article About MediShield Upgrade Comparison - (all-vga-corner)

Ward Selection for MediShield

UPDATE (31 Jan 2014): I have been very busy recently due to work commitment. Surprisingly, this file has more than 7,000 over download. I hope to update this in view of the recent talk about the pioneer package. Stay tuned.... and thanks again for your support.


UPDATE (18 Jul 2011): Thanks for your support. Near to 700 have downloaded and use this excel file to better their health plan. I welcome any constructive suggestions to better this file for future reference.

After posting the excel file (version 11), let's see what MediShield covers.
We shall compare the following scenarios below. You can punch in the data in the excel file to derive the same results.

Scenario	1	2	3	4	5
Room and Board (R&B)	24,200	24,200	24,200	24200	5,200
ICU	1,800	1,800	1,800	1800	0
Day Surgery	728	728	728	728	0
Implant	0	0	0	0	0
Days in R&B	52	52	52	52	5
Days in ICU	2	2	2	2	0
Total Hospital Bill	26728	26728	26728	6300	5200
Ward Chosen	C	B2	B1	A	B2
Age	50	50	50	50	50
Insurance pays	21885.2 or 81.88%	21735.2 or 81.32%	8336 or 31.19%	6914 or 25.87%	600 or 11.54%
You pays	4842.8	4992.8	18392	19814	4600

If you have only MediShield, staying in Ward B2 or C has its merits. This is an ideal case to show CPF MediShield can pays for 80% as intended.
Choosing Ward B1 or A will dramatically blow up your medical expenses as illustrated in scenario 3 and 4 respectively.
But wait a minute, how many of us spend 52 days in hospital?
A more realistic case is Scenario 5 whereby minor accident happens to us. Your feet swells without your permission and you stay only 5 days in hospital and the bill is only S$5,200 with no surgical operations. Now, you will be paying S$4,600 or 89% of the bill under MediShield. If luck is not on your side and you visit a hospital every 5 years, your MediSave savings will be easily depleted before you reach 80. When this happens, many suddenly realized that MediShield is insufficient and need a private plan to fill in the gap. Since private insurance excludes previous medical conditions, you will not be paid for heart related conditions if you have heart problem before you buy the private policy. Therefore it is imperative to buy the insurance before you develop any illnesses since most are guaranteed for renewal without questions. This is especially true because MediShield expects you to die before 86 as you have ZERO coverage when you are 86. Else, it ensures you die poor if you live beyond 86 because you will pay 100% of the medical bills.

An Ideal Private Insurance Plan

From my earlier blog, statistics showed that private insurance companies pay S$22 out of S$100 premium collected while CPF MediShield pays S$53 out of S$100. Claiming insurance may be one of the factors as there are many limitations and constraints especially the micro clauses in the contract dealing with historical medical conditions. But since MediShield has its weaknesses, you would like to maximize your money on a policy that pays the most and covers better than MediShield.
For full coverage (ie. zero payment), the premiums are expensive especially when you grow older. We have to access if we are able to afford the premium because it costs only $42/year when you are young but $7000/year if you are old. Without income after retirement, can you afford to pay the premium at old age? Many jump into buying policies that benefit them in the short term and forget that the premiums are much higher when they are old.
So the criteria for private Insurance are:

1. It should be better than MediShield;
2. It should pay most of the medical bills;
3. In case of hospitalization, the insurance payout should be substantially higher against the premiums paid over the years (remember ROI?); and
4. The policy should be affordable till old age.

Case 1 � Long Stay in hospital

Using the same scenario as above, MediShield (Ward C) shall be the benchmark.

