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Family members living in the household
All related family members (i.e. related by blood, marriage or legal adoption) staying at the same residential address with the patient, as indicated in the NRICs.

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Annual value of place of residence for households with
no income

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Gross income of the person needing care, his/her spouse and all immediate family members living in the same household

Total number of family members living in the same household.

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If they live in a property with an annual value of more than $11,000, they are
given subsidies of 50 per cent and 65 per cent respectively for Class B2 and C wards.

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Receive full subsidy (65 per cent for Class B and 80 per cent for Class C wards).

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Based on either the monthly income derived from the last available net trade
income assessed by Inland Revenue Authority of Singapore within the last
two assessment years; or the income declared to CPF Board within the last
two years.

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Based on the average monthly income received for the last available 12-
month period (bonuses, but not the last salary, are included for calculation).
Voluntary contributions to CPF will not affect the income information.

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1.Consent form for government subsidy for Class B2&C wards
2.Patient gives Payslip and Bank statement
3.Consent to release Medisave/Medishield life information
4.Means-Test Declaration Form
5. Acknowledged that Financial Counselling has been performed.
6. The bill that the patient estimated to pay after discharged
7. Medisave Authorisation Form for withdrawal/claim of medisave/Medishield life.
(This process might change if the patient does not want the procedure/complication arises/change of wards etc.)

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Data from 2002 showed a trend of the well-off patients opting for the highly subsidized C-class and B-class wards.

Means testing is targeted at the preventing the undeserving "rich" from abusing the subsidies.

How is "rich" defined?

Will differentiating the eligibility for different levels of subsidy result in a "middle-class squeeze“?

The middle-income group is expected to be worst hit by means testing.

Those with chronic conditions requiring long-term healthcare fear they might not be able to cope with the financial burden should the existing subsidies be lowered.

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Those that stay longer after they are officially discharge by the doctor.

This is might be because of family problems.

This implement is to "chase" away patients for new patients to use the beds.

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Follow-up at Specialist Outpatient Clinic after discharge 

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Follow-up at Specialist Outpatient Clinic after discharge 

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Class A/B1 patients will be charged at private rate.

Class B2/C patients will be charged at subsidized rate (only for Singapore citizens and PRs)

All other citizenship will be charged at private rate.

•Patients classified under Industrial Accident would be charged at private rate.

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Upgrading

Should you request for upgrading to a higher ward class, all charges (except patient daily standard ward fee) incurred at the lower ward class up till the upgrading will be recomputed and charged at the higher class rate.

Downgrading

Patients can be downgraded from private to subsidized ward class if they pass the downgrading procedure (means testing).

Downgrading/Upgrading is subjected to availability of beds and takes effect when the patient physically occupies the lower/higher class bed.

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It is mandatory that estimated bill size information be given for inpatient or day surgery treatment because they are large bills.

The intent is to save patients and families from financial burden.

Hence, we should observe the intent of this requirement for ALL medical bills that are potentially financial crippling. (includes SOC).

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The estimated bill size must be told to the patient  so that they can make a decision based on:

1. choices of class, subsidized or private

2. Proceed or not proceed with treatment

3. Seek alternative options in other institutes

4. Standard or non-standard options

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Audits and data would be submitted to MOH

Clinical audits to check on application and approval process

All applications are reviewed by MAF Plus Panel and approved by CMB

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1.Expanding MAF to include NSDL Drugs (MAF+)

if they are clinically appropriate and deemed clinically necessary for treatment of the patient’s condition

2. To qualify for subsidy, patient must have:

a documented history of non-response or serious side effects to SDL drugs; or

no other clinical drug alternatives

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1.Expand MAF to cover non-standard(*NSDL) drugs(MAF+)

*NSDL refers to both Non Standard and Non Formulary

2.Increase maximum subsidy level from 50% to 75% upon assessment by Medical Social Service

3.Deducted first before using patient’s Medifund or Medisave.

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Audits and data would be submitted to MOH

Clinical audits to check on application and approval process

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1.Clinical evaluation

–Clearly documented in the form

2.Evidence of efficacy

–Well supported clinical studies in peer-reviewed journals

3.Favorable safety profile

4.Ethical consideration

–No off-label indications

–HSA-approved indications only

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1.  To help lower income patients who may not be considered straightforward cases for Medifund

2. Focus on selected clinically-effective medications that may be expensive

3. Separate funding from Medifund, to provide more flexibility than Medifund framework.

Financial coverage for non standard drugs

–Maximum subsidy level of 75% upon assessment by Medical Social Service

–Per capita household income of $1,500 or less

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Income criteria are guidelines

–Consider bill size relative to ability to pay for bills

Medifund Committees have discretion with regard to definition of income:

