CareShield Life and Long-Term Care (Amendment) Bill

Debate resumed.

Order for Second Reading read.

Mr Deputy Speaker: Coordinating Minister for Social Policies and Minister for Health.

3.21 pm

The Senior Minister of State for Health (Dr Koh Poh Koon) (for the Coordinating Minister for Social Policies and Minister for Health): Mr Deputy Speaker, on behalf of the Minister for Health, I move, "That the Bill be now read a Second time."

Sir, let me begin with a fact that underscores the importance of today's Bill. One in two Singapore residents is expected to develop severe disability at some point in their lifetime.

CareShield Life, our national long-term care insurance scheme, was launched in 2020 to provide basic financial protection against long-term care costs. It is an integral part of our long-term care financing framework and sits alongside other layers of support that work together to help those with long-term care needs. These include: Government subsidies for nursing homes, as well as home-based and community-based care; grants such as the Home Caregiving Grant and Seniors' Mobility and Enabling Fund; MediSave withdrawals for long-term care; and safety nets such as ElderFund and MediFund.

As an insurance scheme, CareShield Life works on the basis of risk-pooling. This means that each birth cohort pays premiums that go towards meeting the claims of those from that cohort who might develop severe disability. This approach allows us to come together to support one another's future needs. It is also a more sustainable approach, as every cohort pays premiums that go towards supporting the long-term care needs of that cohort.

CareShield Life covers all Singapore Citizens and Permanent Residents born in 1980 and later, from when they turn 30. This is regardless of pre-existing disabilities or health conditions. For those born in 1979 and earlier, we encourage them to enrol in CareShield Life, but kept participation optional when CareShield Life was first launched in 2020, as their circumstances and needs could vary widely and they may have already made their own plans. This is the group we term as the Optional Cohort.

Currently, new Singapore Citizens and Permanent Residents born in 1979 and earlier are also covered under CareShield Life if they are not severely disabled when they become a Citizen or Permanent Resident. We term this group as "New SCs/PRs". Under CareShield Life, policyholders pay premiums from their age of entry until age 67, or for up to 10 years, whichever is longer. I would like to highlight that policyholders are covered for life, even after they stop paying premiums.

If policyholders are assessed to be of severe disability, or in other words, unable to perform at least three out of six Activities of Daily Living (ADLs), they will receive monthly cash payouts. These ADLs include washing, dressing, feeding, toileting, walking or moving around and transferring between bed and chair. Upon successful claims, if the individual had still been paying premiums, he or she will no longer need to do so. Policyholders receive cash payouts for as long as they remain in severe disability.

Sir, the CareShield Life Council undertook its first review of the scheme, five years after its implementation, to ensure that it continues to provide meaningful protection in a sustainable and affordable manner. The Council released its recommendations in August 2025, after extensive public engagement and careful deliberation, with its recommendations accepted in full by the Government.

Notably, the Council recommended doubling of the growth rate of CareShield Life payouts from 2% to 4% annually. The increased payouts will better cushion against rising long-term care costs driven by inflation of manpower and technology costs. With this enhancement, a policyholder making a claim in 2030 will receive $806 per month, compared to $731 per month under the previous annual growth rate. This is an increase of $900 annually.

For younger policyholders, the benefits are even more significant over time. Take, for example, a 30-year-old who joins CareShield Life in 2026. Should he or she make a claim at age 70, the payout will be $2,940 per month. This is more than double the payout of $1,406 per month under the current lower growth rate. The Council also recommended adjusting premiums to sustain the higher payouts. This will keep the scheme financially sustainable.

To help policyholders cope with the premium adjustments, the Government has also committed to providing over $570 million in additional support over the next five years. This will moderate annual premium increases from 2026 to 2030 to about $38 on average and no more than $75. Without this support, premiums in 2026 would have increased by approximately $126 on average, with a 4% per annum increase thereafter.

To keep premiums affordable and fair, the Council has also recommended adjusting CareShield Life's underwriting criteria, as planned earlier. I will explain this in greater detail later. These CareShield Life enhancements complement the long-term care subsidy and grant enhancements announced at Budget 2025, where we will be raising subsidies for long-term care services, to up to 80% for nursing homes and 95% for home and community care services. We are also expanding the eligibility criteria to cover seven in 10 households, so that more can benefit. We will increase Home Caregiving Grant cash payouts from a maximum of $400 to a higher maximum value of $600 and will expand the coverage of the Seniors' Mobility and Enabling Fund. These enhancements will be progressively implemented from January 2026.

To illustrate the impact, consider a CareShield Life policyholder with a per capita household income of $1,500. Together, the enhanced subsidies and grants will help to offset more than two-thirds of their community-based long-term care costs, with the enhanced CareShield Life payouts covering another quarter. After the financing support, the patient's individual out-of-pocket expenses will come down to $110 per month. The enhancements to CareShield Life, as well as Government subsidy and grant schemes will collectively provide Singaporeans with greater assurance that long-term care will remain affordable for years to come.

Mr Deputy Speaker, the CareShield Life and Long-Term Care Act was enacted in 2019 to support the establishment, governance and administration of CareShield Life. To implement the Council's recommendations I have just outlined, amendments to the Act are necessary. This Bill makes targeted amendments to two key areas.

First, we will reinstate the planned underwriting criterion for Optional Cohorts and new Singapore Citizens or Permanent Residents. This reinstatement was planned for right from when the scheme was first launched. This move will help moderate premiums for the older CareShield Life policyholders. Second, we will strengthen our premium recovery processes to ensure the scheme's sustainability and fairness to all policyholders.

Let me elaborate more on the first set of amendments, which relates to adjustments to the underwriting criterion. As I mentioned, CareShield Life is kept optional for those born in 1979 or earlier, the Optional Cohorts. This was a considered decision that recognised that many Singaporeans in these cohorts may have already made alternative arrangements for their long-term care needs before CareShield Life was introduced. They might also be enrolled in ElderShield, which was the earlier long-term care insurance scheme, later replaced by CareShield Life.

For the Optional Cohorts, they would also have had to pay higher annual premiums, as they would be enrolling at a later age and have fewer years to pay the premiums needed to support their lifetime benefits under the scheme. Nonetheless, the Government welcomed them to join if they wished to enrol, for greater assurance. We had outreach campaigns and offered participation incentives to encourage them to join. We also relaxed the underwriting criteria as a time-limited measure, so even those who already had mild to moderate disability, could enrol.

I want to emphasise that once insurance take-up is optional, underwriting is important. This is to guard against adverse selection where those who are more likely to claim will be more likely to enrol, driving up claims. Therefore, when the scheme was first conceptualised, it was designed such that only Optional Cohort individuals without any pre-existing disability could enrol in the scheme. However, the Ministry of Health (MOH) decided to grant a time-limited concession to keep the scheme inclusive at its launch. Under this concession, any Optional Cohort individual without severe disability, including those with milder forms of disability, could enrol in and benefit from the scheme. Participation incentives of up to $4,000 were also offered to offset premiums and to encourage enrolment.

With this approach, we have seen many from the Optional Cohort opting to join CareShield Life. As of June 2025, about 900,000, or almost half of them have done so. When CareShield Life was first launched in 2020, we announced that the concession period would be for two years. However, we allowed it to run for twice as long, or about four years, as we recognised that enrolment in CareShield Life might not have been top of mind for Singaporeans during the COVID-19 years that the initial concession was timed for.

Since then, sign-ups are now almost 90% lower than when the scheme was first launched for the Optional Cohorts in 2021 and have levelled off. This indicates that most Optional Cohort individuals who wanted to enrol have done so. Hence, the CareShield Life Council has recommended reinstating the planned underwriting criteria for the Optional Cohorts from 1 January 2026 onwards. This adjustment will benefit all Optional Cohort policyholders.

Remember I said earlier that risk-pooling is cohort-based. So, the risk is taken on and the cost is borne by those in their cohorts. With the earlier concession, premiums had to be set higher to account for the possibility that Optional Cohort individuals with mild to moderate disabilities might be more likely to join CareShield Life. Now that the underwriting criterion will be reinstated, this risk is reduced. This allows premiums to be moderated, keeping the scheme fair and sustainable for all policyholders. For instance, a CareShield Life policyholder from the Merdeka Generation born in 1952 would see annual premiums lower by more than $100 in 2026.

The Bill implements these changes through several key provisions. Clauses 2(a) and 8 introduce a new definition of "not disabled" in the Act, with the detailed meaning set out in a new Fourth Schedule. The Schedule defines "not disabled" as being able to perform all six ADLs without assistance. This provides the foundation for our reinstated underwriting criterion. Clause 6 provides the Minister with powers to amend this Fourth Schedule by order published in the Gazette. Any such order must be presented to Parliament after publication for proper oversight. Clause 3 amends the underwriting criterion or eligibility criteria for CareShield Life under section 6 of the CareShield Life and Long-Term Care Act 2019 which applies to New Singapore Citizens or Permanent Residents.

From 1 January 2026, these new Singapore Citizens and Permanent Residents can only enrol in CareShield Life if they are "not disabled". This means that they have no pre-existing disability and are able to perform all six ADLs independently. We will be amending the relevant regulations so that this underwriting criterion of being "not disabled" will, likewise, apply to the Optional Cohorts. In implementing these changes, I want to assure Members that we remain committed to fairness, inclusivity and sustainability.

The Optional Cohorts have had sufficient time, four years, to join CareShield Life under the more inclusive underwriting criterion. The adjustment of underwriting criterion applies only to new Optional Cohort enrolment from 1 January 2026. Existing policyholders will see no change to their coverage. Importantly, those with pre-existing disability can continue to benefit from other Government financing schemes, such as long-term care subsidies and grants, including the Home Caregiving Grant.

Sir, I will now elaborate more about the second set of enhancements to provisions relating to the service of documents, which strengthen our premium recovery process. Like any other insurance scheme, CareShield Life relies on collective responsibility through risk-pooling within each cohort to provide policyholders with peace of mind in the event of severe disability. As part of this collective responsibility, all policyholders must play their part by meeting their premium obligations. This ensures that CareShield Life can continue to support potential claimants in a timely and sustainable manner. We also recognise that premiums must be kept affordable, especially for those who are vulnerable. This is why the Government provides support in the form of premium subsidies for lower- and middle-income households and has also announced transitional support to help policyholders manage the upcoming round of premium adjustments. Additional Premium Support is also available to fully offset the remainder of the premiums for those who remain unable to afford their premiums even after subsidies and have limited family support.

So, here, I want to emphasise that no one will lose CareShield Life coverage due to an inability to pay premiums, because from what I just said, those in the worst and most dire situations who cannot afford to even pay the premiums after our subsidies, the Government will step in and pay fully whatever is left for them to bear. So, this will be something we want to give assurance to all our Citizens and our residents here in Singapore. However, there are also some individuals who can afford to, but wilfully decide not to pay their premiums despite repeated reminders and eventually become defaulters. Owed premiums that cannot be recovered will affect CareShield Life Fund's financial sustainability and ultimately affect CareShield Life's ability to meet its claims. Consequently, such unrecovered premiums will have to be shouldered by other policyholders within their cohorts in the form of higher premiums.

Premium recovery and enforcement measures are, therefore, needed to ensure fairness for all policyholders. This involves the service of demand notes. To support these recovery efforts, clause 5 of the Bill introduces the new section 61A to scope the modes through which demand notes may be effectively served. Demand notes are formal notices served to defaulters stating their outstanding premiums and any interest imposed that is payable by the defaulter. These demand notes are a key enabler to our premium recovery process. Demand notes will be served before recovery measures can commence. Such recovery measures may include imposing interests or penalties, or appointing agents to recover outstanding premiums.

The current provisions enable demand notes to be served through various channels, including registered mail. However, we face operational challenges when policyholders fail to update their addresses or reside overseas. This often makes it difficult to reach them through traditional postal methods. Clause 5 will enhance our premium recovery efforts by allowing demand notes to be served via additional modalities, such as digital means, on top of existing methods, such as physical letters. Such an effort is in line with the overall move across the Government to complement, not replace, physical touchpoints with digital channels. These amendments will also align the approach with similar provisions already in place for MediShield Life and will improve operational efficiency and streamline premium recovery actions. Those with genuine difficulties affording their premiums will continue to be supported by premium support measures. I would like to reassure this House, again, that nobody will lose CareShield Life coverage due to an inability to pay their premiums.

Mr Deputy Speaker, Sir, the amendments we propose today will help to ensure that CareShield Life remains a robust and sustainable pillar of our long-term care financing system. Together with the substantial subsidy and grant enhancements announced at Budget 2025, these amendments and the changes to CareShield Life will continue to provide Singaporeans with the assurance they need as they age. Mr Deputy Speaker, Sir, I seek to move.

Question proposed.

Mr Deputy Speaker: Mr Ng Chee Meng.

3.40 pm

Mr Ng Chee Meng (Jalan Kayu): Mr Deputy Speaker, the enhancements to CareShield Life are timely as we approach a "super-aged" society in 2026. As the Minister mentioned, one in two residents is expected to develop severe disability in their lifetime. The caregiving needs will increase given smaller families shouldering the burden of caregiving and long-term care costs rising faster than general inflation.

In Jalan Kayu and beyond, I have met families struggling to balance between caregiving, work and the costs of care. Expenses for helpers and nursing homes can run into thousands per month. Even with subsidies, many middle-income households feel the strain. Caregivers often worry about how long they can keep going – physically, emotionally and financially. They want their loved ones to be given the best care in the best way possible. That is why I agree this Bill matters. We must ensure that CareShield Life gives real assurance to families when severe disabilities strike, that both the stricken person and their caregiver will have the support they need.

Today, I would like to touch on three areas: payout adequacy, premium affordability and, in conjunction with CareShield Life, refresh our "Caregiver Compact" so that caregivers themselves are supported even as they care for their loved ones.

First, on payout adequacy. We know that long-term care costs are rising faster than general inflation. The move to double the payout growth to 4% is welcome. But the key question remains: will payouts keep pace with actual costs of long-term care in the years ahead?

To help Singaporeans plan ahead with confidence, I suggest pegging payouts to cover at least a certain proportion of long-term care costs. In other words, make the payout percentages to the estimated long-term care costs clearer. This would give families a clearer, better picture of what CareShield Life will cover and, importantly as well, what it will not cover so that they can plan early for the rest of care needs through other sources or supplementary plans.

I also seek clarity on the stopping of payout growth after age 67 or once claims are made. While I understand the median disability duration is about four years, there are three in 10 Singaporeans that could remain severely disabled for 10 years or more. Without continued payout growth, CareShield Life can fall short just when families need it most, as inflation steadily chips away at the real value of the payouts.

I hope the Minister can share how the Government will ensure that payouts will remain meaningful and adequate during the extended years when the payout is needed. Because at its very heart, like what the Minister has mentioned, this is not just about the policy design, but assuring and giving ordinary Singaporeans peace of mind knowing that the premiums they have paid, faithfully, over the years will translate into real assurance when CareShield Life payouts are needed most.

My second point is on the affordability of premiums. I am heartened by the Senior Minister of State's repeated assurance that no one will lose coverage because they cannot afford their premiums. This assurance matters deeply and I am glad I heard the Minister say two, if not three times. But even so, for many middle-income families, including those in Jalan Kayu who may not qualify for means-tested support, the worry is still real and remains. The 4% annual premium increase, especially after transitional subsidies taper off by 2030, can add up and eat into MediSave balances.

To give families greater assurance, I suggest that premiums be capped at a fixed percentage of the median per capita household income. This ensures premiums remain fair and sustainable, in line with wage growth over longer periods of time. It would also help if the Government could indicate what is the expected upper limit of premiums beyond 2030, so that Singaporeans can plan their finances with greater certainty. Pegging payouts and managing premiums in tandem would give Singaporeans a stronger sense of predictability and stability, knowing both what they can expect in payout support on the one hand and what premiums contribution is needed on the other hand.

This clarity will go a long way in helping families plan responsibly without the anxiety of being overwhelmed when the care needs arise.