Scenario	CPF MediShield	GE SupremeShield B Plus	GE SupremeShield B Plus
Room and Board (R&B)	24,200	24,200	24,200
ICU	1,800	1,800	1,800
Day Surgery	728	728	728
Implant	0	0	0
Days in R&B	52	52	52
Days in ICU	2	2	2
Total Hospital Bill	26728	26728	26728
Ward Chosen	C	C	B1
Age	50	50	50
Deductible	1000	1000	2000
Co-Insurance	3042.8	2572.8	2472.8
Insurance pays	21885.2 or 81.88%	23155.2 or 86.63%	22255.2 or 83.27%
You pays	4842.8	3572.8	4472.8
Years policy is valid	10	10	10
Claims/Premiums	18.33	9.82	9.44

With Great Eastern Supreme Shield B Plus, it covers more for the same Ward C plan. Even if you upgrade to Ward B1, the medical bill foot by you is still lower than CPF MediShield.
If the policy is enforced for the last 10 years (or you have paid 10 years of premiums), the Claims/Premiums ratio will reveal the value of this policy. With lower premium and less coverage, MediShield has a score of 18.33. It implies that the medical claim covers the insurance premiums for the last 18.33 years. For GE Supreme Shield B Plus, both are near to 10 so it implies GE earns little from you.
We conclude that private insurance has its merits for long term hospital stay as it provides better coverage than MediShield. However, we need to compare the various plans to suit personal needs. You can now do so with the excel file.

Case 2 � Short stay in hospital

As illustrated above, MediShield is weak in pure R&B charges. Let's see how private insurances fare.

Scenario	CPF MediShield	AIA HealthShield Gold Elite	Aviva MyShield Plan 3
Room and Board (R&B)	5,200	5,200	5,200
ICU	0	0	0
Day Surgery	0	0	0
Implant	0	0	0
Days in R&B	5	5	5
Days in ICU	0	0	0
Total Hospital Bill	5200	5200	5200
Ward Chosen	B2	B2	B2
Age	50	50	50
Deductible	1500	1500	1500
Co-Insurance	150	370	370
Insurance pays	600 or 11.54%	3330 or 64.04%	3330 or 64.04%
You pays	4600	1870	1870
Years policy is valid	10	10	10
Claims/Premiums	0.5	0.75	1.53

Both AIA HealthShield Gold Elite and Aviva MyShield Plan 3 offer to pay 64.04% of the bill compared to MediShield's 11.54%. Now, with the Claims/Premium ratio, ceteris paribus, we see that Aviva MyShield Plan 3 is better than AIA HealthShield Gold Elite due to lower premiums.

Case 3 � Typical Surgical mid-term stay

Let's consider a case study of a mid-term stay with coronary artery bypass graft surgery (Example from Prudential website).

Scenario	CPF MediShield	Prudential PRUshield A+	NTUC Enhanced IncomeShield Basic + ASSIST rider
Room and Board (R&B)	5870	5870	5870
ICU	1630	1630	1630
Day Surgery	9000	9000	9000
Implant	2400	2400	2400
Days in R&B	7	7	7
Days in ICU	2	2	2
Total Hospital Bill	18900	18900	18900
Ward Chosen	B2	B2	B2
Age	52	52	52
Deductible	1500	1500	1500
Co-Insurance	369.75	1740	1690
Insurance pays	5726 or 30.3%	15660 or 82.86%	17010 or 90%
You pays	13174	3240	1890
Years policy is valid	10	10	10
Claims/Premiums	10.86	4.56	4.17

Private insurances always place their example to their advantage. In this example, MediShield's weakness is exposed as you have to pay 70% of the medical bill. Though the Claims/Premiums ratio is high, forking out $13,174 may wipe out most of your MediSave account. Comparing with Prudential PRUshield A+ and NTUC Enhanced IncomeShield Basic + Assist Rider, both private plans cover most of the costs with the NTUC paying the most out of the 3 plans. However, its premium is also higher as compared with PRUshield.

Benchmarks

To compare policies, benchmarks are introduced. Below are the descriptions:

1. Percentage of bill paid by insurance measures the amount of medical bill paid by the insurance company over the total medical bills. (Higher is better)
2. Claims/Premium paid measures the insurance payout over the premium you paid over the years. (Higher is better)
3. Future Premiums (to be paid till your death) considers your ability to service your premium till you die. (Lower is better)

These factors are given a certain weight to produce the ranking for your consideration.
I hope the excel file will help you get the best plan for your needs.

article About What plan should I upgrade from CPF MediShield? - (all-vga-corner)

Medical need is your top priority in insurance

We do not know when accident will happen but it is happening every day. If health and safety are your top concerns, medical care should be your top priority in insurance. The reason is simple: you may not wish to knock someone but you cannot stop someone from bumping into you. Singapore government realized the needs for medical insurance for all Singaporeans and therefore MediShield is born. In 2009, CPF revamped MediShield to increase premium for better coverage. The revised Medishield aims to take care of as much as 80 percent of the big bills. Yet, 100,000 women are uninsured because they are housewives with no MediSave. So, is MediShield an effective medical care insurance for us?

