Need help understanding how claiming from integrated shield plans work?

[firsttimebuyer]

Hi everyone, I have a query on how does claiming from integrated shield plan works.

I have logged into the "My Great GE app" and reviewed my policy.

I saw that I have the following:

1) Great Supremehealth P Plus
2) Supremehealth Medishield Life
3) Great Totalcare P

But I could not find the sum assured.

So how does it work? For example, let's say (figures stated here are examples only) I am insured up to $100,000. If I go for a colonscopy at a private clinic and total costs run up to $7000, and claim from my Integrated Shield Plan, does that mean i am only left with remaining $93,000 left?

 

[lzydata]

Hi everyone, I have a query on how does claiming from integrated shield plan works.

I have logged into the "My Great GE app" and reviewed my policy.

I saw that I have the following:

1) Great Supremehealth P Plus
2) Supremehealth Medishield Life
3) Great Totalcare P

But I could not find the sum assured.

So how does it work? For example, let's say (figures stated here are examples only) I am insured up to $100,000. If I go for a colonscopy at a private clinic and total costs run up to $7000, and claim from my Integrated Shield Plan, does that mean i am only left with remaining $93,000 left?

You have a very high end policy as it is a private hospital plan. Searching on GE's website,

Supremehealth Medishield Life - their name for Medishield Life, compulsory
Great Supremehealth P Plus - their private integrated shield plan on top of Medishield Life
Great Totalcare P - their rider/supplement to their integrated shield plan

With all 3, the part of your hospital bill you have to pay is capped at 5%, or at $3k if you use their panel specialists. Even without Great Totalcare P, that caps your outlay in this way, the yearly policy limit for Great Supremehealth P Plus is $1.5 million. No lifetime limit i.e. it's unlimited.

The concept of "sum assured" has to with life and TPD insurance and not so much hospitalisation and surgical insurance.

 

[firsttimebuyer]

You have a very high end policy as it is a private hospital plan. Searching on GE's website,

Supremehealth Medishield Life - their name for Medishield Life, compulsory
Great Supremehealth P Plus - their private integrated shield plan on top of Medishield Life
Great Totalcare P - their rider/supplement to their integrated shield plan

With all 3, the part of your hospital bill you have to pay is capped at 5%, or at $3k if you use their panel specialists. Even without Great Totalcare P, that caps your outlay in this way, the yearly policy limit for Great Supremehealth P Plus is $1.5 million. No lifetime limit i.e. it's unlimited.

The concept of "sum assured" has to with life and TPD insurance and not so much hospitalisation and surgical insurance.

Thank you very much for your reply, i really appreciate it. $3K is not exactly cheap for me though, almost 3/4 of my monthly take-home pay. Still weighing my options as I am a bit distrustful of my current doctor.

 

[BBCWatcher]

$3K is not exactly cheap for me though, almost 3/4 of my monthly take-home pay.

OK, but you have MediSave dollars don't you?

By the way, it's an "interesting question" whether an Integrated Shield plan pays for a colonoscopy. I think it does if it's classified as a day surgery. And then you can also use MediSave dollars, up to a limit and if you're age 50+. However, when you make a claim under your particular Integrated Shield plan and rider combination you'll be subject to Great Eastern's claims-adjusted pricing rules. In the scenario you describe (a ~$7,000 colonoscopy from a private medical provider) your rider premiums will increase after you make that claim.

Anticipating the next question, how can you avoid increasing your premiums?

1. Don't make a claim. For example, in most cases the Singapore Cancer Society's free FIT kits are valid alternatives to colonoscopies as long as you take the FITs annually.

There's also a non-free noninvasive test, brand name "Cologuard," that might be an option. This is technically called a MT-sDNA test, sometimes "FIT-DNA." It's not common yet in Singapore, but it was U.S. FDA approved in 2014. This test looks at DNA in the stool to find evidence of cancer. It's less sensitive than colonoscopies in finding precancerous polyps (which is why you take it, or FITs, more often) but more sensitive than FITs. It's also a little high in false positives. However, if you want the "best" noninvasive test then it's a possible option.

Incidentally, the latest global wisdom seems to be to start checking for colorectal cancers from age 45 (5 years earlier than the prior age 50 general recommendation). The SCS still starts their free FIT kits from age 50, so prior to age 50 you'll have to pay for them. But FIT kits, even if you have to pay for them, are rather inexpensive.

Yet another possible option if you're lucky is that your employer will pay for a colonoscopy when you're 50+. Some employers in Singapore do, particularly those who employ a large number of white color office workers since some of them may be prone to colorectal cancers.

