Life Insurance Association, Singapore: Industry response to Position Statement on Integrated Shield Plans (IPs) by the Singapore Medical Association (SMA): Focus needs to be on identifying the best way forward together for the benefit of Singaporeans

Recommendations

Impact on Stakeholders

Introducing Medical
Fee Benchmarks or Guidelines

–         
To have a set of
medical fee benchmarks or guidelines to provide a range of professional fees.
Benchmarks or guidelines should be calibrated to ensure the appropriate involvement
and adoption by stakeholders

–         
To address the
issue of information asymmetry by providing stakeholders access to
information on appropriate charges

–         
To mitigate cases
of over-charging by providers

Consumers (or
Patients)

·        
Provides an
approximation of charges and allows consumers to manage their personal
healthcare financing

Healthcare
Providers

·        
Enhances the
financial counselling process conducted by healthcare providers as consumers
are aware of the possible charges

·        
Provides greater
transparency on charges to promote trust and to improve the patient-doctor
relationship

Payers (IP
insurers)

·        
Provides a
reference for insurers to review size of claims and develop appropriate
product features (e.g. charges are within claim limits)

·        
Addresses cases of inflated
claims

Clarification on
Existing Process to Surface Inappropriate Medical Treatment

–         
To clarify the
existing escalation process which allows insurers to raise cases of
inappropriate and excessive medical intervention to the relevant authorities

–         
To clarify on the
practices amongst insurers when dealing with such claims so as to minimise
the impact on policyholders whose cases are subject to investigation

–         
To increase
awareness of the existing avenue for insurers to raise cases of inappropriate
and excessive medical intervention noted in their review of claims

Consumers (or
Patients)

·        
Ensures impact on
policyholders’ claims is managed by insurers

·        
Provides assurance
of a robust and accountable process when claims are denied on the basis that
treatments were not medically necessary

Healthcare
Providers

·        
Emphasises the
importance of providing medically necessary treatment and discourages medical
professionals from malpractices

Payers (IP
insurers)

·        
Provides greater
clarity and awareness of the escalation process

·        
Allows insurers to
play a more active role in supporting medically necessary treatments

Enhancing Insurance
Procedures and Product Features

·     
Panel of Preferred Healthcare Providers

Consumers (or
Patients)

·        
Provides assurance
that charges by panel healthcare providers are appropriate and
correspondingly, out-of-pocket costs in the form of deductible and
co-insurance are appropriate

·        
Provides clarity on
the potential implications of using a non-panel healthcare provider in terms
of making insurance claims

Healthcare
Providers

·        
Emphasises the
importance of providing required standard of care to patients and discourages
medical professionals from fee arrangements that may influence the
objectivity of their clinical judgement in their management of patients

Payers (IP
insurers)

·        
Encourages insurers
to influence their preferred healthcare providers, TPAs, and intermediaries
to have fee arrangements with medical professionals that are in line with
SMC’s ECEG

·        
Ensures leakage of
claims costs is minimised as claims are based on agreed medical fee charges
and treatment

Enhancing Insurance
Procedures and Product Features

·     
Co-insurance & Deductibles

–         
To encourage
insurers to include co-insurance and/or deductible features in product design
to ensure consumers’ interest are aligned with managing healthcare costs

–         
To address the
risks of overconsumption due to poor product features

Consumers (or
Patients)

·        
Encourages
consumers to play a more active role in managing their medical care costs

·        
Encourages
consumers to be more responsible for their lifestyle habits

Healthcare
Providers

·        
Increases pressure
to provide medically effective and cost efficient treatment

·        
Encourages
communication between consumer and healthcare provider on type and cost of
medical care recommended and, improves the patient-doctor relationship

Payers (IP
insurers)

·        
Aligns product
features with consumers’ interest for long term sustainability of IP premiums

·        
Ensures better
claims cost management

Enhancing Insurance
Procedures and Product Features

·     
Pre-approval of Medical Treatment

–         
To encourage
insurers to approve claims for medical treatment and estimated bill size
prior to the actual procedure, which provides certainty to patients on what
can be claimed from their insurance policy

–         
To address the
risks of inappropriate treatment and high medical charges

Consumers (or
Patients)

·        
Provides a peace of
mind as policyholders know their procedure is within insurance coverage when
actual treatment is sought

·        
Protects consumers
as insurers would not endorse and providers are unlikely to recommend
procedures that are not medically necessary

Healthcare
Providers

·        
Decreases disputes
with payers and consumers over medical treatment and bills

·        
Encourages greater
communication between payer and provider

Payers (IP
insurers)

·        
Provides greater
control over cost of medical bills

Educating Consumers

–         
To educate the
public on the available options, such as the types of hospitals and wards,
and the corresponding costs of their medical treatments

–         
To address the issue of
information asymmetry by ensuring information on medical charges is readily
accessible and easily comprehensible by consumers

Consumers (or
Patients)

·        
Educates consumers
to assess the available information and make informed healthcare choices

Name

Designation

Ms
Mimi Ho

(Chairman)

Principal,
Regulatory Professionals Pte Ltd

Dr
Khoo Kah Siang

President,
Life Insurance Association, Singapore

Mr
Richard Wyber

Deputy
Convenor, Health Insurance Subcommittee, Life Insurance Association,
Singapore

Mr
Lim Biow Chuan

President,
Consumers Association of Singapore

Mr
Seah Seng Choon

Executive
Director, Consumers Association of Singapore

Dr
Wong Tien Hua

President,
Singapore Medical Association

Dr
Wong Chiang Yin

Council
Member, Singapore Medical Association

Mr
Chin Chee Kiat

Director
(Finance Policy), Ministry of Health, Singapore

Ms
Jasmin Lau

Deputy
Director (Finance Policy), Ministry of Health, Singapore

Ms
Lee Keng Yi

Director
& Department Head (Insurance), Monetary Authority of Singapore

Ms
Tan Siew Yen

Director
& Division Head (Insurance), Monetary Authority of Singapore

Name

Designation

Dr
Leow Yung Khee

Head
of Group Insurance and Claims, The Great Eastern Life Assurance Company
Limited and The Overseas Assurance Corporation Limited

Mr
Martin Ho

Chief
Administrator, Singapore Medical Association