CPF members who turn 55 between 1 July 2014 and 30 June 2015 will be subjected to an increased Minimum Sum (MS) of $155,000. This will be set aside in their Retirement Account using savings from their Special, and then Ordinary Accounts. This is an increase of $7,000 from the previous MS of $148,000.

Higher Medisave Minimum Sum and Medisave Contribution Ceiling

The Medisave Minimum Sum is the amount a CPF member needs to set aside in his Medisave Account for his own and his dependants’ healthcare expenses, as well as MediShield and ElderShield premiums during old age.

From 1 July 2014:

a) The Medisave Minimum Sum will be raised to $43,500 from $40,500. A member will need to have this amount in his Medisave Account and also meet the CPF Minimum Sum before excess funds can be withdrawn.

b) The Medisave Contribution Ceiling will be increased correspondingly to $48,500, from $45,500. This is the maximum balance a member can have in his Medisave Account.

Any Medisave contribution in excess of the current Contribution Ceiling will be transferred to the member’s Special Account, if he is below age 55, or to his Retirement Account, if he is above age 55 and has a CPF Minimum Sum shortfall. Retirement Account, if he is above age 55 and has a CPF Minimum Sum shortfall.

To leave your comments, please go to : Increase in CPF Minimum Sum, Medisave Minimum Sum and Medisave Contribution Ceiling 2014

The new limits are as follows:

• From $800 to $1,000 for those aged 66 to 75 (based on age next birthday);
• From $1,000 to $1,200 for those aged 76 to 80 (based on age next birthday); and
• From $1,200 to $1,400 for those aged 81 and above (based on age next birthday).

Essentially, what this means is that the insured elderly (or their dependents if they are paying) can use $200 more of their Medisave to pay for the insurance premiums.

I expect further changes across the board once the premiums of the new Medishield Life has been finalized.

To leave your comments, please go to : Increase in Medisave Withdrawal Limits for Insurance Premiums

The key changes will be an enhancement to CHAS, as well as an extension of the use of Medisave. All the changes take effect from 1st January 2014. There are also some changes to Medishield, which I will cover in a later post.

Enhancement of Community Health Assist Scheme (CHAS)

1. The current qualifying age for CHAS (40 years) will be removed.
2. The qualifying income criteria will also be improved :
   • Blue card – “From $900 or less per capita monthly household income” raised to “$1100 or less per capita monthly household income”
   • Orange card – “More than $900 but $1,500 or less per capita monthly household income” raised to “More than $1,100 but $1,800 or less per capita monthly household income”
3. CHAS cardholders who go to any CHAS participating GP for their  Integrated Screening Programme (ISP) screening will also enjoy subsidies for doctor’s consultation charges (up to $18.50 per visit) for their screening and also for subsequent follow-up consultations up to two times a year. The recommended screening tests under ISP are screening for obesity, diabetes, hypertension, lipid disorders, colorectal cancer and cervical cancer.

Extension of Medisave Use

1. You will be allowed to use your Medisave for the outpatient treatment of five more chronic conditions under the Chronic Disease Management Programme (CDMP). Up to $400 per Medisave account per year can be used to pay for outpatient treatments of these conditions at the Specialist Outpatient Clinics (SOCs), polyclinics and Medisave-accredited GP clinics, including CHAS clinics. This brings the number of chronic conditions to fifteen. The five new conditions are:
   • Osteoarthritis
   • Benign Prostatic Hyperplasia
   • Anxiety
   • Parkinson’s Disease
   • Nephritis/Nephrosis
2. You can use Medisave to pay for screening tests for your newborn baby during the hospital stay for the delivery.  Even for outpatient visits, up to $400 per Medisave account per year can be used for the recommended screening tests for your newborn baby. These include hearing test, G6P deficiency screening, metabolic screening and thyroid function tests.
3. People in high risk groups can use up to $400 per Medisave account per year to pay for pneumococcal and influenza vaccinations at all Medisave-accredited institutions. The list of high risk groups include:
   • Adults aged 65 years and older;
   • Children aged 6 months to less than 5 years (i.e. 59 months);
   • Adults and children who have chronic disorders of the lung or heart systems, including asthma;
   • Adults and children who have required regular medical follow-up or hospitalization during the preceding year due to chronic metabolic diseases (including diabetes mellitus), renal, neurologic, liver, or blood disorders, or immunosuppression (including immunosuppression caused by medications or the Human Immunodeficiency Virus);
   • Children and adolescents aged 6 months to 18 years who are receiving long-term aspirin therapy and therefore might be at risk for developing Reye syndrome after influenza infection;
   • Women at all stages of pregnancy;
   • Residents of nursing homes and intermediate and long term care facilities.

