Whacked with MediShield Life Premium

[x9200]

Yes, you can. That's called signing a document to terminate your PR status (or citizenship, as applicable). That's how you prevent reentering Singapore to live and work...or be sick.

Do you advise the same for all the people with private insurance as myself or the PRs/SCs who are only temporary living overseas? I mean, of course this is a part of the package but I have the impression you are trying to make it appear reasonable/rational based on the fact that one may just sign out. Would you renounce your PR status or citizenship to avoid paying $800 of insurance premium?

[earthfriendly]

BTW, do SG employers require MC for medical leave? If so, I would recommend they eliminate this practise for it is a waste for the healthcare system.

[BBCWatcher]

Adopt a more DIY approach and only go to the doctor when absolutely necessary.

That approach simply doesn't work, as Singapore's Ministry of Health is among the first to point out.

If you want to control medical costs and achieve better health outcomes then the evidence is overwhelming that you want patients getting prompt, preventive-oriented care, to avoid having small problems fester and grow into much bigger, far more expensive, hard to treat problems. "Going to the doctor" (or even having the doctor/nurse practitioner coming to you) is not actually a major cost driver in most medical systems. It's typically a cost saver. Even in Singapore's private medical sector, even without subsidy, a clinic visit is downright affordable. Unnecessary tests, procedures, prescriptions, and delayed care (reactive rather than proactive) are the big cost drivers. And thanks to imported workers, Singapore is particularly well suited to managing costs better and improving qualities of life with an emphasis on home healthcare workers rather than more expensive institutional care.

I agree with you about the medical certificates. For example, if you're sick -- the flu or a cold, for example -- then it's in the employer's own self-interest not to have workers spreading their diseases in the workplace. Unfortunately there are many employers that aren't so smart about this.

[BBCWatcher]

Do you advise the same for all the people with private insurance as myself or the PRs/SCs who are only temporary living overseas?

That's entirely up to you. But the fact remains that citizenship or PR status means you can (and certainly would) "run home" if/when you have a medical problem, especially if you have no other options or poor options. Singapore offers excellent medical care, and Singapore is insuring you no matter what as long as you have that status. It's not actually a choice the government has to let you bleed to death (metaphorically or actually) when you show up on Singapore's doorstep. So, there's a relatively small tax for basic health insurance that's part of the citizenship/PR package, and that tax is subsidized if you genuinely cannot afford it.

Unfortunately I can't really argue with the basic rationale here. It's reasonable. That said, it'd be awfully nice to see some improvements. As a few examples:

1. I hope Singapore starts signing some social insurance-oriented treaties with developed economies. (Singapore has none at present, to my knowledge.) To pick an example, those covered by Australian Medicare get 6 months of emergency medical coverage when they visit most European countries, and vice versa -- coverage that's very similar to the European Health Insurance Card (EHIC) coverage. Now that Singapore has MediShield Life, it'd be nice to see some treaties providing Singaporeans (citizens and PRs) with reciprocal coverage in other countries, at least on an emergency/urgent care basis.

2. The government might consider a partial premium rebate if you've been physically absent from Singapore for the previous year. I think they'd have to do it in the form of a rebate (i.e. retrospectively), and it would necessarily have to be partial since the premium structure is not fully age rated -- the young subsidize the old to some extent, and practically everybody eventually gets old -- and since you're still insured on an emergency "doorstep" basis even if you're out of the country.

3. If possible, the government ought to relabel this tax (and slightly restructure it perhaps in order to give the label meaning) as an "income tax" in order to make it easier for Singaporeans/PRs to get foreign tax credits which are generally limited to income and income-like taxes. There's certainly no harm in getting foreign governments to bear some more of these costs if/when possible, which is what such a change would effectively do.

4. The government could consider a U.S.-style "Minimum Essential Coverage" approach where particular well regulated alternative private and/or public insurance is deemed an acceptable substitute for MediShield Life, starting with a couple expat-oriented policies underwritten in Singapore for example.

Would you renounce your PR status or citizenship to avoid paying $800 of insurance premium?

*I* most probably would not, but it's not my decision to make for you or for others. Competent adults should be free to make their own decisions.

Although it's hard to know anybody's personal motivations, there are probably about 2,000 U.S. citizens per year who renounce or relinquish their U.S. citizenships primarily or exclusively for tax reasons. (There are approximately 750,000 individuals per year who naturalize as U.S. citizens, for comparison.) It's quite rare, in other words, but a few people make such decisions, and they're free to do so.

[BBCWatcher]

Here's another idea. The government could provide a partial premium rebate if you terminate your national status. Since the premiums are not fully age rated, to some extent you're paying "too much" when you're younger in order to compensate for the lower premiums when you're older. Well, if you terminate status before you become older, then you've "overpaid," arguably. If the government then decided to unwind that overpayment in the form of a partial rebate upon termination of status, similar to how CPF refunds are handled, there'd be some rationale in that.

The flip side is that if you reacquire your national status then the "catch up" payment would be that much bigger. You'd only pay the age-related part of the missing premiums, not all the missing premiums, but you'd have to pay something. Right now this isn't the case either, as I understand it. Arguably even brand new PRs ought to pay the age-related part of their "missing" premiums, so "be careful what you wish for."