Mr Deputy Speaker, in conjunction with CareShield Life, we must also refresh our caregivers' compact. We must ensure that caregivers themselves are not left behind. There are many areas of support we can and must strengthen. Today, I want to focus on one – helping caregivers build up their own retirement adequacy.

Many of our caregivers, especially and often women, spend years caring for loved ones, especially those who become severely disabled. Many make the difficult decision to leave the workforce. As a result, they may have smaller CPF balances and savings. Later in life, they may well struggle to afford the long-term care they themselves need.

We must not let those who provided care in their younger years go without care in their own old age.

I urge the Government to consider providing CPF top-ups to primary caregivers who lack retirement savings due to caregiving. This would go some way in giving them assurance that even as they care for others, they, too, will be cared for in turn.

Mr Deputy Speaker, it is timely to review the Caregiver Support Action Plan which was launched five years ago. I hope the Government can refresh the action plan to better recognise caregivers' sacrifices, strengthen the ecosystem around them and help them care for both their loved ones and, in time, for themselves. Mr Deputy Speaker, in Chinese please.

(In Mandarin): [Please refer to Vernacular Speech.] The elderly around us have quietly dedicated themselves to bringing us up. Now that we have grown up, we should remember our roots and safeguard their twilight years.

The CareShield Life scheme is an important pillar of our nation's long-term care system. While strengthening this scheme, we must also ensure that it truly benefits those in need. We can approach this from three aspects: (a) that payouts can cover at least a certain percent of estimated long-term care costs – giving families predictability to plan for their needs; (b) that premiums will remain within reach, by capping premiums at a fixed percentage of the median per capita household income; and (c) that caregivers receive the support they need so that they will be cared for even as they care for their loved ones.

I urge the Government to consider providing CPF top-ups to primary caregivers who lack retirement savings due to caregiving. We have an obligation to care for them when they are in need and be their support.

(In English): Mr Deputy Speaker, CareShield Life is a key pillar of our nation's approach to long-term care. It rests on the promise that when one pays premiums faithfully through the working years, one can count on meaningful support when severe disability arise.

As we strengthen the scheme, let us make sure it better delivers the assurance that: payouts can cover at least X percent of estimated long-term care costs, giving families predictability to plan for their needs; that premiums will remain within reach by capping premiums at a fixed percentage of the median per-capita household income; and that caregivers receive the support they need so that they will be cared for even as they care for their loved ones now.

Mr Deputy Speaker, notwithstanding these suggestions, I support the Bill.

Mr Deputy Speaker: Ms He Ting Ru.

3.49 pm

Ms He Ting Ru (Sengkang): Mr Deputy Speaker, how we view and ultimately support the long-term care of the vulnerable in our society should be a reflection of what Singapore values. Care recipients are our parents, our partners, our neighbours and perhaps, even ourselves.

Every Singaporean hopes that when frailty comes, they can look to a system of support which includes not only from family and loved ones but from the society that we live in, through a national system that spreads the risk equitably, offers dignity and lightens the load on those who give care.

As a developed, wealthy country, the principle of shared responsibility through CareShield Life should rightly form one of the key pillars of our social safety net, providing financial support for Singaporeans faced with severe disability. This is why the Workers' Party (WP) has supported it conceptually since its inception in 2020.

As the scheme matures and as our society continues to age, we must ensure that it continues to embody the spirit of fairness and solidarity that should be a bedrock of a truly caring society. Where we can do more, we must do more.

CareShield Life marked a shift from its predecessor, ElderShield, by extending coverage to provide for lifetime monthly payouts from when an insured becomes severely disabled and becoming compulsory for younger cohorts.

Since CareShield Life was first debated in Parliament in 2018, we have seen significant increases in the cost of living off the back of global events like the pandemic, wars and geopolitical tensions. The increase from 2% to 4% of the annual growth rate of CareShield Life payouts is, thus, welcome as an acknowledgement that long-term care costs have outpaced inflation.

Even with payouts for the severely disabled, costs for long-term care are still significant, with 2024 numbers indicating that it can cost on average between $1,800 to $2,500 a month for home-based long-term care, depending on care intensity and subsidies, rising to an estimated average amount of $2,200 to $4,200 a month before subsidies for institutional-based care, such as in a nursing home. Given that long-term care costs have been outpacing general inflation since, the increase in payouts will be welcome by families.

However, could the Minister explain ongoing and future monitoring mechanisms and calculations for Singaporeans, as policyholders, to better understand what would be taken into consideration for the Government to once again assess whether the current payouts will be adequate?

After all, we can anticipate that any future increases in payout rates would also have consequent increases in premiums and, thus, a direct impact on Singaporeans as we continue to age. Thus, I would like to repeat the call made by the Leader of the Opposition Pritam Singh in his speech when CareShield Life was introduced and debated in this House in 2018, where he asked the Government to reveal actuarial principles and to publish investment returns and premium adjustment factors regularly.

On premiums, I note that while premiums will go up to support the changes to the scheme, the Government has put in place various support measures. However, I wish to, today, again bring up the issue of gender-differentiated premiums because how we price care says something about how we value those who provide it.

This is not a new point and WP Members of Parliament (MPs) shared their concerns about this when CareShield Life was introduced in this House in 2018.

Women pay higher premiums, and this is still the case, with the reasoning that women live longer and claim more. Given that CareShield Life has been running for five years now and the Ministry would, presumably, now have some data about claimants under the plan, could the Minister share whether the assumptions that women would claim more and for longer have been borne out?

Even if the actuarial reasoning and data makes sense, actuarial fairness is not always the same as social fairness. Applying a strict actuarial lens when deciding to charge women more for enrolment in this compulsory plan does not take into account the following factors.

First, women in Singapore have lower lifetime earnings and smaller CPF balances on average. The Ministry of Manpower's 2023 Gender Pay Gap report found that women earn 14.3% less than men on a gross basis, with an adjusted gap of 6% still. CPF Board data also shows that women's balances at age 55 are approximately 55% lower than men's.

It is widely accepted that career decisions have a significant impact on the gender pay difference and that societal, cultural or even biological factors mean that women in Singapore continue to shoulder more caregiving work compared with men. It is often the default position that women are the ones who reduce their working hours, turn down promotions or increased responsibilities at work, or even leave the workforce altogether in order to care for a parent, spouse, child; sacrificing income, retirement adequacy and sometimes, even at the expense of their own health.

Add to this, that globally, women live longer but spend more years in ill health. Studies show they spend about 12% more of their lives in poor health than men. Closing this gender health gap could add over US$3 billion annually to Singapore's gross domestic product (GDP) by 2040.

So, when we ask this very same group, women, to pay more for CareShield Life, we risk deepening structural inequities. The caregiver who has spent years enabling others to work is in effect asked to bear a greater cost for the very care safety net her unpaid labour helps sustain.

This can also be compounded by findings in jurisdictions, like New South Wales in Australia, which noticed that while both women and men experienced disability at similar rates, women only made up 37% of claimants of its national disability insurance scheme. One of the more sobering findings was that because women shoulder more of the care work in the family, they end up with less time to manage their own disabilities and take on the administrative work associated with disability claims.

Could the Senior Minister of State clarify whether a similar picture exists in Singapore and if so, what is being done to address this additional challenge?

Just as importantly, by making women pay more, are we sending a signal that society does not provide for both men and women at the same rate?

Women could be perceived to be penalised financially for two things they cannot control: living longer and providing the majority of unpaid care. When a woman reduces work hours to care for an ageing parent or a disabled relative, she loses income, retirement savings and then pays higher premiums for this privilege of having provided that unpaid care. This is not risk pricing. It is compounding disadvantage.

In view of the above, I hope that we could consider the following: first, greater transparency; second, mandatory periodic review triggers of premium structures; third, explore how best we can close the gender gap.

On transparency, the Ministry should publish actuarial data regularly, including average claim duration, payout levels and fund solvency, as it currently does, to a certain extent, for MediShield Life. Publishing such data of what is, after all, a national insurance scheme will allow the public to be better understand the financial reasons as to why policy shifts occur when they do and to equip us, in this House, with a full picture as we strive to understand the trade-offs to be made within the policy.

Second, given that we are announcing the doubling of payout increases five years after the scheme started, I believe that it would help the public to understand at what point we would need to, again, review the adequacy of payouts, given changing costs of care.

Additionally, the longevity gap between men and women has narrowed over the last two decades from about six years, to around 4.4 years today. If this narrowing of life expectancy between men and women continues and if we were to succeed in our aims to close the gender health gap, it would be remiss not to ask whether there is still a place for gender-based pricing.

We, therefore, hope that the Government can commit to reviewing this policy when a specific threshold is crossed. This could take the form of a review of gender-based premiums that gets triggered when the differences in payouts narrow to a specific threshold on average over a few years. The exact threshold should be determined by actuarists with access to full data and the threshold should be published. And when that threshold is crossed, a mandatory review of the existing policy should take place.

Finally, we need to work towards greater equity in the form of exploring gender-neutral premiums. After all, MediShield Life already does so, and we should explore how CareShield Life can be structured to phase towards this approach once we have adequate claims experience available.

If we accept that CareShield Life is a national insurance rather than a commercial insurance product, given the constraints that women face, there is value in building equity into the design of the scheme rather than attempt to patch up any inequalities using subsidies or ad hoc support of cash offsets.

A baseline protection against disability should be universally accessible to all Singaporeans. And inherently, it does not sit right to penalise a group, that is, women, by making us pay more for what are often factors beyond our control. After all, globally, it has been found that women have a higher prevalence of disabling conditions, such as arthritis.

And to achieve our aims towards a Healthier SG, I hope, too, that we continue to work on various preventative and early intervention initiatives to address the various health challenges that women face, to do what we can to minimise women's time in ill health and address these concerns about a double or even triple whammy facing women as we age.

These suggestions are not about favouring one group over another; they are about ensuring that the principle of shared risk applies equally to everyone and to address any systemic issues at the root that may be causing the inequity. Our goal should not be to rebalance inequity with subsidies but to explore how we can remove inequity from the structure itself.

One of the changes in this Bill too is the reinstating of the underwriting criteria for those born before 1980, which means those with severe pre-existing disabilities would no longer be able to sign up for the scheme. Given this is a finite group who already currently live with severe disabilities, I would like to seek clarification on what support would be available to these individuals who may in the future be faced with an unexpected exigency, for example, in the form of suddenly losing coverage under their own plans, which were meant to cover their long-term care needs. In this case, would the Ministry be willing to consider any appeals on an exceptional basis to be included in the scheme after the reinstatement?

Finally, financial protection is only one part of the long-term care story. For many families, day-to-day realities and challenges of caring for loved ones means a constant juggling of the invisible mental load and unpaid work involved in caregiving, arranging for services, balancing work while simultaneously facing exhaustion and burnout. And for caregivers who take on much unpaid and unseen work, it bears reiterating what my colleague Aljunied group representation constituency (GRC) MP Gerald Giam said during this year’s Committee of Supply debate, that care recipients and carers have different needs and that our support system needs to reflect this.

A 2023 survey found that more than 40% of caregivers in Singapore are at risk of depression. The typical caregiver is a married woman between the ages of 45 and 60, simultaneously holding down full-time employment, spending an average of an extra 6.7 hours on caregiving a day. These details alone should cause alarm, and we must urgently build stronger, more holistic support, with solutions that better capture and respond to the time, skill and emotional resilience needed in their unpaid care work. This can take the form of accessible interventions targeted at realities rather than add to their workload, whether it is in form of mental health support or rallying better social connections within our communities.

Underscoring this, during the launch of our Caregivers’ Wishes initiatives last week, we heard many stories from Singaporean carers and recipients, with a common thread of caregivers needing not only more financial support, but more time, more skills and more understanding. Giving this support is not charity, it is an investment into our society’s care resilience.

To conclude, Mr Deputy Speaker, after our transition from ElderShield to CareShield Life, the next step is to ensure that CareShield Life remains true to its founding purpose: to stand beside every Singaporean in times of need. This means ensuring premiums grow transparently and remain affordable, gender-based differences are regularly reviewed as our care needs and demography changes, and caregivers are given training, respite and recognition beyond financial means.

A truly caring nation should not measure support in actuarial tables only, but in how we treat and support those who give and those who need care. Let us continue towards our goal of a system that reflects our shared values of fairness, inclusion and solidarity, so that every Singaporean, regardless of gender, income or circumstance, is able to live and age with dignity and support. I support the Bill.

Mr Deputy Speaker: Ms Mariam Jaafar.

4.04 pm

Ms Mariam Jaafar (Sembawang): Mr Deputy Speaker, imagine this. The last 10 years of your life. You cannot walk, you cannot dress yourself or feed yourself. Maybe you had a stroke or dementia. Your body fails you, slowly, while your savings drain away.

This is not a distant nightmare. MOH estimates that half of healthy Singaporeans aged 65 will develop severe disability in their lifetimes. This could happen to any of us or to someone we love. That is why long-term care is not a “someday” issue. It is a now issue.

When CareShield Life was lauched, it was a bold, necessary move, one that showed the foresight of this Government in planning for our ageing society. The Council’s recommendations and the Bill before us today takes the next step: enhancing payouts, adjusting premiums and tightening administration to keep pace with rising care needs and healthcare costs. I support it.

But let us not stop there. As we refine the mechanics, we must ask deeper questions. Is the system coherent? Is it fair? And it is ready for tomorrow?

I will speak today on five areas we must strengthen – system coherence, affordability and payout adequacy, inter-generational fairness, coverage, and long-term care delivery on the ground.

First, system coherence. Long-term care cannot exist in silos. Long-term care sits alongside Healthier SG, Age Well SG, S+3M framework, Home Caregiving Grant and other support schemes. There is an opportunity and a need to strengthen the linkages between these schemes.

Today, long-term care is a bit of a jigsaw puzzle with pieces from different boxes. Assessments and eligibility criteria differ. Funding is fragmented. And families, especially middle-income households, sometimes find community-based care harder to access or less supported. Incentives are sometimes misaligned.

Prevention matters. We encourage Singaporeans to get screened, exercise and join Healthier SG. But those who do the right thing do not seem to see any tangible benefits here – no premium discounts, rebates, not even Healthy365 points. Should prevention not count for something?

What we need is a continuum of care that connects prevention, early intervention and long-term care. This means standardising assessment, aligning payouts, subsidies and incentives, and making it easier for families to choose the right care, with structured pathways with less bureaucracy.

Encouragingly, steps have recently been announced. From 2026, the income threshold for nursing home subsidies, Home Caregiving Grant and the Seniors’ Mobility and Enabling Fund will all be aligned at $4,800 per capita household income, and the severe disability assessment for CareShield Life will also apply the Home Caregiving Grant. Families would not need to apply twice.

But we can go further. For example, offering premium rebates for active participation in Healthier SG programmes or automatically bundling CareShield Life payouts with Age Well SG community services. The CareShield Life Council, Healthier SG Office and Age Well SG agencies can be tasked to jointly look at how prevention and community care trends impact financing. This kind of system coherence aligns incentives across a person’s life course, so that we bend the cost curve, not just chase it.

Let me turn to affordability and payout adequacy. With this Bill, premiums will rise, even with means tested premium subsidies, transitional support and additional premium support, the annual premium increase will be $38 on average but can go up to $75 during the transitional period. Without support, the average increase would be $126 annually. For lower- to middle-income families supporting multiple dependants and those with lower MediSave balances, such as retirees and the self-employed, this can be a strain. A middle-income household with a per capita income of just over $3,600 but below $4,800 today gets no CareShield Life premium subsidy, even though they will later qualify for long-term care subsidies if disability strikes. This may make sense within individual schemes, but to families on the ground, it feels inconsistent and the “sandwiched middle” shoulders a heavier burden upfront.

Will the Ministry consider increasing the subsidy income threshold so that greater alignment between financing and service subsidies exist across premium support, care subsidies and Healthier SG and Age Well SG programmes? A coherent, transparent framework will help families plan better and strengthen trust in the system.

For those with very low MediSave balances, the Additional Premium Support scheme is critical. Can the Senior Minister of State share how much Additional Premium Support has been disbursed so far and what is budgeted for the next five years? Will the Minister consider expanding Additional Premium Support to ensure no one loses CareShield coverage due to affordability? And I am heartened to hear the Senior Minister of State speak and reiterate that many times in his speech.