To leave your comments, please go to : Enhancement of Community Health Assist Scheme & Medisave Usage

The announcement of the suggestions is a way for the government to test out the ground reaction to the proposed changes.

While I find some of the ideas good, there are some others that I am not so comfortable with.

Below are some of the proposed changes and my comments.

Setting the same Medisave withdrawal limits for inpatient and stepped down care

This is good as the current situation is such that some people choose to extend their stay in the hospital when they could be transferred to a community hospital as the hospital allows them to utilize more of Medisave daily.

Allow older people to withdraw more from their Medisave and introduce tiered withdrawal

As old people would have more Medisave savings and also have a higher chance to be hospitalized, it is good to allow them to utilize more of Medisave to pay for their bills.

Expanding the scope of Medisave to include more treatments such as health screening

Prevention is always better and cheaper than cure. This move might encourage more people to go for health screening. On the flip side, some health screening providers could take the opportunity to increase their prices.

Getting people to pay more in Medishield premiums when they are younger so that the premiums at the older age can be reduced

I am not too sure about this. If the premiums are increased too much, some young people might drop out of the scheme. When they realize that they need the coverage later on in life, it might be difficult for them to get coverage due to pre-existing conditions.

I would rather that the government continue with the existing system of topping up Medisave accounts of seniors. Another better way is for the government to top up the Medishield pool directly, to ensure that it stays solvent and adequate.

Increase the coverage of Medishield

I don’t know what’s the exact proposal given by GPC but I don’t like the current deductible levels. Having a lower deductible will help people appreciate the usefulness of Medishield and make it less likely for them to drop out of the scheme. If they are always unable to claim due to the bill size being less than the deductible, they will find Medishield useless.

Given that the deductible level was only recently raised this year, I’m not sure that the government will want to backtrack so soon.

Remove the age limit of 90 for Medshield

Generally, this is a good idea but one wonders how much the premiums is going to be when you hit 90.

Ensure Medisave top-ups from the Government are used only to pay premiums

I am neutral about this suggestion. It might be difficult to implement as you will then need to create some tracking for it, perhaps via the use of a Medisave sub-account. As it is now, our system is already complex enough and there will be a cost to implement this tracking.

For ease of administration, I would rather the government make top-ups directly to the Medishield pool. Of course, topping up Medisave accounts directly will make people more positive towards the government so this approach is more likely to happen.

Remove lower age limit of 40 for Community Health Assist Scheme (CHAS) programme

The CHAS is a very good programme for those who are not earning much. If they can reduce the entry age limit or even remove it altogether, it will be wonderful. Not only old and poor people need help. Young and poor people can do with some assistance too.

You may find out more about CHAS in another article that I wrote.

Allow patients who are referred by a GP to enjoy subsidies so they don’t need to be referred by a polyclinic

The current policy is that if you are referred to the outpatient specialist of a government hospital by the polyclinic, you are considered a subsidized patient. If you are referred by a private GP or are a walk-in patient, you are considered a non-subsidized patient.

In my opinion, this is a dinosaur policy that should be abolished immediately. It creates an unnecessary additional step for people to visit the polyclinic to get a referral letter. As it is now, all my polyclinics are already quite stretched and they can do without this additional workload.

Whether a person should be subsidized or not should depend on his residency status and wealth/income, and not how he was referred to the hospital.

Subsidize more essential medicine and publish private sector fees (including GP) online

Good ideas.

Means-test patients only once and apply results to all schemes that enjoy subsidy

This is another system that needs a serious overhaul.

Currently, when you are warded, you will get a subsidy that is a percentage of your bill. This percentage will vary depending on which ward you go to, and how much income you earn.  This can range from 50-80% . The B2 and C wards are subsidized, while the B1 and A wards are not.

