PRUshield and MediShield Life

Transcription

1 PRUshield and Life Frequently Asked Questions MEDISHIELD / MEDISHIELD LIFE Q1 A1 What is Life? When will Life be implemented? is an affordable basic medical insurance administered by Central Provident Fund Board (CPF Board) that protects you from large medical and hospitalisation bills, intended for subsidised (B2 and C) bills. Ministry of Health (MOH) will be enhancing. The enhanced scheme will be renamed Life. It will be launched on 1 November Life aims to provide assurance for all Singapore Citizens and Permanent Residents that they will have health insurance coverage for life, regardless of how their health changes over time. Q2 A2 What are the new features under Life? In its spirit to provide better protection against large hospital bills and expensive chronic treatments, Life benefit limits are set higher than benefit limits. The higher limits are for the daily ward and treatment charges, surgical procedures, and outpatient chemotherapy and kidney dialysis treatment. In addition, the co-insurance levels are also reduced which means Life will cover a bigger portion of the hospital bills. The following table shows the new proposed benefits of Life as compared to the existing benefits of and. Current Proposed Life Current Coverage up to Daily Ward and Treatment Charges Normal ward ICU ward Community Ward Singapore Restructured Hospital B2 / C Ward $450 $900 $250 Singapore Restructured Hospital B2 / C Ward $700 $1,200 $350 Singapore Private Hospital (A Premier) Singapore Restructured Hospital A Ward (A Plus) As Charged Surgical Procedures $150-$1,100 $200-$2,000 As Charged 1

2 Current Proposed Life Current Outpatient Chemotherapy $270 (per 7-day cycle) $1,240 (per 21- or 28-day cycle) $3,000 per month As Charged Outpatient Radiotherapy External or Superficial (per session) Brachytherapy (per session) $80 $160 $140 $500 Policy year limit $70,000 $100,000 As Charged A Premier: $632,700 A Plus: $379,700 (Yearly adjustable) Lifetime limit $300,000 Unlimited Unlimited Co-insurance Claimable Amount $0 - $3,000 $3,001 - $5,000 $5,001 - $10,000 >$10,000 20% 15% 10% 10% 10% 10% 5% 3% 10% Outpatient Treatments 20% 10% Coverage age limit 92 (age next birthday) Lifetime Lifetime Cover for pre-existing conditions N.A Yes N.A Q3 A3 How much will Life premiums be? How does it compare with premiums? The current and Life premiums are as follows: Age Next Birthday Life

3 Age Next Birthday Life , , ,123 1, ,150 1, ,190 1, ,190 1,500 > 90-1,530 However, there are various types of Government subsidies to help Singapore Citizens with their Life premiums. To calculate your estimated Life premiums after the applicable Subsidies, please refer to Q4 When will Life be implemented? A4 Life will be launched on 1 November PRUSHIELD Q5 A5 With Life, will there be any duplication between and Life? is an Integrated Shield Plan(s) ( IPs ) which is made up of two parts today a basic / Life portion provided by CPF Board and additional private insurance coverage provided by Prudential. There will be no duplicate coverage between Life and. Q6 A6 With the launch of Life on 1 November 2015, how does this impact? With the launch of Life, the portion will be replaced by Life. s for existing will be increased for Life, due to the higher benefit coverage as well as coverage for pre-existing conditions. With the existing structure, the overall premium will consist of the Life premium and the additional private insurance premium. When the portion of the premium increases due to Life the overall premium will increase. Prudential has committed not to increase the private insurance premium for one year following the implementation of Life. This is to allow for a smooth transition during the first year following the implementation of Life where policyholders will see no increase in the premiums for the additional private insurance coverage portion. 3

