Last Updated on June 15, 2023 by Tree of Wealth

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Starting April 1^st 2023, Integrated Shield Plans in Singapore will only cover cancer drugs that are on the government’s approved list. The move aims to curb the rising cost of cancer treatments and secure better drug prices, according to the government’s announcement in August 2021. The decision follows a review of MediShield Life, the country’s basic health insurance scheme, which showed that cancer drug spending increased by 20% annually from 2016 to 2019. Projections indicate that the expenditure could reach S$2.7 billion (US$2 billion) by the end of this decade if the trend continues.

TLDR:

Singapore’s Integrated Shield Plans (IPs) will not cover certain drugs for outpatient cancer treatments from April 1 2023. Instead, coverage will be limited to the government-approved list of roughly 150 clinically proven and cost-effective cancer drugs that MediShield Life insurance also covers. IPs sold or renewed from April 2023 will follow this list.

While current IP coverage for outpatient cancer treatments is based on an as-charged basis, claims after April 2023 can only be made for drugs on the approved list. Furthermore, this coverage will be capped, with varying limits depending on the drug used. This change aims to control healthcare costs and align IP coverage with MediShield Life coverage. Riders, which IP policyholders pay out of pocket to cover the majority of their medical bills, are not subject to these changes. Insurers can still cover non-approved outpatient cancer treatments for policyholders with riders.

Overview of the Changes

From 1^st April, all newly purchased or renewed Integrated Shield Plans (IPs) from private insurers in Singapore will only cover cancer treatments on a pre-approved list. This change was made in September 2021 by both the national medical savings scheme, MediSave, and the basic health insurance scheme, MediShield Life, as part of efforts to control the rising cost of cancer treatments in Singapore.

The MOH has increased the number of treatments in the cancer drug list from 270 to 340 as of February 2022, which covers around 90% of all cancer treatments approved by the Health Sciences Authority. However, some treatments are not included in the list due to the high cost and lack of willingness from suppliers to moderate prices. Nonetheless, the MOH is committed to working with suppliers to expand the list in the future.

What Happens if Your Treatment is Not on the Approved Cancer Drug List?

There are seven insurance providers in Singapore offering IPs: AIA, Prudential, Income Insurance, HSBC, Great Eastern, Raffles Health Insurance and Singlife. According to Health Minister Ong Ye Kung, all of these insurers will maintain the current IP coverage of their policyholders until at least Sep 30 this year. After this date, cancer patients who require treatments not on the MOH list may still be covered by IP riders or other insurance plans they have, or they may need to switch to treatments that are already on the list. For those who are unable to pay, subsidised care and financial assistance are available at public healthcare institutions.

In what other ways will the coverage of IP change for patients undergoing cancer treatment?

For now, patients are able to receive coverage for outpatient cancer drug treatments under most IPs, with the exception of any applicable co-payments or deductibles.

Most policyholders will experience a reduction in coverage as IPs will only provide up to five times the MediShield Life claim limit for cancer treatment. The MediShield Life claim limit can range from S$200 to S$9,600, depending on the drug used.

As a result, cancer patients who hold IPs will likely need to consider purchasing insurance riders in order to minimize their out-of-pocket expenses for medical bills.

What impact will the CDL have on my Shield Plan (IP) coverage?

The effective date of this change for most IPs is April 1, 2023, and any cancer drug treatment that is not listed or administered as specified in the CDL will not be eligible for coverage. Therefore, if you require coverage for non-CDL treatments, you may need to purchase an IP rider, which is an additional insurance policy that provides additional coverage beyond what is offered by MSHL or the IP basic plans.

Several insurers offer various coverage options that include IP riders, such as Enhanced Incomeshields, Singlife Shield, GE SupremeHealth, Prushield, AIA Healthshield Goldmax, Raffles Shield, and HSBC Life Shield with Enhanced Care Rider. These plans have different limits, with co-payment percentages ranging from $15,000 per month to $360,000 per year.

What additional coverage do riders typically offer?

Before the changes take effect, the seven insurers have modified or introduced rider policies to offer more coverage for cancer treatment.

AIA, Prudential, and Great Eastern currently offer the best cancer coverage among the three insurers. AIA’s new Cancer Care Booster provides coverage of 16 times the amount offered by MediShield Life for cancer drug treatments on the MOH-approved list in addition to the primary policy. Prudential and Great Eastern’s riders provide 15 and 18 times the MediShield Life claim limit, respectively, in addition to the primary policy limit.

