How Much is Enough for Cancer Coverage? The Importance of Shield Plans and Riders

In a recent seminar, Dr. Ben Chuah, a medical oncologist at OncoCare Cancer Center, provided critical insights into the complexities of cancer insurance claims under Shield Plans, shedding light on the crucial question: how much is enough coverage, and do you really need riders?

Rising Healthcare Costs and the Need for Adequate Coverage

Dr. Chuah began by addressing the ever-increasing costs of healthcare, driven by longer life expectancy, the rise in cancer incidence and the advancement in medical care. These factors have also significantly impacted health insurance premiums, making it imperative for individuals to reassess their insurance needs, especially when it comes to cancer treatment.

The Role of Integrated Shield Plans (ISP)

Firstly, the need for Integrated Shield Plans has sparked considerable debate among Singaporeans, particularly since the introduction of MediShield Life (MSL). In addition to MSL, these plans provide a range of additional coverage options, from basic to more comprehensive protection.  The more comprehensive plans also allow the flexibility to add riders to further minimize out-of-pocket expenses. Dr. Chuah highlighted the critical importance of understanding the specifics of these plans, especially when it comes to outpatient oncology treatments.

Understanding the Cancer Drug List (CDL)

Dr. Chuah’s discussion focused on the Cancer Drug List (CDL), which is maintained by the Agency for Care Effectiveness (ACE) under Singapore’s Ministry of Health (MOH). The CDL has up-to-date, evidence based cancer treatment options.  The CDL is also designed to negotiate pricing with pharmaceutical companies, ensuring that cancer drugs included in the list are cost-efficient, thus controlling the rising costs associated with cancer treatment.

The Need for Riders

One of the critical takeaways from Dr. Chuah’s presentation was the role of riders in cancer coverage.

While basic ISPs provide a substantial amount of coverage, they may not be sufficient for some cancer treatment listed in the CDL.  For instance, a modern lung cancer drug like Osimertinib, which costs around $12,000 per month, patients with ISPs with more comprehensive coverage, including riders, could potentially have their entire treatment covered, reducing the financial burden significantly.   Additionally, riders also provide more coverage for cancer drug services, for example, supportive medications and scans.

Riders may also allow the utilisation of cancer drugs not listed in the CDL, provided that there is sufficient medical evidence supporting their use.  These may include new medications which may not have been approved in the CDL yet.

However, Dr. Chuah emphasized that CDL-approved drugs are not inferior to non-CDL medications.  Non-CDL drugs are only taken into consideration when standard of care treatment options in the CDL are exhausted and other treatment options, with sufficient medical evidence, but not yet approved in the CDL, are available.

How Much is Enough?

Determining how much coverage is enough depends on various factors, including the type of cancer, the required treatment, and the individual’s financial situation. Dr Chuah suggested that while basic Medishield Life coverage might suffice for many, those who want the option of private hospitals care should consider ISPs with riders for more comprehensive coverage. Based on data published by MOH, about 70% of Singapore residents have ISPs from basic to more comprehensive coverage, with half of them having riders. The remaining half without riders may find outpatient cancer treatment in a private hospital more financially challenging.

Conclusion: Tailoring Your Cancer Coverage

In conclusion, Dr. Ben Chuah’s seminar underscored the importance of thoroughly understanding one’s health insurance options, particularly in the context of cancer treatment. While basic coverage might be adequate for some, the rising costs of healthcare and the complexity of cancer treatments make it essential to consider additional coverage through riders. Ultimately, the right amount of coverage is one that aligns with the patient’s needs and financial capabilities, providing peace of mind in the face of a cancer diagnosis.

Additionally, given the constantly evolving landscape of insurance claims and coverage, relying solely on health insurance may no longer be sufficient due to the rising costs of treatment and premiums. There is a possibility that further limitations could be imposed on IP claims, leaving policyholders at risk of not receiving comprehensive protection with Shield Plans alone. It is, therefore, crucial for individuals to take proactive steps to enhance their protection by considering additional coverage, such as critical illness plans. These plans provide a lump-sum payout upon diagnosis, regardless of the medical bills, as long as the claim criteria are met.

By carefully assessing these factors, individuals can ensure they have the necessary financial protection to navigate the challenging and often costly journey of various critical illness treatment.