Rahayu Mahzam
Singapore
“We engage the insurance providers quite regularly, but we are very mindful about where we intervene, especially because they need to be competitive and there is a commercial dimension to it, which we feel that we should respect. So, how we intervene is via the conditions that are put in place vis-a-vis the consumers.”
“So, that is not something they can worry about. There is already the S+3M framework that is already in place, so we know that MediShield Life is one, they have their MediSave and if all else fails, there is MediFund.”
“Should there be disputes over specific claims, policyholders can take it to the Financial Industry Disputes Resolution Centre (FIDReC), an independent and impartial institution that assists with insurance-related disputes.”
“It is just a symptom, so the underlying cost pressures still need to be addressed. The description that we had put earlier in the past is that it is a knot that we need to untangle; and that is something we are doing with a multi-pronged, with engagements with different parties and stakeholders.”
“I appreciate the Member's feedback. As I said earlier, this is something that we will continue to consider. But we do also have to appreciate that the information that we get is live, in terms of waiting times and all that.”
“But I do take the point and we are actually reviewing to see what is a meaningful way to put out this information so that the public can understand, so that we can all track properly whether the good health outcomes are a result of the efforts that we are making. I will take the feedback back and we will continue to review this.”
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“For example, measles has resurfaced in the United States since 2019 and in European countries since 2023, despite ready access to vaccines in these countries. We are fortunate that our vaccination coverage for diseases like measles and diphtheria remain sufficiently high to maintain herd immunity, but we must not rest on our laurels. We must do what we can to maintain these high rates of vaccination coverage, such as addressing misinformation and disinformation on vaccines and provide evidence of their safety, efficacy and importance to individual and public health. It is against this backdrop that CDA is being set up. CDA will be the frontline agency to safeguard Singapore by preparing for, preventing, detecting and responding to infectious diseases. The COVID-19 White Paper put forth a few key recommendations to consolidate our learnings and better prepare ourselves for future pandemics. First, we must systematically build strong expertise and organisational capacity to tackle future pandemics. During the COVID-19 response, we developed and deepened capabilities in areas like data analytics and epidemic modelling to support policy decisions and response. These must not be lost and must be maintained and developed to better prepare Singapore to manage future pandemics. CDA will do this by bringing together the expertise in the Ministry of Health (MOH), the Health Promotion Board (HPB) and the National Centre for Infectious Diseases (NCID), and leveraging academia and international technical networks to further develop CDA's capabilities. Second, the White Paper recommended that we institutionalise the use of science and technology in responding to infectious disease threats.”
“This has increased the risk of infections crossing the species barrier and infecting humans, sparking outbreaks of zoonotic diseases like Ebola Virus Disease and Marburg Virus Disease in Africa. Urbanisation has contributed to more dense human-to-human interactions and increased the risk of spread of infectious disease within communities. Second, globalisation and cross-border travel greatly accelerates the speed at which infectious diseases spread internationally. Singapore, as an aviation air hub, is especially vulnerable. Third, climate change is influencing and changing our environments. Increases in temperature allow disease vectors like the Aedes mosquitos which spread dengue fever, to expand their geographical range, placing more regions and people at risk of infection. Aedes aegypti, present in Singapore, becomes more efficient at transmitting dengue at higher temperatures. Fourth, inappropriate antibiotic use drives the development of antimicrobial resistance, which render previously-effective drugs useless against these resistant forms. An example of such drug-resistant disease is multi-drug-resistant tuberculosis, which is much harder and takes much longer to treat than normal tuberculosis. When these drug-resistant diseases spread, they may cause more severe disease and even death because they are more difficult to treat. Finally, the vaccine hesitancy movement undermines vaccination efforts to protect the population from infectious diseases that could cause severe illness and death. As a result, some countries where vaccine-preventable diseases like measles were previously eliminated have seen resurgences and outbreaks due to the declines in vaccination uptake.”
“Mdm Deputy Speaker, on behalf of the Minister for Health, I move, "That the Bill be now read a Second time." In March 2023, during the Parliamentary debate on the White Paper of Singapore's response to COVID-19, the Minister for Health announced that Singapore will set up the Communicable Diseases Agency, or CDA. Our current capabilities in managing communicable diseases reside in several entities. For example, the Ministry of Health (MOH) sets policy, the National Centre for Infectious Diseases (NCID) administers the public health control measures as part of the national programmes and the Heath Promotion Board (HPB) does public education. By consolidating into a dedicated agency, it will help us systematically build up strong public health expertise and organisational capacity and establish international linkages, to better tackle future pandemics. [Mr Speaker in the Chair] Over the years, we have seen severe infectious disease outbreaks occur with increasing frequency. Since the 2003 Severe Acute Respiratory Syndrome (SARS) global outbreak, the World Health Organization (WHO) has already declared seven Public Health Emergencies of International Concern (PHEIC). These included the 2009 Influenza A (H1N1) pandemic, COVID-19 pandemic, 2022 mpox global outbreak, 2016 Zika global outbreak, all of which affected Singapore. This increasing frequency of infectious disease outbreaks takes place amidst a complex ecological environment, with external forces driving the emergence and re-emergence of infectious diseases. First, unplanned environmental encroachment has resulted in an increase in interaction between humans and animals, including the diseases they might carry.”
“I thank the Member for the questions and the insight. Indeed, we are learning robustly from different countries. They are all having different experiences and some of the experiences are useful in informing us as to the actions we need to take in our space. In Singapore, we have had a very collaborative approach that we have taken with the technology companies. We have been very stern and strict in making sure that they comply with some of the requirements that we have set forth. But we also want to ensure that this is something that can be sustainable and meaningful. With regard to the question on whether they have been putting in the necessary safeguards, I think this is the whole point of the exercise with the annual reports because it is going to be a continuous iterative process. Based on what we have learned so far, we have put in the requirements that we think are necessary for the social media companies to put in place. We constantly engage them to make sure that they comply with these. And the reports actually provide transparency and give us that opportunity to assess whether they have done well. We are still in the midst of reviewing these and when we assess these, this is going to be the foundation of how we can then move forward in either strengthening levers or seeing what are the other measures that we can put in place to provide the necessary safeguards and protection for our children. 11.28 am”
“I thank the Member for the further question. Indeed, these are things that we can continue to review as we see what have been the efforts that are put in place. But just to clarify, the Online Safety Code had already put in certain things that the designated social media companies need to comply with, and if they do not, they will be subject to penalties. These include putting in place systems and processes to minimise presence of harmful content in the services, particularly for children, and establishing community guidelines, enforcing them, providing users of access to tools to manage their own safety and proactively detecting and removing child sexual exploitation and abuse material, as well as terrorism content. So, there are already basic things that they have to do. They are also supposed to provide an effective and easy-to-use reporting mechanism for Singapore users to report harmful content or unwanted interactions on the platform. So, as we continue to do this, there are already some stringent measures that we have put to the designated social media companies to comply with and we will continue to improve on these.”
