Medical insurance upgrade clarified

26 Jan 2007, The Straits Times

Question

Name of the Person: Nelly Yanty (Ms)

Medical insurance upgrade clarified

Should man upgrade his medical insurance? 

I HAVE a question on MediShield coverage. 

Let's say Mr A has been covered under the MediShield Plus plan, starting in 1993. A few years later, he was diagnosed with a medical condition. In view of rising medical costs, Mr A decides to upgrade to a plan with a higher coverage, using his Medisave funds. The new plan has been approved on the basis that it would not cover his pre-existing medical condition. 

This being so, would he still be eligible to make a claim under his original MediShield Plus plan? If the answer is no, then it would seem unwise for Mr A to upgrade his plan as he would be excluded totally from insurance coverage for the medical condition. Different insurance agents have given me different answers. Could the authorities clarify the situation?

Reply

Name of the Person: Karen Tan (Ms)

Director, Corporate Communications

Ministry of Health

In "Should Man Upgrade His Medical Insurance?" (ST, 20 Jan), Ms Yanty asked if someone who had a pre-existing medical condition should upgrade to a different Shield plan. 

For all Medisave-approved integrated Shield plans, there are 2 components. The first is the MediShield "basic" plan which is the basic tier and covers largely B/C wards. The other is the enhanced plan which is basically riders offered by the private insurer to give extra coverage for stays in higher class wards or private hospitals. 

For someone who wants to upgrade to a different Shield plan after developing illnesses, he remains fully covered by MediShield basic because it was purchased when he was healthy. However, the new MediShield rider plan may exclude coverage of the pre-existing illnesses since the upgrade affects the level of private insurance coverage. Consequently, this means that the treatment costs will be covered under MediShield basic alone. 

Nevertheless, it is possible that insurers may consider covering the pre-existing illness for Shield plan upgrades within the same company. Therefore, policyholders should consult their respective insurers regarding this.