MediShield Life Benefits

Inpatient/day surgery

Claim limits

Daily Ward and Treatment Charges¹

-       Normal ward­²

$830 per day*

-       Intensive care unit ward

$5,140 per day*

* An additional claim limit of $800 per day applies for the first two days of the inpatient² stay

-       Psychiatric (up to 60 days per policy year)

$230 per day

-       Community hospital (Rehabilitative)³

$370 per day

-       Community hospital (Sub-acute)³

$570 per day

-       Inpatient palliative care service (General)

$460 per day

-       Inpatient palliative care service (Specialised)

$500 per day

Surgical procedures

A

B

C

-       Table 1 A/B/C (less complex procedures)

$240

$420

$490

-       Table 2 A/B/C

$760

$1,120

$1,120

-       Table 3 A/B/C

$1,390

$1,740

$1,920

-       Table 4 A/B/C

$2,310

$2,370

$2,460

-       Table 5 A/B/C

$2,700

$3,270

$3,270

-       Table 6 A/B/C

$3,540

$3,540

$3,540

-       Table 7 A/B/C (more complex procedures)

$3,900

$3,900

$3,900

Implants

$7,000 per treatment

Radiosurgery, including proton beam therapy – Category 4⁴

$15,700 per treatment course

Continuation of autologous bone marrow transplant treatment for multiple myeloma

$6,000 per treatment

¹ Includes meal charges, prescriptions, professional charges, investigations and other miscellaneous charges

² Includes eligible Mobile Inpatient Care @ Home stays

³ Claimable only upon referral from a hospital after an inpatient admission or from a public hospital’s emergency department for further medical treatment.

⁴ Refer to the MOH website for the approved indications for use of Proton Beam Therapy.

Outpatient treatment

Patients receiving treatment for one primary cancer

-       Cancer drug treatment

$200 - $9,600 per month, depending on cancer drug treatment⁵

-       Cancer drug services

$3,600 per year

Patients receiving treatment for multiple primary cancers⁶

-       Cancer drug treatment

Sum of the highest cancer drug treatment limit amongst the claimable treatments received for each primary cancer per month

-       Cancer drug services

$7,200 per year

Radiotherapy for cancer

-       External (except Hemi-body)

$400 per treatment

-       Brachytherapy

$620 per treatment

-       Hemi-body

$620 per treatment

-       Stereotactic

$460 per treatment

-       Proton beam therapy – Category 1⁴

$400 per treatment

-       Proton beam therapy – Category 2⁴

$620 per treatment

-       Proton beam therapy – Category 3⁴

$460 per treatment

Kidney dialysis

$1,750 per month

Immunosuppressants for organ transplant

$710 per month

Erythropoietin for chronic kidney failure

$220 per month

Long-term parenteral nutrition

$2,200 per month

Maximum claim limit

Per policy year

$200,000

Lifetime

No Limit

⁴ Refer to the MOH website for the approved indications for use of Proton Beam Therapy.

⁵ Refer to the Cancer Drug List on the MOH website for the applicable claim limit.

⁶ Defined as two or more cancers arising from different sites and/or are of a different histology or morphology group. The claim limits for patients receiving treatment for multiple primary cancers are accorded on an application basis; doctors are to send the application form to MOH for assessment.

Section 1

Patients must meet both Criteria 1 and 2

1. The patient will require PN for a minimum of 90 days,

AND

2. The patient must have a diease of the stomach and/or intestine which significantly:

• Impairs the absorbtion of nutrients, OR

• Impairs the ability of nutrients to be transported through the GI system.

Section 2

Patients must be diagnosed with any one condition
A-H

A. Recent massive Small Bowel Resection leaving less than or equal to 1.5 metres of small bowel beyond the ligament of Treitz.

OR

B. Short Bowel Syndrome:

• Severe enough to show evidence of fluid and electrolyte malabsorbtion AND

• GI Fluid intake of 2.5-3 L/day resulting in enteral losses that exceed 50% of the oral/enteral intake

OR

C. Need for Prolonged Bowel Rest for at least 3 months and requiring intravenously 20-35 cal/kg/day for:

• Symptomatic Pancreatitis OR

• Severe exacerbation of Regional Enteritis OR

• Proximal Enterocutaneous Fistula where tube feeding distal to the fistula is not possible

OR

D. Complete Mechanical Small Bowel Obstruction where surgery is not an option.

OR

E. Malourishment and severe fat malabsorption as evidenced by:

• 10% documented weight loss over ≤ 3 months, AND

• Serum albumin ≤ 35 g/L, AND

• Severe fat malabsorption where faecal fat exceeds 50% of oral/enteral intake on a diet of at least 50gms of fat/day as measured by a standard 72-hour faecal fat test

OR

F. Malnourished and severe mobility disturbance as evidenced by:

• 10% documented weight loss over ≤ 3 months, AND

• Serum albumin ≤ 35 g/L, AND

• Severe motility disturbance of the small intestine and/or stomach unresponsive to prokinetic medications demonstrated scintigraphically or radiographically.

