Government accepts MediShield Life Council's recommendations to enhance MediShield Life scheme, Government support more than offsets premium increases

         The Government has accepted the MediShield Life Council’s recommendations for the MediShield Life 2024 review. The recommendations will enhance the MediShield Life scheme, to better protect Singaporeans against major health episodes that result in large medical bills. They will also enable Singaporeans to afford new types of care. The changes will be implemented progressively from April 2025.

2.     To support the enhancements to MediShield Life, premiums will need to increase, starting from April 2025 upon policy renewal. The total premium increases will amount to $1.8 billion over the next review cycle of three years. To help Singaporeans manage the premium increases, the Government will provide an additional $4.1 billion in support measures, comprising $3.4 billion in MediSave top-ups and $0.7 billion in premium subsidies for the next three years. 

3.     For the great majority of Singaporeans – more than nine in ten – the additional MediSave top-ups, and premium subsidies and support, will more than offset the premium increases over the next three years.

MediShield Life Council’s recommendations

4.     There are a few key considerations in this review. First, as a national health insurance scheme, MediShield Life was designed to fully cover nine in ten subsidised bills in public healthcare institutions, with the deductible and co-insurance covered by patients’ MediSave. However, rising medical bills have eroded the coverage of the existing claim limits, and MediShield Life currently fully covers just under eight in ten subsidised bills. 

5.     Second, there has been an increased shift in healthcare delivery from hospitals to the outpatient, community and home settings, which MediShield Life mostly does not cover. Finally, advances in medical technologies have resulted in new, potentially life-saving therapies, such as Cell, Tissue, and Gene Therapy Products (CTGTPs), which MediShield Life also does not cover.

Enhancements to benefits and revisions to scheme parameters

6.     With these factors in mind, the MediShield Life Council has recommended the following changes to the scheme, after considering both the need for better coverage and the impact on premiums. 

a. Increase claim limits and refresh scheme parameters. This comprises:

i. Increase in existing inpatient and day surgery claim limits to fully cover nine in ten subsidised bills. For example, the daily claim limits for the first two days of a normal ward stay will go up from $1,000 to $1,630. The daily claim limits for Intensive Care Unit ward stays will more than double, from $2,200 to $5,140. 

ii. Increase in the policy year claim limit from $150,000 to $200,000, to provide greater assurance for patients with exceptionally large bills. 

iii. Increase in the inpatient deductible by up to $1,500, to keep coverage focused on larger bills and moderate the extent to which premiums need to increase.

iv. Revision of the pro-ration factors for private unsubsidised bills, to prevent cross-subsidisation of private bills by subsidised bills. 

b. Enhance outpatient coverage significantly. This comprises:

i. Refresh of outpatient claim limits to fully cover nine in ten subsidised bills. For example, the claim limits for kidney dialysis will increase from $1,100 per month to $1,750 per month.

ii. Expansion of coverage to new outpatient treatments and home-based medical care, to enable access to more convenient care options beyond the traditional hospital setting. One such treatment is the repetitive Transcranial Magnetic Stimulation used to treat depression.

iii. Introduction of a new outpatient deductible of $500 per year, to keep coverage focused on larger bills and moderate premium impact.

iv. Decrease in co-insurance for outpatient treatments – from a flat 10% to a tiered structure ranging from 3% to 10% – to be consistent with how co-insurance is computed for inpatient bills and make larger outpatient bills more affordable.

c. Expand coverage to high-cost treatments that are clinically effective and cost-effective, to improve affordability and access. This covers two areas: 

i. CTGTPs that have demonstrated the potential to treat cancers and serious diseases effectively. 

ii. High-cost drugs for blood conditions and conditions with childhood onset. 