4 Additional Private Insurance Coverage No Change Increase in Additional Private Insurance Coverage Life Q7 A7 With Life, will I still need? While enhancements will provide higher coverage, A Premier and A Plus plans will continue to provide comprehensive coverage for customers who want coverage above B2 and C Ward. allows you to: - choose your doctor or specialist - choose to stay in any class of ward - choose to stay in any private hospital plans also provide further coverage that will not be covered under Life: Pre- and post-hospitalisation coverage of up to 180 days before and after Hospital Confinement Living Organ Donor Transplant Benefit if life assured is the organ donor or recipient Coverage for Planned Overseas Medical Treatment at selected hospitals overseas Buy a new plan without underwriting with Future Insurance Option upon significant events in life Adjustment feature for policy year limit to offset medical cost inflation The first-to-market medical helpline service, PRUhealthcare assist, is exclusive to our customers. It is designed to provide information and help answer your questions on hospitalisation and medical conditions. Q8 A8 How much will cost after the launch of Life? The overall premiums will increase following the launch of Life, due to the premium increase under Life. premiums before and after Life is launched will be as follows. 4

5 Age Next Birthday Before Life A Premier A Plus After Life A Premier A Plus , , ,390 1,060 1,690 1, ,079 1,510 2,354 1, ,753 1,953 3,078 2, ,213 2,301 3,542 2, ,319 3,098 4,674 3, ,438 3,221 4,748 3, ,606 3,725 5,733 3, ,241 4,170 6,521 4, ,904 4,430 7,214 4, ,904 4,430 7,214 4, ,936 4,539 8,466 6, ,519 4,944 9,049 6, ,749 5,141 9,279 6, ,169 5,584 9,699 7,114 Q9 A9 Will the premium rates for for foreigners change following the launch of Life? The structure of premiums for the different groups of life assureds will remain the same. for foreigners who are the dependants of Singapore Citizens ( SC )/Singapore Permanent Residents ( SPRs ) will have the same premiums as SC/SPRs. for other foreigners with eligible valid pass will have slightly higher premiums (est. 5% higher) than the ones for SC/SPRs. As the total premiums of for SC/SPRs will change with the launch of Life, the premiums of for foreigners will also be adjusted accordingly. 5

6 Q10 A10 for foreigners is not integrated with Life and there is no change to the benefits of the entire plan. Why does the premium have to change? The premiums for for foreigners are changed to cater for the increasing claims payout, larger medical bills and greater healthcare consumption. Q11 A11 When Medishield Life is launched, how do I pay for my premiums? As a policyholder, you will continue to pay one integrated Shield plan premium to Prudential. Prudential will pass the Life portion of the premium to CPF Board to manage. This is similar to what is being done for today. Q12 A12 How will the claim payout under the additional private insurance coverage of my look like after Life is launched? The proportion of Claims Payout will vary under and Life. The following table shows the industry average of the proportion of Integrated Shield Plan (IP) Claims payout: / Life vs Additional Private Insurance Portion. Private IP Plan / Life Additional Private Insurance Portion Actual Proportion of Claims Payout under * Expected Proportion of Claims Payout with changes to Life Change in proportion of payout with changes to Life 14% 86% 20% 80% 6% -6% Public Hospital A Ward Plan Actual Proportion of Claims Payout under * Estimated Proportion of Claims Payout with changes to Life Change in proportion of payout with changes to Life / Life Additional Private Insurance Portion 36% 64% 50% 50% 14% -14% Public Hospital B1 Ward Plan Actual Proportion of Claims Payout under * / Life Additional Private Insurance Portion 53% 47% 6

