Sharing Information on Structure and Workflow in Singapore's Public Healthcare Clusters with Integrated Shield Plan Insurers to Facilitate Disbursements of Claims by Patients for Care Received
Ministry of HealthSpeakers
Summary
This question concerns whether Integrated Shield Plan (IP) insurers receive information on public healthcare cluster workflows to prevent administrative hurdles for patient claims, as raised by Dr Tan Wu Meng. Minister for Health Gan Kim Yong replied that inpatient claims are already streamlined via the MediClaim system, where public healthcare institutions submit claims directly without patient filing. Outpatient claims for pre- and post-hospitalisation benefits are filed by patients directly with insurers and may require supporting documents like referral letters. Minister for Health Gan Kim Yong highlighted that the Ministry of Health and Central Provident Fund Board collaborate with insurers to resolve complex cases and communicate process changes. The government will continue exploring ways to further streamline claims for referrals across institutions that form part of routine clinical protocols and treatment.
Transcript
6 Dr Tan Wu Meng asked the Minister for Health whether Integrated Shield Plan insurers receive information and guidance on the structure and workflow of Singapore's public healthcare clusters so that patients at public hospitals do not encounter unnecessary administrative hurdles to receiving reimbursement for care across departments and institutions within the same public healthcare cluster.
Mr Gan Kim Yong: The inpatient claims process at our public healthcare institutions have been integrated and streamlined for both MediShield Life (MSHL) and Integrated Shield Plans (IPs). Claims are submitted directly by public healthcare institutions (PHIs) through the MediClaim system, without the need for the patient to file any claims.
In the outpatient settings, IPs may provide additional coverage beyond MSHL such as pre- and post-hospitalisation benefits, and the exact coverage may differ across insurers. These claims are filed directly by patients with their insurers and may require the submission of supporting documents such as referral letters.
Once the claims are filed, public healthcare institutions or patients are reimbursed directly by the Central Provident Fund Board (CPFB), or by IP insurers for patients with IP coverage.
MOH and the CPFB work closely with the insurers and public healthcare institutions in resolving any claims filing and reimbursement issues, especially for appeals or complex cases. We also ensure that insurers are informed about any changes to claim processes. We will continue to partner all stakeholders to explore opportunities to further streamline the claim processes, especially where there are referrals across institutions as part of clinical protocol and routine treatment requirements.