IP insurers are subject to regulatory oversight by MOH and MAS
We refer to recent letters and Dr Wong Chiang Yin’s op-ed on Integrated Shield Plans (IPs). Dr Wong raised concerns that Aviva Ltd (Aviva) had removed its IP coverage for medically necessary diagnostic endoscopies and asked if there were gaps in oversight of IP insurers.
Medically necessary diagnostic procedures are covered by IP insurers. The Monetary Authority of Singapore (MAS) has engaged Aviva, which clarified that it did not change its IP terms and conditions (T&Cs). It had tightened its claims assessments, having observed a trend of questionable claims. However, this tightening resulted in claims being rejected despite being medically necessary. Aviva has since revised its assessment approach and undertaken to approve such claims.
The Ministry of Health (MOH) and MAS work closely together in exercising regulatory oversight over IP insurers. IP insurers have to seek approval from MOH for changing IP T&Cs. MAS will take action against insurers if they do not pay claims in accordance with policy T&Cs or have unfair claims handling practices. MOH and MAS will enhance our surveillance efforts so that inappropriate practices can be identified and dealt with more expeditiously. We will also look into: (a) providing guidance on determining the medical necessity for specific procedures; and (b) requiring insurers to incorporate this guidance into their claims assessment.
Dr Wong’s comment that an IP policyholder can be worse off than someone covered only by MediShield Life (MSHL) is incorrect. IPs provide additional coverage above the MSHL component. As the Central Provident Fund Board assesses all claims for the MSHL component of IPs, a person with an IP would not receive a lower pay-out than a person with only MSHL.
All stakeholders – patients, insurers, and medical practitioners – have a role in ensuring health insurance remains affordable. Patients should refrain from over-consuming healthcare; doctors should prescribe only treatments that are medically necessary; and insurers should assess claims carefully to minimise over-consumption without compromising necessary healthcare. MOH and MAS will step up engagement with clinicians and insurers to strengthen good practices that will help ensure appropriate and affordable care.
Cham Dao Song
Director, Finance Policy
Ministry of Health
Executive Director (Insurance)
Monetary Authority of Singapore
Source: Monetary Authority of Singapore