Health insurance is an important topic which can mystify the best of us. What if you have a pre-existing condition? What kind of coverage is desirable for your age group?

Leong Kee Ming Lionel,Tan Siak Lim and Raymond Wee, Financial Consultants from Financial Alliance Pte Ltd, give detailed answers to your questions.

Question by mosmos

I am 34 year old and already have a Medi Shield plan. Do I need to have a private medical insurance for coverage other illnesses or treatment not covered by Medi Shield? Since I have never claim for any treatment or illnesses before, will it be a waste of money to get a private medical insurance instead of a Life insurance?

Answered by Leong Kee Ming Lionel Senior Consultant Financial Alliance Pte Ltd

Let me answer by showing you some numbers: Approximately 1 in 10 Singapore residents are hospitalized in a year (assuming every patient is hospitalized once only). That means that in terms of probability, a person will likely be hospitalized at least once every 10 years.

For the purpose of this discussion, I shall reference private medical insurance to private integrated shield plans. CPF Board operates the CPF Medishield, which covers up to 80% of your H&S bills at subsidised wards in restructured hospitals.

In terms of coverage, the newer Private Integrated Shield plans (also known as Enhanced Shield Plans) offer broader coverage and more depth. For example, MediShield does not cover emergency treatments outside of Singapore, where as it is a standard feature for the enhanced shield plans. MediShield has sub-limits per category of coverage while in general the enhanced plans cover on as "As Charged" basis (ie. claims will be based on overall bill size, rather than by item). And the list goes on.

An interesting point to note that your preference is important too. Whether you prefer private hospitals or as a private patient in Restructured Hospitals (whereby you have a choice of doctors) or subsidised wards.

You may wish to refer to the following link for more answers: http://www.healthxchange.com.sg/healthyliving/SpecialFocus/Pages/Why-Should-You- Consider-Getting-a-Private-Integrated-Shield-Plan.aspx

If you delay getting medical coverage till later on, you might not be able to get full coverage when you need it. Medical insurance is always the basic builidng block for protection planning.

Reference: No. of hospitalization cases: http://www.moh.gov.sg/content/moh_web/home/statistics/Health_Facts_Singapore/Top_10_ Conditions_of_Hospitalisation.html

Question by octane

I have already pass 60 year old. All these years I have been depending on my children and husband's medi save for my operations in government hospital. At my age, will it be costly to get a basic medical insurance especially a private one?

Answered by Leong Kee Ming Lionel Senior Consultant Financial Alliance Pte Ltd

It very depends on your preference. A private medical insurance does not mean that it's meant only for Private Hospitals. For age between 61-65, it can range between approximately $1200 (Private Hospital) to $579 (Restructured Hospital B1 Ward coverage). You can use up to $800 per year from your direct family member's Medisave account to pay for the plan.

The cost will go up as you age. Hence it would be wise to also consider affordability in the future.

Best to consult with a qualified financial advisor.

Question by my

Hi. What should a healthy person in his late twenties consider before getting a health insurance plan?

Answered by Leong Kee Ming Lionel Senior Consultant Financial Alliance Pte Ltd

Health insurance plans are the basic building blocks in insurance planning. Considering that they are extremely affordable (< $150, payable by medisave, for a plan that covers up to 90% of the bill in Private Hospitals), there is really no reason to delay.

Question by sunsandsea1

What is underwriting? How long does it take the insurance company to do underwriting? Regards, Sunsandsea

Answered by Leong Kee Ming Lionel Senior Consultant Financial Alliance Pte Ltd

Usually underwriting refers to medical and financial underwriting.

Medical underwriting duration varies. If it's a straightforward case (ie. no medical history, no history of family medical occurance), it can be as fast as a week (or less).

Point to note: it's always good to declare all relevant information at the point of application. This will greatly reduce any delays in any future claims payout.

Question by hapflower

Hi there, I am currently looking for basic health and hospitalisation insurance for both of my parents. They are in their 50s. I understand that it would be very expensive to assured them at this age group. Thus, I am looking for suitable term insurance for them. Thanks.

Answered by Leong Kee Ming Lionel Senior Consultant Financial Alliance Pte Ltd

Expensive is relative. A basic Integrated Shield Plan coverage for Restructured Hospitals (B1 ward & below) would typically cost around $300 - $400. This is payable from your Medisave account.