Almost all of the other insurers provide coverage that is at least twice the primary IP policy, covering treatments on the cancer drug list, consultation fees, tests, and supportive medication. Singlife, on the other hand, does not specify whether its rider plan offers additional coverage for drugs on the MOH list.

For drugs not on the MOH list, Great Eastern provides the highest annual claim limit of S$250,000, followed by AIA (S$200,000) and Prudential (S$150,000). Other insurers offer a monthly claim limit ranging from S$15,000 (Income Insurance) to S$30,000 (HSBC) or a policy year limit of S$30,000 (Singlife).

Will Riders Increase in Premiums after 1 Apr?

Singlife’s annual premiums for its policies start at S$27 and go up to S$4,132 for those aged 75, with no option to buy new policies for those above 75 years.

AIA is offering a one-time waiver of underwriting for existing policyholders of its private hospital plan who opt for the new booster within six months of their policy renewal between Apr 1 and Mar 31 next year. The booster comes with an additional premium ranging from S$22.70 to S$934.90 for those aged above 100. Policyholders with riders for their AIA private hospital plan will automatically receive the booster, but they may opt out if they do not want to pay the additional premium.

Annual premiums for IP riders for the other five insurers currently range between S$44 and S$12,560, depending on the age of the policyholder and the type of plan purchased.

Here are some examples of insurers’ IP rider coverage options for non-CDL treatments that can give you an idea of what to expect:

Cancer Drug Cover – Integrated Shield and rider offerings

	AIA	GREAT EASTERN	HSBC LIFE SHIELD	INCOME	PRUDENTIAL	SINGLIFE SHIELD	RAFFLES SHIELD
Private Hosp base plan	Healthshield Gold Max A	SupremeHealth P	Plan A	Enhanced Incomeshield Preferred	PruShield Premier	Plan 1	Private
Cancer drug list benefit	5x MediShield Life (MSHL) limit						4x MediShield Life (MSHL) limit
Cancer drug services	5x MSHL limit						4x MSHL limit
Rider	VitalHealth A Value	TotalCare P Select	Life Enhanced Care	Deluxe Care	PruExtra Premier Copay	Private Prime	Key rider
CDL benefit	NA	18x MSHL limit**	5x MSHL limit**	10x MSHL limit**	15x MSHL limit**	NA
Non-CDL benefit	NA	S$250,000/year	S$30,000/month	S$15,000/month	S$150,000/year	NA	S$5,000/year for drug class A,B,C
Cancer drug services	NA	As charged	NA	NA	15x MSHL limit**	NA
Other rider	Cancer Care Booster					Cancer Cover Plus	Premier Rider
CDL benefit	16x MSHL limit**					Up to S$1.5m per policy year	2x MSHL limit**
Non-CDL benefit	S$200,000/year					In excess of deductible	S$20,000/year for drug class A,B,C
Cancer drug services	10x MSHL limit**						2x MSHL limit**
Annual premiums (S$) (age next birthday 31); Medishield Life premium S$393.64
Base IP (S$)	395.6	325	324	292.71	340.15	412.82	342.17
Rider (S$)	348.22 (VitalHealth A Value)	343	570.3	722	575.2	476.17* (Private Prime)	344.75 (Key rider)
Additional cancer Rider	35.60 (Cancer Care Booster)					150 (Cancer Cover Plus)	103.3 (Premier rider)

*Prudential Premium includes 20% Pruwell Reward, Singlife Premium includes 15% no-claim discount

**In addition to MSHL multiple in the base plan

HSBC Life Shield + Enhanced Care Rider

Taking over AXA and the previous AXA Shield, the HSBC Life Shield’s basic plan provides a significant yearly limit of $2.5 million. They also provide an Enhanced Care Rider for added coverage for non-CDL treatments. The rider offers a monthly benefit limit of $30,000 with a co-payment of 5%, if necessary.

Singlife Shield + Health Plus Rider

Singlife Shield, previously known as Aviva MyShield, is a well-known IP provider in Singapore. Their basic plan offers a policy year limit of up to $2 million. If you need more coverage for non-CDL treatments, you can buy an IP rider that offers $30,000 per year coverage, with a 5% co-payment.

