect in the first quarter of next year.

Speaking on the sidelines of an event at Tan Tock Seng Hospital yesterday, Health Minister Gan Kim Yong said of the changes: "We (are taking) the opportunity to see where we can enhance the coverage, especially for those who are more vulnerable."

With the expanded coverage, MediShield will provide financial relief to older seniors, along with newly diagnosed mental patients who require inpatient psychiatric treatment.

The maximum age for MediShield coverage will be raised from the current limit of 85 to 90.

An Institute of Mental Health (IMH) spokesman called the expanded MediShield a "positive step" that will help relieve the financial burden of patients.

He explained: "Currently, patients have to rely on their own or their family's Medisave. Those who require prolonged or repeated hospitalisation will find it a drain on their resources."

MOH is also looking into the coverage of newborn babies with congenital conditions, or medical problems that exist at birth.

As there are mixed views on the issue, MOH is seeking public feedback.

Of the 40,000 babies born every year in Singapore, about 860 reportedly have a serious birth defect.
Mrs Sylvia Mun, KK Women's and Children's Hospital's chief medical social worker, said: "One of the frustrations (that parents of such children) face is that when they try to buy health insurance for their newborn baby, they are often rejected and they worry about how they can continue to manage the cost of treating their baby."

She revealed that for a smaller number of "more-serious premature (birth) cases", the average medical bills can range from $10,000 to $60,000.

Medical expenses may even exceed $100,000, in the rare cases of babies with severe complications, as well as for those who need multi-stage operations and treatment.

To help patients with large medical bills, MOH will bump up the total amount one can claim, in a policy year and for life, from MediShield.

The policy-year limit for claims will be raised from $50,000 to $70,000, and the lifetime limit will be raised from $200,000 to $300,000.

Patients staying in Class C and Class B2 hospital wards will have to pay a greater initial amount before they are able to make claims from MediShield.

This amount forked out by patients, known as a deductible, will be raised from $1,000 to $1,500 for Class C wards, and from $1,500 to $2,000 for Class B2 wards.

On concerns over higher premiums and deductibles, Mr Gan assured Singaporeans that financial aid is in place, such as a one-time Medisave top-up of up to $400.

CPF minimum sum to be raised to $139,000

The CPF minimum sum will be revised upwards to $139,000 from the previous $131,000 from July 1 said the Ministry of Manpower (MOM) on Wednesday.

The new minimum sum will apply to CPF members who turn 55 from July 1, 2012 and June 30, 2013.

The Medisave minimum sum will also be raised to $38,500 from the previous amount of $36,000.

Members will be able to withdraw their Medisave savings in excess of the Medisave minimum sum at or after age 55.

The maximum balance a member can have in the Medisave account is fixed at $5,000 above the Medisave minimum sum.

Corresponding to the increase in the Medisave minimum sum, this ceiling would also be increased to $43,500 from $41,000.

Any Medisave contribution in excess of the prevailing ceiling will be transferred to the Special Account if the member is below 55 years old or his Retirement Account if he is above 55 and has a shortfall in his minimum sum.

The CPF board said that the revisions, which have been adjusted for inflation, are to ensure that Singaporeans have sufficient savings to meet their healthcare expenses.

Buying insurance: Start early, don’t procrastinate

YOUNG adults should consider buying insurance early in the light of the recent discussion on pre-existing conditions. Serious illnesses can strike at any time, leading to hefty medical bills and the likelihood of not being able to work for a significant period.

 

What's more, buying insurance as a young adult is generally affordable, with monthly premiums costing as little as what one would spend on a night out with friends.

 

Some can even be paid using Medisave, thereby saving a person from forking out cash. Medical conditions and risk factors typically increase with age, resulting in decreased insurability.

 

Many Singaporeans do not know how secondary health care is provided and paid for, and perceive insurance agents as people who are out to fleece their clients by selling expensive policies they do not need.

