MediShield

How Medishield works

When making a claim, a MediShield policyholder should be aware of how the main features of MediShield work: the claimable limits, deductible and co-insurance
(A) Claimable LimitsClaimable Limits refers to the portion of your patient bill that is eligible for reimbursement. Your Claimable Limit, or claim amount, is determined by the maximum limits per day of hospitalisation, surgical procedures, surgical implants, and approved specific treatments and outpatient treatments.
(B) DeductibleA deductible is the initial amount you need to pay for claim(s) made in a policy year, before MediShield coverage starts. No reimbursement would be made from the MediShield below this claim amount. You only need to pay the deductible once in a policy year. The deductible helps to sieve out small claims, which can be paid using Medisave and/or cash, and keeps MediShield premiums affordable.
For approved outpatient treatments claimable under MediShield, the deductibles are waived and a 20% co-insurance is applicable. Some examples are outpatient chemotherapy, radiotherapy and kidney dialysis treatment.
If you choose to stay in a Class C ward during your hospitalisation, the applicable deductible would be $1,000. For Class B2 and above wards, the applicable deductible would be $1,500.
(C) Co-insuranceCo-insurance is the percentage of the bill you need to pay on the portion of the bill above the deductible. Co-insurance for inpatient bills is three-tiered, ranging from 20% to 10% as the bill size increases, i.e. the larger your bill, the lower the co-insurance that you need to pay. MediShield will pay between 80% - 90% of the claim amount that exceeds the deductible (if applicable).
The yellow portion of the diagram below shows what is payable by MediShield. The orange parts are the portions payable by the MediShield policyholders either via cash or Medisave.

Credits to www.moh.gov.sg/mohcorp/hcfinancing.aspx?id=340