Weaknesses of MediShield

From Dr Money website, we realized that Medishield is working harder as it is paying 53% of the premium collected while private insurance companies are paying only 22% of the premium collected. However, it is not an all-rounder. Below are some of its limitations:

• Age insured is capped at 85. If you live beyond 85, you lose your "Shield";
• MediShield only covers hospitalization/surgical/day surgery and approved outpatient treatments sought in MOH-accredited medical institutions in Singapore. Expenses incurred at overseas cannot be claimed;
• MediShield pays PART OF THE BILLS at Class B2/C wards in restructured hospitals. If you choose to stay in Class A/B1 wards or private hospitals, you will rather die when you receive the bills. A shiny example is spelt out in MOH website whereby Medishield pays only S$1438 out of S$50,000; and
• MediShield does not pay your deductible and co-insurance payments. The complex calculation of deductible and co-insurance draws more money from MediSave and less money is available for MediShield deduction. For long-term patients, they experienced rapid vaporization of their CPF MediSave account and when it is dry, there is no more payment available for future basic MediShield premiums.

Sourcing for alternatives from private insurance companies

In view of these issues, private insurance companies fill in the vacuum of providing the needful. They provide extensive coverage, overseas coverage, guaranteed lifetime policy renewal and even final expenses (how nice they put it for coffin money!). They offer riders for sophisticated customers who demanded ZERO-dollar upfront. However, the deductible and co-insurance are higher than MediShield which makes the MediSave pool dry up even faster in certain circumstances. The complexity of different plans further confuses the consumers as they cannot compare the plan effectively. Every financial agent is biased and only introduces plans whereby he/she maximize the commissions to reward the promotion effort. The consumers are suffering from this system as they may buy a plan which they cannot afford in the future. However, you can stay in Class B1/A wards or private hospital if you choose the right policy (So it is encouraging to die faster in a private hospital than to suffer MediSave deficit with a long-term illness!)

The need for a comparison table

A comparison table is needed to compare the plans available in the market and there must be indicators to see which plan is comparatively better. I limit the comparison to the next tier of upgrade to MediShield when full coverage (full payment of deductible and co-insurance) is not covered. More restrictions are set to simply the table as depicted below:

• Limit for policy year and lifetime are adequately covered. According to the blog of Mr Tan Kin Lian (ex-CEO of NTUC Income): "Out of 2 million people who are insured for the past 10 years, nobody has ever accumulated a lifetime bill of more than $300,000. Most of the large bills are probably less than $100,000." Unlimited or half a million lifetime limit are just marketing gimmick to sign you up for the plan;
• Out-patient medical bills are not included to simplify the table;
• Riders are not included (except for NTUC PLUS/ASSIST for simple comparison); and
• Specific benefits (eg. Free child coverage), relating to various private companies, are also excluded.

Benchmarks

To compare policies, benchmarks are introduced. Below are the descriptions:

1. Percentage of bill paid by insurance measures the amount of medical bill paid by the insurance company over the total medical bills. (Higher is better)
2. Claims/Premium paid measures the insurance payout over the premium you paid over the years. (Higher is better)
3. Future Premiums (to be paid till your death) considers your ability to service your premium till you die. (Lower is better)

These factors are given a certain weight to produce the ranking for your consideration.
The file (version 1) can be downloaded HERE (outdated).
Update: Version 11 is available HERE. See some illustrations HERE.
Feel free to explore the possibilities and email me of any issues. The file will be constantly updated and I will provide some comparisons in the coming weeks when I am free. If you wish to inject constructive ideas, feel free to email me at sglongfeng@gmail.com. I hope it will assist in choosing the best plan for you.