I assume that you are referring to Term life plans (that covers Death, Disability and/or Critical Illnesses). A term insurance would not be the best option if you are looking at medical expenses coverage. The application is different. Life plans are generally geared towards income replacement (among other applications).

A good hospital plan will make sure your family will not be burdened unduely by a big hospital bill.

A simple example would be:

Mr.X is hospitalized due to back problems after a fall at home. The average length of stay is about 3 days. The 90th percentile bill size at SGH B1 ward is $4119 (ie. 90% of patients pay this amount or less, and 10% pay more. This figure provides an estimate of the upper range of bill sizes.).

Assuming no surgey is required, he can use up to $1350 (up $450 per day for hospital charges) from Medisave to pay for the bill. Even if Mr.X has MediShield, the amount claimable does not exceed the deductible ($2000), ie. not claimable.

With a Restructured Hospital B1 Ward cover, he needs to pay about deductible $2000 + co-insurance $411.90. Ie. $1707.10 is claimable. Total cash outlay would be $1061.90.

Term insurance? Nothing paid out unless this leads to Total and Permanent Disability.

Imagine if the bill size is 10 times...

Note: This is only an illustrative example and should not taken as actual case.

Question by vltoo

I think Medishield is the least expensive health insurance and if you joined before age 60, you get a further 'loyalty discount' after age 70. But Can we claim the insurance for one day surgery?

Answered by Tan Siak Lim Director of Financial Advisory, Financial Alliance Pte Ltd

Medishield does not pay for day surgery, unlike the private shield plan. While medishield is the least expensive, it's important that it is design for B2 and C ward hospitalisation, and even that, it will not cover the full bill.

Question by rsim

Hi, my company provide hospitalistion insurance plan, since this is consider health insurance and provided by the company, do I still need to purchase an additional health insurance, wouldnt this be duplicate? please advise. Thanks.

Answered by Tan Siak Lim Director of Financial Advisory, Financial Alliance Pte Ltd

It is wise to still have your own medical insurance despite the duplication with your company's insurance, the reasons are:

1. Your coverage from your company might usually come with a low sublimit per benefit
2. If you wait until you retire from your company to get your own insurance, you might be unable to be insured then due to poor health
3. If you are strike with a major illness during your employment, you maybe unable to perform your job duties, resulting in termination of your employment. This will also result in the loss of coverage from your company, and you will not be able to buy your own medical insurance by then.

Question by esim

Hi, if i am not aware that I have a pre-existing condition and let's say i purchase a health insurance without declaration as i do not know it, will the insurer refuse my claim in future if im hospitalised of this condition?

Answered by Tan Siak Lim Director of Financial Advisory, Financial Alliance Pte Ltd

Subject to the insurer interpretation of what is considered pre-existing, most insurers will not refuse your claim, especially your hospitalisation event is years after the inception of your policy.

Question by sleepygal

I have a plan under Medishield as well as a rider plan under a private insurance company. I was hospitalised recently for a pre-existing condition and required a surgery to improve my condition. I was told if i claim under Medishield then I will not be able to get reimbursement to that. However, if i used the normal medisave to pay for the medical claim, i will be able to claim a refund back to the Medisave from my private insurer. Why is this so?

Answered by Raymond Wee Associate Director of Financial Advisory, Financial Alliance Pte Ltd

Without knowing the details of your plan, it is difficult to be sure if what you are told is correct.

What we can be certain of is that a successful claim is not based on whether you claim directly from the private insurer or indirectly via Medisave. It is dependent on how your has insurer has agreed to cover your pre existing condition. If they have agreed at the inception of policy to cover the condition fully then the bill for the surgery should be covered. If they have chosen to exclude it, then the claims department has to determined from the medical report from your doctor as to whether the surgery you just went through falls within the terms and conditions of the exclusion. If it is within, no claims will be paid.

Question by deve2545

I have got a life insurance plan that covers death, total permanent disability & 30 major illnesses for about 10-15 years now. Is that enough health insurance coverage or do I need to buy more? How do I determine if my health insurance is sufficient? Thankx...

Answered by Raymond Wee Associate Director of Financial Advisory, Financial Alliance Pte Ltd

In our industry, when we use the term health insurance it usually refers to the following:

• Hospitalisation Insurance or Hospitalization & Surgical Insurance
• Disability Income Insurance
• Long-Term Care Insurance
• Critical Illness Insurance

You currently have one out of the four. Hence you may want to consider the other types of health insurance. Also if you have not reviewed your insurance and financial plans since taking up the life insurance policy you mentioned, it is prudent to do so at this point as your financial and personal circumstances have probably changed significantly and thus lead to changes in your insurance needs.