–Income after CPF deductions

–All sources of income (e.g. Dividends, rental, annuities)

Definition of household:

–Patient + all immediate family members + non-immediate family members (under same roof)

–Patient + all immediate family members

–Patient + family members under same roof

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Other than income
oSocio-economic background of the applicant

oSize of bill incurred

oOutstanding amount

oAny other circumstances that Medifund Committee deems as relevant to the application

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With effect from 1Apr2012,  Medifund  will be extended to nonresidential ILTC services such as day rehab, home medical and home nursing services.
•Only medical intervention scenarios will receive Medifund assistance.
•Experimental treatments on new service types would continue to be excluded until their efficacy has been proven.
•The same guidelineas that of inpatient  or outpatient income criteria applies for nonresidential ILTC services.

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3. The parents use up their Medisave:

• If the parents themselves are aged.

OR

4. The spouse first use up their Medisave:

• If the spouse is aged; or

• If the spouse himself/herself is afflicted with illnesses which require prolonged treatment.

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1. Family members use their Medisave if patient is a PA or MFEC recipient and is warded in the lowest class ward.

• However, the patient is still expected to use his own Medisave if applicable

OR

2. The children first use up their Medisave:

• If children themselves are elderly with their own family to support; or

• If the children themselves are afflicted with illnesses which require prolonged treatment.

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Level 1 (Auto/ Public Assistance)

Exemption

Public Assistance Card

Medical Fee Exemption Card/Assistance Card

IMH/MOH Permanent Waiver

Level 2 (SF)

By Medical Social Worker

Recommed % based on Household income are the same or lower than eligible %

Level 3 (NSF)

By Medifund Committee

Recommended % is greater than eligible % based on household income

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Only class C ward patient enjoy 100% Medifund Assistance

Non-resident (NR) and Permanent Resident (PR) are not assisted by Medifund

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Over 65 years old

Who gets help from siblings who are also old and may have medical needs of their own

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Under 18 years old

Needy families

Large bills than their household income

more serious premature cases or those with neonatal or congenital conditions

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·     For both Medifund and Medifund Silver, if the  household income falls below the minimum level, the patient is eligible for 100% assistance.

·     If it is between the minimum and ceiling income, the level of Medifund assistance provided will vary along a straight line sliding scale between the two figures given.

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For both Medifund and Medifund Silver, if the household income falls between the minimum and ceiling income, the level of Medifund assistance provided will vary along a straight line between the two figures given.

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Total sum of income (including all allowances and bonuses, but after deducting CPF contributions) for

(a)the patient himself;

(b)all immediate family members (defined as parents, spouse and children),regardless of whether they are living together or apart; and

(c) all other non-immediate family members staying in the same household.

Household Income (HI) = Monthly Per-Capita Household Income (gross income net of CPF deductions)

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Singaporean (SC) only

•Received treatment as a subsidized patient, e.g. Class B2 or C  for inpatient or a subsidized outpatient

•Received treatment from a Medifund-approved institution

•Unable to pay healthcare bills despite receiving Government subsidies and drawing on other means of payments including MediShield Life/Integrated Plans, Medisave and cash.

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1. Personal Responsibility

•Patient expected to co-pay according to ability

2. Medical Necessity

•Based on necessity, hence exclude non-essential choices (e.g. Class A ward, cosmetic surgery…)

3.  Family Responsibility

•Use immediate family member’s Medisave where possible

4.  Many Helping Hands

•Medifund to complement, not replace charity funds

•Encourage philanthropy to provide additional assistance

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1. Comprehensive Co-payment Scheme (CCS)

•For Civil Servants appointed before1 Jan 1994
2. Medisave-cum-Subsidised Outpatient Scheme (MSO)

•For Civil Servants appointed from1 Jan 1994 onwards

3. Co-Payment on Ward Charges Scheme (CPW)

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Letter of Guarantee is an official document issued on an episodic or corporate basis by a business entity to undertake the medical bills of patient(s).

A long termed Letter of Guarantee on a corporate basis in the form of a contract is termed the Hospitalization Identity Card (HIC) Scheme .

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For those who are ill or those who are not able to work because of illness, Eldershield can held reduce the burden of long term term care (only applicable if they are insured under Eldershield and and meet the requirements to receive payout) .Due to raising healthcare cost, some opt to upgrade to Eldershield Supplement .

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Enhanced Medisave -Approved Private Shield Plan with riders that can be added to cover Deductible and Co -Insurance Insurance

Note :

Riders are additional provision of an insurance policy that is purchased separately from the basic basicpolicy because it provides additional benefits, hence additional cost is required.

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Medisave - Approved Private Shield Plan for Private class .(for private patients patients in are stricted hospital or patients in a private hospital) hospital)

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Pre -existing illness illness or medical conditions conditions conditions
• As employees change job, the company coverage automatically exclude all pre -existing illnesses or medical conditions at inception and typically for the 12 months thereafter.

