Intimidated by all the acronyms, government schemes and ridiculous jargon surrounding health insurance in Singapore?

Yeah, us too. That’s why we did the research to give you a crash course on the basics of health insurance in Singapore: how it works, why you might need it, and what options there are.

Health insurance in Singapore — the TL;DR version

If you don’t have time to read, here’s a very compressed version of this article:

• All Singaporeans and PRs get basic health insurance (MediShield Life) which covers basic public hospital treatments.
• You can boost MediShield Life with an Integrated Shield Plan (IP), which covers you in better class wards and private hospitals, plus covers your pre- and post-hospitalisation treatment.
• BUT no matter what health insurance you have, you need to pay some money (cash or Medisave) before you can claim the rest.
• You can add on a “rider” to your Integrated Shield plan which helps lower those upfront costs to 5per cent of your hospital bill.
• You can use Medisave to pay for MediShield Life and Integrated Shield plans, but NOT riders.

Is Singapore’s healthcare system expensive? Need health insurance meh?

If you’re asking this, count yourself lucky. It must be a Singaporean rite of passage to swallow one’s shock and dismay upon looking at your first hospital bill.

The Ministry of Health publishes very detailed historical fees that give you an idea of how much different types of medical procedures cost.

Let’s take, at random, the median hospital bills for an uncomplicated knee joint replacement surgery. The bill includes your hospital stay, operation fees and assorted other costs:

So as you can see, one seemingly “simple” medical procedure like this can set you back a few months’ salary. Ouch.

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But I already have Medisave. I can use Medisave to pay, right?

Every working Singaporean would have some money in their Medisave accounts. Channelled from your CPF savings, Medisave is basically a bucket of funds which are meant for healthcare costs. 

The short answer is: yes, you can use Medisave to defray some of the costs of your treatment (or your immediate family’s). But there are withdrawal limits that apply to specific medical bill components:

• Surgery: Depends on how complex the procedure is. Ranges from $250 (simplest) to $7,550 (most complex).
• Daily ward fees: $450/day for a regular hospital stay. For day surgery, it’s $300/day.

Any amount above the Medisave limits — including costs like lab tests that don’t fall under the above categories — will need to be paid out of your pocket.

So… are you saying I should buy health insurance?

Based on the simple projection we went through above, there’s a compelling case for getting some form of health insurance. It would cover more of your hospital bill beyond your Medisave withdrawal limits, plus the other medical bills you can’t use Medisave on.

Hold up though — before you call up your primary schoolmate-turned-insurance agent, know that every Singaporean and PR is already automatically covered with basic health insurance.

It’s called MediShield Life, and no, you can’t opt out. However, premiums are affordable (FOR NOW!) and you can use Medisave to pay them. You can calculate yours here.

Given the low premiums, MediShield Life benefits are correspondingly basic. Payouts are pegged to prices for Class B2 and C wards in public hospitals. If you stay in a Class B1 or A ward, or in a private hospital, you can still benefit from MediShield Life, but you need to top up the rest of the bill.

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What if I don’t want to go to public hospital? What other types of health insurance can I get?

Most Singaporeans would find MediShield Life rather limiting, as if you do end up in a life-threatening condition you would want the best care and treatment you can afford.

Fortunately it is very easy to upgrade your basic MediShield Life with private health insurance.

They work together like a layer cake, where MediShield Life forms the base layer, covering public hospitals’ lower class wards.

The next layer is an Integrated Shield Plan (IP) which combines MediShield Life with additional coverage provided by private insurers.

Finally, if you don’t mind paying extra premiums in cash (not Medisave) you can add “riders” on to your IP to enhance your coverage. I’ll explain these in a bit.

What are the benefits of an Integrated Shield Plan?

About 2/3 of Singaporeans have an Integrated Shield plan, even though it costs more than MediShield Life. Why??

For a start, you can pay for a portion of your or your immediate family’s IP premiums with Medisave within the annual withdrawal limits: $300 (up to 40 years old), $600 (41 to 70 years old) or $900 (71 years old and up). Which is a great way to use up funds that would otherwise just sits there untouched, year after year.

Depending on the combination of plan and riders you choose, IPs can deliver the following benefits:

• Higher class wards in public hospitals
• The option of staying in private hospital
• Higher annual claim limits
• Choice of doctor
• Shorter waiting time
• Bonus benefits e.g. medical coverage outside Singapore

Plus some people like the fact that your insurance agent is your one point of contact for all things health insurance related. If you need to make a claim or check if you’re covered for this and that, no need to dig through the government website — just WhatsApp your agent.

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Which Integrated Shield Plans are available?

There are 7 IP providers in Singapore:

They all basically extend the coverage of MediShield Life to cover Class B1 in public hospitals, all the way up to private hospitals.

Each insurer offers 2 or 3 plans targeting different healthcare levels, e.g. B2 ward, A ward, and private hospital. You can compare their coverage here.

What are Integrated Shield Plan riders? Why buy them?

Fun fact! Regardless of whether you have MediShield Life or Integrated Shield plan — once you’re hospitalised, you’ll need to pay a certain portion of your hospital bill out of pocket or Medisave.

• Deductible: This is like the excess in car insurance — you need to pay this the first time you get hospitalised in a policy year before the insurer will pay the rest. It’s either $2,000 (B2 ward), $2,500 (B1 ward) or $3,500 (A ward/private).
• Co-insurance: You also have to co-pay 10per cent of the hospital bill regardless of the deductible.

So let’s say you go for knee joint replacement surgery in a public hospital A ward, and the bill comes up to $22,000. Even with insurance, you need to pay a deductible of $3,500 + co-insurance of $2,200 = $5,700.

All IPs offer “riders” (add-ons) that reduce those costs down to just 5 per cent co-insurance. In the same knee replacement example above, with a rider, you’ll just need to pay $1,100 instead of $5,700.

IP rider premiums have to be paid in cash (no Medisave, sorry) and they can vary a lot. Check out our Integrated Shield plan comparison to compare rider premiums.

ALSO READ: 3 tips to save on healthcare in Singapore

That was way too much information. What should my key takeaways be?

To sum it all up, your health insurance portfolio should reflect how concerned you are about healthcare costs, a.k.a. your level of kiasu-ness.

Bochup: If your only response to a $22K hospital bill is a nonchalant shrug, then all right, you don’t have to take any action. You already have MediShield Life and that’s enough to save your ass in the most basic sense — as long as you’re not choosy about which ward you stay in.

Normal: If you have faith in Singapore’s public health, but are cautious about potentially high medical bills, then opt for a public hospital Integrated Shield plan. 

Go for a Class A IP if you can afford it; otherwise, even a B1 plan is an upgrade over the basic MediShield Life, since it covers pre- and post-hospitalisation costs too.

Kiasu: So you want to get a private hospital IP just in case? Due to the astronomical cost of private healthcare, we’d strongly recommend getting a rider too. 

Otherwise you’d end up paying thousands of dollars on every hospital visit. Make sure you consider the total cost of premiums — some of which will need to be paid in cash.

This article was first published in MoneySmart.