Integrated Shield Plan

Co-pay riders

All full-rider plans, except for Prudential’s PruExtra Premier Rider, will transit* to co-pay riders upon renewal from 1 April 2021.

Full riders are no longer sold as of March 2018 due to the Ministry of Health’s requirements. (Today, if you are buying an Integrated Shield Plan, your options for riders are only co-payment riders with a minimum of 5% co-payment.)

The thing to note is that the co-payment (your out-of-pocket costs) will likely not exceed 5% of your total hospital bill and will be capped at $3,000, if you obtain pre-authorisation with your insurer prior to your surgery with a specialist on the insurer’s panel. This is subject to annual and lifetime policy claim limits. For example, if your hospital bill is $30,000, with 5% of co-payment, your out-of-pocket costs will be $1,500.

This 5% of the co-payment may be offset partially or fully by MediSave and/or your corporate insurance. It is advisable to check with your Human Resource department if you are covered under a corporate insurance.

As part of the recent changes, some insurers have also introduced claims-based pricing for selected Integrated Shield Plans. Learn more about claims-based pricing below.

* As of 31 March 2021. Please check with your insurance agent for the latest policy changes. Private insurers include AIA, Aviva, AXA, Great Eastern, NTUC Income and Prudential.

Claims-based pricing

Some insurers such as Prudential, AIA and Great Eastern have introduced claims-based pricing for selected Integrated Shield Plans. With claims-based pricing, your rider premiums at each policy renewal are adjusted based on your claims during the previous policy year. How this is calculated is dependent on your insurer.

For example*, the standard premium for a co-pay rider at 38 years old is $722. If a claim is made at a private hospital in 2021, your premium at the next policy year (2022) will increase by 1.5 times to $1,083. The adjusted premium will go then back to the standard level in 2023.

*This scenario is based on a Great Eastern TotalCare Elite-P co-pay rider as of 1 April 2021 with a claim amount > $2,000. Please check with your insurer to find out more information about your plan and premiums.

Call or WhatsApp Parkway Insurance Concierge at +65 9834 0999 to find out more about your Integrated Shield Plan coverage.

You can also estimate your out-of-pocket expenses for common surgical procedures at Mount Elizabeth Hospitals, Gleneagles Hospital, and Parkway East Hospital.

To understand your Integrated Shield Plan coverage better, it is helpful to understand commonly-used terms in insurance.

Deductible, co-insurance and co-payment are the 3 key patient-payable portions of a hospital bill when it comes to Integrated Shield Plans.

Different plans apply the calculations differently.

• Deductible

  Deductible is the basic sum you must contribute to your bill before you make your claim. This is a fixed maximum sum, and if the bill is less than the deductible, the patient pays the full bill.

  If a private hospitalisation deductible is fixed at $3,500 for a patient’s Integrated Shield Plan, this means the patient must first pay up to $3,500 before they can start making an insurance claim for their hospitalisation.

• Co-insurance

  The co-insurance is a percentage that is calculated after deducting the deductible of the bill size. After paying the deductible amount, the remainder of the bill to be claimed is then used to calculate the co-insurance. This means that for every bill, the patient has to pay the percentage of the remaining bill (minus deductible), and the insurance pays the remainder.

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• Co-payment

  Co-payment is an additional component that a patient may have to pay. For riders, the co-payment is calculated as a percentage of the total bill size. Typically, the co-payment for most co-pay riders is 5% of the bill.

  Depending on your rider plan, most insurers have a co-payment cap. If the co-payment amount exceeds the co-payment cap the patient only needs to pay the co-payment cap. The rest is covered by the insurer. Most insurers apply a co-payment cap of $3,000 if policyholders seek treatment from the insurer’s preferred panel of doctors and if the treatment has been pre-authorised by the insurer.

• Pro-ration (AIA plans only)

  Pro-ration applies to some Integrated Shield Plans (under AIA only) when a procedure is not pre-authorised. In the event of pro-ration, the insurer will only service the pro-ration factor percentage of the claim. For example, if the claim is $10,000, the insurer will only cover 85% of the claim, and the rest is to be paid by the patient.

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• Claim limits

  There are 2 types of limits for Integrated Shield Plans:

  • Lifetime limit – the maximum amount your claim can reach throughout your life
  • Policy year limit – the maximum your claim can reach in the policy year

• Panel doctors

  Insurers have their preferred doctors whom they have selected to be on their panel. Patients who visit panel doctors may enjoy enhanced coverage and higher claim limits.

• Pre-authorisation

  Pre-authorisation is a service where your insurer approves coverage for a hospital admission and/or day surgery based on your policy coverage, benefit entitlement and medical information provided by your doctor prior to the actual surgery.

  Pre-authorisation is always recommended for planned treatments as this can ease the claim process and patients may enjoy higher coverage. Where possible, patients should always seek pre-authorisation from their insurers before beginning treatment.

  Most insurers can provide pre-authorisation within a week.

• Claims-based pricing

  With claims-based pricing, your rider premiums at each policy renewal may increase or decrease based on the claims paid by your insurer during the previous policy year. You will receive a discount of 10% – 25% off your premiums if no claims were made in the previous policy year.

  Depending on your hospitalisation experience (e.g. at private or restructured hospitals, choice of insurer panel or non-panel doctors, the amount claimed and your age) your premiums may increase 1.1 – 2 times the standard premiums before they drop back to the standard level in the next renewals. The adjustments will be determined by your insurer.

Still confused? Call or WhatsApp Parkway Insurance Concierge at +65 9834 0999to get clarifications on your Integrated Shield Plan coverage.

If you have an Integrated Shield Plan and a rider that that provides coverage for private hospitals, you may be covered for treatment at Mount Elizabeth Hospitals.

Your Integrated Shield Plan can also serve as an emergency medical insurance.

If your visit to our Accident & Emergency (A&E) department warrants a hospital admission with a minimum stay of 8 hours, you can use your Integrated Shield Plan that covers private hospitals (with a rider) to pay a minimal amount for both your A&E outpatient bill and your inpatient treatment.

Some policies also cover the A&E outpatient treatment, up to a certain limit and can be used as both accident health insurance and emergency health insurance. Contact your financial advisor to understand your full policy details.

*Terms and conditions apply. Valid for full riders purchased before 1 April 2019.

You can find out if you have an integrated shield plan through the CPF Board website. You will require your SingPass to do this.

1. Go to cpf.gov.sg
2. Log on to my cpf Online Services
3. Go to "My Messages"
4. See "Insurance" section

To find out the policy details of your integrated shield plan, please contact your insurance company or financial advisor.

Call or WhatsApp Parkway Insurance Concierge at +65 9834 0999 to find out if your Integrated Shield Plan covers you and your loved ones at Mount Elizabeth Hospitals.

You can also get an estimate of out-of-pocket expenses for common surgical procedures.