[Strong Eagle]

ZZZZZZZZZZZZZZZZZZZZZZzzzzzzzzzzzzzzzzzzzzzzzzz!!!!!!!!!!!!!!!!!!!!!!!!!!!

[BBCWatcher]

I should elaborate that a "side benefit" of MediShield Life premiums is that, at the margins, they're going to encourage a few "well disconnected" citizens and PRs to terminate their statuses, and to do so sooner than they might otherwise have done. Right now there are some/many PRs who leave Singapore and who have no intention whatsoever of moving back. However, "just in case" they hang onto their PR statuses until their re-entry permits expire. If you assume standard 5 year REPs then, on average, that's 2.5 years of "excess" PR status among such individuals. Round that down to 2 years, and there you go: the government is going to "clean out" PRs who are destined to lose their REPs about 2 years earlier on average. Combined with the previous change of dropping REPs from 10 years to 5, and the government is going to be cleaning out runaway PRs. On top of that, the government is going to save a bit of cost in terms of medical care because there's less PR insurance, in effect.

I have to assume this policy change is a "feature, not a bug." It seems the government knows what it's doing on all scores here.

Oh, I just realized this, too: One PR or citizen in the household is enough to trigger a full premium for the entire household, as far as I can tell. (And without subsidy eligibility for the foreigners.) So these premiums should cut down at the margins on "PR shopping" within a household, where one spouse (for example) decamps in Singapore while another spouse tries to nail down PR or citizenship overseas in another country. Households can still do that, but it appears that if you've got dependents, even overseas, even foreign, you've still got to pay their premiums in Singapore. Somebody please correct me if I'm mistaken, but that looks like how it works.

Well played, Singapore.

[earthfriendly]

JR8 in the making . I will sieve thru this tomorrow. I really got to do some zzzzzzzzzzzzzz..... My hubby is waiting or shall I say, pining .

[taxico]

i didn't read this whole thread.

as of late Dec 2015, what i've found out, been told (email, phone calls, etc) is we can't "opt out" or get exemptions right now, regardless of circumstance.

you have to pay if you're SC/SPR. i think CPF will come up with something later as they are "aware of the situation" and are "looking into it."

as of now, if you don't pay, you're breaking da law.

there's a petition somewhere out there. my wife and i "signed" it although i'm pretty sure it's a waste of our time.

[x9200]

Good to hear they have some plans to fix the problems. What they did was so no SG gov.

[Strong Eagle]

I have received an email from CPF, the agency that collects premiums and administers the MOH MediShield Life plan.

Changes were made effective 01 Nov 15 which changed the insurance name from MediShield to MediShield Life, change the benefits, AND changed the premium structures.

I went back and looked at my premium contributions for prior years and there weren't any for the years I was out of Singapore... well, there were but they were reversed when I told them I was out of the country.

However, the email I received clearly explains that the new policy specifically includes all citizens and PR's no matter where they may reside and that I must now pay premiums, and of course, I have "universal health care" in Singapore... at least until my REP runs out.

It seems to me that the intent of the premium change is to take in more money in order to pay for increased benefits. However, an unintended consequence of this will be that people in my situation may decide to renounce PR and remove their CPF funds in order to avoid the premium.

[earthfriendly]

It seems to me that the intent of the premium change is to take in more money in order to pay for increased benefits. However, an unintended consequence of this will be that people in my situation may decide to renounce PR and remove their CPF funds in order to avoid the premium.

I am not too sure about that. Cost of healthcare has been going up and then there is the ageing demographics.

[BBCWatcher]

I am not too sure about that. Cost of healthcare has been going up and then there is the ageing demographics.

MediShield Life's benefits are clearly superior to the previous MediShield's benefits. To pick one example, MediShield had a lifetime limit of $300,000 and an age limit of 92, but MediShield Life eliminates those particular limits. (There's still a $100,000 annual limit, but it's up from $70,000.) Cancer-related limits in particular are much higher. Co-insurance percentages have been cut basically in half. Previously you paid 10 to 20 percent of the claimable amount (after the deductible), and now it's 3 to 10 percent.

Strong Eagle, I don't think the reduction in what I might call "loosely attached" PRs (and even citizens) -- you, as an example -- is an "unintended" consequence of MediShield Life's premiums/taxes, as you prefer. I think the government knows exactly what it's doing here, that this is a feature, not a bug.

[earthfriendly]

An example of Medishield payout. Like all insurance products, it is not meant to cover 100 %. It is an "insurance" to offer you peace of mind that a terminal illness will not bankrupt you.

http://theindependent.sg/medishield-lif ... -medicine/

[x9200]

An example of Medishield payout. Like all insurance products, it is not meant to cover 100 %. It is an "insurance" to offer you peace of mind that a terminal illness will not bankrupt you.

http://theindependent.sg/medishield-lif ... -medicine/

There are many insurance products that cover 100% with much higher life and yearly limits than what CPF enforces. They are more expensive, but this is not like they cost arm and leg. And they cover a lot more and provide even more freedom. E.g. the one I have with GH covers me everywhere, any clinic/hospital, 1BR wards etc etc any country except US.