On payouts, 4% annual payout increases may not keep pace with actual long-term care cost inflation. And since the payout is also fixed at the point of claim or at age 67, their value may erode over time. Will the Ministry consider regular affordability reviews to monitor premiums, subsidies, payouts and inflation, and recalibrate quickly as needed?

As we debate premiums and payouts, we must also look at inter-generational fairness. Younger Singaporeans are paying into CareShield Life, putting trust in a promise: that the system will protect them when they need it most. And let us not forget that some will never make a claim. Still, they contribute to make the system work for all. Yet disability rates and care costs could rise faster than current actuarial assumptions. Will the Majulah Generation and younger Singaporeans be looking at substantial premium increases over their lifetimes? Will coverage still be sufficient when their time comes?

To preserve trust, can the Ministry commit to monitoring actuarial assumptions closely and adjusting premiums gradually and with transparency, integrating prevention with long-term care financing models? Could we explore risk-sharing models that protect vulnerable groups without overburdening the rest?

There is a group we must not forget – seniors who are now excluded with the reinstatement of the underwriting criteria. Seniors who were too old, had pre-existing disabilities, even mild ones, or were not yet Singapore Citizens or Permanent Residents at the time.

People like my Woodlands resident, Mdm T, who told me quietly, “I’m not afraid of dying, I’m afraid of being a burden to my children.” She is not alone. Seniors who are excluded from MediShield Life, may have to rely on family or minimal social assistance. Yet these are the very people most likely to need long-term care soon. Schemes, like the Interim Disability Assistance Programme for Elderly (IDAPE), help but only partially. This underwriting gap is a coverage gap and a fairness gap.

Will the Ministry consider expanding and extending IDAPE or similar fallback schemes? Or creating targeted risk pools or options for partial entry for excluded seniors, even if it means smaller payouts rather than this all-or-nothing coverage? No senior should be left unprotected simply because they were born too early or became disabled too soon.

Finally, design matters, but delivery matters more. Even the best financing design means little if services on the ground are stretched and wait times are long, whether it is for a nursing home bed, home personal care or caregiver services, including respite care. In Woodlands, new facilities like Ren Ci at Woodlands Health Campus have added beds and day places. But waiting times for some services still run weeks and longer for specialised care. Nationally, the median wait time for a nursing home space is four to six weeks, and longer for dementia care. When my Woodlands resident had to look for a nursing home for his brother, he had to put him in a nursing home in Jurong for the fastest enrolment, which means higher travel time and cost for the family. Families should not have to choose between speed and proximity when it comes to long-term care.

Sir, payouts must translate into real, timely, accessible services, and not just paper entitlements.

Mr Deputy Speaker, this Bill is timely and a significant step is ensuring the CareShield Life remains affordable, provides sufficient payouts and is sustainable. But our work is not done. To serve our ageing society well, we must build greater system coherence, keep the system affordable and payouts adequate, ensure fairness across generations, plug the coverage gaps for seniors and make sure the care we promise actually gets delivered where and when it is needed.

Let us build a long-term care system that does not just protects today’s seniors, but keeps faith with today’s young and stands strong for generations yet to come. Because how we care for the most vulnerable around us is a true test of the “we first” society that we are building together. I support the Bill.

Mr Deputy Speaker: Assoc Prof Jamus Lim.

4.15 pm

Assoc Prof Jamus Jerome Lim (Sengkang): Sir, the proposed amendments to the CareShield Life and Long-Term Care Act seeks to introduce amendments that redefine the circumstances under which the scheme applies to certain individuals and to provide for the service of documents related to the Act.

I support the Bill but will share some remarks on the first element, dealing with the scope of coverage of CareShield Life. I will begin with elements close to the specificities of this present Bill, before moving on to more general issues of coverage.

Clause 3 amends section 6(1)(b) to automatically enroll new Citizens or Permanent Residents born before 1980, or who those who became Citizens or Permanent Residents after October 2020, so long as the individual was not already severely disabled. This would, effectively, compel enrollment for those aged 45 and older into the scheme, if they happened to have recently altered their immigration status. In contrast, long-time Citizens and residents remain grandfathered on the older, albeit discontinued ElderShield scheme.

This effectively creates a disparity between older new Citizens and residents, and existing ones, if the latter had not opted into CareShield Life. Does the Ministry have any concerns over whether this disparate treatment might become an issue in the future? If so, would it not be better to compel all to move over to the new scheme?

Relatedly, these amendments, along with those to section 6(4)(b), exclude those who are severely disabled from the scheme, unless approved by the Minister. I understand the economic rationale for such exclusions: we do not wish to create a case of adverse selection, where those enrolled in the scheme are all already disabled, thereby rendering the risk-sharing aspect moot. Still, it remains a moral responsibility for society to take care of those that are already disabled.

I understand that the Government does have in place a multi-pronged approach for supporting such individuals. This includes taxpayer-funded, means-tested subsidies and grants, other supplementary insurance schemes, access to self-funded healthcare savings and a last-ditch safety net. Still, I would appreciate a comparison of how those without CareShield Life coverage would fare, relative to those who would, otherwise, be reliant on piecing together these disparate sources of financial support.

Moreover, it is unclear how the Minister will exercise the discretion afforded to him. Are there specific conditions which would lead an individual to be approved or excluded?

Clauses 7 and 8 formalise the six ADLs, for which an individual must require either maximal or total assistance in three, before they are considered severely disabled and, thereby, qualify for CareShield Life payouts.

I will start by noting the slight difference in the six categories defined by MOH, relative to other standards out there. In particular, our basic ADLs include a separate mobility function which, I believe, is a significantly higher bar than simply transferring. It also strikes me as a greater hurdle than either hygiene and grooming, or continence, which are used by the World Health Organization's International Classification of Functioning, Disability, and Health or the Katz Index, respectively.

Perhaps more important is that these six ADLs remain an incomplete representation of an individual's ability to function adequately in a modern community. They mainly describe aspects of physiological self-care but exclude important ancillary aspects of psychological or social behavior that are nevertheless necessary for independent living. These are otherwise known as instrumental ADLs.

While I accept that it is not possible to cover every possible aspect of effective functioning, I believe that it is, nevertheless, important to recognise that such instrumental ADLs can be materially impacted after a critical illness, which is precisely the sort of circumstances where one would hope insurance protection kicks in.

Moreover, dignified living in modern Singapore virtually requires that individuals be able to perform certain instrumental ADL tasks, such as preparing or purchasing meals, handling money and using transportation. The lack of mention of these activities in the evaluation criteria for disability coverage under CareShield Life is even starker, when such metrics are already being accounted for by certain local medical support organisations, such as Dementia Singapore and the College of Family Physicians. It is also a notably bipartisan concern, having been raised in the previous term of Parliament by Members from both sides of the House.

Admittedly, including all instrumental ADLs in coverage will likely mean a larger risk pool, which could, in turn, materially raise premium. This is an empirical question. But even if we do not go the full extent of including all on the list, which typically includes up to eight distinct tasks, activities, such as communication, transportation and medical management, appear to be functions that are much more necessary for living in a modern city state, such as Singapore.

A related concern is whether the need for maximal or total assistance in three activities is more reflective or indicative of severe disability than, say, moderate assistance but in five distinct activities? Indeed, using an index approach, it is possible to construct outcomes where those who qualify for CareShield Life as severely disabled might even score higher on an index of daily functioning than someone else who would have scored lower. If we take the notion of disability assessment seriously, we should, perhaps, move away from the current binary outcome, like the inability to perform at least three ADLs, toward a more clinically corroborated approach that relies much more on index scoring. The use of indexes is relatively widespread in jurisdictions, including Australia, Japan, the United Kingdom and the United States.

Let me move on to more general issues about CareShield Life, which were flagged in the 2025 Review Council Report, but not yet directly addressed in the present Bill. These have, directly or indirectly, been informed by my interactions with residents in Sengkang that have faced difficulties associated with the current operation of the scheme.

The first concern is related to the optional enrollment process for those born 1979 and earlier. One issue is whether the 60-day "free-look" period may be too brief for those who enroll to decide on whether they wish to remain on the scheme permanently. Relatedly, some appear not to have fully understood what they are truly getting themselves into, in terms of their ongoing premium payments.

While I understand that underwriting principles require that participants be ultimately locked in, I wonder if the free-look period may be extended to a longer duration, such as three months. Similarly, would it be possible for enrollees to opt out within, say, a year, perhaps with some penalty. After all, while optional exits would undeniably mess with actuarial calculations, opting out tends to be far less distortionary for the long-run financial viability of the fund, compared to unrestricted opt-ins.

Second, the Government has assured the public that they will ensure that no one will lose coverage due to an inability to pay their premiums. This is something that the Senior Minister of State Koh Poh Koon had reiterated earlier on several times. This is important, not least because cost of living pressures, while abating over the past year, remain a major concern for many Singaporeans, and the last thing we would like to do is to saddle our workers with yet another cost increase, at a time when they are also simultaneously concerned about job security.

Will the Ministry clarify what proportion of current participants receive premium support, and what the process of accessing additional premium support entails? In particular, would this support kick in, in the event that they lose their job, so that they do not also risk losing their insurance coverage at the same time?

Third, I would like to know whether, in practice, CareShield Life will be directly run by the CPF Board under the direction of the Ministry of Health, or if it will be outsourced to a third-party private insurer, such as Income Insurance, to administer.

I ask this because, to my knowledge, other insurance programmes run by the CPF Board, such as the Dependents' Protection Scheme (DPS) or the Home Protection Scheme (HPS), appear to be administered by companies such as Great Eastern and Income Insurance.

I have encountered instances where residents expressed dismay about how they were caught unaware that there were lapses in their coverage of either DPS or HPS, due to insufficient funds remaining in their CPF Ordinary Accounts (OA). This was already discussed this morning by Minister Tan See Leng. That said, while it is possible that some may be surreptitiously trying to reinstate their insurance plan ex post facto, to make a claim after an untoward event.

There is, in fact, another plausible reason: because premiums had previously been automatically deducted from their CPF OAs, they did not meticulously track the need to routinely make payments. They were, thus, unaware when, due to inadequate OA balances, that their coverage had lapsed. Moreover, because they were expecting a contractual relationship with the Government and not a private entity, they then proceeded to overlook reminder mailings sent by these companies.

For this reason, I believe that it would be useful to ensure that, should CareShield Life ultimately be outsourced to a private insurer for administration, that correspondence pertaining to the scheme still come directly from CPF Board or, at the very least, feature a CPF Board logo prominently in the letterhead. This will ensure that policyholders treat such correspondence seriously.

At the same time, CPF must assure the public that, despite being managed by a non-Governmental entity, claims will continue to be evaluated not just with an eye toward prudence but also compassion and common sense. This will ensure that the hard-won trust of Singaporeans in the institutions of Government is not inadvertently squandered by private corporations that are chasing a bottom line.

Mr Deputy Speaker, the recent ruling by the district Courts against Income Insurance over its "wholly unreasonable" conduct in denying insurance claims by 78-year-old Ko Wah for accident-related damages is a reminder that our pronouncements of a "we first" society must, ultimately, be backed by concrete action that is consistent with that aspiration.

This is, hopefully, an isolated case. Still, we must understand that the promises of CareShield Life to help the most vulnerable in our society to continue living a life of dignity after a devastating accident will only go so far as this is truly realised in practice. If support is too meager, too perfunctory or too grudgingly provided, then this promise will ultimately ring hollow.

Mr Deputy Speaker: Mr Alex Yam.

4.28 pm

Mr Alex Yam (Marsiling-Yew Tee): Mr Deputy Speaker, I rise in support of the CareShield Life and Long-Term Care (Amendment) Bill.

This Bill continues the Government's careful and compassionate work to strengthen our national framework of long-term care, ensuring that no Singaporean faces the challenges of severe disability or extended care needs alone. It reaffirms our social compact, that as we build a more inclusive "we first" society, we also build systems that allow Singaporeans to age with dignity, security and peace of mind.

For me, this Bill does two things.

Firstly, it redefines the circumstances under which the CareShield Life Scheme applies by introducing a clear definition of "not disabled" in a new Fourth Schedule and by clarifying automatic coverage rules for individuals becoming Citizens or Permanent Residents after the scheme’s commencement. Secondly, it modernises the service of documents provisions, including a new section 61A that allows notices, such as demand notes, to be served through multiple channels, including email and approved digital platforms.

This of course reflects the way that Singaporeans increasingly communicate, ensuring that administrative processes keep pace with technological advancements.

These legislative enhancements coincide with significant policy shifts as well.

In August 2025, the Government accepted the CareShield Life Council’s recommendations for the 2025 Review. These include higher payouts to meet long-term care needs and a $575 million in additional premium subsidies to cushion the increase for households. These changes ensure that CareShield Life remains financially sustainable while protecting Singaporeans who develop severe disabilities from being left behind. Mr Deputy Speaker, in Mandarin.

(In Mandarin): [Please refer to Vernacular Speech.] Mr Deputy Speaker, this amendment reflects that the Government's care for the elderly and persons with disabilities, and demonstrates our society's sense of responsibility and foresight when facing the challenges of an ageing population.

As society rapidly ages, more and more families will face the pressure of long-term care. Whether due to age-related disability, or mobility difficulties caused by illness or accidents, long-term care is no longer "someone else's problem", but rather "a common issue for all of us".

This amendment makes the definition of "disability" clearer and more consistent, whilst also ensuring that document servicing channels are more convenient and effective. Although these amendments appear to be technical, they concern whether families can receive timely assistance and protection in their caregiving journey.

I also hope that when the Government implements electronic servicing, it can consider the actual circumstances of elderly people and vulnerable groups, avoiding situations where they miss important information due to the digital divide. We can combine physical letters with social media to ensure no information is missed. Most importantly, we must continue to make "dignified ageing" our goal, establishing a reliable and compassionate long-term care system that allows every citizen to face the future with peace of mind.

(In English): While I support the Bill, I would like to raise a few clarifying questions and suggestions to strengthen its implementation.

Firstly, on assessment criteria and appeals. On the new "not disabled" definition: some individuals have progressive or cognitive disabilities that do not neatly fit into the six ADLs. How will these cases be fairly assessed? Will MOH issue updated clinical guidance and ensure that our assessors receive the adequate training to apply the criteria consistently? Appeals processes should also be transparent and timely. Clearer public guidelines with case examples and possibly tele-assessments for bedridden patients will reduce stress for families.

Secondly, on digital service and inclusion. The shift to digital service is practical, but many affected groups are seniors with limited digital literacy. How will MOH ensure that they are not disadvantaged by missed notices? A "phygital" model should be the default for critical documents, such as demand notes. Community partners, such as the Silver Generation Office, the Infocomm Media Development Authority, media literacy ambassadors and the Community Development Councils (CDCs) can support vulnerable groups in managing their digital interactions.

Thirdly, financial sustainability. The additional subsidies is commendable, but as payouts rise and our population ages, how stable will premiums remain over the longer term? Regular public actuarial reports, similar to CPF's, can build trust. MOH could also consider more progressive subsidies for middle-income families who may not qualify for help but still shoulder heavy caregiving burdens.

CareShield Life also operates in conjunction with many other schemes such as the Home Caregiving Grant and Medisave withdrawals for long-term care. How will MOH ensure that families experience these as a coherent ecosystem, rather than fragmented programmes? A one-stop care portal perhaps, that integrates financial, medical and social services could be a meaningful difference for families navigating sudden disability events.

On monitoring and review, what are the mechanisms that will be available to monitor the impact of these changes over the next few years? Regular publication of disability assessment data, appeals statistics and processing times will also strengthen transparency. Ultimately, social and health initiatives often compete for limited fiscal space and must demonstrate measurable outcomes within short cycles. Yet, long-term care, by its very nature, requires patient sustained investment in our caregivers, in community infrastructure, and preventative programmes. We must continue to find ways to bridge support gaps through deeper partnership, flexible funding models and a mindset that sees care not as a cost but as a shared responsibility and a social investment in our collective future.