OR

G. Paediatric patients:

• Unable to sustain fluid and nutritional requirements for weight gain, AND

• Diagnosed with:

  • Motility Disorders, evidenced by radiological, histology, or manometry findings, OR

  • Congenital Diarrhoeal Disorders with an identified osmotic or secretory cause, OR

  • Short Bowel Syndrome with an inadequate absorptive capacity

OR

H. Advanced Cancer Patients with Intestinal Failure, in whom:

• Prognosis ≥ 3 months, AND

• Eastern Cooperative Oncology Group (ECOG) score 0-2, AND

• Non-functioning GI tract (due to obstructions, fistulae etc.), AND

• HPN is agreed as indicated care by an Oncologist and a Palliative Medicine specialist

1

Eclampsia and pre-eclampsia

2

Cervical incompetency

3

Accreta placenta

4

Placenta abruption

5

Placenta praevia

6

Antepartum, intrapartem and postpartum haemorrhage

7

Placental insufficiency and Intrauterine growth restriction

8

Gestational diabetes mellitus

9

Accute fatty liver of pregnancy

10

Obstetric cholestasis

11

Twin to twin transfusion syndrome

12

Infection of amniotic sac and membranes

13

Amnionic fluid embolism

14

Fourth degree perineal laceration

15

Uterine rupture

16

Postpartum inversion of uterus

17

Obstetric injury or damage to pelvic organs

18

Complications resulting into caesarean hysterectomy

19

Retained placenta and membranes

20

Abscess of breast

21

Ectopic pregnancy, hydatidiform mole and subsequent complications

22

Medically necessary abortions

23

Still-birth

24

Maternal death

1

$200.00

10

$2,000.00

2

$400.00

12

$2,400.00

3

$600.00

15

$3,000.00

4

$800.00

16

$3,200.00

5

$1,000.00

19

$3,800.00

6

$1,200.00

26

$5,200.00

7

$1,400.00

27

$5,400.00

8

$1,600.00

46

$9,200.00

9

$1,800.00

48

$9,600.00

Category

Indication

Proton Beam Therapy Category

Cancer subtypes for patients of all ages

Musculoskeletal system

Base of Skull Chordoma

3

Base of Skull Chondrosarcoma

Spinal and Paraspinal Bone and Soft Tissue Sarcoma

1

Non-metastatic retroperitoneal sarcomas

Central and peripheral nervous system

Ependymoma

3

Pituitary adenoma

Base of skull meningioma

Acoustic neuroma (when treated with PBT as stereotactic radiotherapy)

Acoustic neuroma (when treated with PBT as radiosurgery)

4

Lymphatic system

Localised follicular lymphoma

1

Head and Neck

Advanced (eg, T4) and/or unresectable head and neck cancers

1

Cancers of the paranasal sinuses and other accessory sinuses

Others

Oesophageal cancer

1

Oropharyngeal cancer

Advanced high risk inoperable hepatocellular carcinoma

Locally advanced cancers undergoing concurrent chemoradiation therapy

Prostate cancer

Cancer subtypes for patients younger than 25 years

Central and peripheral nervous system

Retinoblastoma

2

Chordoma/ chondrosarcoma base of skull or spine

3

Ependymoma

Craniopharyngioma

Pineal parenchymal tumours (not pineoblastoma)

Medulloblastoma

1

Intracranial germ cell tumour

Primitive neuroectodermal tumours

Esthesioneuroblastoma

Neuroblastoma

Glioma

Musculoskeletal

Ewing sarcoma

1

Spinal/ paraspinal bone and soft tissue sarcoma

Rhabdomyosarcoma: orbit, parameningeal, head and neck, pelvis

Pelvic Sarcoma

Osteosarcoma

Others

Salivary gland cancer

1