2. Get your colonoscopy from the public medical sector instead of private sector. (But if you're going to do that anyway then why are you attempting to insure for private medical sector care?)

3. "Downgrade" to a lower cost plan. For example, you could switch to TotalCare P Select, a lower cost rider than TotalCare P. TotalCare P Select is still subject to claims-adjusted pricing, but it starts from a lower cost. (The co-insurance is also higher, of course.) Or switch to one of Great Eastern's public hospital Integrated Shield plans and (lowest cost) riders.

 

[aarontansp]

Hi everyone, I have a query on how does claiming from integrated shield plan works.

I have logged into the "My Great GE app" and reviewed my policy.

I saw that I have the following:

1) Great Supremehealth P Plus
2) Supremehealth Medishield Life
3) Great Totalcare P

But I could not find the sum assured.

So how does it work? For example, let's say (figures stated here are examples only) I am insured up to $100,000. If I go for a colonscopy at a private clinic and total costs run up to $7000, and claim from my Integrated Shield Plan, does that mean i am only left with remaining $93,000 left?

Medishield trumps all for non-emergency health issues.

 

[limster]

https://forums.hardwarezone.com.sg/...scopy-clarifies-insurance-body-follo.6369479/

Whether Integrated plans cover endoscopy already explained.

 

[reddevil0728]

Thank you very much for your reply, i really appreciate it. $3K is not exactly cheap for me though, almost 3/4 of my monthly take-home pay. Still weighing my options as I am a bit distrustful of my current doctor.

if it is going to be so substantial. why choose private?

 

[BBCWatcher]

Whether Integrated plans cover endoscopy already explained.

Yes, but note carefully that the insurance industry has an “out.” Colonoscopies are covered because they’re classified as day surgeries. Weirdly if medical science comes up with a new, even better diagnostic test that isn’t a day surgery then it won’t be covered. Suppose for example someone invents a Bluetooth capsule that you swallow at home. You keep your smartphone nearby, and the capsule transmits data as it passes through your digestive tract. Then it passes harmlessly and biodegrades in Singapore’s sewers. All on an outpatient basis. An Integrated Shield plan wouldn’t cover this test under current rules. It could be better in every way and less expensive, but that wouldn’t matter for these purposes….

And that’s a problem! That’s the sort of thing that can happen with perverse financial incentives. And it’s one reason why we might see some movement toward medical insurance (still with co-insurance) from the mostly hospitalization insurance system we have now. In fact, this particular problem might already exist. Cologuard has been approved elsewhere for nearly a decade. It’s much less expensive than a colonoscopy, it’s noninvasive (safer, although colonoscopies are pretty safe), much easier to take (thus more people will actually do it), and its diagnostic power is pretty good (between FIT and colonoscopy). So why isn’t it more popular in Singapore? Probably because insurance won’t generally cover it, and it might not be MediSave claimable either.

I don’t think you should make medical decisions based solely or predominantly on what insurance will pay — not if you can avoid it. That cuts both ways.

 

[firsttimebuyer]

OK, but you have MediSave dollars don't you?

Thank you very much for your replies, help and advice!

Yes, i do have Medisave, in fact, I got some kind of department from the public hospital that they will be deducting a large portion of it from Medisave.

By the way, it's an "interesting question" whether an Integrated Shield plan pays for a colonoscopy. I think it does if it's classified as a day surgery. And then you can also use MediSave dollars, up to a limit and if you're age 50+. However, when you make a claim under your particular Integrated Shield plan and rider combination you'll be subject to Great Eastern's claims-adjusted pricing rules. In the scenario you describe (a ~$7,000 colonoscopy from a private medical provider) your rider premiums will increase after you make that claim.

Wow, that is news to me, I did not know that the annual premiums I make every year will increase each time I make a claim!

Anticipating the next question, how can you avoid increasing your premiums?

1. Don't make a claim. For example, in most cases the Singapore Cancer Society's free FIT kits are valid alternatives to colonoscopies as long as you take the FITs annually.

I actually had IBS, i managed to get a referral letter to a specialist clinic and was hoping to sort it out via the doctor treating me for IBS. I was quite surprised that he scheduled a colonscopy right away, I was a little bit unhappy with the whole process (for various reasons), and sort of had a wrong vibe from the doctor. I did take a FIT test earlier in Jan this year.