“IMDA offers many bite-sized resources on their DfL portal. So, one example is the Online Safety Digital Resource Kit, which was developed in collaboration with technology companies, and recommends the necessary parental controls and safeguards to protect their children's safety online. We also work closely with other Ministries, with MOE, as I mentioned earlier in their CCE curriculum. The Cyber Wellness lessons are important to teach the children how to be safe, respectful and responsible users of digital devices. The Ministry of Health also has the Guidance on Screen Use in Children which we will continue to update and revise. To empower and equip parents further to build strong parent-child relationships, and strengthen their children's mental well-being, and emotional resilience through this digital journey, MOE, MSF and HPB also launched the Parenting for Wellness initiative in September of 2024. This also brings together resources to help support parents in this journey. My Ministry, the Ministry of Digital Development and Information, will also introduce a Positive Use Guide on Technology and Social Media in the first half of this year. So, these are the different initiatives and efforts that we were putting in place to hopefully strengthen community's ability to also walk together in this journey in safeguarding and protecting our children.”
“I thank the Member for her questions. On the first bucket of questions that she raised relating to the designated social media services, indeed, the whole intent of having them submit the annual online report is to provide transparency on their measures and levels of safety to see what they are already doing in the space and also help us to understand what are some of the features that can be put in place to provide the safeguards. These reports are in, but IMDA is still in the midst of assessing these reports. We plan to publish them, so that will be coming in soon. With this, indeed, we will be seeking to learn from this exercise and we will look to improve the safeguards and processes. With regard to the second bucket of questions that the Member had in relation to the role of parents and the community, as I mentioned earlier, it is a whole-of-society effort. This is something that we need to do together. The Government is looking at how we can enhance regulatory measures, but we also are strengthening our public education efforts. This gives me the opportunity to share some of the work that we have already been doing in this space. These efforts include the National Library Board's S.U.R.E programme. I think that is something that Members will be familiar with because that is something that had been launched in 2013 to strengthen Singaporeans' resilience to misinformation and online falsehoods. We have also more recently launched the IMDA's Digital Skills for Life Framework, which was launched in January 2024. It identifies the set of skills to equip Singaporeans to carry out day-to-day tasks online, including staying safe and smart online. We are also looking at equipping parents with the skills to guide their children on online interactions.”
“Even as we consider further steps to improve protection for children online, we are mindful that research findings on the impact of social media on children are not conclusive. While it has been linked to mental health issues, social media has also been shown to help children develop social skills and build connections with their peers. This is why we have stepped up complementary efforts in public education to equip and educate parents and children on how to be safe online. We do this through Cyber Wellness lessons in the Ministry of Education’s (MOE's) Character and Citizenship Education (CCE) curriculum, as well as various initiatives such as Parenting for Wellness launched in 2024 by MOE, the Ministry of Social and Family Development (MSF), the Health Promotion Board (HPB) and the Online Safety Digital Resource Kit on the Infocomm Media Development Authority's (IMDA's) Digital for Life (DfL) portal. These are complemented by efforts of industry and community partners, such as Google’s Be Internet Awesome Programme and Touch Community Services’ First Device Campaign. We are constantly looking to do better, and I welcome Members and everyone’s suggestions. Ensuring online safety is a whole of society effort and everyone can play their part.”
“The stated objective of legislating age limits for social media access is to protect children and youths from its harms. We share the same objective and will continue to study the effectiveness of mandating age limits. For example, how will the authorities assess the extent of violation? Where will the line be drawn if younger users turn to accessing unregulated platforms or services? We are engaging our Australian counterparts in social media platforms to understand their views. This will help inform our thinking on the next steps. In the meantime, we have taken several steps to protect our children on social media. In 2023, we introduced the Code of Practice for Online Safety. It requires designated social media services to put in place measures to enhance the safety of Singapore users, including more stringent measures for children. Among other obligations, they must ensure children are not targeted to receive content that is detrimental to their physical or mental well-being. They must also have more restrictive account settings for children and provide tools for parents to manage their safety. We have also taken decisive steps to require the implementation of age assurance methods, which have grown in availability and effectiveness, and can help to minimise children’s access to harmful online content. Such methods include age estimation using technology and age verification based on submission of official documents. Our upcoming Code of Practice for Online Safety for App Distribution Services will require designated app stores to put in place such measures to ensure that children access only apps that are appropriate for their age.”
“Mr Speaker, I note the Member's deep interest in this matter and appreciate his enthusiasm. He has raised this matter in an Adjournment Motion previously and also in several Parliamentary Questions. Certainly, the Ministry is aware of and empathise with the situation faced by cancer patients, especially if they are of low income. And I can imagine it must be traumatic and devastating for them to go through this journey. As I have also explained, we are reviewing this matter. MediShield Life is designed as a basic insurance scheme, covering large bills due to treatment of diseases in subsidised public hospitals. That is a separate thing. We are looking at this matter. We have also taken note of some of the suggestions Dr Tan has made in his Adjournment Motion. We will be looking at how we can continue to provide more support and see what is the adequacy of co-funding of other support that we can provide in fertility treatments of cancer patients.”
“Mr Speaker, for young cancer patients who want to undergo fertility preservation, so that they can have children in the future, they can tap on MediSave for egg freezing. If they get married in the future and would like to use their eggs for Assisted Reproduction treatments, they can also receive Government co-funding support and use MediSave for their treatments. We will study extending more support for such patients, separately from the MediShield Life 2024 review, bearing in mind there may be other medically necessary treatments for conditions besides cancer that could also affect fertility.”
“We need to take a close look at this because there appears to be a race to the bottom and we are constantly worried that these private policies are not sustainable. That is the key thing that we need to look at because the change in terms is really a sign of this happening. Insurers need to take a step back and renew their fundamental designs of their schemes. It cannot be about enhancing the payouts to get the market share and when the sums do not work out, then they adjust the terms. So, that is the point that the Minister for Health was trying to address and that is indeed why we are calling for a fundamental redesign of the system.”
“I note the questions raised by Members. Indeed, these issues are real issues. And the Member highlighted the point about the IP products being of a special category, because you can tap on your MediSave to pay for your premiums. So, certainly, we agree that the IP insurers must have a sense of social responsibility towards policyholders and this includes ensuring that their products are sustainable. They cannot compete for the market to the point that they then are unable to sustain the product, which is what is happening now. To the Member's question as to whether we can scrutinise this, we are indeed scrutinising it quite intently and this is because we are seeing some of these challenges. What we are seeing is that the companies are either barely breaking even or making losses from their health portfolios, and this is an issue of concern. The Member also raised the issue of moving of the goalposts. I will make a few points in this respect. Firstly, we should note that it really depends on the contract because it is not just what was sold or bought. It is what are the terms in the contract that parties had agreed upon. Secondly, actually at an individual level, we can appreciate that it is quite human nature; individuals want to be fully protected and they want maximum coverage, so be covered for everything. And the response and the motivation by the insurance company is then to actually create these products to cater to all these expectations of the customers. But the third point, the more important point, is really this. We need to understand that at the national level, this will all cost and contribute to higher costs. And this is where the Ministry's concerns lie and this is what the Member alluded to.”
