What's the deal with Deductible and Co-Insurance

Here's the definition of Deductible and Co-Insurance by the Ministry of Health:

Deductible

A deductible is the initial amount you need to pay for claim(s) made in a policy year, before MediShield coverage starts. No reimbursement would be made from the MediShield below this claim amount. You only need to pay the deductible once in a policy year. The deductible helps to sieve out small claims, which can be paid using Medisave and/or cash, and keeps MediShield premiums affordable.

For approved outpatient treatments claimable under MediShield, the deductibles are waived and a 20% co-insurance is applicable. Some examples are outpatient chemotherapy, radiotherapy and kidney dialysis treatment.

If you choose to stay in a Class C ward during your hospitalisation, the applicable deductible would be $1,000. For Class B2 and above wards, the applicable deductible would be $1,500.

Co-insurance

Co-insurance is the percentage of the bill you need to pay on the portion of the bill above the deductible. Co-insurance for inpatient bills is three-tiered, ranging from 20% to 10% as the bill size increases, i.e. the larger your bill, the lower the co-insurance that you need to pay. MediShield will pay between 80% - 90% of the claim amount that exceeds the deductible (if applicable).

Deductible and Co-Insurance Table:

(for outpatient treatment, the deductible is waived and a 20% co-insurance applies)

Deductible (Per Policy Year):

• Class B2 & Above Ward/Day Sugery = $1500
• Class C Ward = $1000

C0-Insurance (amount payable):

Class C Ward

1. 20% is payable from the first $1001 - $3000
   
2. An additional 15% if bills go into the range of $3001 - $5000
3. An additional 10% if bills go into the range of $5001 and above

Class B2 and above Ward

1. 20% is payable from the first $1501 - $3000
2. An additional 15% if bills go into the range of $3001 - $5000
3. An additional 10% if bills go into the range of $5001 and above

*Please also check your Claimable Limits.

Claimable Limits is the portion of your bill that is eligible for reimbursement. Your Claimable Limit, or claim amount, is determined by:

1. The maximum limits per day of hospitalisation
2. Surgical procedures
3. Surgical implants, and
   
4. Approved specific treatments and outpatient treatments.

Deductible and Co-Insurance calculations example:

If you needed to pay a total of $10,000 and you are staying in a C Class Ward:

Deduct the Deductible of $1000 from the total payable amount:

A. $10,000 - $1000 = $9000 balance.

Now you take 20% of the first $2000 of your $9000 balance:

1. $2000 x 20% = $400

Next, you take 15% of the amount up to the next $2000:

2. $2000 x 15% = $300

Finally, you take 10% of the balance $5000:

3. $5000 x 10% = $500

Your total Co-Insurance payable is:

B. $1200 ($400 + $300 + $500)

So the total you needed to pay from your $10,000 bill is:

$2200 (A. $1000 deductible + B. $1200 Co-Insurance).

Pro-ration factors

MediShield is designed to help Singaporeans pay their hospital bills incurred in subsidised Class B2/C wards.

1. Bills from Class A, B1 or B2 wards in restructured hospitals, and private hospitals are pro-rated.
   
2. Those who receive reduced subsidies in B2/C wards will also have their bills pro-rated to the full-subsidy bill size.

*Please use the Calculator provided by the CPF board to calculate exactly how much you need to pay.