Adjustment to premiums

7.      With higher claims and expansion of coverage, premiums will need to increase. The Council has worked with the scheme’s actuaries to determine the premium adjustments needed to ensure the scheme remains sustainable. Older Singaporeans in particular, will see larger increases. Hence the Council has recommended several measures to cushion the premium increases: 

a. Cap the total premium increase at 35%, and phase in the increases evenly over three years, from April 2025 to March 2028. With this, premiums will increase by an average of 22% per policyholder by the end of the third year. This can be funded through a one-off release of capital from the MediShield Life Fund. Due to the Monetary Authority of Singapore’s adoption of the Risk-Based Capital Framework 2, there is a change in the MediShield Life Fund’s risk model which will enable some excess capital to be released, so as to cap the total premium increase at 35% and phase it in evenly. The Fund will remain in a healthy position after this release of capital. 

b. For the Government to consider:

i. Enhancing existing premium subsidies to provide more assistance to the lower- and middle-income groups. 

ii. Providing MediSave top-ups to support Singaporeans through the Pioneer Generation, Merdeka Generation and Majulah Packages. This will be especially helpful to Singaporeans with low MediSave balances, such as homemakers and informal workers. 

iii. Providing premium discounts to policyholders who lead healthy lifestyles, such as exercising regularly and going for recommended health screenings. 

Government accepts the recommendations, adjusts MediSave withdrawal limits accordingly 

8.     The Government has reviewed the Council’s recommendations on the MediShield Life scheme and agrees that these will ensure that MediShield Life continues to provide adequate and meaningful protection to Singaporeans. 

9.     The Government will also adjust the MediSave withdrawal limits so that patients can use MediSave to cover the co-insurance and the revised deductibles. 

10.     The revised MediShield Life benefits and MediSave limits will be implemented progressively from 1 April 2025, together with the first phase of the increase in inpatient deductible. The outpatient deductible will be introduced on 1 January 2026, followed by the second phase of the increase in inpatient deductible on 1 April 2027. All other changes will be made progressively from 1 April 2025 onwards. Please refer to Annex A for details of changes to MediShield Life claim limits and MediSave withdrawal limits, and Annex B for bill examples that reflect the changes to the MediShield Life scheme.

Government provides premium subsidies and MediSave top-ups, which will more than offset premium increases

11.     The Government accepts the Council’s recommendation to release capital from the MediShield Life Fund to cap and phase in the premium increases. This will require a release of around $600 million from the Fund, and will not affect the scheme’s ability to meet its claim obligations. 

12.     In addition, over the next three years, the Government will provide an additional $4.1 billion in premium support measures, which will more than offset the cumulative $1.8 billion increase in additional premiums over the next three years. The offset package comprises:

a. Increases in premium subsidies, including enhancements to means-tested premium subsidies amounting to $ 0.7 billion. The Government will increase premium subsidies by five to ten percentage points for lower-income and middle-income Singaporeans in older age groups. From 1 April 2025, they will be able to receive premium subsidies of up to 60%, from up to 50% today.

b. Additional MediSave top-ups of $3.4 billion. The Government will:

i. Increase annual MediSave top-ups for the Pioneer Generation. The Government will increase this annual top-up by up to $300, bringing the maximum annual top-up to $1,200. Under the Pioneer Generation Package, those who are above the age of 90 in 2025 will continue to have their MediShield Life premiums fully covered by these annual MediSave top-ups and their existing special subsidies, while younger Pioneer Generation seniors will continue to see about two-thirds of their premiums covered. 

ii. Enhance the one-time Majulah Package MediSave Bonus. The Majulah Package was announced in August 2023 to provide greater assurance over healthcare costs for seniors, including Young Seniors in their 50s and early 60s. Under the Majulah Package, the Government announced that Singaporeans born in 1973 or earlier will receive a one-time MediSave Bonus of up to $1,500. This MediSave Bonus will be enhanced by $500. The MediSave Bonus will be paid in December 2024. 

iii. Provide an additional MediSave Bonus for Young Seniors and the Merdeka Generation with lower MediSave balances. Recognising that some Young Seniors and Merdeka Generation seniors born between 1950 and 1973 (inclusive) may not have been able to accumulate enough savings in their MediSave account, the Government will give a further MediSave Bonus of $500 in 2025 to help cover the rise in premiums for those with low MediSave balances. 

iv. Enhance the one-time Budget 2024 MediSave Bonus. At Budget 2024, the Government announced that Singaporeans born between 1974 and 2003 (inclusive) will receive a one-time MediSave Bonus of up to $300. This MediSave Bonus will be enhanced by $200, and will be paid in December 2024. 

v. Increase MediSave Grant for Newborns. From 1 April 2025, the Government will increase this grant from $4,000 to $5,000. With the increase, a Singapore Citizen newborn’s MediShield Life premiums will continue to be fully covered up till age 21.

c. Expansion of Additional Premium Support amounting to $80 million. Additional Premium Support is for Singaporeans who are unable to afford their MediShield Life premiums after premium subsidies, and have limited family support. The Government will expand the eligibility criteria to cover more lower-income Singaporeans.