CareShield Life is also ultimately very important as part of our care framework. But by its very nature, it is abstract and its technical design makes it difficult for many to understand. Compared to ordinary health insurance, disability-type insurance is less intuitive to many people. It is hard to internalise eligibility criteria, payout triggers, limitations on how premiums evolve. And therefore, this requires much more public education. And I do urge the Ministry to continually inform and educate our public on the importance of CareShield Life and how it operates.

By 2030, one in four Singaporeans will be aged 65 or above. The CareShield Life Scheme is a key pillar of our response to this demographic transformation. This Bill is not merely about technical amendments, but it is about how families experience vulnerability, care and experience dignity.

I therefore support this Bill and I believe the suggestions that I raised today can make a good Bill even better.

Mr Deputy Speaker: Ms Jessica Tan.

4.36 pm

Ms Jessica Tan Soon Neo (East Coast): Mr Deputy Speaker, I rise in support of the CareShield Life and Long-Term Care (Amendment) Bill. The proposed enhancements reinforce Singapore’s commitment to inclusive and future-ready care. It clarifies who qualifies for coverage and strengthens how the scheme is administered and communicated. These refinements lay the groundwork for enhanced benefits for CareShield Life from 2026, including higher monthly payouts and moderated premium increases, ensuring that long-term care for severe disabilities remains accessible and fair.

CareShield Life offers lifetime monthly payouts for those who are severely disabled. This goes some ways to help families manage the emotional and financial weight of caregiving. The Scheme is based on our ethos of shared responsibility – where individuals, families and the Government co-contribute to care financing. The proposed amendments clarify the eligibility criteria of CareShield Life for the Optional Group – those born in 1979 or before, or aged 46 and above in 2025. The intent is to ensure fair and consistent eligibility and claims for the cohort while balancing inclusivity with scheme sustainability.

These proposed enhancements are welcomed moves. But as we refine CareShield Life, we must also examine the lived realities of those navigating it. So, while I support the proposed amendments, there are a few points I would like to speak on: one, the underwriting criterion for the Optional Group and the implications for them; two, the affordability of premiums for retirees without subsidy support

Given the importance of coverage for severe disability and to encourage more in the Optional Group to sign-up for CareShield Life, currently those with milder forms of disability can sign up for CareShield Life. And as the Senior Minister of State has shared, this was a very deliberate decision to allow for some limited time for people to sign up. The Bill proposes the reinstatement of the underwriting criterion for the Optional Group to moderate premium for older policy holders. With the proposed amendment, eligibility now is tied to their disability status. This means that they can only enrol in CareShield Life if they do not have any pre-existing disability as defined in clause 8 of the Bill and the new Fourth Schedule. The definition states that a person is “not disabled” if he or she is able to do all of the ADLs. This intent is to prevent adverse selection risk, where those who are more likely to claim, opt in for CareShield Life.

I do agree with the rationale for this stricter definition as it provides clarity of eligibility as it also prevents adverse selection risk. This will keep the scheme fair and more importantly, more sustainable. It does however mean that those in the Optional Cohort with mild disability, who would have qualified under the current time-limited requirements of mild disabilities will now not be able to be covered. And as the Senior Minister of State has shared, this is concerning because one in two individuals in their lifetime will encounter severe disability. These individuals may need the coverage as they age.

Since the launch of CareShield Life, as the Senior Minister of State has shared, 1.9 million Singapore Residents have joined the scheme with 900,000 of them, or half of that population of the Optional Cohort opting in. That being the case, we still have 900,000 not covered, and some of them may not have opted in due to perhaps not fully understanding the scheme and therefore not having the coverage. I know that there has already been time given, but I do suggest and I do think that we must do more to help them navigate the full sweep and to understand the caregiving support. I am not suggesting that we force this group to sign up, but what I think we have to do is ensure that people understand the full sweep of the Government schemes available so that they can make more informed decisions and more confident decisions for their long-term care financing.

I know that the Agency for Integrated Care (AIC) today, as well as the Silver Generation Office play a central role in providing resources and helpline to reach out and help families understand care options, eligibility and application processes.

I think more of us in the community need to understand these care options better and to help seniors with low digital literacy and also their caregivers understand the suite of long-term care financing support schemes available. Why does this matter? It matters because it helps bridge the last mile of families who lack coverage and who may not proactively seek help as they may be unaware or just too overwhelmed with their caregiving needs.

I would like to speak about affordability of premiums. The affordability of CareShield Life premiums is tightly coupled with the Bill which lays the ground work for the enhancements proposed by the CareShield Life Council, which the Government has accepted fully. And this includes the recommendation for higher payouts and correspondingly higher premiums to keep the scheme sustainable.

There is concern about affordability of long-term care for those who do not qualify for subsidy support, particularly retirees. These are often individuals who own modest assets but have limited cash flow. They fall just outside the means-tested thresholds, are caregivers for spouses or ageing parents while managing their own health. Several of my residents in Changi Simei do fall under this category. And the temporary transitional support for CareShield Life which is not means-tested is definitely welcome as it applies to all policy holders and it will moderate the premium increase to $38 per year on average and capped at $75 per year on average and can be fully paid by MediSave.

The amount of increase may be small, but the retirees who are cash stretched that are not eligible for subsidy support for premiums, the increases may risk them opting out of the scheme even though they may be eligible and are vulnerable.

I have called for long-term care policies and support to remain inclusive and responsive to our rapidly ageing population as long-term care is not a one-off but it is an ongoing expense, including premiums. So, based on the current means-testing criteria, if a household has no household income, the annual value (AV) of the home is used as the criterion. Given the higher property valuation in recent years, this impacts those living in modest private property with no income and who wish to age in place. The means testing criterion of AV of property applies not just to CareShield Life but to other long-term care schemes. Hence, those who fall in this category are not just impacted by higher premium for CareShield Life but eligibility for support of other long-term care schemes including MediSave Care, Home Caregiving Grant and the Elder Fund.

I know that the Senior Minister of State did give multiple reassurances that no one will be denied of CareShield Life coverage if they cannot afford the scheme, but this goes beyond just CareShield Life. The principles of supporting our caregivers and their families goes beyond just the CareShield Life premium. So, I do encourage that we continue to review and refine the criterion as we go.

We encourage families to be the main caregivers for their family members. In my engagement with our residents, it is heartening to see many families care of their elderly parents, siblings or relatives with disabilities and they live together. If they are living in a private property, AV is used for means testing and they are not eligible for the subsidy support for long-term care if they live in a private property, which generally, in my ward, falls beyond the current threshold.

Can MOH consider refinement with the use of AV? Would MOH consider, for example, tiering the AV threshold by age, adjusting the AV cut-off for older cohorts who own only one property? In using AV as a criterion, can the number of those requiring caregiving and living in the household be a factor for assessment? This will support the sandwiched generation.

Refining AV as a criterion for means testing for long-term care support is vital for our policies to keep pace with the evolving demographics and caregiving realities as Singapore's population ages. This will still preserve our ethos of shared responsibility, where individuals, families and the Government co-contribute to care financing.

Mr Deputy Speaker, CareShield Life is an important component of Singapore's long-term care system, offering lifelong monthly payouts to support individuals who become severely disabled. It provides financial assurance at a time when care needs are high and income may be low, helping families manage the costs of home care, nursing services or caregiver support.

Yet, we must ensure that Singaporeans understand that CareShield Life does not stand alone. It is complemented by a suite of targeted schemes like MediSave Care, which allows monthly withdrawals for care expenses; the Home Caregiving Grant, which offsets informal caregiving costs; and the ElderFund, which provides discretionary support for those with limited income and family help. Together, these schemes form a layered safety net that ensures affordability, dignity and inclusion across diverse care settings and life stages.

I support the amendment as it ensures affordability and sustainability of CareShield Life while balancing inclusivity of the scheme.

Mr Deputy Speaker: Ms Yeo Wan Ling.

4.47 pm

Ms Yeo Wan Ling (Punggol): Mr Deputy Speaker, I declare that I am the Director for the National Trades Union Congress' (NTUC's) Women and Family Unit and Secretariat to the NTUC's Women's Committee.

I thank the Government for the CareShield Life review. These enhancements strengthen our long-term care system and give Singaporeans assurance that as our population ages, our system will remain robust, sustainable and responsive to evolving care needs such as the increased popularity of home caregiving services.

[Mr Speaker in the Chair]

Mr Speaker, caregiving is an essential part of our social fabric. Behind every effective care policy lies a network of individuals, many of them women, who take on the responsibility of caring for their loved ones. They do so out of love and duty, often balancing employment, family commitments and financial pressures.

Their contributions may not always be visible, but they are fundamental to the well-being of our households and communities.

Allow me to share the story of Ms T, a young graduate in her late 20s. For the past six years, she has been the main caregiver to her grandmother, who lives with dementia. When she left the workforce to take on this role, she gave up her income, her CPF contributions and opportunities for career progression.

Her story reflects the reality for many informal caregivers – that caregiving comes with long-term financial implications. These are not only emotional sacrifices, but also economic tradeoffs that affect retirement adequacy and financial security later in life.

Beyond the financial impact, caregiving can also be administratively demanding. Indeed, I have written several Meet-the-People Session appeals quite recently to help our Punggol residents navigate this.

Indeed, caregivers like Ms T often find themselves navigating a complex landscape, applying for grants, coordinating across agencies and managing multiple appointments. She shared that to apply for a home caregiving grant, she had to obtain payslips from both immediate and extended family members for means testing.

Mr Speaker, while our schemes are well-intentioned, such processes can be very overwhelming. I therefore urge our Government agencies to continue efforts to streamline caregiving-related schemes, simplifying claims, reducing duplication and easing coordination. Caregivers should be able to focus on what truly matters – caring for their loved ones.

I note too that Senior Minister of State Koh has shared that more payouts would be given to home and community care. I welcome this development, given that ageing in place is much preferred by our Singaporean families. However, given that home caregiving services by a professional nurse can go up to $280 per shift, I call on the Government to consider, in time, higher payouts to families choosing homecare options.

Mr Speaker, we must also recognise that women may face higher health and long-term care insurance premiums compared to men. When combined with the gender pay gap, this creates the impression of a double disadvantage – women earn less, yet pay more for protection.

I recognise there is a danger in over-simplifying insurance premiums along gender lines as there are differences in women's health needs. We live longer and there are very real illnesses that only women are afflicted with. Our women's health needs to be comprehensively covered by our paid insurance for payouts and coverage, and not to be generalised into a one-size-fits-all coverage plan.

While I recognise that premiums will need to make actuarial sense, I urge the continued monitoring of women's affordability under CareShield Life to ensure no woman is left behind simply because premiums and care costs outpace her ability to pay. To this, I thank the Senior Minister of State for his assurance that no one will be left without insurance coverage because of premiums and urge that we continue with the many layers of protection we currently have to support those who find premiums a burden.

Mr Speaker, caregiving, whether formal or informal, holds real economic value. We must consider ways to ensure that caregiving is appreciated, recognised and rewarded by all in our society. We must look to ways to enhance and promote CPF or CareShield Life top-ups for informal caregivers through family contributions, Government co-funding and contributions from civic society and employers.

I thank the Government for enhancing the Matched Retirement Savings Scheme and I also call for its expansion to include informal caregivers below the age of 55 to help build their nest eggs early. No doubt Ms T would be very grateful for this. Such measures would recognise both the social importance and economic contribution of caregiving while helping caregivers build long-term retirement adequacy.

Mr Speaker, a strong care ecosystem also requires supportive workplaces. Employers play a vital role in enabling caregivers to remain economically active. Tripartite standards such as work-life harmony, flexible work arrangements and even paid caregiver leave can make a meaningful difference and an impact to employees managing care responsibilities.

At NTUC Women and Family, we continue to work with progressive employers to foster fair and supportive workplaces for women and caregivers. We also encourage companies to open return-to-work pathways through flexible training, job redesign and re-employment opportunities so that caregiving does not permanently close doors to career development and livelihoods.

As we strengthen CareShield Life, we must also remember those who form the backbone of our care economy – our nurses, community care professionals and, of course, our migrant domestic workers. Their work is demanding, both physically and emotionally. Amidst rising care costs, it is critical that our care workers are treated with dignity, paid fairly and given adequate rest. Through tripartite collaboration, we must ensure that productivity gains in the care sector translate into both better wages for our workers and affordable services for our families.

Caregiving is essential work – in our homes and across our healthcare system. I welcome the enhancements to CareShield Life, including escalating payouts, higher subsidies and a simpler claims process. But beyond these improvements, let us continue to monitor care costs closely, support caregivers in balancing work and family, and ensure fair and safe conditions for our care workers.

Ultimately, caring for our carers is an investment in our shared future. When we strengthen this compact for care – between Government, employers, families and the community – we build not only just a stronger care system, but a more compassionate and united Singapore. Mr Speaker, I support the amendments to the Bill.

Mr Speaker: Ms Joan Pereira.

4.55 pm

Ms Joan Pereira (Tanjong Pagar): Mr Speaker, I would like to begin with stating my support for the amendments proposed in this Bill, which are aimed at enhancing the sustainability and equitability of the CareShield Life scheme.

As our national insurance scheme for severe disabilities above the age of 30, CareShield Life plays an important role in helping to defray the costs of long-term care, having evolved from the ElderShield scheme from earlier days. As part of the enhancements, the planned underwriting criteria for Optional Cohorts born before 1980 will be reinstated.

This will mean that persons with existing disabilities born before 1980 will not be able to join the scheme. But when we look at the bigger picture, this will help with reducing the uncertainty when the actuaries are calculating the premiums and thereby reducing the extent of premium increases for everyone in the Optional Cohorts.

I am heartened to know that there will be other long-term care subsidies and grants available to them, such as the Home Caregiving Grant. I would like to call upon the Government to continue to monitor the situation for persons in the Optional Cohorts to ensure that they are able to afford the long-term care that they need.

I would also like to ask if the Government has data on the percentage of this group who has made other plans to pay for the provision of long-term care, such as private insurance, and whether these plans are deemed sufficient.

It is crucial that CareShield Life remains financially viable and sustainable. I can understand that the proposed annual increase in both payout growth rate and premiums from 2026 to 2030 can help to ensure that the scheme keeps pace with inflation and rising care costs. I understand that this enhancement will be reviewed after 2030, but it will be difficult to imagine that premiums will not continue to rise.

I am assured by the Government's commitment of over $570 million in additional premium support to offset more than 30% of the premium increase over the next five years. These Government subsidies for the premiums, especially for the lower-income groups, enhance affordability and ensure majority participation in the scheme. I am also glad to note that the Government has reiterated that no one will lose coverage due to their inability to pay their premiums.

I would like to ask the Minister, beyond the next five years of insurance premium support, what are the Government's plans to continue to ensure that CareShield Life remains affordable for our people in the face of rising premiums?

CareShield Life is designed to provide basic financial support and reduce out-of-pocket expenses should an insured develop severe disability and need long-term care. For people that have to make a claim under CareShield Life, there could be other costs that cannot be fully covered by CareShield Life payouts, especially if they did not purchase a CareShield Life supplementary plan.

In effect, while CareShield Life helps to defray the costs of long-term care, Singaporeans will have to continue to ensure that they have enough savings or funding sources to afford the type of long-term care that they need and not assume that the insurance scheme will take care of everything. I hope that the Government can consider raising public awareness about the types of costs that are associated with long-term care and the kinds of support that are available to them. Mr Speaker, in Mandarin.

(In Mandarin): [Please refer to Vernacular Speech.] While CareShield Life helps to defray the costs of long-term care, Singaporeans will have to continue to ensure that they have enough savings or funding sources to afford the type of long-term care that they need and not assume that the insurance scheme will take care of everything. I hope that the Government can consider raising public awareness about the types of costs that are associated with long term care, and the kinds of support that are available.

(In English): In conclusion, Mr Speaker, CareShield Life's long-term sustainability faces challenges from our ageing population, rising care costs and the limited coverage relative to actual expenses. Continued Government oversight and actuarial reviews will be essential to maintaining a balance between the adequacy of benefits and the affordability of premiums over the coming decades.

Mr Speaker: Ms Elysa Chen.

