Speech by Dr Amy Khor, Senior Minister of State for Health, on the MediShield Life Scheme Bill, on 29 January 2015

Madam Speaker, MediShield Life marks a major milestone towards providing all Singaporeans – the young, the very old, and those who are already ill - with protection against large medical bills, for life.  Universal coverage of this scope is a goal always lauded but challenging to attain, even in advanced economies.  That Singapore is taking this huge step shows the government’s commitment to give Singaporeans greater peace of mind for their healthcare needs.  Premiums will have to increase with the enhanced coverage.  But Singaporeans can also be assured of the Government’s commitment to help them with premiums through various subsidies. 

2.     I would now like to speak on how the Bill provides for convenient and easy access to MediShield Life premium subsidies.  I will also elaborate on the Ministry’s key communications and outreach efforts during this period leading up to the roll-out of MediShield Life towards the end of the year.  

3.     Mr Baey Yam Keng, Mr Zaqy Mohamad and Ms Jessica Tan mentioned the importance of communicating MediShield Life to all Singaporeans. Since this House unanimously supported the MediShield Life Review Committee’s recommendations in July last year, the Ministry has stepped up its efforts to share with Singaporeans the benefits of MediShield Life.   Through these outreach efforts, we learnt that getting Singaporeans to understand MediShield Life is not simple, because  most of us do not think about hospital bills, or health insurance, until the day we fall ill. 

4.     We also learnt that using only the mass media to spread the word is not enough.  The communications challenge is quite daunting.  We have had to reach out through a mix of platforms, channels and languages, each with different tailored messages.   Besides print, radio, TV and social media platforms, we also shared on MediShield Life at the People’s Association’s and Agency for Integrated Care’s (AIC) grassroots events and dialogue sessions.  Thus far, we organised or participated in more than 35 dialogues and community events reaching out to over 7,000 residents.   Some of the common concerns raised during these sessions were, the affordability of MediShield Life premiums and rising healthcare costs over time; misunderstandings about duplication between MediShield Life and private insurance; the mandatory nature of MediShield Life and duplication of coverage between MediShield Life and pensions benefits or other employer-provided healthcare insurance. We sought to address some of these concerns and clarify misperceptions though explanations at dialogues, by putting up FAQs on our MediShield Life website, and through the mass media.  And I agree with Mr Alex Yam, that our communications and outreach efforts would have to be comprehensive and sustained over time.

5.     Alongside the Ministry’s outreach efforts, many Advisors and grassroots leaders have been actively engaging their residents, and I would like to take this opportunity to thank them for their efforts. We have received good feedback from MPs that these efforts have helped their constituents better understand how MediShield Life and health insurance work, and how MediShield Life can better protect them when they suffer from serious illnesses.  

6.     While Singaporeans understand that MediShield Life offers better benefits than the current MediShield, some have asked whether they will benefit from MediShield Life if they have already bought a private Integrated Shield Plan.  Some even have the mistaken view that they will have to pay for two policies – their IPs and MediShield Life. This is clearly not the case. Let me explain it this way - MediShield as it is today forms the Foundation of all Integrated Shield Plans, and the IPs, the enhanced portions, ride on this foundation to provide additional coverage targeting the Class B1/A wards or private hospitals.  When MediShield Life is launched, it will become the new Foundation.  So, MediShield Life plus the top up portion, form one integrated plan, and a single premium is paid. To use everyday language, MediShield Life is like plain Milo, which is tasty enough for most people. IPs are like Milo Dinosaur or Milo Godzilla, which tastes even richer than Milo, but will definitely cost more. Mdm Speaker, perhaps, I should not be giving high-cholesterol illustrations in talking about healthcare issues, but I believe members get the picture?  Let me also clarify, that IP policy holders will also be eligible for MediShield Life subsidies, if they meet the criteria.