7 Public Hospital B1 Ward Plan / Life Additional Private Insurance Portion Estimated Proportion of Claims Payout with changes to Life Change in proportion of payout with changes to Life 67% 33% 14% -14% * Industry average based on experience Note: Experience varies across insurers. A simple average across the five insurers has been taken to derive the estimates of 14% and of 6%. Q13 A13 Since Life will have higher coverage than, wouldn t that reduce the portion of premiums on the additional private insurance coverage of my policy and hence reduce the overall cost of premiums of? The increase in coverage from Life is expected to reduce claims payout from the additional private insurance coverage portion of and all other IPs. However, this effect varies between IPs covering public hospitals and IPs covering private hospitals. For public hospital IPs, claims payout from the additional private insurance coverage portion is estimated to reduce by approximately 14 per cent 1. For private hospital IPs, the reduction in claims payout from the additional private insurance coverage portion is estimated to be substantially lower, of approximately 6 per cent 1. However, claims for IPs have increased over time due to larger medical bills, greater healthcare consumption and the increased use of newer and costlier procedures which leverage medical technological advancements. Therefore, although Life will have higher coverage than, it would not reduce the portion of premiums on the additional private insurance coverage of the IPs. 1 Experience varies across insurers. A simple average across the five insurers has been taken to derive estimates of these four percentages. Q14 A14 If I am unable to afford premiums in the long run, what are my options? In the event that you do not wish to continue paying the premiums for your, you can switch to a more affordable plan with us, or cease your plan. You will still remain covered by Life. You are encouraged to consider your choices carefully as once you lapse your cover and should you wish to re-join later, you may be subject to underwriting and some of your health conditions may be excluded. You may wish to speak to your Financial Services Consultant or a representative of Prudential who will be able to advise on your options and their implications. 7

8 Q15 A15 Life will be providing universal coverage. Will provide coverage for those with pre-existing conditions? Unlike Life which is a national scheme, is a private insurance and covering preexisting conditions will translate to higher costs and higher premiums. To ensure that remains affordable, underwriting will be required in order to assess the risk of any pre-existing conditions. Regardless of the underwriting outcome, will still provide higher coverage for other conditions, and all Singapore Citizens and Permanent Residents will be assured of basic coverage under Life. will not impose the additional premiums (loading) to pre-existing medical conditions. It will continue to impose exclusion to certain pre-existing conditions when necessary. As is integrated with Life you can be assured that you will still be covered up to the Life benefit limits for any excluded benefits. Pre-existing Condition Other Condition (As charged cover) Additional Private Insurance Coverage Life (up to B2 ward average bill size) Excess of the bill that is not covered by Life is EXCLUDED COVERED up to Life benefit limits Excess of the bill that is not covered by Life is COVERED COVERED up to Life benefit limits PRUSHIELD EXTRA / EXTRA LITE Q16 A16 With Life and, why should I need Extra/Extra Lite? Life is a basic plan which will protect against large hospital bills at Class B2/C wards of restructured hospitals only. remains very important if you require higher coverage up to private hospitals, as well as A and B1 ward of restructured hospitals. also provides additional coverage which will not be covered under Life: Pre- and Post-hospitalisation Benefit Living Donor Organ Transplant Benefit Planned Overseas Medical Treatment Benefit Future Insurance Option With Extra you will also have: 100% coverage of the deductibles and co-insurance which ensure coverage from first dollar for all eligible medical expenses Up to $200 daily hospital incentive when you stay in a ward class lower than your entitlement Up to 180 days cover for Post-Hospitalisation follow-up for Traditional Chinese Medicine treatment Extra Lite covers 50% of the deductible and full co-insurance of the eligible medical expenses for a more affordable premium. 8