13.     The package will offset the cumulative increase in MediShield Life premiums over the next three years for almost all ages and income levels.

14.     No one will be denied coverage due to an inability to pay their premiums. Please refer to Annex C for details of the Government’s premium support measures, Annex D for details of the revised premiums, and Annex E for household archetypes and worked examples.

Redemption of premium discounts using Healthpoints

15.     The Government also agrees with the Council’s recommendations to offer premium discounts for those who lead a healthier lifestyle. This can be done through the Health Promotion Board’s (HPB) Healthy 365 programme, which already awards Healthpoints in exchange for rewards.

16.     In support of Healthier SG, policyholders aged 40 and above may redeem MediShield Life premium discounts via HPB’s Healthy 365 app, at a conversion rate of 150 Healthpoints to $2, higher than the regular conversion rate of 150 Healthpoints to $1. To earn Healthpoints, they can participate in healthy lifestyle programmes and challenges on the Healthy 365 app, or enrol with a Healthier SG clinic and complete the first Health Plan consultation. For instance, an individual who, on average, does 30 minutes of moderate to vigorous physical activity almost daily for the entire year, could redeem $80 worth of discounts off his or her MediShield Life premiums.

17.     This programme will commence in the third quarter of 2025, and will run as a pilot for three years. The Government will review the outcomes of the pilot before deciding whether to make it a permanent feature of MediShield Life. 

Pilot financing framework for CTGTPs

18.     While CTGTPs have the potential to transform healthcare and treat serious diseases, they have high upfront costs. Without financing support, patients may not be able to access these potentially effective treatments.

19.     However, such financing must also be designed in a sustainable manner given the high cost of CTGTPs and uncertainty around their longer-term effectiveness. Hence the Government has introduced a pilot financing framework to focus support only on CTGTPs that have been assessed to be both clinically effective and cost-effective. The first CTGTP to be listed on the Ministry of Health’s (MOH) CTGTP list is tisagenlecleucel (Kymriah), for the treatment of relapsed/refractory B-cell acute lymphoblastic leukaemia, and relapsed/refractory diffuse large B-cell lymphoma. Over time, more CTGTPs will be added to the list.

20.     Since 1 August 2024, eligible patients who require the use of CTGTPs that are included on MOH’s CTGTP List have been able to receive means-tested subsidies of up to 75%, capped at $150,000 per treatment course, at public healthcare institutions. 

21.     From October 2025, the Government will also extend MediShield Life and MediSave coverage to CTGTPs on MOH’s CTGTP List. Given the high costs of CTGTPs, MediShield Life and MediSave limits will be sized to fully cover two in three subsidised patients initially. Please refer to Annex F for details. 

22.     The Government thanks the MediShield Life Council for the significant time and effort they have committed to review MediShield Life. We note that the Council has carefully considered all aspects of the scheme, and engaged many Singaporeans and stakeholders for their input along the way. The Council’s recommendations strike a good balance between providing greater protection for Singaporeans against large medical bills and keeping premiums affordable and sustainable. 

MINISTRY OF HEALTH 

15 OCTOBER 2024

Annex A

Changes to MediShield Life Claim Limits and MediSave Withdrawal Limits 

Table A-1: Revised MediShield Life claim limits and MediSave withdrawal limits for treatments currently covered by MediShield Life

Table A-1

Table A-2: MediShield Life claim limits and MediSave withdrawal limits for
new treatments to be covered by MediShield Life 