3.33 pm

Ms Elysa Chen (Bishan-Toa Payoh): Mr Speaker, Sir, I stand in support of the CareShield Life and Long-Term Care (Amendment) Bill at its Second Reading.

What makes Singapore a truly first world country, having systems in place to ensure we can place those who mean the world to us first. That is what truly makes us a first world society. Thus, I appreciate the Government's unwavering commitment to ensuring that CareShield Life remains a cornerstone of Singapore's social protection framework. The Government's acceptance of the council's recommendations, along with a substantial $570 million commitment in premium support over five years, clearly shows the depth of commitment to protecting Singaporeans.

However, as we move forward with these important refinements, particularly the modification of underwriting criteria, I believe it would be prudent for this House to understand the potential implications. While I fully appreciate that these changes are necessary to prevent adverse selection and maintain actuarial fairness, I would like to seek clarification from the Minister on specific areas of concern. Mr Speaker, Sir, I would like to seek clarification on the following two points.

First, how many individuals are projected to fall outside the scope of CareShield Life coverage due to the revised stipulations set out in this Bill? What might be the potential long-term impact of societal and healthcare costs of disability of persons excluded from the scheme?

Secondly, can the Minister clarify the precise meaning of performing an activity of daily living without assistance all the time, as stated in the new Fourth Schedule? How would this definition be applied to individuals with temporary disabilities or fluctuating or intermittent medical conditions?

Thirdly, for those who are excluded, but may apply for coverage, what are the conditions determined by the Minister, and what are the factors and considerations the CPF board will take into account in exercising its discretion under section 6(4B) of the act to grant an approval.

Lastly, what transitional provisions or support mechanisms, if any, are in place or contemplated for individuals who no longer qualify because of this legislative change? I am heartened by the Government's commitment that enhanced payouts will grow from $731 monthly in 2026, to over $800 by 2030, providing meaningful relief to families facing the profound and persistent challenges of severe disability. [Please refer to clarification later in the debate.] The streamlined assessment processes and expansion of accredited assessors will, undoubtedly, reduce burdens on families during their most difficult times.

Mr Speaker, Sir, this Bill represents not just legislative refinement, but a reaffirmation of our social compact to care for the most vulnerable among us. It demonstrates that we can strengthen our schemes' sustainability, while deepening our support for those who need it most.

The balance between fiscal responsibility and social protection is commendable and necessary for the long-term viability of our social safety nets. In my maiden speech, I describe caregiving as a relentless wind buffeting a tree in a storm.

Sir, CareShield Life is like a lighthouse, standing steadfast against the storms of uncertainty that age and illness may bring. Its light must reach everyone, especially those navigating the toughest waters. As we refine the system, let us ensure that no one drifts unseen beyond its beam of protection.

With these questions, I look forward to the Minister's reply and further details on the measures to safeguard the inclusivity and effectiveness of CareShield Life. Notwithstanding the questions I have raised, I commend the Minister and his team for their thoughtful approach to these complex challenges and support the Bill.

Mr Speaker: Dr Hamid Razak.

5.05 pm

Dr Hamid Razak (West Coast-Jurong West): Mr Speaker, Sir, thank you. Before I begin, I wish to declare that I am an orthopedic surgeon in practice and, from time to time, I do medical assessments for permanent disability. I rise in support of the CareShield Life and Long-Term Care (Amendment) Bill.

I want to first start commending the Ministry of Health, our public officers and the CareShield Life Council for continually refining this critical social protection framework that safeguards Singaporeans against the long-term financial impact of severe disability.

CareShield Life is not merely an insurance scheme but one of the key pillars of our health and social security ecosystem. It reflects our collective commitment to care for one another, not only in good health, but also when illness or disability affects our independence and dignity.

This Bill, by updating definitions, clarifying administrative provisions and streamlining service processes, demonstrates the Government's responsiveness to demographic shifts and societal change. While I broadly support the Bill, I would like to raise several suggestions for consideration, really aimed at strengthening the fairness, inclusion and sustainability within the CareShield Life framework.

Mr Speaker, Sir, clause 3 of the Bill introduces the concept of the Singapore Citizenship/Permanent Residence date. The date an individual becomes a Singapore Citizen or Permanent Resident. This clause rightly ensures that automatic coverage applies only if the person is not disabled at that point, safeguarding the integrity and sustainability of the insurance pool.

However, this may unintentionally exclude long-serving residents who attain citizenship or permanent residence later in life, after decades of service, taxes and social contribution. By the time they become Singaporeans or Permanent Residents, some may already have developed chronic or mobility-related conditions.

For such individuals, the inability to access CareShield Life coverage can leave them feeling vulnerable and dependent on family or charity. I would, therefore, urge the Ministry to consider a transitional enrolment mechanism, perhaps through a time-limited transitional enrolment window with medical review or a subsidised premium buy-in or a limited base-coverage plan for those with pre-existing conditions. This would combine fairness across cohorts and affirm our ethos that contribution to society should never go unrecognised.

Mr Speaker, Sir, second point concerns dementia, a condition that is sadly growing prevalent in our ageing society. Current estimates suggest that one in 10 seniors above 60 in Singapore lives with dementia, and this number is projected to reach well over 150,000 by 2030. As we know, dementia progressively affects memory, reasoning and daily functioning, often leaving the person dependent on full-time care. Yet, under current arrangements, dementia patients do not automatically qualify for CareShield Life claims and must, first, undergo a severe disability assessment to determine the impact of dementia or cognitive impairment on their functional abilities.

While clinical evaluation is important, this additional step can cause delay, uncertainty and emotional stress for families already struggling with care arrangements. I propose that these patients already have a clinical diagnosis of dementia and this could be used to trigger automatic base-tier eligibility under CareShield Life, with subsequent functional assessment determining higher-tier payouts.

This would affirm the dignity of those living with dementia and provide greater peace of mind to caregivers – many of whom are already ageing spouses or adult children managing multiple responsibilities. Recognising dementia under CareShield Life would bring policy coherence and, importantly, compassion into one framework.

Mr Speaker, Sir, the third area relates to mental health. While we have made commendable progress in destigmatising mental illness and expanding community mental health services, the CareShield Life framework remains primarily oriented around physical disability, although our National Mental Health and Well-Being Strategy rightly emphasises holistic recovery.

Yet, for many individuals, mental illness can be equally disabling, preventing them from working, maintaining self-care or even engaging socially. Conditions, such as severe depression, schizophrenia and bipolar disorder, can become long-term and debilitating.

In fact, as an example, one of my Jurong Spring residents often comes to me complaining that her 19-year-old nephew, due to schizophrenia, basically lies in bed for 18 hours a day, similar to many patients with physical disability, and this takes a toll on her as a single caregiver.

I would suggest that the Ministry explore ways to include mid- to severe-level mental illnesses within the Act's coverage parameters, based on formal and structured psychiatric assessment. The Government's plans to add 500 acute psychiatric beds by 2040 already underpin the burden of mental illness in our society.

Eligibility for this could be based on three factors: chronicity of disease, treatability and degree of functional impairment. These, of course, could be assessed by psychiatrists. By integrating mental health conditions into our longer-term care framework, we send an important signal that mental wellness is not peripheral to healthcare but central to human dignity and societal participation. This would also encourage early intervention, continuous treatment and family support, key tenets of our national mental health strategy.

Mr Speaker, Sir, clause 5 of the Bill introduces a new section 61A, which modernises how demand notes may be served, including electronically, which is a step forward, in my opinion, in administrative efficiency, aligning with our national Smart Nation vision and the broader digital transformation of our public services.

This same spirit of simplification can extend to the claims interface itself. Currently, caregivers of severely disabled or dementia-afflicted family members must navigate multiple forms, medical reports and appeals, often while juggling employment and caregiving duties. This process can be exhausting, especially when they are elderly caregivers who are not digitally fluent.

A unified online platform, perhaps integrated into current existing platforms, could allow caregivers to view eligibility status, submit documentation, receive updates and access related schemes, such as AIC support services.

Such streamlining would not only reduce the administrative friction but also convey empathy through design, ensuring that our social insurance processes are as humane as the principles behind them. Ultimately, a compassionate policy must also feel compassionate in process.

Mr Speaker, Sir, beyond financial assistance, the real test of long-term care policy lies in how it supports the people behind the patients – the caregivers themselves and I am really heartened to see Hon. Members Mr Ng Chee Meng, Ms He Ting Ru and Ms Yeo Wan Ling reiterated this in their speeches earlier. Many Singaporean families are quietly performing full-time caregiving roles at home, often without formal training or respite. They manage medications, behavioural changes and physical lifting, sometimes for years.

Recent heartbreaking cases remind us of the quiet struggles many caregivers face and the question that lingers is, who will look after the vulnerable when caregivers themselves can no longer do so? The emotional and financial toll is significant and while CareShield Life helps with the costs, it does not yet address the broader ecosystem of caregivers' needs.

I urge the Ministry to deepen integration and interaction between CareShield Life, the AIC, Silver Support and Healthier SG initiatives, so that financial, emotional and respite support reach families seamlessly. Such coordination would reflect a care partnership model, recognising that the caregiver's well-being is a crucial part of the patient's recovery and quality of life. As our society ages, empowering caregivers will become as important as funding the care itself.

Mr Speaker, Sir, the CareShield Life and Long-Term Care Act embodies Singapore's ethos of mutual care and responsibility – that we pool the risk as a society so that no one faces disability alone. The current amendments modernise and strengthen that system. But as we look ahead, we must ensure that CareShield Life continues to evolve from purely a financial safety net into a comprehensive framework of care and dignity – one that embraces mental and cognitive conditions, supports caregivers and includes all who call Singapore home.

By doing so, we move closer to a society that values every life, not just for its productivity, but also for its humanity. From insurance to assurance, that should be the next chapter of CareShield Life.

Notwithstanding my suggestions, Mr Speaker, Sir, I support the Bill.

Mr Speaker: Dr Wan Rizal.

5.15 pm

Dr Wan Rizal (Jalan Besar): Mr Speaker, I rise in support of the Bill. This first major review since 2020 strengthens a safety net that more families will rely on in the years ahead.

From 2026 to 2030, payouts under CareShield Life will grow at 4% a year, which means that a new claimant in 2030 can expect about $806 a month, a meaningful step-up to keep pace with rising long-term care costs.

To cushion the impact on households, I welcome the Government’s commitment of $570 million in additional premium support over five years, which will help moderate the premium increases for workers and families who are already managing higher everyday expenses.

I am also reassured that premiums remain fully payable by MediSave, because, at its heart, a national safety net must be accessible to all where no one should lose coverage simply because they cannot afford to pay at a point in time.

The case for action is clear. By 2026, Singapore will be a super-aged society. Severe disability can strike in mid-life as well as old age; claimants have ranged from 30 to 93, with a median age of 52.

As a labour Member of Parliament, I view this Bill through the lens of working families and caregivers on the ground. My remarks focus on the "3As": Affordability, Adequacy, and Accessibility, with prevention, cost transparency, and the care workforce woven through each.

Sir, the expanded means-tested premium subsidies, up to 30%, together with higher income thresholds and the increase of the Home Caregiving Grant to $600 in April 2026, will make a practical difference to households who are watching every dollar.

These measures are necessary, but they must also feel fair in real life, not just on paper. For many self-employed and commission-based workers, their incomes swing month to month. Means-testing should therefore reflect typical earnings over a reasonable period, rather than penalising a brief spike that nudges a family across a line.

Affordability must also recognise gendered realities. Women often shoulder more caregiving and face career interruptions; we should continue monitoring women’s affordability and study targeted participation incentives for those who have prolonged caregiving spells, so premiums remain manageable without eroding retirement adequacy.

Affordability also depends on families knowing what to plan for. To give households and policymakers shared, reliable signposts, I propose an Annual Long-term Care (LTC) Cost and Workforce Report. This should set out a simple, public “basic basket” of long-term care costs across home care, day care and nursing home settings, including transport and consumables, alongside wage and staffing trends in the care sector.

With clearer signals, we can calibrate subsidies early, rather than react late, and keep CareShield Life affordable and sustainable. Finally, the most affordable dollar is the one we never have to spend. Sustained investment in promoting physical and mental well-being, chronic disease control, early rehab, and community health can delay or possibly avert disability and reduce time spent in severe disability. Upstream health is not a slogan; it is the first pillar of affordability for our families.

So, I urge MOH to continue keep scaling Healthier SG community programmes that help workers maintain good health and mental health, so they can stay employed longer and recover better if illness ever strikes.

Sir, my next point is on adequacy. CareShield Life provides basic, lifelong protection. Keeping the claims threshold of three of six ADLs preserves affordability for the broadest base, while those who want earlier triggers can opt for supplement plans.

That balance between solidarity and choice is appropriate for a national scheme.

I note ground feedback that I have received from care workers and our unions that even with faster payout growth, the net dollar impact, after premium increases, may fall short for some families, and that some private supplements pay from one to two ADLs.

While I support keeping CareShield Life affordable at three ADLs, I ask MOH to publish side-by-side publications, illustrations of premiums and payouts, base scheme versus supplements, so households can make informed choices.

Adequacy must keep pace with reality on the ground. If care inflation or sector wage growth outstrips payout growth beyond 2030, we should be prepared to adjust the scheme parameters. The Annual LTC Cost and Workforce Report will give the Council and us in Parliament early warnings of cost and wage pressures, so refinements can be timely rather than overdue.

Adequacy rests on people, not just on numbers. When care workers are short-staffed or burnt out, our families end up paying more, paying more for private help or coping alone. We should therefore scale workplace transformation through Company Training Committees, for example, workflow redesign, assistive technologies, tele-rehab and AI-enabled documentation, to lift productivity while protecting rest time.

Crucially, productivity gains should translate into fair wages for care workers and tangible savings for families. A stable, respected workforce is how we keep services available at a standard and cost that families can live with.

My third point, Sir, is on accessibility. Access should feel straightforward in moments that are anything but. A single severe-disability assessment ought to open the door to related schemes, such as the Home Caregiving Grant, without repeated forms and revisits. Where clinically appropriate, tele-assessments can spare less-mobile seniors and time-pressed caregivers additional trips.

Two refinements would make the process fairer without changing the ADL threshold: first, assessment guidance should explicitly recognise supervision needs arising from cognitive impairment or serious mental health conditions, so assessors apply criteria consistently and compassionately; second, repeat assessments should be waived or further subsidised when a condition’s trajectory is pretty clear, and recent specialist documentation should be accepted where appropriate. Alongside this, aligning eligibility rules, including property AV thresholds, would prevent families from qualifying for one scheme but missing out on another due to technicalities. Mr Speaker, in Malay, please.

(In Malay): [Please refer to Vernacular Speech.] Sir, in my constituency of Kolam Ayer, comprising old estates like Bendemeer, Geylang Bahru, Sims Vista and St George's, many senior citizens live close to their children and grandchildren.

In many Malay/Muslim families, caregiving duties are shouldered by working family members, including the women, in addition to raising children and supporting parents. Daily costs, such as transport, adult diapers and follow-up treatment, can rise quickly, and the mental stress of caregivers often goes unnoticed.

Therefore, three priorities must be given urgency: flexible work as the norm so that caregivers can remain employed; a "one-stop" service for assessment, grants, such as the Home Caregiving Grant, and community services; and pathways to return to work through training credits, job placement and CPF support so that retirement needs are not affected.

These measures improve access, lighten the burden and protect the mental well-being of caregivers.

(In English): Sir, in conclusion, if we get the "3As" right, affordability with fair help and clear cost signals, adequacy that keeps pace with real pressures and is anchored by a respected care workforce, and accessibility that is simpler, faster and kinder, then seniors in our older estates like mine and caregivers across Singapore can face the future with dignity and confidence.

This Bill moves us in the right direction. Let us pair it with the Annual LTC Cost and Workforce Report that I suggested, sustained workforce transformation that shares gains with both families and workers, and continued emphasis on prevention and mental well-being. Mr Speaker, I support the Bill.

Mr Speaker: Mr Melvin Yong.