Question by imoky

Both my parents are in their early seventies, have high blood pressure and is under medication.

1. Are they eligible for private shield plan?
2. Will they be accepted?
3. Is it worthwhile to get a shield plan for them? Thanks.

Answered by Raymond Wee Associate Director of Financial Advisory, Financial Alliance Pte Ltd

From our experience, insurance underwriters are cautious about insurance applicants with high blood pressure. It usually leads to them placing an exclusion on the condition or they may decline coverage altogether. However in saying so, they will consider the merits of each case like how high the blood pressure readings are, how well the condition is controlled and also if there exists any other health risk factors.

If you are able to successfully effect a private "Shield plan" for your parents, it is certainly a good thing. "Shield plans" are highly recommended as a means of covering hospital expenses. The last age to apply for private shield plan is age 75, therefore if your parents are below age 75, they are still eligible to apply. As for whether they will be accepted, it will be subjected to underwriting as mentioned above.

Question by gmrtsk

My husband is 59 years old and, has high blood pressure and is under medication. He has an Enhanced Incomeshield plan without rider. Since he has a pre-existing illnesses, should he add rider to his Enhanced Incomeshield plan?

Thanks
TSK

Answered by Raymond Wee Associate Director of Financial Advisory, Financial Alliance Pte Ltd

A rider to the Enhanced IncomeShield plan covers the deductible you would otherwise have to pay when claiming on a hospital bill. Hence it will help lower the amount you have to pay out of your own pocket.

With your husband's pre-existing medical condition, the insurer may impose some conditions of exclusion to his rider. If that happens, you will be given a choice as to whether you want to go ahead with the rider. You may want to take note that pre-existing medical conditions are likely to be excluded for coverage under hospital insurance plan, therefore it is important that your husband's Enhanced Incomeshield plan be kept in forced at all time as I assume his high blood pressure was diagnosed after the plan was incepted and thus the it is covered under the Enhanced Incomeshield plan.

Question by synergy

Hi there, I was diagnosed with congenital small VSD since young. I was covered under Medishield. Few years ago, I upgraded to Incomeshield Basic. The policy did not state any exclusion though I declared my existing condition. So can I assume that my heart problem is covered under this Incomeshield Basic? I was thinking to get a policy for critical illness. But I have family history of high blood pressure and diabetes. My mum was diagnosed with breast cancer previously also. Together with my heart problem, is it still advisable for me to get critical illness policy as I forsee many conditions will be excluded?

Answered by Tan Siak Lim Director of Financial Advisory, Financial Alliance Pte Ltd

If you had declared your condition and NTUC Income did not revert with a counter-offer with exclusion, than you are covered without an exclusion on this condition.

Because of your family multiple conditions, it makes it even more important that your get covered with a critical illness policy. Trying to avoid an exclusion by not getting covered does not put you in a better condition. Having said that these condition is not likely to be excluded under a critical illness policy. There maybe a loading, which means your premium maybe increased in order to get covered, this is much better than no cover, since you are in a higher risk group.

Question by Khengtiong

I have brought an health plan called supreme health plus plan A from great eastern , I didn't buy the rider which cover the co-payment n 'excess' similar to car which you have to pay if the claim is not more than centain amount.

My question is should I buy the rider which have to pay by cash every year and not sure I can still buy the rider if it make sense to me. I am 52 year old male married with three kids.

Thanks in advanced
Khengtiong

Answered by Tan Siak Lim Director of Financial Advisory, Financial Alliance Pte Ltd

The "rider", which in the case of Great Eastern is call TotalShield policy, is not as critical to get as the basic Supreme Health policy. Whether you should get the TotalShield policy depends on the result of your cost / benefit analysis. It is important that you make decision with proper facts. Without TotalShield, your exposure to a medical bill is $3,000 + 10% of the reminder of the bill. The will not break your bank if the bill is small, and you can typical pay it out of your medishield account. However, it can be a hefty figure if you are presented with a bill that runs up to a few hundred thousands, which is likely especially for a surgery in a private hospital. If you have to might your own decision whether you prefer to transfer this risk to the insurer or to self insure.

Ref: T12