 

Many young people often overlook the long-term implications of being uninsurable when they grow older.

 

Conversely, purchasing hospitalisation insurance when one is young gives peace of mind for the long term, as many policies guarantee renewal even if illness strikes subsequently.

 

While the old may already be uninsurable, young adults have no excuse not to insure themselves and their future.

 

 

Government cuts healthcare subsidies for PRs

SINGAPORE - The Government announced today through a press release that the healthcare subsidies for Permanent Residents are to be reduced, starting from the third quarter of this year.

The Ministry of Health said that the changes mean that most PRs will soon enjoy only about half the subsidies citizens enjoy.

This is to draw a further distinction in the privileges offered to citizens as compared to PRs.

The adjustments will apply to inpatient services of Class B2 and C wards, day surgery and specialist outpatient clinics in restructured hospitals, and intermediate and long-term care services.

For example, a patient of an average monthly income of $3,200 and below staying in a Class C ward can currently receive a subsidy rate of 60 per cent.

Under the changes, the subsidy rate will be reduced to 55 per cent. The subsidy rate for citizens is 80 per cent.

PRs in the same income band staying under a Class B2 ward will see decrease of subsidy rates from 45 per cent to 40 per cent.

For day surgery, the subsidy rate for PRs is to be lowered to 40 per cent, down from 45 per cent.

For specialised outpatient clinics, the subsidy rate for PRs will be lowered to 25 per cent, down from 30 per cent.

The ministry said that the subsidy adjustments are different for lower income PRs, as it is mindful of the impact of the changes.

The changes in restructured hospitals will be implemented in two phases, one in October this year and the next in April 2013, while that for the intermediate and long-term care sector will see the changes implemented in the third quarter of 2012.

Other changes include the lowering of subsidies for PRs for Community Hospitals and Residential Services and the fixing of subsidy rates of citizens for these services at 75 per cent.

This fixed subsidy rate will kick in from the third quarter of the year.

More got Medifund aid in 2010

SINGAPORE - More than $78 million of Medifund aid was given to needy Singaporean patients in 2010, $14 million more than in the previous year.

The biggest chunk of that sum, amounting to about $68.2 million, was disbursed to patients with acute needs. The remaining $10.5 million went to those who required intermediate and long-term care.

The Ministry of Health (MOH) said in a statement yesterday that there were 480,869 successful applications for Medifund in 2010, from 393,980 successful applications in 2009, an increase of 86,889 or 22.1 per cent.

The number of successful applications does not represent the actual number of patients who received the grants, as a patient can make multiple applications.

The MOH added that it distributed $81 million of Medifund and Medifund Silver - meant for needy patients aged 65 and above - to Medifund- approved institutions such as restructured hospitals, and care facilities such as hospices and nursing homes.

There are 37 Medifund- approved institutions, according to MOH.

Of these, 13 are restructured hospitals and institutions while the rest are facilities that provide intermediate and long-term care (ILTC).

Up to 473,033 successful applications were made via restructured hospitals and institutions in 2010, while those from ILTC facilities, such as hospices and nursing homes, amounted to 7,836.

The Medifund scheme was introduced in 1993 to help needy Singaporeans who are unable to finance their medical expenses, even with funds from Medisave and MediShield.

It is meant mainly to provide a safety net for lower-income Singaporeans but it can also be tapped by better-off Singaporeans who need help with exorbitant medical bills.

Out of the total number of successful applicants in 2010, more than 92 per cent had their bills fully subsidised.

Outpatient treatment accounted for 96 per cent of the applications made via restructured hospitals and institutions.

On average, the sum given to help patients cope with their medical bills ranged from $1,321 for inpatient admission to $94 for outpatient treatment.

Grants given to needy elderly patients rose by 22.8 per cent in 2010, from about $18.9 million in 2009 to $23.2 million in 2010.

