Great Eastern cuts coverage for A and B1 policyholders who upgrade to a higher-class ward
INSURANCE company Great Eastern Life (GE) has reduced significantly the coverage for its integrated shield plans (IPs) – which pay for non-subsidised treatment – when a policyholder opts for a higher class of treatment than the class they had paid for.
So, someone with a public hospital Class A IP policy but who chooses to go to a private hospital instead would have only 35 per cent of the bill covered by insurance – down from 70 per cent previously. This applies to all who recontracted with GE from October 2024. There is no change for patients who get treatment in the class they had paid for, such as Class A or B1.
The Ministry of Health (MOH) told The Straits Times that in 2024 “all IP insurers except Raffles Health Insurance had made changes to their products. These changes include adjustments to claim limits, coverage and benefits, to varying degrees”. Most also increased their premiums.
All changes to IP coverage have to be approved by MOH.
The changes in GE’s coverage caught Sharon Chong by surprise. She had moved her 78-year-old mother, who has a Class A plan with GE, from a public hospital to Mount Elizabeth Novena Hospital because she felt her mother was not getting good treatment following a stroke.
She said: “Usually we won’t study the insurance details till we make a claim. It would be useful if we were given an option to upgrade before they unilaterally enforced a change.
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“Years of payment with the original contract had covered 70 per cent of private, based on the fact that bills for private patients in a government hospital are 70 per cent of private hospital charges. How can it change to 35 per cent just like that?”
Fortunately, her mother was still covered under the previous contract, so she received 70 per cent coverage.
GE also changed the percentage of bills covered for those with a Class B1 IP policy – from 50 per cent for private hospital treatment and 80 per cent for Class A treatment, to 25 per cent and 70 per cent, respectively.
A spokesperson for GE said that it made the changes “to reflect the cost differentials between treatment at a private versus a restructured medical provider”.
“Recalibrating the pro-ration factors was crucial to ensure that customers who use their plans for the intended use at restructured hospitals don’t end up unfairly subsidising the higher cost of private hospital claims. This way, everyone benefits from a fair and balanced system,” he added.
There is a big difference in premiums for the different IPs. A 70-year-old has to pay S$5,595 a year for a private hospital IP with GE; S$2,679 for a Class A IP; and S$2,185 for a Class B1 IP.
The MOH spokesman said pro-ration factors for IPs are dependent on insurers’ own claims experience and commercial considerations. The ministry’s concern is largely to ensure that the key parameters, such as co-payment and deductible requirements, are met.
Paying for deductibles and co-payment is mandated by MOH. A deductible is the initial amount the patient has to pay before insurance kicks in, while co-payment refers to the 10 per cent of the rest of the bill, which is not covered by insurance.
GE’s move to reduce coverage, should a patient opt for a higher class of treatment, reflects changes to basic MediShield Life that will come into effect in April.
MediShield coverage will fall from 25 to 10 per cent for private sector hospitalisation, from 35 to 25 per cent for a Class A ward, and from 43 to 35 per cent for a Class B1 ward.
Explaining the move, the MediShield Life Council said: “The current pro-ration factors have not kept pace with the growth of private and unsubsidised bills. Hence, the council recommends revising the pro-ration factors to prevent cross-subsidisation of private bills by subsidised bills.”
No other insurer has made changes to pro-ration coverage recently. Coverage for private sector hospitalisation ranges from 50 to 70 per cent for those with a Class A plan, and 35 to 60 per cent for patients with a Class B1 plan.
However, with changes to coverage of MediShield Life in April, some insurers are expected to make further changes to their coverage in 2025. MediShield Life changes include higher claim limits and coverage for additional outpatient treatments. It will also reduce coverage of non-subsidised treatments, and increase deductibles.
Said an AIA spokesman: “In the light of the Ministry of Health’s changes to MediShield Life, we will carefully evaluate these updates and make the necessary adjustments to offer solutions that best serve our customers’ needs.”
GE has also reduced its Class B1 coverage from 80 to 70 per cent for non-subsidised short-stay wards, day surgery and outpatient treatment at public hospitals.
SingLife is the only other insurer that does not provide full coverage for such treatments under Class B1 IP plans. It pays 85 per cent of the bill. Others cover the bill fully.
Class B1 in a public hospital is considered a private class where patients are allowed to choose their doctors, while enjoying a 20 per cent subsidy from the government.
Another change by GE in 2024 was to lower the age, from 85 to 80 years, for older patients who need to pay a 50 per cent higher deductible. This is the amount a patient has to pay each year before insurance kicks in.
Prudential currently requires the higher deductible only for those aged 85 and older. For other insurers, it is between 80 and 82 years.
Insurers have also made some changes that are beneficial to policyholders. All of them now cover Mobile Inpatient Care@Home (MIC@Home) at normal inpatient ward rates.
MIC@Home is an initiative by MOH to have stable patients treated in their homes instead of a hospital ward, thus freeing up beds for those who need them more.
As required, doctors and nurses will carry out video consultations or visit these patients at their homes.
GE has also raised its coverage in some areas, such as for proton beam therapy, which has gone up by S$10,000 to S$30,000, depending on the IP plan.
Income increased its coverage in September 2024 for cancer drug services to five times the payout by MediShield Life for both its Class A and B1 plans – up from four times and three times previously. This brings it in line with the coverage offered by most of the other insurers.
Income also raised the annual ceiling on psychiatric treatment to S$20,000 for its private hospital plan, S$10,000 for its Class A plan and S$7,000 for the Class B1 plan. THE STRAITS TIMES
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