“For IP policyholders with pre-existing conditions, the assurance for them is that the Government always stepped in to ensure that MediShield Life will cover them for their pre-existing conditions, even if their private insurance does not. The best way to provide assurance to everyone is to keep healthcare costs manageable. At the national level, MOH will continue to look at measures to manage healthcare costs and ensure that all Singaporeans have access to good and affordable basic healthcare.”
“This feature continued to be retained even as policy reforms later extended universal access to public hospital care to this group. In all instances where full portability between private insurers is ensured, whether in the Netherlands, Switzerland, Australia or Ireland, additional compensation mechanisms need to be established. In other words, for insurance company A to take over from insurance company B, a policyholder with a pre-existing condition and of higher risk, A will receive compensation from B. To facilitate this compensation system, countries set up a risk equalisation fund, usually funded with public monies and insurer contributions and where a neutral body facilitates transfer payments between insurers. Insurers with a lower-than-average risk profile provide net funding into the fund while insurers with a higher-than-average risk profile receive net funding from the fund. Significant additional national resources will need to be set up and to administer the fund. If we do this, it will be a whole new department. For these reasons, MOH does not believe that mandating full portability for IPs is the right solution for the issues faced by policyholders. Most of all, it is not an international best practice for supplementary and commercial personal health insurance to be fully portable. Fundamentally, for the group of IP policyholders with pre-existing conditions, the issue may not be a lack of competition among insurers, but that insurers are not actively competing for this group of customers. It is because their probability of claims is higher, which means that insurers may have to pay out to them more than what they collect in premiums.”
“These private insurers are, therefore, required to accept any applicant, regardless of whether they are switching from another insurer or are uninsured previously. This gives the impression that the commercial insurance is portable, but actually it is not, as only the basic coverage under the universal, national health insurance scheme is fully portable. These countries do have supplemental, private insurance, which involves underwriting and is not portable. Our parallel is MediShield Life. As our national health insurance scheme, MediShield Life covers all residents, regardless of age, health status, personal insurance or employer coverage. This ensures that all residents enjoy a basic level of protection against large hospital bills. Last month, MOH announced a set of enhancements for MediShield Life which will be progressively implemented from April 2025. We will continue to ensure that MediShield Life stays relevant and affordable to Singaporeans as our national health insurance scheme. Australia and Ireland are two notable examples that have implemented full portability for non-national, supplemental private health insurance plans. But they did so for different reasons than one may think. In Australia, private hospital care accounts for close to half of admissions. So, good uptake of private health insurance, including through features like full portability, is integral to support access. As for Ireland, private insurance was initially introduced for a population segment who was not eligible to receive free treatment under their public healthcare system. Private insurance with full portability was established to ensure that the segment previously mentioned had protection against large bills.”
“Mr Speaker, the suggestion for Integrated Shield Plan (IP) insurance to be made portable has been raised a number of times. The Ministry of Health (MOH) has carefully studied the issue, including the arrangements in other countries. The calls for portability of IPs stem mainly from three groups of policyholders: those who are unhappy with changes in the terms of their policy coverage imposed by their insurer; those who faced difficulties in making claims; and those who find it difficult to afford their IP premiums as they become older. Hence, they want to switch to another plan offered by another insurer but realised that they have to undergo another round of underwriting and may not be able to preserve the coverage they already have or they have to pay more premiums. The conclusion is that IP portability – allowing all IP policyholders to switch insurers freely – will enhance competition and improve bargaining power of IP policyholders. IP portability is generally uncommon across the world, as it is usual practice for insurers to underwrite new policies in order to price the risks of accepting more policyholders with pre-existing conditions into their risk pool. Underwriting can result in the insurer imposing additional conditions on the policyholder’s coverage, such as a waiting period during which no claims will be paid or exclusions to the coverage. Policyholders may also have to pay higher premiums in view of the higher risks. For countries that ensure full portability where policyholders can switch insurers without underwriting, it is usually a feature limited to their mandatory, national health insurance. For example, in the case of the Netherlands or Switzerland, universal coverage is mandated but administered by private insurers.”
“I thank Member for the query. In respect of the second question – first, I just want to add that the MediShield Life scheme is something that we review and its coverage is something that we will continue to monitor and assess. So, this is something that will allow for us to continue to look at it and if it meets the criteria, it would be something that can be included. This is something that we will look at on a regular basis. On the assurance, actually, we ensure that people will not lose their coverage because of that. But as I explained, the whole thinking behind this is that there is 1% of those that we are not able to recover from and we just want to ensure that out of this, the people who are doing it out of just not wanting to comply and not wanting to actually make payment are then caught out. But for those who are actually in really dire circumstances, the processes that I have earlier mentioned will be able to catch them and will ensure that there will be some support given in the event they really cannot pay because of the difficulties. 5.25 pm”
“I thank Members for their support of this Bill. Mr Speaker, I beg to move.”
“In addition, we fully acknowledge the need to help Singaporeans, especially our seniors, understand the key healthcare policies such as MediShield Life, and changes that are made to them from time to time. So, in addition to ongoing efforts to raise awareness and improve public understanding of MediShield Life, MOH is also working closely with various community partners like grassroots leaders and Silver Generation Ambassadors to engage Singaporeans on the recent changes to MediShield Life. Such efforts allow us to reach more citizens, including seniors, and ensures that no one is left behind. Let me conclude. The debate has largely focused on how we can ensure that MediShield Life continues to adequately protect Singaporeans against large medical bills, while ensuring that the scheme remains sustainable and premiums affordable for all Singaporeans. This has always been our objective from the initial launch and subsequent reviews of the MediShield Life scheme, and the design of the Act which provides us the legislative framework to operationalise it. This Bill will strengthen the legislative framework to help us better achieve these objectives by: Enabling MediShield Life to provide adequate protection as the healthcare delivery landscape evolves from hospitals to the community and home settings; Providing a clear and robust framework to manage medical institutions participating under MediShield Life to ensure the appropriate use of MediShield Life monies, especially as MediShield Life coverage expands to new treatments and services; and Facilitating the implementation of premium enforcement measures to ensure that everyone pays their premiums as part of collective responsibility to one another and to ensure the sustainability of the scheme.”
“One such amendment is allowing the MediShield Life premium schedule to be specified on a website rather than in legislation. Mr Yip Hon Weng asked about the potential impact of such a move on our less digitally savvy seniors. Let me clarify that the amendment is not meant to change anything about how premiums are communicated to Singaporeans. All policyholders will continue to receive a premium notification letter which details their premiums payable and premium subsidy entitlements for a given policy year. These will continue to be delivered through mail, SMS or email, depending on the policyholder's contact information available to the CPF Board. So, Singaporeans, including seniors, already have many platforms through which to access information about premiums, and this amendment will not change this. Instead, this amendment is simply intended to allow MediShield Life premiums to be published on a website instead of through legislation. In enabling this, we will significantly streamline the administration of the scheme. This is also the approach already in place for other healthcare schemes such as CareShield Life, for which premiums are available online instead of through legislation. Mr Gerald Giam spoke about the stability and predictability of premium rates. The premiums are already published on the website today and we have also given advance notice for the next policy cycle – it is actually three years' worth of premiums in the press release and also in the Council's report. To address also another administrative point that Mr Gerald Giam raised on individuals who unknowingly provide false or misleading information – actually, such conduct does not amount to an offence under the Act.”