MP urges more help for low-wage workers

SINGAPORE: Member of Parliament (MP) for Tanjong Pagar Group Representation Constituency (GRC) Lily Neo has called for the Workforce Income Supplement Scheme to be tweaked to help low-wage workers.

Dr Neo said those who earn about S$1,200 per month will need at least twice the present average WIS allocation despite GST vouchers.

She said the scheme should be reviewed yearly, based on Average Monthly Household Expenditure (AMHE) of the lowest 20 per cent of households.

Dr Neo suggested setting up a permanent-system approach to tailor assistance for individual families based on their needs.

"This is set up for the purpose of good take-up rate and to improve the long-term outcome of such families through hands-on intervention and follow-up," Dr Neo said.

"This will help these parents plan a better life for themselves and for their children and to increase their children's educational attainment."

Meanwhile, MP for Ang Mo Kio GRC Yeo Guat Kwang raised the issue of encouraging employment among low-income earners.

Mr Yeo stressed one area that needs to be looked at is the social responsibility of government service buyers.

"I urge all government agencies to set a good example as service buyers and support the Best Sourcing Initiatives advocated by the Labour Movement," Mr Yeo said.

"When outsourcing work, they should adhere to best sourcing practices. Commonly, when tendering for a contract, to get ahead of the competition, vendors are likely to offer a lower price -- at the expense of their workers. The lowest quote often suppresses the wages of contract workers.

"For example, at MOE's (Ministry of Education) schools, many of the cleaners' salaries remain around S$700, unchanged from many years ago.

"This is not fair to the workers. Public agencies should walk the talk and take the lead. I am pleased to learn that PAP (People's Action Party) Town Councils are taking the lead and now, thanks to skills upgrading and an overhaul of the tender system, their cleaner have seen a 30 per cent pay increase since 2008."

Mr Yeo also urged the government to consider increasing personal tax reliefs and reliefs for spouses and dependents.

He said he hopes the government will continue to ensure sufficient medical insurance coverage for all.

He said: "The top-ups and GST vouchers for Medisave are good moves, but by no means sufficient.

"I believe MOH (Ministry of Health) should continue to restructure MediShield coverage so as to protect more and ensure it does indeed help shield Singaporeans in times of crisis and illness.

"We should also look into how we could help the eight per cent who do not even have Medisave."

She's sick but hasn't seen doctor in 10 years

People like housewife Tan Miu Muay could well be who Deputy Prime Minister Tharman Shanmugaratnam had in mind when he spoke about the Government's emphasis on a fair and inclusive society.

She's poor. She's sick. She has five school-going children.

And because she hasn't seen a doctor in 10 years - she fears she cannot pay her medical bills - she has only a vague idea of what ails her.

The 41-year-old is a needy Singaporean who hasn't been forgotten in this year's Budget, which was announced yesterday.

She will benefit from a new GST voucher scheme, a permanent system of offsets to help lower-income Singaporean households.

Her children will also benefit indirectly from top-ups to various funds which help with education and social support.

Madam Tan has been living in a two-room rental flat on Lorong Lew Lian for the last 10 years.

She has five sons, aged seven to 17. Her husband, Mr Chua Chue Po, 40, is a Malaysian who is a permanent resident here. He earns $1,200 a month moulding cornices.

Their monthly rent is under $200.

Madam Tan, who left school after Primary 6 and can't read or write, has been having trouble with her liver since she was 28.

She said: "The last time I went to see a doctor 10 years ago he said that there were some levels in my liver which were very high."

Liver operation 

She said she had an operation on her liver in 1998, and was in and out of hospital for three years after that.

She eventually discharged herself even though she needed further treatment because she was afraid of incurring further medical costs.

"I had help from a medical social worker. But I was afraid that I could not pay if I continued to seek treatment.

"So now I just tong ('endure' in Hokkien)."

Since then, Madam Tan has foregone medication. She often breaks into cold sweat and feels cold even when the room temperature is normal.

She suspects she also has low blood pressure because she often feels weak and tired, and cannot stand for more than 30 minutes at a stretch.

