Ward classes, pro-rations and IP plans: Here’s what you need to know

The healthcare system in Singapore is praised for being one of the most efficient in the world.

The way we structure our mixed payment system is second to none.

According to the Ministry of Health (MOH) themselves, there are up to 18 different subsidy and financial assistance schemes alone if you are a Singapore Citizen, with MediSave, Medishield Life, CareShield Life ElderShield, CHAS and MediFund being the six most prominent government-assisted programmes for healthcare expenditure.

Government assistance can only do so much when it comes to covering the most basic form of healthcare. In fact, it is encouraged to take up private health insurance in order to get access to better healthcare treatment and accommodation in the hospital.

The differences between ward tiers

There are different hospitalisation wards in Singapore. In public or government-funded hospitals, wards are split into four classes: C Wards, B1 Wards, B2 Wards, and A Wards. Insurers will also include private hospital wards in their high-tier IP plans.

Ward type	Cost per day	No. of beds	Possible amenities
C	$34-$43	Seven-nine	N/A
B2	$76-$87	Five-six	Semi-automated electric bed
B1	$230-$279	Four	Bathroom, TV, phone, electric bed, choice of meals, choice of specialist
A	$316-$544	One-two	Toiletries, TV, phone, sleeper unit, choice of meals, choice of specialist, bathroom

C Ward covers the basic necessities, and a C Ward is shared with 12 patients. The ward is heavily subsidised, with a 65-80 per cent subsidy level.

A B2 Ward is a tier higher than a C Ward, with one B2 Ward being shared with six patients and each patient getting a semi-automated electric bed. B1 Wards have four patients sharing the ward with more amenities like a television, air conditioning, and bathroom.

B Wards are moderately subsidised, with the subsidy level for a B2 Ward being 50-65 per cent and a B1 Ward being 20 per cent

A Wards are private wards that provide the most amenities in the room, like air-conditioning and a private bathroom, with no government subsidies.

Subsidies are distributed according to the patient's income level via means-testing, meaning that despite your choice to stay in a C/B2 Ward, the higher your monthly income, the less subsidy you will receive to pay for your C/B2 Ward expenses.

The point of means testing is to ensure that the financially needy people in Singapore can afford healthcare and provide equity of healthcare resources to the lower-income groups.

Here is a list of government hospitals listed from the government website:

Public hospital	Phone number	Location
Alexandra Hospital	6472 2000	Queenstown
Changi General Hospital	6850 3333	Tampines
Khoo Teck Puat Hospital	6555 8828	Yishun
KK Women's and Children's Hospital	6294 4050	Kallang
National University Hospital	6772 2002	Kent Ridge
Ng Teng Fong General Hospital	6716 2222	Jurong East
Sengkang General	6930 6000	Sengkang
Singapore General Hospital	6321 4377	Bukit Merah
Tan Tock Seng Hospital	6227 7266	Novena

Private hospital wards do not receive any government subsidies at all. Here are the list of private hospitals:

Private hospital	Phone number	Location
Concord International Hospital	6933 3722	Bukit Timah
Farrer Park Hospital	6363 1818	Kallang
Gleneagles Hospital	6473 7222	Tanglin
Mount Elizabeth Hospital	6737 2666	Orchard
Mount Elizabeth Novena Hospital	6898 6898	Novena
Parkway East Hospital	6377 3737	Telok Kurau
Raffles Hospital	6311 1111	Rochor
Thomson Medical Centre	6250 2222	Novena

What does a MediShield Life cover?

If you are a Singaporean or a Permanent Resident (PR), you are automatically covered with MediShield Life, which is a government insurance scheme covering the most basic forms of healthcare that can be paid by MediSave. You can read the details of MediShield Life here.

MediShield Life covers hospitalisation expenses for C and B2 Wards. You are entitled to MediShield Life payouts that are calculated based on the subsidised bills payable at Class B2/C Wards. For outpatient treatment and day surgery, the payout is also pegged to the applicable subsidised rates.

MediShield Life, however, has an annual deductible of $1,500 for patients under 80 and $2,000 for patients above 80 if they want to stay in a Class C Ward and use MediShield, as well as $2,000 for patients under 80 and $3,000 for patients above 80 for stay in a Class B2 Ward and above.