“This is aligned to many other Government schemes that differentiate subsidies based on PCHI to ensure that resources are targeted at those who need more support. We acknowledge the Members' concern that this may not differentiate retired seniors with different financial situations, including those who are asset-rich and cash-poor. This is why we have APS, which serves as a discretionary safety net, to give support to those who may have fallen through the cracks and face genuine difficulty affording their premiums. Eligibility for APS is assessed holistically with appeals considered on a case-by-case basis, taking into consideration the unique social and financial circumstances, and needs of individuals. Individuals receiving APS will have their outstanding premiums, as well as premiums for the next two policy years fully covered. Premium enforcement would not apply to them. For individuals who do not qualify for APS, we will still exercise flexibility for those with extenuating circumstances, on a case-by-case basis. For instance, we may delay premium enforcement until their financial circumstances improve. If some require a longer time to pay their premiums, they may contact the CPF Board, which oversees premium collection, to work out an instalment payment plan. For premium enforcement, we work with the MediShield Life Council on detailed criteria as well as the appeal guidelines for cases at the margins, to ensure enforcement does not unfairly penalise such groups. Let me take the chance here to reiterate that no one will lose MediShield Life coverage due to an inability to pay premiums. Besides refining provisions to support premium recovery efforts, we are also making some amendments to clarify and strengthen existing administrative processes.”
“This is why we have a strong set of recovery and enforcement actions in place. However, we are mindful that some Singaporeans may face difficulties paying for their premiums due to complex circumstances. Hence, we adopt a compassionate stance towards premium recovery and enforcement. This way, we do not inadvertently cause hardship to those who are unable to meet their premium obligations. For example, we withhold enforcement from vulnerable groups as such elderly above the age of 85 years old. One proxy for an individual's ability to pay their premiums is their means information. The proposed amendment will support the use of means information to enable a calibration of our premium recovery and enforcement efforts when it comes to Singaporeans with genuine difficulty in affording their premiums. Mr Yip Hon Weng asked about how such means information would be used, the criteria used to calibrate enforcement efforts and whether such criteria would reduce accessibility for individuals that do not meet the bar. Mr Gerald Giam also raised concern that some Singaporeans with complex circumstances may face difficulties paying premiums and this is precisely why we are creating this avenue to allow for a more calibrated approach. I would like to assure the Members that the intent of this amendment is not to withhold subsidies and support from Singaporeans. On the contrary, it is meant to help Singaporeans – by ensuring that premium enforcement measures are targeted at those who have more means, while calibrating enforcement measures for those who have less means. Means information is used to derive per capita household income.”
“This includes individuals who do not update their residential or correspondence addresses with the Government after they renounce their Singapore Citizenship or lose their Permanent Residency status, as well as individuals residing overseas in areas with unreliable postage services. As demand notes are often not successfully delivered to such individuals, enforcement against this group is limited in effectiveness. Therefore, the Act amendments provide for more avenues through which demand notes may be served, including via digital means. So, to address Mr Gerald Giam's concern, this is actually on top of existing means such as the physical mail. This maximises the likelihood that recovery bodies can serve demand notes on defaulters who do not maintain a valid postal address. We will leverage on two additional avenues: one, the Bill will provide for demand notes to be served via email; two, the Bill will also empower the Minister to make regulations to allow demand notes to be served via existing electronic service platforms. This could include IRAS' "myTax Portal" and CPF Board's "my cpf" portal. We will work with both agencies to explore the feasibility of tapping on their electronic service platforms. This is a fair approach – Singaporeans already use these portals to manage their tax- and CPF-related matters, and it is reasonable for the Government to make contact with them through such channels. We will explore with IRAS and CPF Board on the feasibility of sending notifications through SMSes and emails, to ensure demand notes are brought to the attention of the recipients. As I mentioned earlier, everyone must pay for their premiums as part of our collective responsibility to one another and to ensure the sustainability of the scheme.”
“Family members, such as parents and spouses, will be identified to pay for their loved ones' premiums using MediSave, on an opt-out basis. Those notified may choose to cancel this payment arrangement if they do not wish to help with their family members' premiums. Eligible individuals will also be invited to apply for APS. MOH works with the Ministry of Social and Family Development to conduct proactive outreach to low-income, elderly individuals who may need help with their APS applications. Quarterly reminder letters are also sent to remind policyholders to top up their MediSave accounts, change the premium payor or arrange for monthly instalment payment plan for their owed premiums. Significant efforts are made to ensure that those who are genuinely in need receive support to pay their premiums. Only when these efforts are exhausted, would premium enforcement commence. Before any enforcement action can be taken against defaulters, a demand note must first be served. A demand note notifies defaulters of their outstanding premiums and gives them sufficient time to pay their premiums, before interest and penalties are imposed and further enforcement measures like agent appointments are taken. These measures take reference from income tax recovery measures and are already provided for in the existing legislation. IRAS, which is a prescribed recovery body under the MediShield Life scheme, sends the demand notes via mail, as provided for under the legislation. However, there are some defaulters who are difficult to reach via post.”
“Indeed, private providers are an important part of our healthcare ecosystem. We will continue to partner and educate them on these changes. Altogether, the amendments in this category allow MediShield Life to be more flexible and responsive to the evolving healthcare landscape. The Act also needs to be amended to better support premium recovery. For a universal scheme like MediShield Life, premium recovery is necessary to discourage policyholders who can afford to, but wilfully decide not to fulfil their premium obligations. This in turn keeps the scheme sustainable. Without a robust set of premium recovery measures, it is entirely possible that premium defaults could go up, translating to bad debts which could materially impact the Fund and result in higher premiums for all. This would be unfair to policyholders who have paid their premiums and undermines collective responsibility. Over the years, the premium default rate, which is the total premium debt as a proportion of total premiums payable, has remained low, below 1%. This means that the vast majority of the policyholders are able to pay their premiums. This is made possible through a comprehensive support system to help Singaporeans, especially those of less means, with their premiums, thereby reducing the likelihood of individuals defaulting in the first place. I had covered these in detail earlier in my speech. Even with these support measures, there will be a small group of individuals who do not fulfil their premium obligations. When deduction of the premium from the policyholder's or his designated payor's MediSave fails, the Government embarks on a series of premium recovery measures.”