"I thought of getting a job, but all the jobs I qualify for are strenuous and I cannot do them."

Her days are spent doing household chores - mostly while she is seated - and looking after her children.

Yesterday, the new measures brought some relief. She was especially pleased with the Government's moves to make health care more affordable.

"I hope health care will be cheaper, so I can find out what is wrong with me.

"Right now, the thought of hospitals and clinics scares me. I don't know who can help me."

What are the health care changes under Budget 2012?

By 2020...

>> Number of beds in acute-care hospitals to increase by 1,900 – or about 30 per cent.
>>  Number of beds in community hospitals to increase by 1,800 – more than 100 per cent.
>>  Two more community hospitals in Outram and Seng Kang.

Enhanced subsidies
>> In community hospitals, low-income patients will receive 75 per cent government subsidy. Patients above the median income to receive 20 to 50 per cent subsidy. They did not qualify for subsidies previously.
>>  Subsidies for nursing homes, day care and rehabilitation facilities, and home-based care packages will be raised. About 80 per cent of elderly will qualify.
GST will be fully absorbed for subsidised patients under long-term care.

Enhanced Medishield
>> Coverage extended from age 85 to 90.
>>  One-off Medisave top-up to meet increase in premiums. Those aged under 40 will receive $50; aged 41 to 50, $100; aged 51 to 60, $200; aged 61 to 75, $300; and those aged above 76 will receive $400.

Help for Mrs Tan

New moves to offset GST

1. Cash component
Given to Singaporeans whose incomes fall within the bottom 40 per cent, and who live in HDB flats, or the bottom 15 per cent of private properties, based on assessable income and the annual value of their homes. They can expect to receive this from August.

2. MEDISAVE Top-up

Up to $450. This will go to about 85 per cent of Singaporeans aged 65 and above from August.

3. U-SAVE
Between $180 and $260 for all HDB households to help directly offset their monthly utilities bills. To be given out in January and July each year, from July this year. Those who qualify for this scheme will receive a letter in July.

How Madam Tan's family will benefit from the GST VOUCHERS

Estimated GST they pay in a year: $810

But Madam Tan will get:
Cash: $250
Medisave: $0
U-Save: $260

Effect: The GST voucher scheme will offset more than half of the GST incurred by her family in a year.

Other ways she may benefit:
>> More affordable health care
>>  More affordability in long-term care
>>  Top-ups to Medifund, an endowment fund set up by the Government to help needy Singaporeans who can’t pay for their medical expenses.

Help for Madam Tan's children

More support for children from low-income families:

>> Pre-school subsidies will be extended. A family of five, with three children, will now pay $20 for each child in child care compared to $110 previously.

>>  More students will benefit from the Education Ministry’s financial assistance scheme. The qualifying household income ceiling will be raised to $2,500 a month from $1,500.

>>  About 40,000 more students will be subsidised for school fees, uniforms and textbooks, and receive a 75 per cent subsidy on their exam fees.

Top-ups for school advisory and management committees:

>> To help them introduce new schemes in school, like transport assistance for students.

Enhanced student-care fee assistance scheme:

>> Subsidies for student care will be extended to families with up to $3,500 in monthly household income. Currently, only families earning $2,500 or less qualify. A family under this scheme will typically see the amount they pay for student care reduced from $200 to $80 per month.

Top-ups:

>> $200 million to EduSave Endowment Fund to let children enjoy meaningful enrichment programmes.

>>  $200 million to ComCare Endowment Fund to support needy families.

>>  $5 million to self-help groups and $5 million the CCC ComCare Fund.

Better to get medical insurance while young and healthy

Some people say they fear sickness and disability more than death, as the former will drain their wealth.

But you can easily avoid this problem by buying health insurance, and by buying it early when you are healthy.

Do not think that you need insurance only when you are old, as the risk of illness goes up as you age.