There's also a non-free noninvasive test, brand name "Cologuard," that might be an option. This is technically called a MT-sDNA test, sometimes "FIT-DNA." It's not common yet in Singapore, but it was U.S. FDA approved in 2014. This test looks at DNA in the stool to find evidence of cancer. It's less sensitive than colonoscopies in finding precancerous polyps (which is why you take it, or FITs, more often) but more sensitive than FITs. It's also a little high in false positives. However, if you want the "best" noninvasive test then it's a possible option.

Doctor did not recommend this, so I am a bit surprised.

Incidentally, the latest global wisdom seems to be to start checking for colorectal cancers from age 45 (5 years earlier than the prior age 50 general recommendation). The SCS still starts their free FIT kits from age 50, so prior to age 50 you'll have to pay for them. But FIT kits, even if you have to pay for them, are rather inexpensive.

I am aged 38.

Yet another possible option if you're lucky is that your employer will pay for a colonoscopy when you're 50+. Some employers in Singapore do, particularly those who employ a large number of white color office workers since some of them may be prone to colorectal cancers.

I did checked my company insurance and it does not appear (and this is something which I am confirming with HR now) to cover any kind of health insurance, only personal accident or injury. I shared this with my parents and they said that it is very unusual.

2. Get your colonoscopy from the public medical sector instead of private sector. (But if you're going to do that anyway then why are you attempting to insure for private medical sector care?)

I am getting the colonscopy from a public hospital, the one that I mentioned was scheduled.

3. "Downgrade" to a lower cost plan. For example, you could switch to TotalCare P Select, a lower cost rider than TotalCare P. TotalCare P Select is still subject to claims-adjusted pricing, but it starts from a lower cost. (The co-insurance is also higher, of course.) Or switch to one of Great Eastern's public hospital Integrated Shield plans and (lowest cost) riders.

Thank you but I feel that I won't be downgrading though.

 

[firsttimebuyer]

Yes, but note carefully that the insurance industry has an “out.” Colonoscopies are covered because they’re classified as day surgeries. Weirdly if medical science comes up with a new, even better diagnostic test that isn’t a day surgery then it won’t be covered. Suppose for example someone invents a Bluetooth capsule that you swallow at home. You keep your smartphone nearby, and the capsule transmits data as it passes through your digestive tract. Then it passes harmlessly and biodegrades in Singapore’s sewers. All on an outpatient basis. An Integrated Shield plan wouldn’t cover this test under current rules. It could be better in every way and less expensive, but that wouldn’t matter for these purposes….

And that’s a problem! That’s the sort of thing that can happen with perverse financial incentives. And it’s one reason why we might see some movement toward medical insurance (still with co-insurance) from the mostly hospitalization insurance system we have now. In fact, this particular problem might already exist. Cologuard has been approved elsewhere for nearly a decade. It’s much less expensive than a colonoscopy, it’s noninvasive (safer, although colonoscopies are pretty safe), much easier to take (thus more people will actually do it), and its diagnostic power is pretty good (between FIT and colonoscopy). So why isn’t it more popular in Singapore? Probably because insurance won’t generally cover it, and it might not be MediSave claimable either.

I don’t think you should make medical decisions based solely or predominantly on what insurance will pay — not if you can avoid it. That cuts both ways.

This is a pretty good analysis, the doctor that I saw was in a public hospital; he mentioned the possibiity of a CT abdomoinal scan but never the Cologuard!

 

[BBCWatcher]

Cologuard is most focused on detecting possible colorectal cancer since it’s looking for its DNA markers. Cologuard’s cost is somewhere in between FIT and colonoscopies, and so is its sensitivity. So it’s used every year to every 3 years — equally or less frequently than FIT, more frequently than colonoscopy — to screen for colorectal cancer. IBS is a very different matter (it’s not colorectal cancer), and a colonoscopy might be helpful in understanding its cause(s) and/or treating it.

I‘m not an expert here, but FWIW it makes sense to me that a doctor would suggest a colonoscopy after a negative FIT in these circumstances. Although maybe the FIT could’ve been skipped if you were going to have a colonoscopy no matter what the FIT result. Was the FIT combined with a stool study (studying the flora)? Because that’d make sense — if you’re going to run one test collection you might as well run the FIT. FITs are cheap, so cheap that the Singapore Cancer Society can offer a nationwide free FIT program for most residents of Singapore age 50+.

If you’re going to be discouraged from obtaining care from a private medical provider because your rider premiums would increase then it’s well worth thinking about why you’re paying for that type of coverage at all, and in its maximalist form to boot. It’s an “interesting question.”