Addressing Insurance Clauses Refusing Coverage for Corrections of Medical Procedure Complications, and Implications for MediShield and CareShield Life
Ministry of HealthSpeakers
Summary
This question concerns MP Mr Yip Hon Weng's inquiry on whether insurance contracts can exclude payouts for correcting medical complications, whether this causes defensive medicine, and if the Ministry will regulate such clauses. Minister Ong Ye Kung stated that Integrated Shield Plans do not contain such clauses and generally cover complications arising from prior medically necessary treatments. Private insurers may, however, prohibit reimbursements for providers involved in malpractice, negligence, fraud, waste, and abuse to avoid passing costs to patients. He highlighted that MediShield Life provides universal coverage for Singapore residents for corrective treatments following medically necessary procedures. Finally, CareShield Life provides payouts strictly for severe disability and is not impacted by such clauses.
Transcript
24 Mr Yip Hon Weng asked the Coordinating Minister for Social Policies and Minister for Health (a) whether insurance clauses refusing payouts for corrections of medical procedure complications or errors are allowed in consumer insurance contracts; (b) if so, whether this has been observed to result in healthcare providers practising defensive medicine for complex issues and high-risk patients; and (c) whether the Ministry will regulate such clauses, given their potential impact on MediShield and CareShield Life.
Mr Ong Ye Kung: We have not observed such clauses in Integrated Shield Plan policyholder contracts. Where patients require additional procedures to manage complications arising from a prior medically necessary treatment, insurers will generally cover them. However, private insurers may include clauses that stipulate that providers who have been found to have been involved in malpractice, medical negligence or fraud, waste and abuse cases are not allowed to seek reimbursement from insurers or patients for any corrective procedures they carried out to rectify the initial problem. This will prevent passing of these costs to patients and policyholders in such specific and rare circumstances.
MediShield Life provides universal coverage for all Singapore residents, and pays for corrective treatments and procedures, even if it is in correction of earlier medically necessary procedures. CareShield Life is a separate scheme that pays out in the event of severe disability, and is not impacted by such clauses.