5.24 pm

Mr Melvin Yong Yik Chye (Radin Mas): Thank you, Mr Speaker. Sir, I stand in support of the Bill, which seeks to implement the recommendations made by the CareShield Life Council, ensure that premiums remain affordable and importantly, to improve administration of the CareShield scheme.

Sir, the CareShield Life scheme is an important assurance for many Singaporeans, as it provides those who cannot perform three or more ADLs with lifelong protection for their long-term care needs. This gives Singaporeans an important safety net, where long-term care will remain accessible and affordable, regardless of their pre-existing conditions.

My speech today will touch on how we can better enhance these two key aspects of CareShield Life – accessibility and affordability.

Sir, the minimum age for CareShield life enrolment is when the policyholder turns 30 years of age. While I can understand every policy needs a cut-off age, I would like to ask what the policy considerations were behind limiting CareShield Life coverage to those aged 30 years and older.

Would the Minister be able to share statistics of Singaporean adults between 21 and 29 years of age, who have severe disabilities and are unable to perform at least three or more ADLs. Does this statistic differ substantially for the age group of adults between the ages of 30 and 39?

Sir, I would like to take this opportunity to highlight the plight of my Radin Mas resident. Mr Ong has a 17-year-old son who has suffered an unfortunate brain injury and is therefore unable to engage in many ADLs. Mr Ong must therefore expend significant resources, and he has done so to ensure that his son is well cared for. Under the current scheme, Mr Ong’s son would only be able to enrol into CareShield Life when he turns 30.

I had written to MOH to highlight the plight of Mr Ong, and I understand from my resident that he was referred to caregiving support measures by the Agency for Integrated Care (AIC) and ComCare, as his son does not meet the minimum age for CareShield Life enrolment.

While I appreciate MOH’s assistance to the resident, the support provided by AIC and ComCare to Mr Ong are general schemes that would also apply to CareShield Life policyholders who are above the age of 30.

While such situations may be rare, I am certain that it is by no means unique. Others like Mr Ong and his son would benefit from an expansion to the accessibility of the CareShield Life scheme, by lowering the minimum age of enrolment.

Given the automatic enrolment nature of the CareShield Life scheme, I propose that we should have parity with other national insurance schemes that provide automatic insurance coverage. For example, the CPF Board’s Dependants’ Protection Scheme (DPS), where automatic insurance coverage in the event of death, terminal illness, or total disabilities, is extended to Singapore Citizens and Permanent Residents above the age of 21, with an option for manual application for those aged 16 and above.

While DPS and CareShield Life serve different purposes, the minimum age for coverage for debilitating injuries should be harmonised. I therefore urge MOH to consider expanding CareShield Life coverage to all adults from 21 years of age, with an option for manual application for those aged 16 and above.

We already have existing systems in place for family members to use their Medisave to pay for the CareShield Life premiums for other family members. This can be extended to the younger cohort of policyholders that I am proposing for them to be covered by CareShield Life. The various premium support measures by the Government for lower-income families can also be extended to policyholders below the age of 30, thereby ensuring minimum financial burden.

Expanding CareShield Life coverage to more adults could also have potential advantage of lowering overall risk, helping therefore to keep premiums affordable to everyone.

Sir, let me next touch on enhancing affordability of our long-term care needs. I support the proposal to double the CareShield Life payout growth rate. This is vital to ensuring that CareShield Life payouts continue to defray a meaningful portion of long-term care costs and keep bills affordable for more Singaporeans.

This is especially important as Singapore becomes a super-aged society, and our healthcare expenses continue to increase. Singaporeans should not just rely on CareShield Life. Indeed, many consumers already have private insurance policies to provide additional coverage in the event of a health incident that results in severe disability.

Despite this, insurance literacy in Singapore remains low. It is common to read in the media about consumers frequently being both under-insured where policyholders do not have adequate insurance coverage, and over-insured where policyholders have duplicate policies and excessive coverage amounts.

Both situations of being under-insured and over-insured are not ideal, as it leads to policyholders paying more and increasing their financial burden over time. But it can be hard for consumers to cut through the noise when it comes to insurance. In fact, the CPF Board has an entire toolkit, called the Health Insurance Planner, to try and help policyholders cut through "the sheer volume of conflicting advice that makes it hard to know what to trust."

We must do more to improve insurance literacy and help consumers save on their healthcare bills. I urge MOH to work closely with the Consumers Association of Singapore to study insurance literacy in Singapore and to work on improving consumer knowledge about how to best safeguard themselves against sudden, unintended, healthcare expenses.

In closing, the amendments proposed under the Bill are timely, as it will help ensure that CareShield Life payouts continue to defray a sizeable proportion of healthcare costs for those who suffer severe disabilities. I urge MOH to expand the minimum age of enrolment for the scheme, to help young adults with disabilities and to improve insurance literacy among consumers. Mr Speaker, I support the Bill.

Mr Speaker: Dr Choo Pei Ling.

5.32 pm

Dr Choo Pei Ling (Chua Chu Kang): Mr Speaker, Sir, I would like to declare that I am a registered member of the Allied Health Professions Council and my work involves assessing, treating and educating on disability.

CareShield Life will play an increasingly vital role in our social safety net as we join the ranks of super aged societies. As a cornerstone of our national insurance framework, its financial support ensures that Singaporeans and Permanent Residents with severe disability and who require long-term care will have the funds to meet their care needs. I support the review and recommendations of the CareShield Life Council, which have been timely and necessary. Its stance is balanced, weighing the need for sufficient payouts for essential care against affordable premiums.

To be sustainable in the long term, higher payouts have to be backed by corresponding premium increase rates. Hence, the Government's transitional support for policyholders in the form of premium subsidies, is welcomed. After this five-year financial support ends, how would the Government ensure that the premiums remain affordable? Would the MOH consider premium discounts for policyholders who lead healthier lifestyles, such as abstention from smoking?

I welcome the Government's decision to improve and simplify the claims process and streamline applications across all national care schemes which the claimants are eligible for, as recommended by the Council.

One of the Council's recommendations being considered by MOH is tele-assessments for claimants, in addition to those performed at their own residences, public hospitals and the assessors' places of practice, such as clinics. When does the Ministry expect to conclude its feasibility study on this? How will the assessors guard against fraud and potential misdiagnoses for tele-assessments?

Assessors play a pivotal role in the CareShield Life scheme, serving as the gatekeepers who determine eligibility for payouts based on an individual's ability to perform ADLs. Their assessments directly impact the timeliness and fairness of financial support for those in severe disability, making their expertise and judgment essential to the integrity of the system. As we seek to improve the claims process and make it more claimant-friendly, it is timely to ask: what qualifications and training are required to become an assessor and how are we ensuring that there are enough assessors to meet growing demand?

As of 2024, there were 1,821 active claimants under CareShield Life. The age of the claimants ranged from 30 to 93, with about half of them in their 30s and 40s.

Would MOH provide a breakdown of the claimants by age groups of 10, for example, starting from age 30 to 40, 40 to 50 and so on; and by types of major causes, such as strokes, hereditary diseases and so on? With these information, would it be possible to implement preventive measures to reduce the number of cases in each age and vulnerability group?

In addition, would the Ministry share how many cases of appeal it had received in each of the years since CareShield Life started? What were the percentages of successful and unsuccessful appeal cases? What were the lessons learnt from these appeals and how has the Ministry improved on its assessment process?

Mr Speaker, these changes demonstrate our commitment to make CareShield Life financially sustainable and people-centric in its delivery. We must continue to review the scheme periodically to ensure that it serves our people expediently and compassionately in their time of need. I support the Bill.

Mr Speaker: Mr Yip Hon Weng.

5.37 pm

Mr Yip Hon Weng (Yio Chu Kang): Mr Speaker, Sir, this Bill strengthens one of our most important social-safety pillars – long-term care protection for Singaporeans. The decision to double payout growth to 4% until 2030 is both bold and prudent. It helps residents keep pace with rising care costs.

The Government's $570 million in additional premium support also sends a clear message – as we enhance the scheme, we will not leave low- and middle-income families behind. Yet, a scheme of this scale must be more than sustainable and fair in design. It must also be compassionate and clear in execution. With that in mind, I will raise four key areas for clarification.

Mr Speaker, Sir, my first point concerns section 6, which governs automatic inclusion. The amendment replaces the earlier threshold of being "not severely disabled" with a new statutory test of being "not disabled." The difference may seem subtle, but it can be significant. An individual must now be able to perform all six ADLs without assistance, all the time. That is a much higher functional bar.

Under the new section 6(1)(b)(iii)(A), Singaporeans and Permanent Residents born before 1980 will be automatically enrolled only if they are not disabled when they first become citizens or Permanent Residents. Those who are disabled at that time will not be automatically included. However, under section 6(4)(b), the CPF Board retains discretion to cover such individuals on a case-by-case basis.

For those who became Singapore citizens or Permanent Residents before the commencement of this amendment, the earlier "not severely disabled" threshold will continue to apply. This ensures continuity and fairness for those who entered the scheme under earlier rules.

Reinstating underwriting for older cohorts is understandable for financial sustainability. But it also risks leaving behind residents who are still in recovery. A caregiver in Yio Chu Kang once told me about her husband's post-stroke journey: "Some days he can lift himself. Some days he cannot." Should a single assessment, taken mid-recovery, permanently close the door to protection? Could the Ministry consider a more compassionate filter, such as, temporary waiting periods or premium loadings for manageable pre-existing conditions? This approach would allow recovery and inclusion to remain possible, while managing risk fairly.

And for those still in rehabilitation, could there be a reassessment window, perhaps 12 to 24 months later, to give them a second chance once their condition stabilises? Making a lifelong decision based on one judgment carries enormous weight. We know assessor judgments can vary. What training and quality-assurance framework will ensure consistency, so that residents' futures are not determined by luck?

Finally, transparency builds trust. Will MOH publish annual statistics on applications, acceptances, rejections and appeals for this older-cohort group? This will help the public monitor fairness and coverage over time.

Mr Speaker, Sir, my second point concerns disability assessments. The "assess once, apply to many" approach reduces paperwork for families. But it also means that the result of a single assessment now carries more weight than ever before.

The Bill codifies in the new Fourth Schedule that a person is "not disabled" only if they can perform all six ADLs without assistance, all the time. This phrase, now enshrined in statute rather than just clinical guidance, represents a significant tightening of the functional benchmark. It may be precise, but it does not reflect the lived reality of many seniors whose abilities fluctuate from day to day. Some residents worry that outcomes can feel like a lottery – depending on who their assessor is, where the assessment is held, or even the time of day.

How can we assure them that the system sees people, not checkboxes? Will MOH publish the clinical guidance and training protocols for accredited assessors? How frequent will audits be? Will the results, such as inter-assessor reliability rates, be made public? And if a resident disagrees with an assessment, can they appeal directly through CPF Board channels?

Beyond procedure, the assessment must capture lived reality. A 30-minute clinical test cannot show how a senior manages narrow corridors, steep steps, or the absence of grab bars at home. Can caregiver testimony and home-environment factors be formally considered as part of every assessment?

A caregiver in Yio Chu Kang told me that bringing her frail mother across town for an assessment left both of them in tears. To ease such stress, can MOH pilot video-based assessments for bedridden seniors, conducted with caregivers present? To safeguard the integrity of ADL assessments, I suggest three measures.

First, a second assessment by another provider upon appeal, so no senior's fate rests on one single judgement. Second, formal integration of caregiver testimony into reports and third, public release of audit and appeal data to reinforce public trust. I also note that under section 63 of the Act, the Minister may amend the Schedules – including this new Fourth Schedule – by order in the Gazette. This flexibility is important to ensure that our definitions of disability can evolve alongside medical knowledge and social realities.

Mr Speaker, Sir, my next point concerns the Bill's overhaul of document service under sections 61 and 61A. These clauses modernise how official notices, including demand notes, are served. Importantly, the Bill now requires written consent, replacing the previous implied consent for email service. This is a significant safeguard. Written consent may be given in either physical or digital form, but it must be explicit and verifiable, not assumed. I support this move.

Still, we must ensure seniors truly understand what they are consenting to. How will we protect seniors from replying to fraudulent emails that look official? Under the new section 61A, a demand note can be served by post, by hand, by fax or by email. Email service is only allowed with written consent, or if the person replies to an email after being clearly informed that such a reply counts as consent. This legal structure is well thought out. But will ordinary residents understand it?

To reduce confusion, can all demand notes, whether physical or digital, be written in plain language, in all four official languages and paired with an SMS alert? A simple text saying, "You have an official notice. Please check your mailbox or MyInfo", can prevent panic and reduce the risk of scams. Most critically, can the Senior Minister of State assure this House that no policy will lapse while a senior is still clarifying a discrepancy or appealing a premium issue? Efficiency must never come at the cost of compassion. Furthermore, to shift responsibility from seniors to the system, I would suggest for digital-only communication to be opt-in for residents aged 65 and above. Those who are confident online can choose it. And those who are not, should continue receiving paper notices.

Fourth, Mr Speaker, Sir, looking ahead, the 4% payout growth until 2030 gives citizens confidence for the near term. But long-term care is a multi-decade challenge.

Can the Senior Minister of State share how payouts will be indexed beyond 2030? Will there be an automatic formula pegged to a dedicated long-term care inflation index? Or will each adjustment still require a separate review? To ensure payouts remain meaningful, could MOH set a public benchmark? For example, anchoring benefits to a fixed proportion of median nursing home or home care costs. Would the Ministry also consider a triennial actuarial review tied specifically to long-term care inflation? A predictable three-year cycle would make adjustments transparent and consistent.

Yet, payouts are only half the story. The other half is access to care. In estates like Yio Chu Kang, where senior density is high, residents worry not just about affordability but also availability. Will there be enough home care slots, therapists and community-based services nearby?

In conclusion, Mr Speaker, Sir, this Bill strengthens the foundation of CareShield Life. But our task is not only to build a stronger system. It is to build a more human one.

In my speech, we have spoken about fairness, making sure that older Singaporeans who are still recovering are not permanently excluded. We have spoken about compassion, ensuring disability assessments are consistent, holistic and grounded in the lived realities of our seniors and caregivers. We have spoken about protection, guarding senior residents from confusion and scams as services move online. And we have spoken about foresight, keeping CareShield Life sustainable and meaningful well beyond 2030.

These are not administrative details. These are choices about the kind of society we want to grow old in, one defined by fairness, empathy and respect. As policymakers, our responsibility does not end with legislation. It begins with listening, to every caregiver, every senior who worries about digital notices and every resident who wonders if the system will remember them when they grow old.

Let us make CareShield Life not just a financial safety net but a moral compact. One that says, in Singapore, we see our seniors not as dependents but as dignified individuals who built the foundation we now stand on. Let us commit, as Government, as community, as people, to ensure the compassion we enshrine in this Bill is felt in every assessment, every letter and every act of care.

Mr Speaker, Sir, this is the Singapore we must build, one where no one is left behind, not by circumstance, not by design and not by time. I support this Bill.

Mr Speaker: Ms Elysa Chen, you have a clarification?

Ms Elysa Chen: Mr Speaker, I would like to make a clarification. I said earlier that payouts would grow from $731 monthly in 2026. I misspoke. The figure should be $689.

Mr Speaker: Alright, thank you. Senior Minister of State Koh Poh Koon.

5.48 pm

Dr Koh Poh Koon: Mr Speaker, Sir, I thank Members who have spoken for their unanimous support for the amendments proposed in this Bill. And I thank them also for the thoughtful questions and useful suggestions they have given. I have touched on some of these in my opening speech. So, I will now elaborate more on those other areas that were raised by Members on three different areas: one, supporting Singaporeans with long-term care needs; two, keeping CareShield Life affordable and sustainable; and three, simplifying processes and improving access to financial support.

First, on supporting Singaporeans with long-term care needs. I have already explained this earlier but I think it is worth re-emphasising that CareShield Life cannot be seen in isolation. It must be viewed alongside other layers of long-term care support, such as subsidies and grants, healthcare savings and social safety nets.

