Changes to how private patients with Integrated Shield plans (IPs) are reimbursed for cancer treatment went into effect on April 1. Salma Khalik, a senior health correspondent, examines the implications for patients with IPs.What exactly has changed?
A: There are several modifications. Cancer treatment is no longer covered “as charged” in the way it was covered by all still-available IP subscriptions. (Despite the fact that some plans are no longer being sold, those who were already enrolled in them were still maintained. However, the coverage is less.).
Another modification is the division between cancer medications and cancer services (which include everything else, such as doctor visits, lab fees, scans, and other medications that might be required for conditions like infection or nausea). Each has its own cap.
Depending on the course of treatment, the MediShield Life (MSL) drug cap ranges from $200 to $9,600 per month, while the cap for services is $3,600 per year.
Additionally, it is made very clear what kinds of medications and treatments IPs can cover. Only medications and therapies that are on the Cancer Drug List (CDL) are covered by IPs. These make up about 90% of the medications and medical procedures that the Health Sciences Authority (HSA), the regulator, has approved for use in this country.
IPs cannot provide coverage for the final 10% of authorized medications and therapies. They either lack clinical evidence supporting their efficacy or their price does not represent good value.
In the event that a patient needs more than one cancer medication, they may submit an insurance claim up to the maximum allowed for the most expensive medication, unless the CDL lists all of the medications as a combination treatment. Insurance used to cover the cost of all medications.That is too complicated, I agree. Tell me straight up if my cancer treatment will be fully covered by my IP.
A: How much the insurer is willing to pay will depend on the insurer you are with and which one you are. The seven insurers do not all provide the same level of coverage.
The likelihood is that you won’t experience any issues with drugs if you are receiving treatment from a B1- or A-class IP in a public facility because the CDL price limits are based on what the public sector pays plus the government subsidy.
The insurance payout for cancer drug services, which is set at two to five times the MSL limit of $3,600 annually, is where you might run into trouble. Once again, the amount of coverage you receive is determined by your plan and the decision of your insurer.
With the exception of outliers like patients who need extremely expensive treatment, like an antifungal one, this will typically be sufficient for the majority of patients in the public sector.
Most insurers offer five times the MSL limits for both drugs and services if you are receiving treatment in the private sector. Again, it should typically be sufficient, especially for simple, early-stage cancers.
But if you’re given medications in cycles of three weeks, which is the most typical method, there might be a problem. For some months, this might mean taking twice as much medication. The cost of the drugs will determine whether this sum stays within the restrictions imposed by the IPs.
The same is true for private hospital IPs, who will spend up to $18,000 annually on extras like doctor visits, tests, scans, and other medications. It would depend once more on what you needed and how much you were charged for these services.
If I require a treatment that is not listed on the CDL, what happens?
A: Your IP is unable to pay for non-CDL treatments, unfortunately. The good news is that more medications and therapies have been added to the list, bringing the total up from the original 270 to over 340, or roughly 90% of all HSA-approved therapies.
More medications will be added to the CDL if drug manufacturers selling non-CDL medications are willing to reduce their costs to a point where the government deems it to be worth the money.
For non-CDL drugs, most riders do offer some protection, though. The best non-CDL rider coverage among the major IP insurers appears to be provided by Great Eastern, which offers $250,000 annually. AIA, Income, and Prudential also provide non-CDL rider coverage, but at $200,000, $180,000 annually, and $150,000 annually, respectively.So, if I don’t have a rider, do I need to get one?
A: The answer to that query is a challenge. Today, riders have been purchased by two out of three IP holders.
Riding is undesirable on a national scale. Patients with first-dollar riders in 2016 incurred medical costs that were 60% higher than those without riders.
Explaining why there was a need for patients to pay part of their bill, then Health Minister Gan Kim Yong said riders that paid for everything “encourage unnecessary treatment, leading to rising healthcare costs not only for those with such riders but for all of us”.
However, on a personal level, people worry about having to pay a significant amount of money up front for medical care. Prior to the modifications to cancer financing, they purchased riders in order to lower their out-of-pocket expenses for large bills.
Without a rider, patients are responsible for paying their annual deductible plus 10% of all other expenses. They pay 5% of the bills with a rider, subject to conditions, up to a maximum of $3,000 per year.
Therefore, a rider might not make sense for people who do not anticipate receiving large bills because its premium can be expensive and must be paid in cash, in contrast to IPs, which are paid for with money from MediSave.
However, with the changes to insurance coverage for cancer treatments, riders now play a different role.
Insurance continues to cover most other treatments on an “as charged” basis, so riders just pay the mandated patient’s share.
As previously mentioned, there are limitations to cancer coverage. For both drugs and cancer services, they are five times the MSL limits for private hospital plans, and they offer less coverage for A- and B1-class plans.
Will this amount of coverage suffice? Most patients probably need enough, but not all. Would the patient’s share be a big deal for those whose insurance isn’t enough? It might be determined by the treatments and medications used.
Additional coverage for non-CDL procedures that IPs cannot provide is provided by riders. Typically, such treatments wouldn’t be necessary. But what if you do?A: I recently received a cancer diagnosis, and I’m currently taking a non-CDL medication. There is no rider with me. How will this affect the availability of insurance?
A: If your treatment has already begun, your insurer will continue to provide coverage for you through the end of September under the prior system.
It will depend on when your insurance year begins if you have not yet begun treatment. This is so that you are aware that the insurance coverage changes won’t apply until after your current contract has been renewed.
If your insurance year runs from April to March, the modifications take effect right away. If your contract was renewed in March, there won’t be any changes to the way you are covered until your next contract renewal is due in March 2024.
