Integrated Shield plan – what’s in it for me?
What is an integrated shield plan? Integrated shield plan is a health insurance plan approved by the Ministry of Health (MOH) sold by private insurance company. These companies are AIA, Prudential, Great Eastern, Aviva and NTUC Income.
As discussed in the previous article on MediShield works best for patients who are warded in B2 or C ward. For people who want more coverage in B1 or A ward in a restructured hospital or private hospital, they can opt to enhance their MediShield insurance with an integrated shield plan. From the diagram below, you can see that together with the MediShield plan, an integrated shield plan provides you enhanced benefits beyond class B2/C wards.
How does this plan work?
There are two key differences between a MediShield Insurance plan and an Integrated Insurance plan.
1. There is no claim limit for surgical procedure in the integrated insurance plan.
2. There a pre and post hospitalization benefits in the integrated insurance plan.
Let’s take a look at how integrated plan work through an example:
Mr A, aged 50, needs a hip replacement surgery. Currently he has a MediShield plan, however instead of staying in a class B2 he wants a more comfortable ward. He also would like to continue treatment under his current doctor. (Note: in class B2/C, you cannot choose your preferred doctor). Hence he wanted to upgrade to class A ward in a re-structured hospital. The table below illustrates the amount Mr A needs to pay under MediShield vs the Integrated shield plan.
Ward Class: A
Length of stay: 18 Days
Procedure Performed: Hip Replacement
Pro-ration Factor based on Ward Class: 35%
|Hospital Bill||35% of hospital bill1(refer to Table C)||MediShield Claim Computation||Integrated shield plan|
|Daily Ward & Treatment Charges (for 18 days)||$7,500||$2,625($7,500×35%)||$2,6252||$7,500|
|Surgical Procedure (Table 5)||$5,000||$1,750($5,000×35%)||$8403||$5,000|
|Claimable Amount (less Deductible)||–||–||$2,865||$13,000|
|Integrated shield plan pays||–||–||–||$11,700|
|Medisave and/or Cash(This is the amount borne by insured)||–||–||$14,114.75||$4,800|
|1||As the insured member is a Singaporean who stayed in Class A ward, the MediShield claim is computed based on 35% of the bill.|
|2||Lower of the claim limit in Table A for Daily Ward & Treatment Charges, ($450 x 18 days) = $8,100, or 35% of charges incurred of $7,500 = $2,625. Therefore, the claimable amount is $2,625.|
|3||Lower of the claim limit in Table A for surgical procedure, $840 (Table 5), or 35% of charges incurred of $5,000 = $1,750. Therefore, the claimable amount is $840.|
|4||Lower of the claim limit in Table A for implant, $7,000, or 35% of charges incurred of $4,000 = $1,400. Therefore, the claimable amount is $1,400.|
|5||The insured member is below age 80, subject to Deductible of $2,000 for Class A Ward.|
|6||Co-insurance = ($1,000 x 20%) + ($1,865 x 15%) = $479.75.|
As there is a limit to the amount under MediShield plan, if Mr A has only the Medishield plan, the amount claimable before co-insurance and deductible is $4,865. The final amount MediShield plan pay out for Mr A’s hospital bill is $2,385.25. In this case, MediShield plan covers about 14% of the whole of Mr A’s bill. He has to pay the remainder of $14,114.75 either through Medisave or in cash.
Let’s take a look at the difference if Mr A had taken the integrated shield plan. As mentioned earlier one of the key difference between MediShield plan and Integrated Shield plan is the limit placed on surgical related procedure. In Mr A’s case, under the Integrated Shield plan, all cost is covered (i.e. $5,000 for surgical and $4,00 for implant). The deductible for class A is $3,500. Depending on the private insurance company where Mr A signed up the Integrated shield plan with, the co-insurance amount may vary. On average, we can safely assume that it would be 10% of the amount left over after the deductible. In this case, it would be $1,300.
The total amount covered by the integrated shield plan would be $11,700 ($13,000 less $1,300). This leaves $4,800 to be paid by Mr A through either Medisave or cash.
From this example, you can see that if Mr A enhanced his MediShield plan to the Integrated Shield Plan, he gets better coverage and lesser payout to be made.
For the icing on the cake, integrated shield plan provides pre-post hospitalization benefits. There is 90 day pre-post hospitalization benefit for a patient who is scheduled for a surgical operation. Consultation with specialist and medicine will be covered only if the patient hospitalized. If no hospitalization is required, there is therefore no pre-post hospitalization benefits.
Please click here for more information on integrated shield plan with rider.