Once illnesses develop, insurers may slap on an extra charge, or choose not to cover your pre-existing conditions. A pre-existing medical condition is a condition, disability or illness that you have before you apply for health cover.

Apart from basic medical expense insurance or hospitalisation plans, which pay for hospital and surgical expenses, there are hospital cash insurance plans which pay a fixed amount of cash should you be warded. You can also choose a critical illness plan or a disability income insurance. Then, there is long-term care insurance, which gives you a regular cash payout if you are too ill to look after yourself.

The common mistake many people make is to hold off on taking out a basic hospital plan as they are already covered under their company's insurance plan.

Most companies do not offer portable group health insurance plans. So the coverage ceases once the employee leaves the company. Those who have an existing illness may then realise too late that they are no longer insurable, or that the insurer will not cover their illness.

Singapore's health-care financing system offers three tiers of protection - through heavy subsidies in acute public hospital wards; Medisave; and MediShield and the private Integrated Shield plans.

Medisave

This is a national medical savings scheme whereby individuals put aside part of their income into their accounts with the Central Provident Fund. It can be used for the co-payment of their personal or immediate family members' health- care bills. All employees, as well as self-employed persons earning more than $6,000 a year, have to contribute to Medisave.

Medisave can be used to pay for the premiums of Integrated Shield plans, subject to a limit of $800 per policy per year. The limit for those aged 81 and above is $1,150 per policy per year.

Medisave can also be used to pay for treatments that are not covered by insurance, such as outpatient treatment of chronic diseases.

It is important to maintain your Medisave account and to use it prudently. Note that the cash will run out fairly quickly when you stop working. This is why it is important to have health insurance, as it can cover major medical expenses.

MediShield

This is a low-cost catastrophic medical insurance scheme that helps meet medical expenses incurred for class C or B2 wards in government restructured hospitals.

All Medisave account holders who are Singaporeans or permanent residents will be automatically covered unless they opt out of it.

Because it is a catastrophic policy, which covers extended hospital stays, you may find that you have to fork out a large sum for short stays after all the limits are applied.

Also, the subsidies for class B2 and C wards are subject to means-testing, where lower-income patients will get more subsidy than higher-income patients.

Therefore, higher-income patients or those who want to use higher ward classes or private hospitals should go for Integrated Shield plans on top of their MediShield.

Integrated Shield plans

These are Medisave-approved private health insurance plans currently offered by NTUC Income, Great Eastern Life, Aviva, Prudential Assurance and American International Assurance.

They do not usually cover pre-existing health conditions. But the good news is you can use your Medisave to pay the premiums.

Also, the premiums are kept affordable because the plans are designed with deductible and co-insurance components which promote individual responsibility for one's health-care needs.

Deductible refers to the first layer of costs that you have to pay before the insurance kicks in. Co-insurance is the share of the insured portion of the bill that you must pay. It is typically set at 10 per cent.

You can get a rider to cover these components or extend coverage to medical expenses incurred abroad but the premium has to be paid in cash.

Many Integrated Shield plans offer lifetime cover, or up to age 100, which is something you are unlikely to find among private insurers outside the Integrated Shield plans.

Key things you should know about Integrated Shield plans

· Claim limits: Plans may vary in terms of the maximum claim that you can make per policy year. Some plans may also stipulate a lifetime claim limit; other plans may not set a cap on lifetime claims.

· Pro-ration factor: If you stay in a higher-class ward than what your plan entitles you to, a pro-ration factor will be applied. It reduces the sum that can be claimed.

· Last entry age: For most plans, the latest age you can apply for coverage is 75. The maximum coverage age is the length of coverage.

Some plans offer lifetime coverage, while others may extend cover until age 80 or 85. Note that the riders attached to a plan with lifetime coverage might offer coverage up to a certain age (for example, 100).

· Premiums: All plans can be renewed as long as the premium is paid. But the rates, which rise with age, are not guaranteed. They can rise on renewal depending on the claims experience of the portfolio.

