Health Insurance Regulations Flashcards

What is the MOH Standard Drug List and how does it affect health insurance?

Answer: A list of subsidised medications at public healthcare institutions; MediShield Life and Medisave cover drugs on this list, while non-standard drugs may not be covered

The Standard Drug List determines which medications are subsidised at public institutions and covered under MediShield Life. Drugs outside this list may require out-of-pocket payment or IP coverage.

What penalties exist for health insurance fraud in Singapore?

Answer: Fraudulent claims can result in policy voidance, claim rejection, recovery of past claims paid, criminal prosecution, and industry-wide blacklisting

Health insurance fraud is treated seriously. Consequences include voiding the policy, rejecting the claim, recovering previously paid claims, criminal prosecution under the Penal Code, and potential industry blacklisting.

How does the Portable Medical Benefits Scheme (PMBS) work for employed Singaporeans?

Answer: Employers can contribute to employees' Medisave accounts instead of providing company-specific medical benefits, making benefits portable when employees change jobs

PMBS allows employers to make contributions to employees' Medisave accounts as part of their medical benefits. These benefits stay with the employee even when they change jobs, unlike company-specific insurance plans.

What is the role of the CPF Board in Singapore's health insurance system?

Answer: CPF Board administers MediShield Life, manages Medisave accounts, processes claims, and collects premiums through the CPF system

The CPF Board plays a central role: administering MediShield Life (enrollment, premiums, claims), managing Medisave accounts, and processing healthcare withdrawals from CPF savings.

What changes did the MediShield Life Council recommend in the 2020 review?

Answer: Higher claim limits, removal of lifetime limits, lower co-insurance rates for larger bills, and enhanced coverage for outpatient treatments

The 2020 review enhanced MediShield Life with higher annual claim limits (SGD 150,000), removal of lifetime limits, lower co-insurance for larger bills, and expanded outpatient treatment coverage.

What is 'medical underwriting' for health insurance in Singapore?

Answer: The process by which insurers assess an applicant's health status and medical history to determine coverage terms, premiums, and any exclusions

Medical underwriting evaluates the applicant's health risks through health declarations, medical reports, and sometimes medical examinations. It determines whether to accept the application, at what premium, and with what exclusions.