Table A-2

Annex B

Bill Examples Incorporating MediShield Life Scheme Changes

Illustration 1: Higher payouts for subsidised patients seeking inpatient care

Illustration 2: Higher payout for subsidised patient seeking dialysis treatment

Annex C

Details of the MediShield Life 2024 Review Premium Support Measures

Table C-1: Summary of the Premium Support Measures

Table C-2: Enhanced Means-Tested Premium Subsidies for Singapore Citizens

Table C-3: Additional Merdeka Generation Subsidies

Table C-4: Pioneer Generation Special Subsidies and MediSave Top-Ups

Table C-5: Revised Majulah Package MediSave Bonus

Table C-6: Additional MediSave Bonus

Table C-7: Revised Budget 2024 MediSave Bonus

Table C-8: MediSave Grant for Newborns 

Annex D

Revised MediShield Life Premiums

Table D-1: MediShield Life Premium Schedule for Singapore Citizens in 2025
After Phased Increase

Table D-2: MediShield Life Premium Schedule for Singapore Citizens in 2027
After Increase Has Been Fully Phased In

Annex E

Household Archetypes and Worked Examples

The following figures illustrate the premium impact on various groups.

Illustration 1: Mr A 

• Single Merdeka Generation (MG) senior, 67 years old

• 2-room HDB 

• Per capita household income of $1,000 monthly 

Mr A would enjoy means-tested subsidies of 40%, additional MG subsidies of 5%, and support to phase the increase evenly over the next three years. 

Note: Figures in brackets refer to the increase in premiums using 2024 as the base year. Cumulative increase over 2025 to 2027 refers to the sum of the figures in brackets. 

After subsidies and phasing, Mr A’s cumulative net premium increase over 2025 to 2027 of $109 will be fully offset with the enhanced MediSave Bonus of $1,250 under the Majulah Package. 

If he has a low MediSave balance, he may also be eligible for the additional MediSave Bonus of $500 in 2025 which could further help him pay his annual premiums and other healthcare expenses. 

Illustration 2: Mrs B

• Single Pioneer Generation (PG) senior, 87 years old

• 2-room HDB

• No household income

Mrs B would enjoy special PG subsidies of 59% and an annual PG MediSave top-up of $700. She would also receive support to phase in the increase evenly over the next three years. As a younger PG, she will continue to see at least two-thirds of her premium covered. 

Note: Figures in brackets refer to the increase in premiums using 2024 as the base year. Cumulative increase over 2025 to 2027 refers to the sum of the figures in brackets.

After subsidies and phasing, Mrs B’s cumulative net premium increase of $574 will be fully offset with the enhanced MediSave Bonus of $1,250 under the Majulah Package. 

Any remainder could be used to further help her pay her annual premiums and other healthcare expenses.

Illustration 3: Mr and Mrs C 

• MG senior couple, 67 years old

• Private residential property

• Per capita household income of more than $3,600

Mr and Mrs C would enjoy MG subsidies of 5% and support to phase in the increase evenly over the next three years. 

Note: Figures in brackets refer to the increase in premiums using 2024 as the base year. Cumulative increase over 2025 to 2027 refers to the sum of the figures in brackets.

After subsidies and phasing, Mr and Mrs C’s cumulative net premium increase of $758 will be fully offset with the enhanced MediSave Bonus of $2,500 (i.e. $1,250 each) under the Majulah Package which they will both receive. 

Any remainder could be used to pay for their annual premiums and other healthcare expenses. 

Illustration 4: The D family 

• Grandfather and grandmother (both 67-year-old MGs) 

• Husband and wife, 42 years old, both working

• Primary school-going daughter and son

• 5-room HDB 

• Per capita household income of $2,500 monthly

The D family would benefit from means-tested subsidies of up to 35%, additional MG subsidies of 5%, and support to phase in the increase evenly over three years. 

Note: Figures in brackets refer to the increase in premiums using 2024 as the base year. Cumulative increase over 2025 to 2027 refers to the sum of the figures in brackets.

After subsidies and phasing, this family’s cumulative net premium increase of $722 will be fully offset with the enhanced MediSave Bonus of $3,500 which the grandparents (i.e. $1,250 each) and parents (i.e. $500 each) will receive, and the MediSave Grant for Newborns which the children had received previously. 

Any remainder could further help the D family to pay their annual premiums and other healthcare expenses.

Annex F

Details of CTGTP Pilot Financing Framework

Illustration 1: Reduced out-of-pocket cash payment for subsidised patient