“The Minister for Health can also permit claims for such treatment or services provided during the suspension or after the revocation, if necessary, to safeguard the patient's interest. This power to safeguard MediShield Life monies will be exercised judiciously, to minimise any undue care disruptions to patients. Third, let me assure Members of the House that there are safeguards in place to ensure accountability and due process. To Mr Neil Parekh's question, the conditions of approval will be made clear to medical institutions and we have provided clear grounds for when approvals may be suspended or revoked under the Act. These include circumstances where the approval has been obtained fraudulently or if the licence granted to the medical institution under the Healthcare Services Act 2020 to provide the licensable healthcare service that the approved medical treatment or services is or is a part of has also been revoked or suspended. For these reasons, we do not think it is ideal to include statutory consultation requirements before restricting service delivery modes, as Mr Yip Hon Weng has suggested. In cases where patient safety is at risk or where the provider has committed fraud, restrictions of coverage will likely need to be immediate. That said, any restriction of service delivery modes will be exercised judiciously and only applied where the conditions of approval have been breached. In addition, in suspending or revoking an approval, the medical institution concerned must be given written notice and a reasonable opportunity to make representations as to why the approval should not be suspended or revoked, which is already our practice today. Dr Syed Harun also asked that we engage private medical practitioners to support them in navigating these changes.”
“With this, when we take action against the medical institution for other treatment or services which are not provided in compliance with the Act, we can still safeguard the patient's ability to continue making claims for approved medical treatments or services that are provided in compliance with the Act. Let me illustrate how this works. A single medical institution today may be delivering multiple care models or treatment through different licensed healthcare services or different service delivery modes. Today, enforcement measures taken against an approved medical institution in a non-compliant area would involve suspending or revoking the approval of the entire medical institution. The amendments, however, will allow the Minister for Health to suspend or revoke the approval given in respect of a specific medical treatment or service provided by a medical institution. This could be when a non-compliant service delivery mode is used by the medical institution. The approval for the medical institution to submit claims for other treatments or services via other delivery modes remain valid, and patients can still be covered by MediShield Life. Mr Yip Hon Weng asked if there would be transitional arrangements in situations where approvals to medical institutions are suspended or revoked, to avoid disruptions to ongoing care of patients. The amendments require medical institutions providing any non-compliant medical treatment or services to inform all patients of the suspension or revocation of approval of such medical treatment or services immediately. Claims made by patients for such treatment or services provided before the suspension or revocation will continue to be processed without issue.”
“The Minister for Health may also impose conditions of approval, which could include requiring the medical institution to ensure that MediShield Life claims are submitted in accordance with the relevant claim rules. Mr Yip Hon Weng raised concerns about the broad powers for approvals, suspensions and revocations, and how they will affect patients currently receiving treatment and services. Similarly, Mr Neil Parekh asked how the conditions of approval would apply and be communicated, whether there would be continuity of coverage for insured persons under the new framework, as well as the processes in place for the approval or rejection of applications, or for appeals related to revocations. Let me touch on all of these issues together. First, as stated in my opening speech, the Minister is empowered to grant approvals to medical institutions under the new amendments. Unless there are extenuating circumstances, medical institutions that have existing approvals as of the date immediately before the amendments come into effect, can be approved in respect of approved medical treatment or services that are or are part of their existing licensable healthcare services and respective service delivery modes. Hence, to address Mr Yip Hon Weng and Mr Neil Parekh's concerns about continuity of care, we do not expect the care of existing patients to be disrupted by this transition. Second, enforcement measures can now also be tailored to respond to specific medical institutions, or specific treatments or services offered by them that fail to comply with the requirements or their conditions of approval under the MediShield Life Act.”
“To Mr Yip Hon Weng's query on how patients can know which services are claimable under MediShield Life, I would like to share that new approved medical treatment or services, including home care and telehealth services, will be publicised through the MediShield Life Council's report, on the MediShield Life website and be stated clearly in the MediShield Life Scheme Regulations 2015. In addition, the expansion of the scheme's coverage will be complemented by amendments setting out the framework for approvals and suspensions and revocations of approvals, of medical institutions under the scheme. Mr Gerald Giam spoke about the criteria for approval of medical institutions. This framework will allow MOH to continue safeguarding and ensuring the appropriate use of MediShield Life monies, while maintaining a clear and robust framework for managing medical institutions participating under the scheme. For instance, to be approved, the medical institution will need to have a valid licence issued under the Healthcare Services Act 2020. The scope of the medical institution's approval under the scheme is also tied to the specific licensable healthcare services that it is authorised to provide by its licence, as well as their respective service delivery modes. The key appointment holders of the medical institution, as well as any medical practitioner that is employed or engaged to provide the approved medical treatment or services in that medical institution must also not be found to be in breach of certain requirements, such as being convicted of an offence involving fraud or dishonesty.”
“Premiums will need to go up, but we have provided a significant package of support that offsets premium increases for more than nine in 10 Singaporeans over the next three years. The Government will continue to work with the MediShield Life Council to review the scheme regularly to ensure that it remains a source of assurance for large healthcare bills and that its premiums remain affordable for Singaporeans. At the same time, we will continue to press on with our efforts to keep our healthcare system sustainable for many years to come. I will now move on to address Members' questions and comments on the MediShield Life Scheme (Amendment) Bill. Let me address them according to the three areas of amendments we are making to the Act. First, on supporting the expansion of coverage to models of care received outside the physical premises of providers. As mentioned earlier, we will enhance MediShield Life to cover more types of care, such as home-based medical or telehealth services delivered outside of the traditional hospital setting. This will allow more patients to receive the care that they need in a more convenient way. Going forward, we expect to see the emergence of more care models where treatment or services are completely delivered outside of a physical medical institution. These care models may eventually become the standard of care. The MediShield Life Council will review the coverage of MediShield Life from time to time and recommend to the Government if it would be appropriate for the scheme to cover treatments and services offered under these models. This Bill will provide flexibility for MediShield Life to cover such treatments and services in future, where we so decide to, which will allow patients to make claims for these treatments and services.”
“First, we have been re-designing the healthcare system to better support right-siting of care from our acute hospitals to other settings such as the outpatient, community and home settings where one can receive the same care at lower costs. Our enhancements to MediShield Life coverage through the recent review will also support patients in accessing care at such settings. Second, we have been applying Health Technology Assessments to more high-cost technologies and drugs. This allows us to rigorously assess that a new treatment is clinically- and cost-effective before we extend financing coverage to it. This also allows the Government to negotiate for more competitive prices from industry, moderating the cost impact to our system. Third, and most important, is our increased focus on staying healthy. This is why we have Healthier SG, which is our national initiative focusing on preventive health and chronic disease management. We have introduced premium discounts in this review, to complement our national efforts to incentivise healthier living, where Healthpoints can be redeemed for MediShield Life premium discounts. I am glad that Ms Ng Ling Ling is supportive of this idea, and has raised useful suggestions such as broadening the range of activities that qualify for incentives and implementing a system to encourage sustained activity. We will take all of these into account as we study the outcomes of this pilot, before deciding whether to make the scheme permanent. I thank the Members for their support of the MediShield Life changes. These will go some way in providing relief for Singaporeans amidst rising healthcare costs.”