For outpatient specialist treatment, you are either subsidized or non-subsidized.

Here’s the thing. If you stay in a B1 or A ward, you will be seen as a non-subsidized patient for all your follow-up outpatient visits for that condition. You will need to pass the means testing for your entire family before you can revert back to subsidized rate.

So even if you don’t mind paying a bit more during your hospital stay to stay in a B1 ward, (note that B2 wards and C wards do not have air-con), you may hesitate to do so because you do not want to jeopardize your subsidy for your follow-up treatments. You also end up not getting any subsidy for your hospital stay, no matter how poor (or rich) you are.

The unfair thing is that should you happen to upgrade from a B2 to B1 ward midway through your hospital stay, you will lose all your subsidies for your treatment from day one! However, you will still be subsidized for the earlier ward charges.

As I pointed out earlier, the amount of subsidy that a person receives should really be only dependent on his residency status and wealth/income.

This suggestion by GPC is consistent with my thinking and I hope it gets looked into.

My ideal system would be one where a person will get categorized based on his income.

The basic idea goes like this : you will fall into two categories, either subsidized or non-subsidized.

For the subsidized group, there can be many sub-categories for greater differentiation. For each sub-category, you will be given a different maximum subsidy level for each day you are hospitalized. For example, one category may get $50 a day, another might get $200 a day. There will also be a surgical subsidy cap for the different groups.

There will be another table for permanent residents.

It will be relatively easy to categorize people as the information can be pulled from IRAS. For those who are not working, they can be categorized by the annual value of their house (as what the government always use to determine growth dividends, etc).

When you are admitted to hospital, there is no need to calculate subsidies based on percentages or ward type.

No matter which ward you go to, be it A or C, your total bill will simply be offset by your subsidy amount. In this way, the patient can still have a choice of ward, and enjoy his or her subsidy benefit. The follow-up outpatient subsidy should of course be de-linked from the type of ward which was stayed in.

To leave your comments, please go to : Suggestions for a Better Singapore Healthcare System

The CPF Minimum Sum actually stood at $80,000 in Jun 2004. The original plan was to increase it to $120,000 over a period of ten years from 2004. This works out to about $4000 a year. However, an inflation factor was also applied to the increase, so the actual increase over the years looks like this:

Until 30 Jun 2004 – $80,000
1 Jul 2004 – $84,000 ($84,500 – after inflation adjustment)
1 Jul 2005 – $88,000 ($90,000 – after inflation adjustment)
1 Jul 2006 – $92,000 ($94,600 – after inflation adjustment)
1 Jul 2007 – $96,000 ($99,600 – after inflation adjustment)
1 Jul 2008 – $100,000 ($106,000 – after inflation adjustment)
1 Jul 2009 – $104,000 ($117,000 – after inflation adjustment)
1 Jul 2010 – $108,000 ($123,000 – after inflation adjustment)
1 Jul 2011 – $112,000 ($131,000 – after inflation adjustment)
1 Jul 2012 – $113,000 ($139,000 – after inflation adjustment)
1 Jul 2013 – original target not provided ($148,000 – after inflation adjustment)
2 more increase to come, for 2014 and 2015

Medisave Minimum Sum and Medisave Contribution Ceiling

The Medisave Minimum Sum (MMS) is the amount that a person turning 55 needs to set aside in his old age for his own or his dependants’ healthcare expenses and basic MediShield and ElderShield premiums.

From 1 July 2013,

1. The Medisave Minimum Sum (MMS) will be raised to $40,500 from $38,500. Members will be able to withdraw their Medisave savings in excess of the MMS at or after age 55.
2. The maximum balance a member may have in his Medisave Account, known as the Medisave Contribution Ceiling (MCC), is set at $5,000 above MMS and this would be increased correspondingly to $45,500, from $43,500.

Any Medisave contribution in excess of the current MCC will be transferred to the member’s Special Account if he is below age 55 or to his RA if he is above age 55 and has a MS shortfall.

To leave your comments, please go to : Increase in CPF Minimum Sum, Medisave Minimum Sum and Medisave Contribution Ceiling from 1 July 2013