7.     Over the next few months, the Ministry of Health will continue with our outreach and engagement efforts to explain and clarify the benefits of MediShield Life.   In particular, we will focus our communications and outreach on the steps Singaporeans need to take to make sure the Government is able to give them the right amount of premium subsidies that they are eligible for under MediShield Life.  Let me elaborate on these. 

Facilitated Eligibility Checks for Premium Subsidies

8.     As Minister Gan said, premium subsidies are a permanent, key feature of the MediShield Life Scheme.  In their report, the MLRC also recommended that the process of applying for subsidies should be simple and convenient, so that eligible Singaporeans and PRs can access these subsidies easily.   We have, however, heard feedback from some MPs that their constituents have asked how to start applying for these subsidies.  Some were worried that they might miss out on subsidies if they missed the deadline, or did not know where to get the application form. When the MLRC conducted its focus groups last year, we also heard concerns about the process of applying for healthcare subsidy schemes – some elderly Singaporeans commented that it is ‘paiseh’ to get their children’s signatures for the application because they were busy working!     

9.     Mr Gerald Giam had asked if the MediShield Life subsidies will be provided in a convenient and hassle free manner, and I would like to assure Members that MOH intends to extend MediShield Life subsidies to all eligible Singaporeans as conveniently as possible. 

10.     How will we do this? Firstly, all Pioneers will receive special Pioneer Generation Subsidies.  There is no need to apply. They will get it automatically.  Secondly, for transitional subsidies which the Government will give to all Singaporeans who experience an increase in net premiums, again, no need to apply.  Everyone who is eligible gets it automatically. So, to use a Hokkien phrase, it’s “bao jiak” or, to be more exact, “bao gia” (sure take) in these two instances.

11.     Thirdly, for the premium subsidies for lower to middle income households, Singaporeans will also not need to apply.  Instead, MOH will tap on existing records in Government databases to determine how much subsidies each Singaporean should receive. We have decided on such an approach of facilitated eligibility checks to ensure that the MediShield Life premium subsidies can reach as many eligible Singaporeans as possible. We are aware that there are Singaporeans who may not know how to apply for the subsidies.  By doing this facilitated eligibility checks, we ensure that low income and vulnerable Singaporeans do not miss out on MediShield Life subsidies.  We will kickstart the exercise in a few months’ time, so that the premium subsidies can be computed in time for the rollout of MediShield Life at the end of the year.  

12.     These facilitated eligibility checks will be done back-end, using the latest information available to the Government, which include NRIC addresses for us to determine who lives in the same residences, their income, and property ownership information.  The first key step is to work out ‘estimated households’, by  grouping those with the same NRIC address as part of the same household, and excluding any tenants that have been declared to HDB.  We will then use these ‘estimated households’ and their corresponding income information to calculate the household’s eligibility for MediShield Life premium subsidies. 

13.     However, for some Singaporeans, these ‘estimated households’ may not reflect their actual household composition.  This is because existing Government data is only accurate if they have been updated by Singaporeans.  For example, we only know the latest address on your NRIC, and would not know if you have moved if you do not tell us!  To help us know your latest household structure, we will need Singaporeans to do two simple things.      
   
14.     I shall simply call it: ‘2-steps to get it right’. 

15.     Number One – update your address in your I/C.  We urge all citizens and PRs to update your NRIC address.  If you have other people living in your household, such as tenants in your HDB flats, please update your tenant records with HDB.  MOH will need your address information to be up-to-date, as we will use these records to estimate who your household members are. 

16.     Number Two – check the letter that MOH will be sending to all households in a few months’ time.  The letter will provide more information on how to confirm your ‘estimated’ household composition, or make changes if necessary.     

17.     For most Singaporeans, if their latest address is reflected in Government records including NRIC records, it will be easy to confirm their household composition with a few quick clicks online. For those who are unable to access the internet, they can also check the information through phone hotlines.  Finally, those who need help with the process in-person, can also head to selected community touch points, for example Citizen Connect Centres. 