· Pre-existing conditions: These are not usually covered. You have to disclose all pre-existing conditions at the time of application as insurers may declare the policy void if you misrepresent or fail to disclose them.

Some plans may cover a pre-existing condition following a waiting period of, say, five years, provided the insured does not experience any symptoms or receive treatment or medication for the conditions during this time.

· Coverage: The inpatient benefits commonly include daily room and board, and treatment costs. Outpatient benefits can include kidney dialysis and cancer treatment. All these may be subject to a claimable limit or covered on an 'as charged' basis, which means that you can claim for what has been billed for all eligible expenses.

· Final expenses benefit: With this, the deductible and co-insurance portions of the bill - up to a limit of say $5,000 - will be waived if the insured dies during hospitalisation or within a stipulated period after discharge from the hospital. Not all plans provide this benefit.

· If you are warded: Your insurer may provide a letter of guarantee - an assurance of payment for the portion of the bill covered by the insurer. It can help to reduce the upfront payment to the hospital.

But the sum indicated in the letter may not be sufficient for the entire bill. To better plan for the cost, ask the hospital for an estimated billing amount, and also query the insurer on the basis for the sum indicated in its letter of guarantee.

To compare benefits, coverage, policy features and the premiums for the different Integrated Shield plans here, go to the health care financing section of the Health Ministry's website (www.moh.gov. sg).

You can contact me if you wish to know more about the  Integrated Shield plans.

Medifund to be extended to home nursing services in 2012

Coming April this year, Medifund subsidies will be available for home-based healthcare services, said the Minister of Health Mr Gan Kim Yong.

Mr Yong was responding to a question asked by Mr Patrick Tay Teck Guan, MP of Nee Soon GRC, in today's Parliamentary session.

Mr Tay asked if Medisave and Medishield schemes can be extended to home palliative care and home nursing services.

To that, Mr Yong said that the Government provides subsidies of up to 75 per cent for lower and middle income patients who require home palliative and home nursing services.

Patients can also use cash payouts from ElderShield to further defray the cost of such services.
For home palliative care, the Government has allowed use of Medisave funds since 2010.

However, as MediShield is designed as a basic insurance scheme for catastrophic hospitalisation expenses to keep premiums affordable, it is therefore unable to cover home-based services.

Nevertheless, needy patients who require additional financial assistance for home-based healthcare services beyond the subsidies they are receiving will be able to apply for Medifund subsidies soon.

The Government will be extending Medifund subsidies to such home-based services from April 2012, Mr Yong said.

Medifund is an endowment fund set by the Government.

The interest income from the capital sum of Medifund is allocated to approved hospitals and medical institutions in the form of grants, which are then used to help needy Singaporeans pay for the medical bills which they cannot afford.

Mr Yong added that the voluntary welfare organisations (VWOs) that provide home-based services also provide additional financial help for their patients if necessary.

Mr Yong said the ministry will continue to review government subsidies and the use of ElderShield and Medisave to ensure affordability of such home-based services for the elderly, while balancing against the adequacy of Medisave and the impact on ElderShield premiums.

Govt looking at allowing Medisave for home care services

SINGAPORE : The government is looking at allowing the use Medisave for home care services and reviewing current subsidies to make home care options more affordable.

This was announced by Minister of State for Health, Dr Amy Khor, at the opening of the TOUCH Home Care Centre in Jurong on Wednesday.

78-year-old Sapri Amat suffers from hypertension and cataract, and some months ago, a gout attack left him almost bed-bound.

His wife Madam Piah has cancer.

Their only caregiver - son Mohamad Sapri - left his job about two years ago to care for his elderly parents.

The new TOUCH Home Care Centre in Jurong now provides transport for Madam Piah for her hospital appointment visits.

A nurse and therapist also visit Mr Sapri to monitor his condition and provide home-rehabilitation.

After subsidies, the family pays about S$60 a month for the services - 10 per cent of the total cost.