AIA Healthshield Gold Max with Max VitalHealth Rider

AIA Healthshield Goldmax provides a yearly benefit limit of $2 million and also offers IP riders for non-CDL treatments. If you require additional coverage for non-CDL treatments, you can purchase an IP rider that provides $50,000 per year of coverage with a 10% co-payment amount.

Raffles Shield + Riders

Raffles Shield is a recent addition to the IP market, and their basic plan offers a substantial yearly limit of $1.5 million. They provide multiple shield plan riders for additional coverage for non-CDL treatments, such as a Key Rider that offers coverage of $5,000 per year and a Premier Rider that offers coverage of $20,000 per year, both with a 5% co-payment.

Prushield + PRUExtraRider

Prushield, an established IP provider in Singapore, offers a basic plan with a high annual limit of $1.2 million. They also offer IP riders for non-CDL treatments, similar to other insurers. If you need additional coverage for non-CDL treatments, you can purchase an IP rider that provides $150,000 per year coverage with a 5% co-payment.

GE SupremeHealth + TotalCare Rider

GE SupremeHealth is a well-known IP provider in Singapore that offers an annual limit of $1.5 million. If you require additional coverage for non-CDL treatments, you can also purchase an IP rider that provides $120,000 per year coverage with a 5% co-payment.

Key factors to keep in mind when evaluating non-CDL coverage options from different Shield Plans.

When selecting an Integrated Shield Plan, it is crucial to examine the coverage provided for non-cancer drugs list. It is important to note that various insurers have different limits for outpatient non-CDL treatments, and therefore, it is recommended to check with your insurer to comprehend their coverage and limits. While this information is available on their website, it can be subject to change due to the dynamic nature of Integrated Shield Plans and MediShield Life coverage. Therefore, it is advisable to stay informed and make an informed decision for you and your loved ones.

Understanding Other Cancer Protection Coverages in Singapore

Critical Illness Insurance Plans – offers a lump sum payout upon the diagnosis of a critical illness, which includes cancer. This payout can be used to cover various expenses, such as treatment costs, lost income, or other expenses incurred during the treatment. They also come in Single or Multiple Critical Illness Payouts depending on your concerns and needs.

Standalone Cancer Insurance Plans – Certain insurance providers offer dedicated insurance policies that cover cancer-related expenses, such as surgery, hospitalization, chemotherapy, and radiation therapy. These policies are designed to provide comprehensive coverage for cancer treatment expenses.

FAQs

Why has cancer treatment financing changed?

Prior to September 1, 2022, MediShield Life covered up to $3,000 per month for all cancer drugs, while Integrated Shield Plans (IPs) often provided unlimited coverage with a small co-payment. However, this reimbursement structure led to drug companies having no incentive to lower prices for drugs that were less expensive, resulting in higher costs for cancer drugs in Singapore compared to other countries. The changes in cancer treatment financing now enable us to negotiate for lower drug prices, ensuring that cancer treatment costs and insurance premiums remain affordable for Singaporeans in the long run.

Since 1 September 2022, how will my claims be affected by the new Cancer Drug Treatment benefit?

MediShield Life and MediSave will provide coverage only for cancer treatments listed on the Cancer Drug List (CDL). Each cancer drug treatment on the CDL will have its own claim limits and withdrawal limits for MediShield Life and MediSave. You can refer to the CDL for the list of claimable cancer drug treatments and their respective limits. If you are uncertain whether the treatment you are receiving is on the CDL, please consult your doctor. For Integrated Shield Plans (IPs), the CDL will only be effective from 1 April 2023, upon renewal or application. If you currently have an IP, you will continue to be covered under your existing policy terms until it is renewed on or after 1 April 2023.

Find out more: Full list of the Cancer Drug List

Are inpatient cancer drug treatments covered under the Cancer Drug List as well?

At present, the Cancer Drug List is not applicable to inpatient cancer drug treatments. These treatments are covered separately under the inpatient claim limits for MediShield Life and MediSave, along with any other expenses incurred during the inpatient stay.

Will patients who are already undergoing cancer drug treatment that is not on the Cancer Drug List receive support when the changes come into effect?