Publicity and Outreach Efforts for FEC

18.     To ensure that Singaporeans are aware of what they need to do to get the right premium subsidies, MOH will be publishing advertisements – in the print media, television, and radio, and in the heartlands to raise awareness and inform Singaporeans of the simple steps that they need to take.  This mass media publicity will be timed to coincide with the letters households will receive. So, please do not rush to the nearest Citizens Connect Centre now.

19.     We also recognise that the human touch is needed to reach out to more Singaporeans.  We intend to organise briefing sessions with the People’s Association, Grassroots Organisations and conduct roadshows to help spread the message. More details will be made available later.  After the facilitated eligibility checks are completed around the middle of the year, MOH will determine the amount of subsidy that each Singaporean should receive, before the launch of MediShield Life. 

Privacy of Income data

20.     I would also like to address the concerns raised on privacy of income data.  In order to determine eligibility for MediShield Life premium subsidies, income information is needed to calculate each household’s per capita income, similar to what we do for other healthcare subsidy schemes like CHAS.  We will only be assessing information already existing in the government’s database and not your bank accounts.

21.     To safeguard and protect income information, the MediShield Life Bill only allows persons authorised by the Minister to access such information.  There are also penalties in place against those who access the information without appropriate authorisation or consent.  For those who do not wish to have their income information accessed, they can choose not to allow MOH access to the information for the facilitated eligibility checks. This will mean that we cannot determine their premium subsidies eligibility and they, and their household members, will not be able to benefit from the MediShield Life premium subsidies.  Subsequently, if they change their mind and wish to enjoy the premium subsidies, they can apply manually for the premium subsidies but would have to submit their financial information in any case. 

Outreach to the needy

22.     Finally, I will like to focus on the group of needy Singaporeans, those who cannot afford their remaining premiums even after the various subsidies are applied.  Ms Denise Phua, Mr Gerald Giam and Ms Tin Pei Ling had also raised concerns that harsh recovery actions will be taken against those who are needy.  Some members of the public have been very worried after reading newspaper reports that some may be penalised or sued for not paying their premiums.     There was even a headline that suggested you will end up in jail for not paying your premiums.  I would like to assure Members that there is no jail for not paying your premiums.  The jail term only applies if you are served with a travel restriction order and you defy it and try to flee the country.  In addition, we will make every effort to reach out to those who need help.    Let me explain how we will do this.

23.     Prof Fatimah Lateef asked about the touchpoints for Singaporeans who may need additional premium support.  We recognise that the group of needy Singaporeans have very diverse needs and profiles, and our messages might not reach them through the traditional mass media channels. For this group, we know from the experience of implementing the PG Package that the face-to-face interaction and human touch, especially communicating in the vernacular, is important. 

24.     Hence, there will be comprehensive efforts to reach out to such Singaporeans.  For those who have missed premium payments, there will be multiple reminder letters; checks on whether another family member is able to assist them in paying the premiums; and alerts on the availability of Additional Premium Support.  There will also be direct outreach by the government.  This process will help us determine those who are truly needy from those who can afford it, but choose not to pay their premiums.  Mr Hri Kumar had asked about the actions to be taken against defaulters. For those who intentionally evade paying their premiums even though they have the means, the Minister for Health has explained the need for measures such as penalties on late premiums and recovery of arrears from employers and bank accounts.  This is only fair to all those Singaporeans who have paid their premiums responsibly and on time. 

25.     Some MPs have also asked if one will lose coverage due to non-payment. Let me repeat our promise that no Singaporean will lose their MediShield Life coverage, or be unfairly penalised for not paying their premiums, if they truly cannot afford it. 

Conclusion

26.     To conclude, I would like to say that the MediShield Life Bill provides a sound legal and governance framework for the efficient administration of the MediShield Life scheme.  MOH will continue to reach out over the next few months to communicate the key aspects of this inclusive scheme to all Singaporeans. With MediShield Life, Singaporeans can have better peace of mind for life.

27.     Madam Speaker, I support the Bill.