You will also be subjected to co-insurance after paying for deductibles, which typically varies between three per cent and 10 per cent of the total bill amount and falls as the value of the bill rises.

MediShield Life pro-rated for A Wards

Hospital bill	$7,000
Deductible ($2,000)	$2,000
Co-insurance (10 per cent)	$45
Pro-ration (100 per cent - 35 per cent)	($7,000 - $2,450 = $4,550)
Total claims	$405
Total bill paid by insured	$6,595

However, if you stay in a Class A/B/B2+ Ward in a public or private hospital, the payout will be reduced on a pro-rated basis.

For example, if your bill is $7,000, since the pro-ration factor for A Wards under MediShield Life is 35 per cent, you would have to pay 65 per cent of the bill.

You have to pay a deductible of $2,000 (assuming that you are 80 years old or below). You will then need to pay another 10 per cent co-insurance. The 90 per cent of the remaining amount will be covered by MediShield Life.

If you do not have an IP covering an A ward, and you use MediShield Life, you need to pay a total of the balance of the pro-rated amount ($7,000 - $2,450) + Deductible ($2,000) + co-insurance amount ($45) = $6,595, MediShield Life will only cover $405.

What does integrated shield plan cover?

An integrated shield plan is an add-on to the MediShield Life by private insurers providing coverage for B1, A wards, and private hospitals. As of May 1, 2016, all IP insurers must sell the Standard IP regulated by MOH. The benefits of Standard IP are identical across all IP insurers and have claim limits sized to fully cover nine out of ten Class B1 bills.

Prudential - For A Ward hospitals

Promo: 15 per cent off first-year premiums for PRUShield Premier and/or with eligible riders.

Consider this if you are an average consumer.

• Co-insurance
  • 10 per cent

• Hospital type
  • Public Ward A and below

• Eligibility requirement
  • Singapore Citizens, Permanent Residents, Foreigners

• Last entry age
  • 75 (Age next birthday)

Summary of coverage

Benefits	Benefit limit	Ward A avg.
Annual limit	$600,000	$528,571
Hospitalisation & surgical benefits	As Charged	As Charged
Pre-hospitalisation (days)	180	120
Post-hospitalisation (days)	365	180
Outpatient cancer treatment	As Charged	As Charged
Pregnancy & childbirth complications	As Charged	As Charged
Total psychiatric treatment (including Pre- and Post- hospitalisation expenses incurred)	$7,000	$8,286

Analyst's review

The best hospitalisation insurance for the average value-seeking consumer is Prudential's PRUShield Plus. First, its premiums are around 23-47 per cent lower than average for all ages, despite a higher than average annual limit of $600,000 compared to other Ward A plans in the market.

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Its 365 post-hospitalisation coverage is also one of the longest on the market.

Additionally, you can purchase Prudential's PRUExtra Plus CoPay Rider, which will cover 95 per cent of your deductible, half your co-insurance and provide miscellaneous coverage for things like parental ward accommodation, ambulance services and emergency outpatient treatment.

Combined with the Plus plan, the total cost comes out around 27-39 per cent below average for base plan and Rider packages.

In terms of its specific coverage benefits, cancer treatment, dialysis, pregnancy complications, surgery, and room and board expenses are covered on an "as charged" basis, meaning they will be paid in the full amount (subject to limits, deductibles and co-insurance).

On top of this, you will also receive a final expense provision benefit of $3,000 and be covered for hyperbaric oxygen therapy (for treatment of carbon monoxide poisoning, severe anemia and other blood-oxygen related maladies).

However, Prudential's PRUShield Plus does lack comprehensive coverage for severe psychological disorders and critical illnesses, which are better covered by Great Eastern or Aviva.

There are tiers where you can upgrade your IP from a standard shield plan covering B1 Wards without pro-ration, to an A class IP covering A Wards, and the highest tier covering private hospitals. You are still subjected to deductibles and co-insurance.