Madam Piah said: "I feel better. There are now people to look after me. If not, there is only me taking care of my husband, along with my son."

TOUCH Home Care is only the second voluntary welfare organisation (VWO) to provide home care services in the West, an area it said has been under-served, till now. But in just two months, its staff of 10 are now catering to the needs of 30 clients, a number it hopes to expand to some 300 within the next two years.

Besides VWOs providing these services, needy Singaporeans can soon also tap on Medifund for home care services. Some 1,000 Singaporeans are expected to benefit.

But the government acknowledges that cost is still a big factor, and it may also allow the use of Medisave for such services.

Dr Khor said: "Home care will play a substantive role in future as one of the care options for the elderly. The issue of accessibility and affordability of elder care services is critical and we need to address that, so we are looking at ways to grow the home care sector.

"Some of the areas we are looking at include reviewing our subsidies as well as the use of Medisave."

The government is also looking at leave options to alleviate the stress faced by caregivers.

The Agency for Integrated Care and the Centre for Enabled Living will provide TOUCH with a funding of S$700,000 over two years.

Small percentage of S'poreans use CPF for parents' medical fees

Less than five per cent of Singaporeans with Central Provident Fund (CPF) accounts used these funds to pay for their parents' healthcare expenses in 2010.

Health Minister Gan Kim Yong revealed these figures in Parliament on Friday, in response to a parliamentary question by Non-Constituency Member Gerald Giam, who had asked for these figures.

Mr Gan said in 2010, there were around two million working Singaporeans with CPF accounts, and among them 80,000 used their CPF to pay for their parents' medical fees. If older CPF members were excluded from the figures, the proportion would be slightly higher.

Singaporeans withdrew $732 million from their Medisave accounts in 2010, of which 18 per cent was used to pay for their parents' treatment.

CPF Special, Medisave & Retirement Accounts to remain unchanged at 4%

The Special, MediSave and Retirement Accounts (SMRA) will remain unchanged at four per cent for another year, the Central Provident Fund (CPF) Board revealed on Friday.

This is because of the heightened uncertainty in the global economy and continued low interest rate environment, the CPF Board explained.

The rate of four per cent has been in place since 2008.

It's been extended twice before, once in 2010 and again in 2011, due to the unfavourable global economic conditions and exceptionally low interest rate environment back then.

Investing with your CPF

YOUNG adults already in the workforce will no doubt be familiar with their CPF (Central Provident Fund) accounts, into which a portion of their monthly salary is automatically squirrelled away, along with a percentage contribution from their employers.

Having surveyed the gamut of asset classes and investment vehicles over the last few months, the Young Investors' Forum takes a look this week at how young working adults can think about investing their CPF savings for the future.

While the prospect of retirement may still be far from the minds of energetic go-getters just scaling the lower rungs of their career ladders, it is only prudent to start preparing for that future today.

Know your CPF

The government bills the CPF as a 'comprehensive social security plan'. Meant to provide working Singaporeans financial security in their old age, the scheme covers retirement, healthcare, home ownership, family protection and asset enhancement.

These aims are met by mandatory monthly sums of money working Singaporeans and their employers channel into each individual's three CPF accounts:

• The Ordinary Account (OA), which is where the bulk of your monthly contribution goes if you're under 35, and stores monies which can be used to buy property and insurance policies, make financial investments or pay for your own or your children's education.


• The Special Account (SA) is to accumulate funds for old age and contingencies, which can be used to invest in retirement-related financial products.


• The Medisave Account's (MA) savings are meant for hospitalisation expenses and approved medical insurance plans.

While entrepreneurs and the self-employed need not contribute to the Ordinary and Special Accounts, they must contribute to the Medisave Account if their yearly net trade income exceeds $6,000.

Without you choosing to invest, CPF savings in all these accounts will earn interest. Funds in the OA earn an interest rate based on the 12-month fixed deposit and month-end savings rates at major local banks, but the CPF Act guarantees a minimum risk-free interest of 2.5 per cent.

