ElderShield insurance reform
- Country:
- Singapur
- Partner Institute:
- Department of Community, Occupational & Family Medicine, National University of Singapore
- Survey no:
- (9)2007
- Author(s):
- Lim, Meng Kin
- Health Policy Issues:
- Pflege, Finanzierung
- Reform formerly reported in:
Elder Shield - Severe Disability Insurance Scheme
Current Process Stages
| Idee | Pilotprojekt | Strategiepapier | Gesetzgebung | Umsetzung | Evaluation | Veränderung/Richtungswechsel | ||
|---|---|---|---|---|---|---|---|---|
| Implemented in this survey? |  |
|
|
|
|
|
 |
 |
Abstract
The Ministry of Health is taking the opportunity of a statutory review of ElderShield in September 2007 to enhance the scheme?s benefits while at the same time encouraging more innovative supplementary schemes from private insurers. The main changes envisaged are higher monthly payouts, longer period of coverage, and greater options, including more insurers to choose from.
Neue Entwicklungen
Criticism on ElderShield
ElderShield, an opt-out disability insurance scheme designed for those 40 years and older with long-term disabilities drew criticism when it was first introduced in 2002 (see survey (1)2003). The major criticisms have been:
a. Eligibility criteria (insurees must be unable to perform three or more of the six Activities of Daily Living (ADLs) - washing, dressing, feeding, going to the toilet, walking and transferring) for payout was too stringent;
b. payout of $300 a month was too little to be of much help; and
c payout period was too short as disabled persons may need help for more than five years.
The five-year tender concessions awarded to the two insurance companies that underwrote the policies - NTUC Income and Great Eastern Life - will run out in September 2007. The Ministry of Health (MOH) will be conducting an open tender to appoint insurers for ElderShield for another five-year period, i.e. until September 2012. The selection will take into account factors such as the proposed premium, the effectiveness of business plans, expertise and experience in long term care plans and the level of investment in resources for ElderShield.
Government proposes changes
The MOH is taking the opportunity to increase the scheme's benefits and, at the same time, encourage more innovative supplementary schemes from private insurers. The main changes contemplated are:
- Higher monthly payouts and longer period of coverage:
The Ministry of Health is proposing to increase the monthly ElderShield payout from the current S$300 to S$400, and extending the length of payouts from the current five years to six years. This would increase the maximum total payout from S$18,000 to S$28,800. The challenge is to bring about a better balance between the premium outlay of the clients and the insurer's risk. A slight increase in premiums (estimated to be about S$10) is widely expected. There is also a suggestion that policy holders may have to pay an additional one-off premium to adjust for the lower premiums paid in the earlier years under the current scheme.
- Greater options: more providers and supplementary policies
More insurers are being encouraged to join the ElderShield scheme, to provide both basic (opt-out) and supplemental rider (opt-in) policies. Possible enhancements could be in the form of higher premiums in exchange for assessment on two instead of three qualifying disabilities, for those who find the present assessment criteria for payout eligibility (three disabilities of daily living) too stringent. Medisave may be used to pay for these premiums, subject to a cap. Consumers may even have the choice of buying their basic ElderShield policiy from one insurer and the rider from another insurer.
The following table summarizes the main changes proposed for Eldershield:
| Current ElderShield | Proposed revision | |
| Payouts | $300 | $400 |
| Payment period | 5 years | 6 years |
| ElderShield insurers | NTUC Income, Great Eastern Life | Open to more insurers |
| Supplementary products | Not allowed | Allowed, subject to MOH guidelines |
| Assessment fees | $25 at clinic; $100 for house call | Successful claimants will have assessment fees reimbursed |
Suchhilfe
Characteristics of this policy
 current  previous
|
Purpose and process analysis
Current Process Stages
| Idee | Pilotprojekt | Strategiepapier | Gesetzgebung | Umsetzung | Evaluation | Veränderung/Richtungswechsel | ||
|---|---|---|---|---|---|---|---|---|
| Implemented in this survey? | |
|
|
|
|
|
|
|
Stakeholder positions
Public:
ElderShield experienced an opt-out rate of 38 percent in the year it was launched, but the rate has steadily decreased over the years to 14 percent in 2006, as people realized that some cover was at least better than no cover. ElderShield currently covers some 748,000 people out of the 1.2 million that are eligible.
Government:
Since the premiums worked out in 2002 were based on certain expected payouts, MOH had assured the public that rebates of any excess amounts collected will be given to subscribers.
Insurers:
The two insurers had promised to return more than half the "excess" amount collected in exchange for guarantees that no changes to premiums and payouts would be made and that there would be no competition for five years.
Monitoring and evaluation
The actual number of claims appears low: As at end-2006, a total of 2,811 claims were received by the insurers, of which 2,366 were successful claims. This could be due to the relatively young age profile of ElderShield policyholders - 54 percent of policyholders were below 50 years of age. It is likely that rebates will be given in the form of cheaper premiums for the 748,000 subscribers, but details can only be determined when the concessions run out.
A month-long public consultation to receive feedback has been declared.
Expected outcome
References
Reform formerly reported in
| Elder Shield - Severe Disability Insurance Scheme Process Stages: Umsetzung |
Author/s and/or contributors to this survey
Lim, Meng Kin