Retirement/Unemployment
• Employee health insurance does not insure a person after after their retirement or unemployment, thus exposing him/her to financial risk when they need it most after their retirement.

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If your Integrated Shield Plan has exclusions, there will be no payout from the private insurance coverage portion.

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Singaporeans can pay for their Medishield Life premiums fully using Medisave. For those with IPs, there are Additional Withdrawal Limits (AWLs) to enable Singaporeans to use Medisave, up to a cap, to pay the additional premiums for the private insurance portion of IPs.

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used to pay for the premiums of these plans, subject to withdrawal limits applied to Integrated Shield Plans. Premium in excess of the Integrated Shield Plan withdrawal limits will have to be paid using cash.

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Employed Singaporeans have medical insurance coverage provided by their employers.

Some consider themselves to be adequately insured, so they are not inclined to purchase further medical coverage.

In truth, the issue is that employee hospitalization & surgical insurance does not provide long term coverage

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provide additional benefits and coverage to the patients when they opt for Class A and B1 wards in public hospitals, or private hospitalisation.

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1. Medishield Life (run by CPF Board)

2. Private Medical Insurance coverage (run by private insurers)

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with higher claim limits lower co-insurance rates

Medishield Life pays more and patients payless.

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all Singaporeans and Permanent Residents,

including those who already have pre-existing illness

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Elements of the Medishield Life philosophy

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Elements of the Medishield Life philosophy

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1. To provide peace of mind for patients should they fall ill, by covering them through their lives, to take advantage of riskpooling.

2. To avoid “buffet syndrome” where patients may over-consume healthcare because a third party (the insurance policy) pays, by setting limits on payouts and requiring patient co-payment (coinsurance).

3. To have affordable premiums, due to it being a self-sustaining, not-for profit scheme. Working-age members pay ahead of their needs and receive rebates when they are older to ease their cost.

4. Co-payment and deductibles can be paid using Medisave or cash but not for payment of riders.

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Designed to cover medical expenses (excluding the
deductible and co-insurance) for stay in Class B2/C wards at
public hospitals.

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Better protection and higher payouts, so that patients pay less Medisave/cash for large hospital bills

Protection for all Singapore Citizens and Permanent
Residents, including the very old and those who have preexisting conditions

Protection for life

Cover Singapore Citizens and Permanent Residents who were previously not covered under Medishield

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Calculation formula for insurance coverage

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Calculation formula for insurance coverage

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(Claim limits- deductible) = less deductible

(less deductible x co-insurance) - less deductible = insurance coverage.

Original bill - Insurance coverage =Patient pays

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Elderly

Unable to do activity daily living (ADLs) like bathing, dressing, feeding, going to the toilet and moving around.

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basic health insurance plan that helps patients cope with large hospital bills and selected costly
outpatient treatments.

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Qualifications for approving non-immediate family members for Medisave usage

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Qualifications for approving non-immediate family members for Medisave usage

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1. Patient stays in a B2/C class (highly subsidized class ward with little or no frills)

2.  Patient or immediate family members do not have sufficient
Medisave balance and cannot afford to pay for hospital bill.

3. Patient is a Singapore Citizen or PR.

4. Patient does not have a Medisave account.

5. Patient is below 18yrs old, unemployed, handicapped or mentally ill.

6. Patient is a dependant of Medisave holder.

7. Patient is brother, sister, uncle, aunty, in-laws, niece and nephew.

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The Medisave Scheme defines the Inpatient Episode and Day Surgery Episode in a financial manner.

Day Surgery is an episode with a TOSP procedure while Inpatient may or may not have a TOSP procedure.

Inpatient episode duration must be 8 hours and longer. A Day Surgery can be of any duration but less than 8 hours.

If the criteria for an Inpatient or Day Surgery is not fulfilled, the Medisave claims will not be activated. Similarly, for Medishield Life or Private Medical Insurance claims.

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Under chronic diseases, there is 15% co-payment

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siblings cant use

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Criteria:
• Singaporeans who were 65 years or older in 2014; and
• Became a Singaporean by 31 December 1986
• Additional 50% off subsidised services at SOC and
Polyclinics on top of Means Test Subsidies
• With effect from 1 January 2015
• Additional 50% off medication listed under the Standard Drug
List (SDL) or the Medication Assistance Fund (MAF)

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Main factors to determine drug subsidy:
Essential for the treatment of medical conditions that are important causes of morbidity and mortality in
Singapore.
Offers a big improvement in terms of efficacy and effectiveness when compared to existing standard
drugs.
Adequate evidence of long-term safety and the cost-benefit of the drug.