9 Furthermore, all customers have exclusive access to PRUhealthcare assist, a medical helpline service. Q17 A17 Will the changes in Life affect Extra and Extra Lite? As Extra and Extra Lite pay the co-insurance and deductible (50% of deductible for Extra Lite), any changes to will affect Extra and Extra Lite. To ensure adequacy of premium rates to meet our future claims obligation, the premiums of these plans are expected to increase over time Extra and Extra Lite are non Medisave-approved plans. The premiums for these plans are not payable through Medisave. You need to pay the premiums for these plans with cash or other non- Medisave paying mode. MEDISAVE WITHDRAWAL LIMIT Q18 A18 What is the current Medisave Withdrawal Limit ( MWL )? Currently, policyholders are allowed to use their Medisave money to pay for their premiums up to a limit per policy. The limit differs according to age bands. As at 1 Nov 2013, the withdrawal limits are: ANB MWL (per policy) , , above 1,400 This means if Mr. Tan is a life assured and 51 ANB (age next birthday) with A Premier premium of $955, he can use his Medisave to pay for the premium up to the MWL of $800 per policy and pay the remaining $155 with cash. This will change with effective of the launch of Life. Q19 A19 How will the MWL change to Additional Withdrawal Limit ( AWL )? Currently, everyone in the same cohort has the same MWL which is applied to total (i.e. premium and additional private insurance coverage portion). To provide more certainty over what Medisave can be used for, the current MWLs will be restructured into 2 components: - To cover the net Life premium, including Additional s (for those with serious pre-existing conditions) and after netting off the subsidy (where applicable); - An additional MWL for the additional private insurance coverage portion only (Additional Withdrawal Limit) 9

10 Current On and after Launch of Life Additional Private Insurance MWL Additional Private Insurance AWL Amount one can withdraw from Medisave to pay for plan Withdrawal limit no longer apply to MSL Life Portion fully paid through Medisave For example, the AWL for Mr. Tan s age (51 ANB) is $600 and A Premier premium after Life is $1,240: Life premium = $630 Payable by Medisave in full Additional private insurance portion = $610 Payable by Medisave up to $600 Total IP premium (after Life) = $1,240 Total payable by Medisave $1,230 Cash outlay $10 Mr. Tan can use his Medisave to pay the Life premium in full and the additional private insurance portion of A Premier premium up to AWL of $600. He needs to pay the remaining $10 of the premium in cash (cash outlay). Q20 A20 What are the new Additional Withdrawal Limits ( AWLs )? The AWLs are set as follows and will apply to all IPs, including, renewing and commencing on or after the launch of Life: ANB AWL (per policy) above 900 Q21 A21 How will policies be affected under the new AWLs? In general, policyholders will be able to use the same amount or more of their Medisave to pay the additional private insurance coverage component of their premiums. 10

11 Q22 A22 How will the Medisave Withdrawal Limit ( MWL ) be applied for foreigners? For foreigners life assured whose policies are not integrated with / Life, and premiums are payable via Medisave, the MWL will be applied from the first dollar. IP equivalent Plan IP Equivalent Plan for Foreigners MWL Q23 A23 What are the new limits for foreigners? For foreigners life assured whose premiums are payable via Medisave, the MWL will be as follows: MWL ANB For Foreigners (per policy) , , , , , , , , , , , and above 2,430 Q24 A24 How will for foreigners policies be affected under the new MWLs? In the case of foreigners life assured, whose plan is not integrated with Life, the impact to the amount of cash required is similar to the one for Singapore Citizens and Singapore PRs. policyholders will be able to use the same amount or more of their Medisave to pay the additional private insurance coverage component of their premiums. 11

12 Q25 A25 The new AWLs/MWLs amounts appear to be lower than that of the existing Medisave withdrawal limits. Does this mean that policyholders can use less Medisave in future to pay for the premiums? For Singapore Citizens and Singapore PRs, the new AWLs apply to only the additional private insurance component of the premiums, while the base Life layer can be separately and fully be paid by Medisave. In comparison, today s Medisave withdrawal limits apply to the total premium for the component and the additional private insurance coverage component. Hence, the existing Medisave limits naturally appear higher numerically. GOVERNMENT SUBSIDIES Q26 A26 What are the different types of Government subsidies to help Singapore Citizens with their Life premiums? Who will be eligible for them? The Government will directly help Singapore Citizens with their Life premiums, through Subsidies for the lower- to middle-income, Pioneer Generation subsidies for the Pioneers, Medisave top-ups and Transitional Subsidies for Singapore Citizens to phase in the shift to Life. The different types of subsidies are: Subsidies Pioneer Generation Subsidies and Medisave top-ups for the Pioneer Generation Transitional Subsidies Additional Support for all needy Singapore Citizens families on a case-by-case basis. This is to provide help for those who are unable to afford premiums even after the subsidies provided by the Government. Q27 A27 What is Subsidy for lower to middle income? Subsidy for lower to middle income is the premium subsidy applicable to Singapore Citizens staying in properties with Annual Value (AV) of $13,000 or less. Those with AV of between $13,101 to $21,000 will receive 10 percentage points less. Those with AV of above $21,000 will not receive premium subsidies. Singapore PRs receive half of the applicable subsidy for Singapore Citizens. Q28 A28 More details can be found in Life website: What is Pioneer Generation Subsidy? This Subsidy is applicable to all Singapore Pioneer Generation. Pioneer Generation refers to those who: - are aged 66 and above as of now (born on or before 31 Dec 1949); and - obtained Singapore citizenship on or before 31 Dec More details can be found in Life website: 12