Mr Ng Chee Meng and Ms Yeo Wan Ling will be heartened to know that the Government has been progressively enhancing these layers of support. We enhanced the Caregivers Training Grant last year to better support individuals undergoing caregiver training. From next year, long-term care recipients and their caregivers will also enjoy further support for long-term care, through enhancements to Home Caregiving Grant and long-term care subsidies. Together, these enhancements to financing mechanisms complement each other to ensure that Singaporeans can access affordable long-term care when they need it most.

We recognise that Singaporeans have different long-term care needs and preferences. As earlier mentioned, this is why we have made CareShield Life optional, for existing Singapore Citizens and Permanent Residents born 1979 and earlier. As for new Singapore Citizens and Permanent Residents, they are required to join CareShield Life as part of the compact of becoming a new Singapore Citizen or Permanent Resident and this is made known to them at the point of application to be a citizen or a Permanent Resident.

Mr Ng Chee Meng asked how the Government will ensure that CareShield Life payouts remain meaningful and adequate. The CareShield Life Council had recommended doubling the payout growth rate from 2% to 4% per annum to allow payouts to more meaningfully cushion against rising long-term care costs. The Council considered whether to make further enhancements to payouts, but was careful to balance benefit enhancements with premium affordability for policyholders. As part of the review, the Council consulted the public on a range of enhancement options through focus group discussions, including a higher payout growth rate.

However, ultimately, there was recognition that premium affordability must remain a priority for our national scheme designed to provide basic coverage. The Council's recommendation therefore balanced the need for meaningful support while keeping CareShield Life accessible to all Singaporeans.

Nevertheless, those seeking more comprehensive coverage on top of CareShield Life and who are willing to pay higher premiums for this can consider privately-offered supplement products. The premiums for these can also be paid for using MediSave, up to the annual withdrawal limits.

I would like to preface that the ADLs construct, is recognised internationally for disability assessments by entities, such as the World Health Organization and the European Union. It is also commonly used by insurers. This is because the ADLs construct is an objective measure of the level of caregiving assistance that a patient requires, regardless of the underlying conditions. For the purpose of CareShield Life, the loss of three ADLs remains an appropriate threshold to indicate severe disability and higher care needs.

Mr Alex Yam, Dr Wan Rizal and Dr Hamid Razak asked how CareShield Life supports those with cognitive disabilities and impairments, such as dementia patients, as they, too, have significant care needs.

MOH's severe disability assessment framework does consider the impact of cognitive impairments on one's ability to independently perform an activity of daily living. For example, an individual with severe dementia may physically be able to chew and swallow the food but may not remember how to do it without supervision. This individual would be assessed to be unable to perform this ADL due to his cognitive impairment. And you can imagine, the same patient with dementia who may not be able to remember how to feed himself or herself could well also not remember how to dress himself or herself and may also have problems managing their toileting functions and, in which case, they will have crossed the threshold of three ADLs to qualify for payouts. Such individuals, therefore, can qualify for CareShield Life payouts when they are unable to perform three ADLs.

Mr Melvin Yong asked if the CareShield Life mandatory enrolment age can be lowered from age 30 to 21, with an optional enrolment application for those aged 16 and above.

CareShield Life policyholders pay premiums during their working years for protection against severe disability, which occurs mostly at older ages. Mandatory coverage begins at age 30 as most Singaporeans would have started work by then, have some income and savings in their MediSave accounts so they can use these MediSave savings to pay for their premiums. So, it is a design feature of CareShield Life to make sure that it is something that is affordable, that those who have begun working for some time will begin to be able to service their premiums.

If we extend CareShield Life coverage to those aged 16 and above on an optional basis, this will lead to adverse selection where those who are more likely to make claims are more likely to opt in. This will push up premiums for everyone else in that cohort. There is a clear trade-off here and such a move needs to be considered very carefully. But I would like to assure Members that young Singaporeans with disability requiring assistance to perform their ADLs, can access other Government schemes besides CareShield Life and these include, long-term care subsidies and grants, such as the Home Caregiving Grant, as well as safety nets, such as MediFund. So, we will make sure that care is affordable and is accessible to everyone.

Second, on keeping CareShield Life affordable and sustainable.

Members would appreciate that for any insurance scheme to be sustainable, enhancements in benefits must be accompanied by a corresponding adjustment in premiums. Several Members who spoke earlier made this point as well.

To support the increase in payout growth rate, there needs to be a one-step increase in premiums in 2026, followed by 4% increase per annum thereafter. Given that the one-step increase is something that may be of concern to policyholders, we are providing an additional $570 million in premium support to cushion the increase for all policyholders. This includes transitional premium support to spread out and slowly phase in the increase over the next five years. With this support, annual premium increases from 2026 to 2030 are moderated to $38 on average and no more than $75. Lower- and middle-income policyholders will see even lower premium increases, as they will enjoy further subsidies.

Mr Ng Chee Meng, Ms Joan Pereira and Dr Choo Pei Ling asked how we can keep premiums affordable even after this transitional support ends. Beyond the transitional support, MOH will continue to provide means-tested premium subsidies for lower- and middle-income policyholders. This will offset up to 30% of their premiums.

Premiums will also continue to be fully payable by MediSave, with additional support provided to those with lower MediSave balances. Recently, in July 2025, the Government provided MediSave top-ups of about $320 million to 600,000 Singaporeans. The Government will also be introducing the Matched MediSave Scheme from 2026, with 1:1 Government matching for voluntary cash top-ups of up to $1,000 per year, for those with lower MediSave balances.

Lastly, there is also the Additional Premium Support for policyholders, which Assoc Prof Jamus Lim asked about. We will extend invitations to policyholders who are unable to afford their CareShield Life premiums even after subsidies and family support to apply for this additional premium support. I would like to assure this House and reiterate, once again, that no one will lose CareShield Life coverage due to an inability to afford premiums.

Ms Jessica Tan and Dr Wan Rizal have asked about the means-testing framework. In particular, concerns have been raised on whether the current approach towards considering property AV disadvantages some policyholders, such as in a scenario in which policyholders receive less subsidies after retirement when they no longer earn an income.

Let me, first, recap that CareShield Life premiums are typically paid through MediSave contributions during one's working years. So, in general, policyholders from lower-income households receive more premium subsidies than those from higher income households. For most policyholders, there will be no more premium payments after retirement, as CareShield Life premium payments currently end at age 67. This is pegged to the re-employment age in 2020 when the scheme was launched. So, the issue of a retiree living in a private property with high AV is not really relevant here. Most of them, by that age, would have stopped paying premiums. Only a small group of individuals in the Optional Cohort, who had chosen to opt-in at older ages, would have to pay premiums beyond age 67. We, likewise, support eligible individuals through premium subsidies and, in addition, those who joined before 31 December 2024 would have also been receiving additional participation incentives of up to $4,000 in total, to offset their premiums.

Should anyone still face difficulty paying premiums after subsidies and other support, the Government will provide Additional Premium Support to fully cover their premiums. I say again, to fully cover the premiums. This is why I keep saying to Members that no one will lose CareShield Life coverage due to an inability to pay their premiums.

Ms Yeo Wan Ling, Ms He Ting Ru and Dr Wan Rizal raised concerns about premium affordability for women. This was also discussed extensively in this House in 2019 when CareShield Life was first introduced.

In general, within any insurance risk-pool, premiums are actuarially priced such that the premiums collected can pay out for expected claims. This is the case for both men and women.

Here, gender is a relevant factor for CareShield Life as the key parameters that affect long-term care insurance claims such as lifespans, duration and likelihood of disability do vary between men and women. Women tend to live longer than men and are more likely to develop severe disability, and therefore are more likely to stay in disability for a longer period.

This has remained the case in the past few years too. It will mean that in the event of a severe disability, a woman will typically receive CareShield Life payouts for a longer duration.

Support is available for women in lower-income households through existing support schemes, including premium subsidies and Additional Premium Support. Beyond these measures to ensure premium affordability for those who need more support, there is also a need to ensure that the long-term trajectory for CareShield Life premiums remains sustainable and affordable for all policyholders.

As I listened to Ms He Ting Ru's speech, I got the sense that she has not quite grasped the features of CareShield Life. There are two distinct features in CareShield Life that are quite different from all other insurance schemes.

The first is that this is a cohort-based risk pooling. In other words, the risk-pooling happens in your age cohort. It is not whole-population risk pooling, it is risk pooling among those who are born in the same birth year. It means that the burden of any premium that needs to go up is borne by a lower number of people, just in that age cohort alone.

The second feature is that this is a pre-funded scheme with limited premium contribution duration but has a lifelong payout as long as a person remains in disability.

These are two unique features.

As I said earlier, women do live longer and reach older ages where severe disability becomes more likely. The average life expectancy for women is 85.6 years in 2024 compared to 81.2 years for men. We can all understand that as one ages, at older ages, women are 10% more likely than men to enter severe disability at a given age.

This is not about discriminating women, this is just biology. It is just the way science is. As you get older, as you live longer, you are just at a higher risk for many other health problems. Women are at a higher risk of getting osteoporosis compared to men. They are therefore more likely to get severe hip fractures when they sustain a fall and they may remain disabled for a far longer period of time.

If I can just contrast the design of CareShield Life with MediShield Life, which will hopefully illustrate why there is that gender differentiation in the premium.

MediShield Life policyholders pay premiums for life as opposed to CareShield Life, where you stop paying when you reach 67. This means that for MediShield Life, there is no need to insure against the different life expectancies across genders, because the premiums are payable for every year of coverage. If you live longer, you just pay more premiums. For every year you live, you pay.

CareShield Life, as I have said, one of the features is that it is pre-funded – for a limited duration, while one is working. Over a lifetime, while women may make more claims due to a longer life expectancy, they will also have to pay more for their premiums because there is the only fair principle. If you are going to claim more and claim for longer, one pays more during the contribution years.

Sir, it is about being fair to both genders. It is not about discriminating women or being unfair to women. It is also being fair to the men. Remember, this is about risk-pooling within one cohort, with a limited number of people sharing the risk and therefore, maintaining the payouts for that cohort that needs to claim.

A key change that we are introducing through this Bill is intended to safeguard the sustainability and affordability of CareShield Life. By restoring the underwriting criteria for the scheme, we will lower premiums for older Optional Cohort policyholders who today pay higher annual premiums than the mandatory cohort policyholders who joined the scheme at a younger age.

I hear Ms Elysa Chen, Ms Jessica Tan and Dr Hamid Razak's concerns over whether reinstating underwriting criteria would make the scheme less inclusive. Let me take the opportunity to emphasise that for all Singapore Citizens and Permanent Residents born in 1980 and later, CareShield Life coverage is universal, regardless of preexisting disability.

This means that a young person in the mandatory cohort with preexisting disability will still be auto-enrolled when he turns 30 years old. He will pay the premiums for his age once on enrolment and if he is determined upon disability assessment to meet the three ADLs threshold for severe disability, he will be eligible for claims for life thereafter and stop paying further premiums.

This is how we make sure that the scheme is inclusive and takes care of those with needs.

For the Optional Cohort, those born in 1979 and earlier, we had provided a time-limited concession for those with mild or moderate disabilities to join the scheme. This concession, as I have said earlier, was originally intended to be for two years, up to 2023. After two years, we extended this concession to enable more to join in. The extension enabled us to redouble our outreach efforts in the post-COVID-19 period. We also extended the duration of participation incentives and conducted extensive outreach to seniors to encourage them to join. In fact, the concession period lasted for about four years in total.

As of June 2025, about 900,000 individuals in the Optional Cohort, or about half of the cohort, have enrolled in CareShield Life. If we were to include those who chose to remain on ElderShield, about seven in 10 older Singaporeans are enrolled in our national long-term care insurance schemes. So, the coverage is not bad.

As shared in my opening speech, new CareShield Life applications from the Optional Cohort have decreased by almost 90% compared to when the scheme was first launched. Most Optional Cohort individuals who wanted to join CareShield Life would have already done so by now. Hence, the CareShield Life Council has assessed that it is timely to reinstate the planned underwriting criteria from 1 January 2026 onwards.

This will moderate the premium impact for all Optional Cohort policyholders, keeping the scheme fair and sustainable. To keep the scheme fair, this approach will be taken for new Singapore Citizens and Permanent Residents of the same age groups as well.

Ms Mariam Jaafar, Ms He Ting Ru, Ms Joan Pereira and Ms Elysa Chen asked whether there have been sufficient provisions made for those in the Optional Cohorts who may have chosen not to enroll in CareShield Life.

As mentioned in my opening remarks, there are different layers of financial support for those who require long-term care. Individuals may have chosen to prepare for and pay for their long-term care in other ways, such as through personal savings or private insurance. For those who are not enrolled in CareShield Life, there continues to be other layers of support, such as subsidies and grants, which have been significantly enhanced recently. I hope this addresses Ms He Ting Ru's concerns.

MOH will continually review our financing schemes to ensure that long-term care costs remain affordable.

Another change we are making through this Bill is to strengthen our provisions for premium recovery. Specifically, the provisions in the Bill enable us to serve important documents to policyholders through additional modalities, including electronic means.

Let me explain that this is on top of existing modalities, not replacing existing modes. So, I want to assure Mr Alex Yam and Mr Yip Hon Weng that physical notifications will continue to be sent to all policyholders where necessary, including those who are less tech savvy.

More broadly, the changes are necessary to equip our administering agencies with tools to recover premiums that are due. Without such tools, premiums owed by wilful defaulters will become bad debt, which will be borne as higher premiums by other policyholders in that cohort. This is unfair to those who have been responsibly paying their premiums.

Members have rightly observed that an ageing population and rising costs of care could present challenges to premium affordability over the long run. We agree with Ms Mariam Jaafar that sustained investment in prevention and well-being is crucial. The Government is paying close attention to these trends and has embarked on national strategies to address this. This includes Healthier SG and Age Well SG, which aim to empower Singaporeans to live healthy and active lives.

By staying in good health, we not only minimise the cost of care, but importantly, enable every Singaporean to live their lives to the fullest. That in itself should be the biggest benefit to Singaporeans, although there are also other subsidies and incentives in place to promote preventive health.

Dr Choo Pei Ling suggested offering CareShield Life premium discounts for those who lead healthier lifestyles. At the heart of Dr Choo's question and suggestion is the principle that prevention is better than cure. We fully agree with that. I had earlier shared the strategies the Government has rolled out to support healthy and active living. Premium discounts are an extension of this.

MOH had rolled out a premium discount pilot for MediShield Life just last month. Eligible Singaporeans participating in healthy lifestyle programmes and challenges will be rewarded with discounts of up to $580 off their MediShield Life premiums per year.

Unlike MediShield Life, CareShield Life is still a nascent scheme with just a few years of claims experience. This is especially since onset of severe disability typically takes place only at older ages and most CareShield Life policyholders are still young today. Therefore, there is only limited data, including on how healthy behaviours translate to lower claims for severe disability.

When more claims data is available, we can consider if similar premium discounts can be considered in future.

The CareShield Council will also review CareShield Life regularly over time to ensure that both the benefits and premiums, including the actuarial assumptions, remain relevant and sustainable over time as our demographic profile evolves.

The Council regularly monitors the financial status of the CareShield Life and ElderShield Insurance Fund to ensure that premiums, which are set on a non-profit basis, remain adequate to sustain the scheme's obligations to all policyholders over time. In response to Ms He Ting Ru's question, I want to assure her that the information on the Fund, including the amount of claims and investment claims, is already publicly available in CPF Board's annual financial statements.

Third, on simplifying processes and improving access to financial support.

Before I elaborate further, let me just first clarify with Assoc Prof Jamus Lim that CareShield Life is administered by the CPF Board and not outsourced.

We fully acknowledge the challenges faced by caregivers. We are committed to improving the user journey for care recipients and caregivers and ensuring a citizen-centric experience that allows residents to get support in a timely manner, as Ms Mariam Jaafar has shared.

Since CareShield Life was launched, we have doubled the number of severe disability assessors island-wide from over 300 at launch to now more than 700 assessors. More GPs in the community, therapists and nurses are being trained, and every public hospital now has in-house assessors. We have also expanded the number of assessors who perform house calls to improve access and convenience for policyholders.

MOH and AIC will press on with efforts to expand our assessor pool. I would also like to assure Mr Yip Hon Weng as well as other Members that we will continue to ensure that assessors are rigorously trained to conduct fair and high quality assessments. These assessment outcomes are also subject to further clinical reviews, if necessary.