“Mr Yip Hon Weng, Ms Jessica Tan and Mr Gerald Giam also asked how lower-income individuals who are living in or owning properties with high AV will be supported. It is true that such individuals receive lower means-tested premium subsidies on account of their higher AV properties. This is because those who live in properties with a higher AV would generally be better off than those who live in properties with a lower AV. While this approach is not perfect, it strikes a balance between being more precise in assessing applicants' means, while keeping the process simpler for most applicants. However, the Government periodically reviews the eligibility criteria for subsidies so that Singaporeans with greater needs can continue to receive the support they require. For instance, the AV thresholds were recently raised earlier this year. With this, those staying in or owning these lower-value private properties can still qualify for premium subsidies. Those who need more help or are facing extenuating circumstances may appeal for more assistance, which would be assessed on a case-by-case basis. Let me assure Members that no one will lose MediShield Life coverage due to an inability to pay premiums. Lastly, sustainability of the scheme. Ms Ng Ling Ling and Dr Wan Rizal have commented about rising healthcare costs and the impact to the long-term sustainability of the MediShield Life scheme, especially with the expansions of MediShield Life coverage. This is indeed an area that the Government is committed to addressing. We have implemented various strategies on this front.”
“Ms Ng Ling Ling asked how vulnerable groups, such as the lower-income, elderly and those with chronic conditions, will be supported in affording their premiums. I wish to assure the Members that we have taken special care to support them. As announced by the Government earlier, premium increases will be capped at 35%, which mostly benefits older age groups. Premium increases will also be phased in evenly over the next three years to help all policyholders. On top of this, older Singaporeans in lower- to middle-income households will also benefit from the means-tested premium subsidy enhancements that were recently announced. They will receive higher means-tested premium subsidies of up to 60%, from up to 50% today. Seniors, including those with lower MediSave balances, will also benefit from additional MediSave top-ups provided by the Government, which can be used to pay their MediShield Life premiums. These include an increase in MediSave top-up for the Pioneer Generation by up to $300, bringing their maximum annual top-up to $1,200; an enhancement of the one-time MediSave Bonus under the Majulah Package for Young Seniors by $500; and an additional MediSave Bonus of $500 for Young Seniors and the Merdeka Generation with lower MediSave balances. Lower-income Singaporeans who require more support paying for the premiums after subsidies and top-ups may also be invited to apply for APS, which will fully cover their premiums for the next two years. With this package of support, most seniors, regardless of income, will have their premium increases fully offset over the next three years. In addition, the MediShield Life premiums of older Pioneer Generation seniors will continue to be fully covered.”
“That is not to say that patients do not have support for their pre- and post-hospitalisation needs, such as consultations or scans, when seeking subsidised care at our public healthcare institutions. Patients can already access a combination of subsidies and MediSave, where applicable, for these. Likewise for other mental health services. Ms Ng Ling Ling and Ms Jessica Tan also asked about the impact of the deductible changes on patients, especially the lower income. The inpatient deductible has not been adjusted since the introduction of MediShield Life in 2015. With rising medical bills, the deductible has become less effective in sieving out smaller, more affordable bills that can be paid for by MediSave. The revision in deductibles will refocus MediShield Life's coverage on larger medical bills which, in turn, will moderate the premium impact. With significant enhancements to outpatient coverage and home-based medical care, we will also introduce a new outpatient deductible of $500. This will keep the scheme focused on larger outpatient bills and ensure premiums remain sustainable. The Government will raise MediSave withdrawal limits in tandem with the MediShield Life changes to help patients pay for the higher deductibles. I understand the Members' concern about the lower-income households and seniors who may not have sufficient MediSave. The MediSave top-ups by the Government will provide some help for these more vulnerable groups. I also wish to assure the House that Singaporeans who face difficulty affording their bills after subsidies, MediSave and MediShield Life, can apply for financial assistance such as MediFund. No one will be denied access to appropriate healthcare due to an inability to pay. Second, on premium affordability.”
“However, the Government is committed to helping Singaporeans manage the premium increase and will provide an additional $4.1 billion in support measures, comprising MediSave top-ups and premium subsidies, for the next three years. This will more than offset the total increase in premiums of $1.8 billion over the same period. For more than nine in 10 Singaporeans, the additional support will more than offset the premium increase over the next three years. Members have raised comments in three broad areas: one, affordability of healthcare for patients; two, affordability of premiums for policyholders; and three, sustainability of the scheme. Let me deal with each of these in turn. First, on affordability of healthcare for patients. Ms Ng Ling Ling, Ms Jessica Tan and Dr Wan Rizal asked how the MediShield Life Council had selected the new areas that MediShield Life coverage would be extended to in this review and whether other areas such as pre- and post-hospitalisation treatments or mental health services were considered for coverage in the review. In general, the Council prioritised treatments that had significant affordability gaps, were suitable for risk-pooling, clinically- and cost-effective and supported the shifting of care to lower-cost settings. This includes expansion of coverage to repetitive transcranial magnetic stimulation, which is used to treat depression. We will also be raising the MediShield Life psychiatric ward limits by about 40%, from $160 per day to $230 per day. In making recommendations on where to enhance or extend coverage, the Council strikes a fine balance between improving patient affordability and premium impact.”
“Mr Speaker, I thank the Members for their questions and comments on the MediShield Life Scheme (Amendment) Bill. Members have also raised questions on the changes to MediShield Life that were announced last month as part of the 2024 review. Let me briefly address these questions before moving on to comments relating to the Bill. As the Members have pointed out, this review of MediShield Life is a significant one. The Government has accepted the recommendations made by the MediShield Life Council and we will be making three changes to the scheme. First, we will ensure MediShield Life coverage remains adequate for Singaporeans, given the rise in healthcare costs. We are most concerned about major health episodes that result in large medical bills and cause financial strain. Therefore, MediShield Life's claim limits will be increased to better protect Singaporeans against such bills. Second, healthcare is increasingly delivered outside of the hospital, in the community and home settings. This is more convenient for patients and their family members. To support this shift, we will enhance outpatient coverage significantly to include treatments, such as for depression. Third, technological advancements have enabled the emergence of novel drugs such as cell, tissue and gene therapy products. While these have the potential to cure serious diseases, many of them are very expensive. Insurance, like MediShield Life, is a suitable way to finance such treatments, which are costly but have a low incidence rate. Therefore, MediShield Life's coverage will be extended to selected high-cost treatments that are clinically- and cost-effective. With the enhancements in coverage, it is inevitable that premiums have to go up.”