13 Q29 A29 What is Transitional Subsidy? In the first year, all Singapore Citizens who face an increase in the net premiums from to Life (i.e. after taking into account various subsidies including Subsidies or Pioneer Generation Subsidies) will be subsidised 90% of the net increase in premium followed by 70% in the second year and so on. Transitional Subsidies First Year Second Year Third Year Fourth Year 90% 70% 40% 20% This means in the first year of Life, Singapore Citizens will pay only 10% of the increase in the net premiums from to Life. More details can be found in Life website: Q30 A30 How will the subsidies work? Subsidy for lower to middle income and Pioneer Generation Subsidy are computed the same way and a member cannot be eligible for both subsidies at the same time. The Transitional Subsidy, together with the Pioneer Generation Subsidy, will be given automatically. No application is needed for Subsidies for lower to middle-income household. The government will use existing information in government databases to determine the subsidies applicable to each of Life covered member. You are encouraged to update your particulars on the government fronts to ensure you do not miss any communication on Life. Q31 A31 Are IP policyholders eligible for premium subsidies? IP policyholders will receive the applicable Life subsidies (i.e. Pioneer Generation Subsidy, Subsidy and Transitional Subsidy) for the component of the IP, if they meet the eligibility criteria. No government subsidies will be provided for the additional private insurance coverage portion of the premiums. EXISTING POLICIES Q32 A32 For existing policies, when will Life replace? On 1 November 2015 when Life is launched, the portion in will be replaced by Life. Hence, all benefits enhancements on Life, e.g. inclusion of cover for pre-existing conditions and other enhancements will take effect on all existing policies immediately. 13

14 The premiums of the Life component under, including the additional premium imposed under Life for substandard lives, will take effect on the next renewal date on or after 1 November 2015 onwards. Q33 A33 For SC/SPRs, how will the existing policyholders be informed about the new premiums? The Ministry of Health (MOH) will send a welcome pack to all existing policyholders who are SC/SPRs on the change in premium on to Life. The welcome pack includes details of additional premium for substandard lives (if applicable). The Renewal Notice with detailed premium breakdown including information on the premium due, the applicable premium subsidies and the additional premium for those with serious pre-existing conditions, will be sent prior to the respective renewal date. For the 1 st batch of renewal (1 Nov 2015), Renewal Notice will be sent 30 days before the renewal date. For subsequent batches of renewals, premium notices will be sent 40 days before the renewal date. Q34 A34 For Foreigners, how will the existing policyholders be informed about the new premiums? For foreigners, a customer notification letter will be sent to existing policyholders before their renewal date to inform them on the change in premium. This is followed by the Renewal Notice. The first batch of renewal policies on 1 Nov 2015 will receive the customer notification letter 31 days before the renewal date and the Renewal Notice will be sent 30 days before the renewal date. Subsequent batches of renewal policies will receive the customer notification letter 50 days before the renewal date and the Renewal Notice will be sent 40 days before the renewal date. 14