It is recommended to discuss with your doctor to explore alternative cancer drug treatments on the Cancer Drug List (CDL) that are subsidized and covered by insurance. However, if switching treatments is not feasible, there is still support available to help patients currently undergoing cancer drug treatment that is not on the CDL:

• Public Healthcare Institution (PHI) patients without an Integrated Shield Plan (IP) who had started treatments that are unsubsidised or not on the CDL before 1 September 2022 can receive additional financial support from MOH. Subsidised patients facing financial difficulties can also approach a Medical Social Worker (MSW) in their PHI for assistance, such as MediFund.
• For those with an IP being renewed between 1 April 2023 and 30 September 2023, and have received cancer drug treatment between 1 January 2023 and 31 March 2023, insurers will maintain their current IP coverage until 30 September 2023.
• Private patients can also consult with their doctor about transferring to a PHI for subsidised care and financial assistance. The PHI’s medical team will review the treatment plan and provide financial counselling (e.g., eligibility for subsidies) before the patient decides whether to transfer.

Selected treatments beyond the CDL may be covered by IP riders, although coverage may vary among insurers. A summary of each insurer’s IP and rider coverage for cancer drug treatments/services can be found here. If you have further queries on your IP and rider coverage, you may contact your insurer for clarification.

What if cancer drugs are taken off the CDL at a later time?

The CDL is subject to updates every four months. Typically, drugs will remain on the list unless there are compelling reasons for their removal. Additionally, claim limits may be adjusted or treatments may be removed if pharmaceutical companies increase their prices to non-cost-effective levels or if generics or biosimilars become available.

If there is a change in the CDL, the prevailing limits or listing at the time of treatment will apply. If a patient had received a non-CDL treatment before it was listed or after it was delisted, there will be no payout from MediShield Life, MediSave, or Integrated Shield Plans. MOH will provide sufficient notice to medical institutions and insurers to implement changes to the CDL, and patients are encouraged to discuss alternative subsidized treatments on the list with their doctors, where feasible.

Is it possible for a patient to make a claim for cancer drug services from the Cancer Drug Services limit if they are receiving a treatment that is not on the CDL?

Yes, patients can still make a claim for cancer drug services from the annual Cancer Drug Services limit even if the treatment they are receiving is not on the CDL. This means that the claim limit is not specific to treatments on the CDL.

Is it possible to claim a drug that is not on the Cancer Drug List under the Cancer Drug Services Limit?

If a patient is prescribed a drug that is not on the Cancer Drug List, they may be eligible to claim for the drug under the Cancer Drug Services limit, provided that the drug is a supportive medication used to manage the symptoms and side effects of their cancer drug treatment, such as pain medication or anti-nausea medication. However, if the drug is used to treat the cancer or tumour itself, such as chemotherapy, immunotherapy or targeted therapy, it should be claimed under the Cancer Drug Treatment limit instead. It’s important to note that Cancer Drug Treatments not listed on the Cancer Drug List are not eligible for MediShield Life, MediSave and Integrated Shield Plan claims, and should not be claimed under the Cancer Drug Services limit.

How are claim limits determined when multiple cancer drugs are used in treatment?

Typically, MediShield Life (MSHL) claim limits for cost-effective treatments are based on the bills for subsidised patients in Public Healthcare Institutions (PHIs) after subsidies have been applied.

The Cancer Drug List (CDL) includes treatments that involve either a single drug or multiple drugs (i.e. combination treatments).

For combination treatments, the MSHL claim limit depends on whether the treatment has been evaluated as cost-effective: • If the combination treatment is considered cost-effective, the MSHL claim limit will cover the entire combination cost after subsidies at PHIs. • If the combination treatment is not cost-effective, it may still be listed on the CDL after negotiations with drug manufacturers. However, the claim limit will be set to the highest individual claim limit of the drugs in the combination. Patients and doctors are advised to use cost-effective treatments.

Wrapping Up

If you are concerned about selecting the right type of critical illness insurance policy for cancer and other major illnesses, we can help you compare and evaluate different options. To make an informed decision, it’s crucial to assess your needs and preferences.

Understanding how critical illness insurance policies work and what to consider before purchasing one is important for making an informed decision. By taking the time to assess your needs and preferences, you can select a policy that provides the right level of protection and financial security for you and your loved ones.

Our team can guide you through the process of understanding how universal life insurance policies work and what to consider before purchasing one. By taking the time to explore the available options, you can select a policy that provides the right level of protection and financial security for you and your loved ones.

If you are interested in learning more about critical illness insurance policies, don’t hesitate to reach out to us and drop us an inquiry today. Contact us today to discuss your insurance needs and explore the options available to you. We are here to assist you and help you make an informed decision about protecting your future.

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