“This amendment will not impact these individuals' MediShield Life cover or premiums, as there will not be any breaks in their coverage and premiums continue to be calculated based on their age over the insurance period. Lastly, we will expand the scope of offences arising out of false or misleading information provided under the Act. Today, section 19 makes it an offence where a person knowingly provides material information which is false or misleading and knowing that the information will be included in a health declaration, means declaration or claim application. However, such information may also impact the payment of benefits under MediShield Life, as well as the disbursement of premium subsidies or APS. Therefore, the scope of such offences will be expanded to include cases where the information provided may affect the amount of grants, subsidies or benefits to be paid or given to an individual. The amendments by clause 6 to section 19 provide for this. The amendments will enable us to take a stricter stance against such offenders and ensure the proper payment of claims as well as the disbursement of grants and subsidies, to protect the interest of Singaporeans. Mr Deputy Speaker, let me conclude. The Act serves as the fundamental legislative framework that enables the implementation and operation of MediShield Life, an important component of our S+3Ms healthcare financing framework. This Bill ensures that coverage of MediShield Life keeps pace with changes to our healthcare landscape whilst allowing the Government to more effectively and efficiently administer the scheme. Mr Deputy Speaker, I beg to move. [(proc text) Question proposed. (proc text)]”
“There is scope to enable premium amounts to be more conveniently accessed by Singaporeans as well as to streamline the administrative process by reflecting premium revisions for operational efficiency. Therefore, going forward, clause 5 will amend section 4 to allow the amount of premiums payable for each insurance period to be specified in a prescribed manner, including a website, with consequential amendments made by clause 11 to section 34(2). This mirrors the practice adopted for CareShield Life, our national long-term care insurance scheme. Second, we will make clear the date when a person is taken to attain a particular age for the purposes of calculating their MediShield Life premiums. This is achieved through the amendment to section 2(4) of the Act by clause 2(f). For most Singaporeans, their age is taken to be on their birth anniversary. However, there is a small group of individuals whose birth date and/or month cannot be ascertained. Currently, our practice is to take their birth date to be on the first day of the month in which the individual was born, if their birth date cannot be ascertained; and their birth month to be in January, if their birth month cannot be ascertained. This is not currently set out in legislation. The proposed amendment to section 2(4) will clarify this. There is another group of individuals who are born on a leap day. For them, MediShield Life starts on 29 February in the year they are born and in subsequent years, their birth anniversary is taken to be on 1 March. Going forward, the birth anniversary for these individuals will be taken to be on 1 March in non-leap years, and on 29 February in leap years. This mirrors the approach taken by CareShield Life today and ensures consistency across our schemes.”
“The Minister is also empowered to make regulations to allow a demand note to be served via an existing electronic service such as CPF Board's "my cpf" portal or IRAS' "myTax Portal" by applying the requirements set out in existing laws regarding these electronic services to the service of demand notes by CPF Board or IRAS respectively. This facilitates recovery bodies in their recovery efforts, especially in relation to individuals on whom they were previously unable to serve demand notes and documents by registered post. While we have a strong set of recovery measures to ensure the sustainability of the scheme, we should take a calibrated approach based on the means of defaulters. For example, some defaulters may come from lower-income households with complex circumstances. We should be more empathetic towards such groups of people and provide them a longer time to pay their outstanding premiums. On the other hand, premium recovery should proceed along the normal timelines for those with more means to pay their outstanding premiums, such as individuals from higher-income households. To support this, clause 9 of the Bill amends section 28 to broaden the scope for access and use of means information to assess whether premium recovery and enforcement measures under Part 3 of the Act should be exercised on premium defaulters with lesser means. Finally, let me touch on the last objective: amendments to improve the administration of the scheme, which aim to streamline, clarify and strengthen existing processes. First, we will specify MediShield Life premiums in a manner that is more accessible, such as on MOH's website, instead of legislation. Currently, MediShield Life premiums must be prescribed in regulations.”
“The note may be served by the prescribed recovery bodies under the Act – the Central Provident Fund (CPF) Board and the Inland Revenue Authority of Singapore (IRAS). It notifies defaulters of their owed premiums and of the time by which these must be paid before further measures are taken. We will amend the Act to recognise the different modes through which demand notes and other documents, are served on a defaulter. At present, demand notes are only deemed served if sent by registered post to a person's residential address provided in accordance with section 31 of the Act or any correspondence address provided by the person under certain prescribed circumstances. This is pursuant to regulations made under the limited scope provided by section 34(2)(k) of the Act. However, this has impeded the recovery of outstanding premiums, such as in cases where no valid address information on the defaulter is available or service at an overseas address is required. Clause 10 of the Bill inserts the new sections 33A and 33B. The new sections provide how demand notes and other documents permitted or required by or under the Act to be served may be effectively served. With those new sections, section 34(2)(k) of the Act is no longer necessary and will be deleted by clause 11. This would include serving them through additional modalities such as digital means, which will improve operational efficiency and streamline premium recovery actions for the recovery bodies. For example, a demand note may be served by sending it to an email address of a person where there is deemed consent to such service in accordance with the new section 33B(3)(b).”
“All policyholders must play their part by paying their premiums. This ensures that MediShield Life can continue to meet its obligations and support those of us who fall ill and need to make a claim. At the same time, we recognise the need to keep premiums affordable, especially for vulnerable groups. This is why the Government provides strong support in the form of premium subsidies for lower- and middle-income households, Pioneer Generation and Merdeka Generation subsidies, and additional MediSave top-ups. We also have a comprehensive set of measures to facilitate the payment of premiums. For example, for those who have missed premium payment due to insufficient MediSave balances, we remind them to top up MediSave and facilitate the process for immediate family members to take over premium payment. For those who need further help with their premiums even after subsidies and MediSave use, and have limited family support, we will assess their eligibility for Additional Premium Support (APS). However, there are some individuals who do not pay their premiums despite these measures and become defaulters. In such cases, premium recovery and enforcement is needed. Any owed premiums that cannot be recovered will affect the MediShield Life Fund's sustainability and ultimately, affect MediShield Life's ability to meet its claims. If left unrecovered, these debts will have to be shouldered by other policyholders in the form of higher premiums. A key enabler of this premium recovery process is the service of a demand note. Today, a demand note needs to be served before recovery measures, such as the appointment of an agent to recover outstanding premiums, and the imposition of interest and penalties for late payments can commence.”
“We will also introduce provisions to enable the Minister to impose conditions of approval and to suspend or revoke the approvals given. To support the framework, clause 2(c) of the Bill amends section 2(1) by introducing a new concept of "claimable medical treatment or services". This ensures that the scheme only covers medical treatments or services provided by approved medical institutions according to the scope of their approval. Under the new amendments, the Minister is also empowered to grant approvals to medical institutions. For example, while HVRSS will be an approved medical service from late 2025 onwards, it does not follow automatically that all providers will be able to make MediShield Life claims for it. MediShield Life will only cover HVRSS where a medical institution has been approved in respect of the service for the purposes of MediShield Life, and if the service is provided in accordance with the conditions of that medical institution's approval. Taken together, the amendments will allow MediShield Life to be responsive to emerging models of care. It will also enable the Act to be more targeted in its approvals, and suspension and revocation of the approval of providers and their claimable medical treatment or services. This will strengthen the accountability of approved medical institutions and ensure compliance with the claim guidelines for MediShield Life. Let me move on to the second objective: amending the Act to strengthen our premium recovery efforts. MediShield Life is a universal scheme which relies on collective responsibility through risk-pooling, to provide all Singapore Citizens and Permanent Residents peace of mind in affording large, unexpected healthcare bills throughout their lives.”
