SINGAPORE - People who have bought Integrated Shield Plans (IPs) from private insurers may not be able to claim for certain drugs used in outpatient cancer treatments from April 2023.
The Ministry of Health (MOH) has come up with a list of clinically proven and cost-effective cancer drug treatments that can be covered by MediShield Life insurance from September next year.
The same list will apply to coverage by all IPs sold or renewed from April 2023, the MOH announced on Tuesday (Aug 17).
Currently, many IPs cover outpatient cancer treatments on an as-charged basis. This means that treatment costs are only capped by the overall annual limit of the insurance plan, which could exceed $2 million.
With the change, coverage will be limited to the 150 or so drugs that are on the MOH's approved list. Claims cannot be made for drugs that are not on the list.
This coverage for outpatient cancer treatments will also be capped, though the cap can vary depending on the drug used.
The Life Insurance Association of Singapore said: "IP insurers will study the changes and bring their plans into alignment with the direction from MOH."
This new requirement however, does not apply to coverage by riders, which IP policyholders pay out of pocket for to cover the bulk of their share of medical bills. Premiums for IPs are paid with Medisave.
This means that the eight insurers can continue to fully cover the cost of treatment for the more than 1.7 million policyholders who have bought riders.
The Government requires patients with IPs to pay a deductible of up to $3,500 a year before insurance kicks in, and a co-payment of 10 per cent of the rest of the bill.
Prior to 2018, riders could pay for the patient's entire portion of the bill. However, people who bought riders from March 8, 2018, have to pay 5 per cent of the bill up to a minimum cap of $3,000 a year.
The MOH made the change to riders to curb rising healthcare costs, as it found that people who do not pay a cent for their treatment have bills that were 60 per cent higher than patients who did not have riders.
As it stands, unless insurers change the conditions of rider coverage, should a patient with a rider get non-approved outpatient cancer treatment, the rider will pay for all but 5 per cent of the bill.
Associate Professor Jeremy Lim of the National University of Singapore Saw Swee Hock School of Public Health pointed out that there are two parts to the term "cost-effective". Drugs not on the list might be effective, but may not meet the MOH's cost requirement.
He said: "I do hope there is a system for appeal and consideration of exceptions for individual patients, as there won't be a 'one size fits all' for everyone."