For the Special, Medisave (SMA) and Retirement Accounts, which earn an interest rate equal to the 12-month average yield of 10-year Singapore Government Securities (10YSGS) plus one per cent, the government announced last September that it would keep an interest rate floor of 4 per cent till this December.

Also, the first $60,000 you have across your CPF accounts - with up to $20,000 coming from your OA - earns an extra one per cent interest.

Hence, one possible way to grow your CPF savings is to transfer monies from your OA into your SA, to take advantage of the higher interest rate that uninvested savings in the SA earn. But such a move is irreversible, as fund transfers in the opposite direction are not allowed.

CPF Investment Scheme

As long as you are at least 18 years old, are not bankrupt and have more than $20,000 in your OA or more than $40,000 in your SA, you can tap the CPF Investment Scheme (CPFIS) to grow that 'retirement nest egg'.

The CPF Board runs two separate investment schemes for the OA and the SA, allowing for your CPF savings to be put to work via a wide range of instruments, in the hope of reaping a return above the prevailing interest rate.

The ultimate aim, of course, is still to accumulate wealth for retirement, so any profits made from these investments are still subject to the standard CPF withdrawal rules.

If losses are incurred on your CPF investments, you need not top up the accounts from which the investments were made, but your retirement savings would have shrunk.

Financial planners posit that, as a rule of thumb, a person needs about 70 per cent of his last annual income to keep up his current lifestyle in retirement. CPF savings are meant to cover basic retirement needs and may not meet a person's other lifestyle needs - one key motivation for private savings and investments.

Also worth considering before you decide to start investing your CPF savings are any financial obligations that would require payment from a CPF account. For instance, whether you need to use your OA to make monthly housing payments will help you decide how much of your savings you are willing to channel into investments.

Getting started
 
The CPFIS's range of investment options include fixed deposits, bonds, annuities, endowment insurance policies, investment-linked insurance products, unit trusts and exchange traded funds (ETFs).

What is available to you under the CPFIS-OA and the CPFIS-SA differ, since the two accounts are meant to help accumulate savings for different purposes.

So, while OA funds can be invested in fund management accounts, shares, property funds, corporate bonds and gold or gold products, SA savings cannot.

Other restrictions you should be aware of before investing your CPF savings include the fact that you may only invest in unit trusts, exchange traded funds and fund management accounts approved by the CPF Board.

And CPF savings can only be used to purchase common shares, Reits and corporate bonds issued by companies incorporated in Singapore and traded on the Singapore Exchange (SGX).

Also, you can put a maximum of only 35 per cent of your investible savings into shares, Reits and corporate bonds, while the cap on gold (including gold ETFs and other gold products) is 10 per cent.


More details on restrictions and possible charges you may incur from the CPFIS and the other financial intermediaries are available at www.cpf.gov.sg, where you can also calculate how much of your investible CPF savings you have at the moment.

If you intend to use funds from your OA, you will need to apply for a CPF Investment Account with any one of the CPFIS agent banks: DBS, OCBC and UOB. Do note that you can have only one CPF Investment Account at any one time.

Such an account is not needed if you intend to invest from your SA, in which case you can approach investment product providers directly.

Naturally, all the usual caution urged with regard to investing in general will apply to investments made using your CPF savings too.

Any investor must consider his investment time horizon, asset allocation, the risks and returns of each product, and diversification across his portfolio, before committing to an investment - even ones made under the CPFIS.

'No one can guarantee that investments under the CPF Investment Scheme will always be profitable,' the CPF Board states on its website.

'CPF members have to decide for themselves how to invest their savings, and what risks to accept, and exercise prudence and care in investing their CPF savings to ensure their financial well-being after retirement.'

'If they are not confident of investing on their own, they should leave their money in their CPF account which earns interest and is risk-free,' it adds.