“Today, section 3(1) of the Act requires the insured to receive treatment or services in an approved medical institution. However, going forward, clause 3 of the Bill amends section 3(1) to enable MediShield Life to cover medical treatment or services received by the insured, as long as it is from an approved medical institution. This means that the scheme will be able to cover care that is received entirely outside the premises of a medical institution and provides flexibility to cover newer care models that may develop in future. Second, we will set out a clearer and more robust governance framework that allows scoped approvals, and suspensions and revocations of such approvals, of medical institutions in respect of approved medical treatment or services they provide under MediShield Life. This will allow MediShield Life to support patient access to new models of care whilst ensuring appropriate use of MediShield Life Fund monies. Therefore, clause 4 of the Bill introduces the new sections 3A and 3B which set out the framework for scoped approvals, and suspensions and revocations of such approvals. Under the framework, the Minister for Health can approve providers to be approved medical institutions in respect of specific approved medical treatment or services and/or specific delivery modes for the purposes of MediShield Life. Additionally, where a "medical institution" has been granted more than one licence under the Healthcare Services Act 2020 to provide "licensable healthcare services", the Minister has the prerogative to approve all, or only one or some of such licensable healthcare services provided by the approved medical institution for the purposes of MediShield Life.”
“One example is the Home Ventilation and Respiratory Support Service (HVRSS), which provides mechanical-assisted ventilation to persons with breathing insufficiency, in the comfort of their homes. We need to amend the Act to allow MediShield Life to cover the increasing number of treatments that are now being delivered beyond the hospital setting as well as new care models that may emerge in the future. Second, over the last nine years since its launch, the Government has gained more experience in administering MediShield Life. We have identified issues that have limited our ability to administer it effectively and efficiently. A key area to be covered in this regard is premium recovery. When MediShield Life was made universal in 2015, it became mandatory for all Singapore Citizens and Permanent Residents to pay their premiums and contribute to the national risk pool. This also means that we must recover premiums from those who are able to but evade making payments. Having had nine years of experience administering this, we have identified areas where the Act needs to be strengthened to better support premium recovery and improve scheme administration. In view of these developments, the MediShield Life Scheme (Amendment) Bill, or the Bill for short, seeks to amend the Act to achieve three objectives: (a) support expansion of coverage to new models of care; (b) strengthen provisions to support premium recovery efforts; and (c) improve scheme administration. Allow me to elaborate. Our first objective is to support the expansion of MediShield Life coverage to new models of care received outside the physical premises of healthcare providers. This requires amendments in two areas. First, we will amend the Act to redefine where treatments or services can be received.”
“Mr Deputy Speaker, on behalf of the Minister for Health, I beg to move, "That the Bill be now read a Second time". MediShield Life, our national health insurance scheme, was launched in 2015 and is an integral part of Singapore's "S+3Ms" healthcare financing framework, comprising subsidies, MediShield Life, MediSave and MediFund. MediShield Life protects all Singaporeans against large healthcare bills for life, regardless of pre-existing health conditions. This ensures that no Singaporean is denied appropriate healthcare due to an inability to pay. The MediShield Life Scheme Act 2015, or the Act, was enacted in 2015 to support the establishment, governance and administration of MediShield Life. The Act has not been amended since it was passed. Since then, two key developments have taken place, which warrant amendments to the Act. First, the landscape for healthcare delivery has evolved since MediShield Life's launch in 2015. The centre of gravity for healthcare delivery has been shifting to the outpatient, community and home settings, because not all patients require care in a hospital for their treatment. With this shift, more patients can benefit from easier access to necessary care. To support this, MediShield Life coverage has been gradually expanded to more types of treatments beyond the acute inpatient setting. For example, in 2020, we expanded MediShield Life to cover inpatient palliative care within community hospitals and inpatient hospices. We are continuing our efforts to do more to support care outside of the acute inpatient setting, in the community and at home. Last month, the Ministry of Health (MOH) announced that MediShield Life's coverage would be expanded to new outpatient treatments and home-based medical care.”
“I note the concern that the Member raised on the limitations of the SMF. I would say though that there are over 16,000 seniors per year since 2019, I believe, who have already applied for this fund for assistive devices, and most of them will actually get subsidies; 99% of them are eligible and actually would get the subsidies. So, for those of them who cannot meet the eligibility requirement, they can go to AIC for any additional support.”
“I note the concern that the Member raised on the limitations of the SMF. I would say though that there are over 16,000 seniors since 2019, I believe, who have already applied for this fund, and most of them will actually get subsidies; 99% of them are eligible and actually would get the subsidies. So, for those of them who cannot meet the eligibility requirement, they can go to AIC for any additional support. [Please refer to "Allowing Seniors to Purchase Hearing Aids with MediSave", Official Report, 16 October 2024, Vol 95, Issue 144, Oral Answers to Questions section.] [(proc text) Written statement by Ms Rahayu Mahzam circulated with leave of the Speaker in accordance with Standing Order No 29(5): (proc text)] I wish to make the following factual correction to the reply given for Question No 17 at the Sitting of 16 October 2024. My reply should be read as follows:”
“Together, by providing education and support, we hope to take a whole of society approach to enable women to navigate this transition with confidence, maintaining their well-being and full participation in all aspects of life. [(proc text) Question put, and agreed to. (proc text)] [(proc text) Resolved, "That Parliament do now adjourn." (proc text)] Adjourned accordingly at 8.11 pm.”
“There have been calls for menopause leave or reproductive leave in other countries. Most recently in the UK, the government rejected a call by the Women and Equalities Committee to conduct a trial of menopause leave last year. Like the UK, our preferred approach is to support women to remain in the workforce and be well-supported at work. Introducing specific menopause leave may inadvertently negatively impact the employability of women in this age group rather than helping them, which we should be careful to avoid. In addition, flexible work arrangements (FWAs) can help employees with other medical conditions to balance the care needs for their condition with work responsibilities, including women experiencing perimenopause or menopause. The upcoming Tripartite Guidelines on FWA Requests, which will take effect on 1 December this year, aim to cultivate a norm where employees feel it is acceptable to request for and use FWAs. We encourage employers to use these Guidelines to engage their employees in conversations and find mutually beneficial arrangements. The Government will continue to work with tripartite partners to foster supportive workplaces, so that all employees can participate fully at work while managing their own personal needs, such as family responsibilities and medical conditions. In conclusion, supporting women through menopause is not just a medical issue, it is also about awareness and empowerment. The Government is committed to building a society where all Singaporeans have full and equal opportunities to flourish and achieve their aspirations. Civil society and community organisations have an important part to play as well.”