Sir, I agree with Members that we can make our financial support schemes more seamless. We now have nine AIC Link offices across the island. These serve as a one-stop resource to help connect care recipients and their caregivers to the support they need. Our Silver Generation Ambassadors also reach out to seniors to explain schemes in a clear and more personal manner.

As Mr Melvin Yong and a number of Members have noted, better awareness and insurance literacy can help families make more informed financial decisions. Community touchpoints also continue to remain an important source of help for seniors and caregivers to understand the suite of long-term care financial support schemes available. We will continue to work with AIC and community partners to reach out to families to increase awareness of the support available.

We agree with Ms Mariam Jaafar that we can make our scheme application process more claimant friendly. One way we have done so is by giving residents the opportunity to be automatically assessed across various disability schemes after having undergone a disability assessment. This reduces the administrative burden and ensures timely support for families. We will continue to identify areas for improvement and ensure the claims process remains efficient and responsive to policyholders' needs.

Mr Speaker, ageing is part of life's journey. While we cannot stop time, we can shape how we age. The Government is taking steps to empower Singaporeans to lead active, healthy and purposeful lives in their silver years through national initiatives such as Age Well SG.

Some of us may come to require more support for our ADLs. Our commitment to Singaporeans is that we will continue to develop our care ecosystem through more community care services and Age Well Neighbourhoods, to enable more to age-in-place confidently.

Financially, we have reviewed our support ecosystem to ensure that Singaporeans have access to affordable care through enhancements to long-term care subsidies and grants earlier this year. With the enhancements to CareShield Life, Singaporeans can be assured that these insurance payouts, too, will continue to provide meaningful support for long-term care, should they need it. The Council will continue to review the scheme to ensure that it remains relevant to policyholders.

This Bill supports these enhancements by strengthening the legislative framework to ensure that the scheme remains fair and sustainable through appropriate underwriting criteria and enhanced premium recovery mechanisms. These amendments will help ensure that CareShield Life continues to provide essential financial protection when families need it most, for current and future generations of Singaporeans. I thank Members for their support of this Bill. Mr Speaker, Sir, I seek to move.

Mr Speaker: Are there clarifications from Members? Ms Jessica Tan.

6.16 pm

Ms Jessica Tan Soon Neo: Mr Speaker, I do have a clarification for the Senior Minister of State. He says that the AV is not relevant for retirees. I would say it is relevant with regard to CareShield Life premium because the assumption is that people only retire at 67. But that is the reemployment age and many of my residents had to have to retire before that and they are in their early 60s; because either of poor health, sometimes because of caregiving needs because some of their family members require it so they do have to retire slightly earlier.

And some, their jobs are disrupted and for someone older, especially a matured professional, it is usually harder to get a job at that age. And so, therefore, it is relevant, and they have no income and if they happen to live in a property that is just slightly above the threshold, they do not qualify. And it is not just for CareShield Life premium, but like I said, it is the same means-testing for across all the other long-term candidates so it sort of exacerbates the point. So, I hope the Senior Minister of State understand that it is still relevant.

Dr Koh Poh Koon: Sir, I thank Ms Jessica Tan for raising that concern. But let me just say that the biggest assurance from my speech today that the Member should take back is that, under whatever circumstances, if a Singapore Citizen cannot pay any part of the premiums needed, we will cover fully whatever is needed through the additional premium subsidies to make sure that no one is without coverage for CareShield Life. In the instance if there is any premium that is owed, we will not hold back the disbursement of support that is needed for this individual and talk about the recovery of the premiums that may take place at some point in time. But we will act with compassion and make sure that the person who needs the payout from CareShield Life will not have a lapse of payment from CareShield Life in any instance.

Mr Speaker: Ms Tan.

Ms Jessica Tan Soon Neo: Thank you Mr Speaker for your indulgence. The Senior Minister of State, I hear him and I agree with him and I have his assurance on CareShield Life premium. I just hope that we look at it in a more holistic landscape. As the Senior Minister of State have said, long-term care is a larger framework and because the current support framework is based on that same criteria and therefore that is why I am harping on this point because it is a larger impact and I do see families, they are seniors themselves and they care for other seniors or families with disability and that little bit more support will make a big difference.

Mr Speaker: Ms He Ting Ru.

Ms He Ting Ru: Mr Speaker, I thank the Senior Minister of State for the response. I have a couple of clarifications for the Senior Minister of State. The first being while we acknowledge that women are at risk of longer-term disability and living more years in ill health and this I acknowledged in my speech. I think the point I was making is and this is why I raised the New South Wales study, which found that even though the level of disability in their case was about 50/50 between women and men, they found that women actually only made up for 37% of the claims and one of the reasons or the concerns raised there was that women were actually not, for whatever reason, not claiming as much.

So, I was just wondering whether we are facing similar challenges here in Singapore and whether the Senior Minister of State can share some data about the differentiation between the claims because biology, lifespan, health span all that is one thing. But, of course, what matters in the case of an insurance scheme is the actual claims and the actual data and who is actually claiming and for how long. I think it would be helpful for the House to understand this.

And the second point would be about, again, more on the gender-differentiated premiums. I just wanted to note that yes, we understand, at least I understand that the cohorts is by age cohort and I think the point that I was making was how can we work towards making each cohort gender neutral? And, in fact, this was a point that was raised in 2018 by the Leader of the Opposition when he actually stated, noting at the same time the then-health Government Parliamentary Committee Chair had also called for how we can move towards gender neutral premiums, and Mr Singh at that time also said that it would mean men will pay more and women less, let it be so.

Dr Koh Poh Koon: I thank Ms He for her two clarifications. On the first one, for claims data. I think this CareShield Life is barely about five years and as I said earlier, many of the policyholders today are still quite young and the claims data is, at this point, not mature enough for us to draw any robust conclusions. But the way we do it, on your second clarification, was the fact that we use principles from actuarial science to actually price the premium based on the gender differences in their biological behaviour over time. And the Council is prepared to relook at actual data over time and decide if further adjustments are needed. Whether it will move towards completely equal parity between men and women, I do not know. Maybe men will participate more in Healthier SG and become healthier, and they can live just as long. We might reach parity but only time will tell how the data will pan out.

Mr Speaker: Ms Mariam Jaafar.

Ms Mariam Jaafar: I thank the Senior Minister of State for his very comprehensive clarifications. I wanted to follow up on the reinstatement of the underwriting criteria for the Optional Cohort. As we know this cohort is senior, you know, most of them are now in their 50s and 60s and I take the Senior Minister of State's point that the enrolment has dropped to a trickle, but I am concerned that the people who perhaps have not enrolled by now may fall more in the lower-income brackets who did felt that they did not have, you know, enough savings for the premiums or did not have the financial literacy for it. And also, mild and undiagnosed conditions may be more common in those cohorts that are in the lower-income segments than others. So, it is a little bit of a concern to me that those are most likely to get screened out, and this applies to the Optional Cohort as well as the new Citizens.

So, three questions from me. First, what assurances does the Senior Minister of State have that the underwriting process will be fair, transparent and medical robust? In particular, the borderline cases for the mild conditions. Second, will there be clear appeals or a second opinion pathway so that one assessment does not mean that somebody is excluded for life. And third, this one I raised and I did not hear a response to it. Do we really have to take this all-or-nothing approach? Is there some way that you can consider some tiered or partial entry options for those who may have some mild disabilities and may be excluded under the underwriting criteria?

Dr Koh Poh Koon: Sir, I thank the Member for her concern regarding the Optional Cohort. But let me just give some context to this because the Optional Cohort is the older cohort that is actually a much smaller cohort, because the number of people in that age range would be lesser than those in the younger cohort. The Member can imagine that as they age, less and less of their peers will be around. Which means that the burden will be shared by a lesser number of people in terms of premiums that need to keep the funds for that cohort for claims sustainable. And that is why the premium will be higher and once we tighten the reins and reinstate the original underwriting criteria, as I mentioned in my speech earlier, the Optional Cohort who are still policyholders today will see a premium drop from next year onwards because they now do not have to pay higher premium to account for some of the peers who may suddenly join in with disability that may draw down on the claims. The Member understands the math behind it, yes?

So, I think in trying to help this Optional Cohort to be part of the CareShield Life we also have to consider what it means to the rest of them who are already in the same cohort who are CareShield Life policyholders. Is it fair to them as well? Because they are bearing a lot more premiums today in anticipation of someone who may choose to join much later on with disability. And that is what their cohort has been bearing for the last few years before we now make this move to tighten the underwriting criteria.

And we have actually extended the sign-in period from two years to four years to give ample time and double our outreach efforts as well to encourage those who may want to consider to come in to join the scheme before the end of this year, including availing up to $4,000 of premium subsidies to make it more as a reassurance that when they come in there will be premium subsidies to make it affordable for the Optional Cohort to join in.

So, given that the number who are signing up now has dropped down to a lower number, we think this is about time to tighten the underwriting to make sure it is fair to the other existing policyholders who are in the Optional Cohort that has already come in for the last few years.

So, I hope this is something that the Member can appreciate that, it is really striking the balance between wanting to help the remaining small number of people or to be fair to the rest of them who has already made the effort to come in and do the risk-pooling.

On the second case of whether there is an appeal mechanism. We take this on a case-by-case basis. But, in general, severe disability, especially permanent disability does not really change over time. That is why they are called permanent disability. And if the assessment is that this is a permanent disability, generally, the assessor would have to be quite certain that it is a particular condition that will see no chance of improvement over time and it is something that we have to strengthen in terms of the training we provide to the assessor so they can make a clear, unbiased assessment of the level of disability to qualify for the three ADLs threshold that we talked about here and I hope that is something that will help to allay the Member's concerns about this particular aspect.

Have I answered all the Member's three questions? I would say that will be a very difficult thing to construct because once you have a partial kind of system that is neither here nor there, not very clearcut, you would open things to gaming, to adverse selection and that will make the whole scheme unsustainable. So, and that is part of the reason why we are now tightening the underwriting and this is to respect the principles of making sure that it actually is sound and the underwriting is fair.

Mr Speaker: Dr Choo Pei Ling.

Dr Choo Pei Ling: Mr Speaker, Sir, I thank the Senior Minister of State for his elaboration. I have a few questions. As mentioned in my earlier speech, one of the Council's recommendations being considered is tele-assessments for claimants. May I clarify, when does the Ministry expect to conclude the feasibility study on this and how will the assessors guard against fraud and potential misdiagnosis? Separately, I would also like to seek clarification on whether the Ministry would be able to share any cases of appeal it had received in the years since CareShield Life started? And what were the percentages of successful and unsuccessful appeal cases?

Dr Koh Poh Koon: Sir, I thank Dr Choo for her two questions. On the second one on cases of appeal, I do not have data on hand right now, so if she wants to know more, perhaps, she will have to file a Parliamentary Question at some other Sitting.

On the tele-assessment, this is still very much a pilot at the moment, as Dr Choo would probably understand, assessing disability on the remote setting carries technical challenges. The assessor on the other end of the line will have to first make sure that it is safe for the person with disability to be assessed without the assessor's assistance. There could be a risk of falling, for example. And also, you make sure that it is not something that can be gamed.

So, there are some real challenges and so this pilot will help us to understand what are the challenges we need to overcome, what are the safeguards we need to put in to make sure it is fair, to make sure it is something that is robust, before we can think of rolling this out in a broader way.

So, I hope the Member will give us a bit more time to take a look at what are the outcomes that the pilot shows before we can think about how to broaden it to wider application.

Mr Speaker: Assoc Prof Jamus Lim.

Assoc Prof Jamus Jerome Lim: Thank you, Speaker. Two follow-up questions from me. The first builds on the question by Ms He Ting Ru about gender-neutral data. I appreciate Senior Minister of State Koh's explanation that CareShield is a brief programme, but we have a predecessor programme, ElderShield. Although it is different, I wonder whether that longer history would afford us the ability to differentiate between the gender data that Ms He requested and if we do not have that on hand, perhaps if we should be filing a Parliamentary Question on this.

My second question also riffs off a clarification by Ms Mariam Jaafar about the all-or-nothing approach. I understand his clarification that we do not want to have a system where it is gamed. But one point that I raised in my speech was about an index approach, either Katz Index or modified Barthel Index would assign scores that differ according to whether it is moderate disability or severe disability, and then mapped those through an ultimate score. That kind of scoring approach is purely objective and may rule out the possibility of this kind of gaming of the system.

Dr Koh Poh Koon: Sir, I think the gender-related claims data, like I said, we do not have enough mature data to share, even if we looked at some of the ElderShield claims from before, because that is a different construct and at a different time point where not all the individuals may give us good data at the moment to project forward for CareShield Life. So, we can take a look and if there are data to share, we would do so maybe at a future Sitting.

On the scoring system, the crux of the issue is whether we want to allow those with moderate, maybe even mild, disability to be included and that means expanding the scope of coverage. Because if you are taking a graded approach, it means that you are trying to define those who are lesser than severe disability according to today's ADL definition, to be assessable for claims. That means broadening the coverage to a wider pool of people which must mean that the payouts must increase, which must mean that premium loading on existing cohorts must go up.

The CareShield Life Council did consider whether we should broaden from beyond severe disability to those with more moderate disability. But I think in the end, the Council took the approach that that would mean that there will be policy premium impacts on the rest of the policyholders and potentially make it less affordable to more Singaporeans. As I mentioned in my speech, the Council's decision is to take a balanced one where, as a basic level of protection for all Singaporeans, they want to make this affordable and more broad-based rather than opening up to a lot more claims and making it far more difficult for especially those in the lower income to be accessible.

And for those with milder disability, generally you can imagine that their care needs would be much lesser, in which case our approach of strengthening subsidies at the care delivery setting would make many of these care more affordable already and available to those in milder disabilities.

So, it is not just trying to solve the problem with one tool but looking at the multiple layers of support we have, by first of all, making the overall care cheaper through subsidies, through grants so that the need to even tap on CareShield Life for milder, maybe to moderate, disability will be much lesser as well.

Mr Speaker: Assoc Prof Jamus Lim

Assoc Prof Jamus Jerome Lim: Mr Speaker, I do not wish to belabour this point too much. But allow me to clarify that actually using an index approach, you do not necessarily need to expand the coverage to individuals purely facing mild disabilities.

I will give you an example. An individual reporting maximal assistance in three areas, let us say toileting, bathing and dressing, for instance but be able to fully perform all other functions – so this is someone that would fully qualify for CareShield Life – would score 80 points on the modified Barthel Index, which is actually a higher score that another individual who requires just moderate assistance in, for example, transferring mobility, dressing and feeding and yet be able to perform other functions independently.

So, my point is that when you use a scoring system, it is not necessarily the case that you immediately will expand to a much larger pool of individuals but actually just those individuals that truly need the assistance to disability.

Dr Koh Poh Koon: Thank you, Sir. I understand there are different assessment tools in the market in assessing disability but what we are choosing to use is something is widely adopted at the World Health Organization, in the European Union, widely used by insurers. It is also something that many of our clinicians and doctors are familiar with. I think it is something that we want to do, that it is aligned with international practice, that is also easy and convenient for our assessors and our clinicians to use, rather than put in different matrixes that actually ends up promulgating different tools and creating some confusion.

I think we both agree that we should try to make sure that the scheme is sustainable at this moment as far as CareShield Life is concerned, to limit the support to those with severe disability. Those at the margins, we will take a compassionate approach. If they require care that cannot be claimed through CareShield Life but for which they need further support, we have other means to help them to access that care as well. And that is ultimate thing: to make sure that regardless of the severity of your illnesses or disability, care is always accessible; and if need be, other forms of support can come in.

6.36 pm

Mr Speaker: I do not see any more hands, so I assume all clarifications have been sought and addressed by Senior Minister of State Koh.

Question put, and agreed to.

Bill accordingly read a Second time and committed to a Committee of the whole House.

The House immediately resolved itself into a Committee on the Bill. – [Dr Koh Poh Koon].

Bill considered in Committee; reported without amendment; read a Third time and passed.