IP (P) Ward A hospitalisation bill

Hospital bill	$7,000
Deductible ($2,000)	$2,000
Co-insurance (10%)	$500
Total bill paid by insured	$2,500
Total claims	$4,500

From the example above, assuming that you have a base shield plan from insurer P (without riders that cover deductibles or co-insurance) that covers an A Ward for a government hospital or higher, assuming that the deductible amount is still $2,000 (Some plans' annual deductible can be as low as $1,000) and the co-insurance is still 10 per cent (Some plans’ co-insurance can go as low as 5%).

The total bill paid by you will only be Deductible + Co-insurance = $2,500, and your IP provider will pay the remaining $4,500, which is ten times more than MediShield Life for the same treatment, making your expenses lower as a result.

You can even pay as low as $1,250 if you select the right plan or even lower as you get a rider.

Great Eastern SupremeHealth P - For private hospitals

Promo: 20 per cent off 1st year GREAT TotalCare Premiums.

Consider this if you want comprehensive coverage at private Hospitals.

• Co-insurance
  • 10 per cent

• Hospital type
  • Private

• Eligibility requirement
  • Singapore Citizens, Permanent Residents, Foreigners

• Last entry age
  • 75 (Age Next Birthday)

Benefits	Benefit limit	Private hospital avg.
Annual limit	$1,500,000	$1,050,000
Hospitalisation & surgical benefits	As charged	As charged
Pre-hospitalisation (days)	120	150
Post-hospitalisation (days)	180	173
Outpatient cancer treatment	As charged	As charged
Pregnancy & childbirth complications	As charged	As charged
Total psychiatric treatment	$25,000	$10,583

If you are looking to receive maximum private hospital coverage regardless of cost, you can consider Great Eastern's GREAT SupremeHealth P Plus plan along with its Great TotalCare Classic P Rider.

The P Plus plan offers the highest annual limit for private hospitals of $1,500,000, and provides full medical bill coverage for cancer treatment, dialysis, pre and post-hospitalisation treatment.

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You will also receive the highest psychiatric, speech and occupational therapy benefits currently offered, as well as a combined $20,000 of coverage for congenital abnormalities for your child. This is all for a cost that is 20-40 per cent cheaper compared to other Private Hospital plans.

To top off your coverage to the maximum, you can purchase the TotalCare Classic P Rider to reduce your deductible and coinsurance responsibility to five per cent of your bill (or deductible if its higher).

You will also receive $250 of ambulance, $80 per day of parental accommodation coverage (for parents with children in the hospital) and $2,000 of accidental outpatient treatment.

Lastly, Great Eastern can save you thousands of dollars if you have their A Plus plan and choose to get care at a Private hospital.

This is because its pro-ration factor for getting care above your ward level is 70 per cent instead of the 50 per cent implemented by other insurers (Great Eastern will pay 70 per cent of the incurred cost rather than only 50 per cent if you choose to get care at a ward above your level).

Conclusion

MediShield provides the bare minimum in terms of hospitalisation coverage; despite insuring every Singaporean and PR regardless of pre-existing conditions for C and B2 class wards, there are limitations, with it mainly being that there is a pro-ration factor for B1 Wards and above.

We have added a comparison table for MediShield LIfe vs the median benefits for IP by private insurers.

Benefits of MediShield LIfe vs IP Plans Median

Premiums & coverage	MediShield Life	B1 standard ward median	A Ward median	Private hospital median
25-year-old premiums	$250	$49	$90	$218
45-year-old premiums	$525	$103	$229	$638
65-year-old premiums	$1,020	$254	$664	$1,592
Value (limit/$ premium)	N/A	$1,494	$2,421	$2,379
Annual limit	$150,000	$150,000	$600,000	$1,000,000
Inpatient psychiatric	$160/day (60 days)	$17,500	$6,000	$6,000
Surgery benefits	$240 - $2,600	As charged
Daily ward (non-ICU)	$800/day	As charged
Pre-hospitalisation benefits	N/A		120	150
Post-hospitalisation benefits	N/A		180	173

The benefit of IP Plans is that they provide higher coverage for better hospital wards and hospital treatments. You can check this page for a detailed comparison between different IPs and which IP suits you depending on your condition.

This article was first published in ValueChampion.