When the Ministry of Health introduced the Cancer Drug List on 17 August 2021, it aimed to offer “clinically proven and cost-effective treatments” to help curb rising healthcare costs in cancer treatment. However, the announcement left those with Integrated Shield Policies (IPs) facing significant uncertainties. In essence, these policies would now only cover treatments on the MediShield Life positive list, with specific claim limits per cancer drug—yet, these changes wouldn’t impact IP riders paid in full by the policyholder.
My client, K, was diagnosed with lung cancer in February 2022. He held the highest tier of IP coverage, which included private hospitals and, at the time of purchase in 2017, promised “as charged” coverage for all hospitalisation and surgical procedures, capped by an annual limit. With his additional rider, K’s yearly out-of-pocket expenses were limited to $3,000.
In March 2018, an update mandated a co-payment requirement for all new Integrated Shield Plans with riders, aiming to address “buffet syndrome.” This allowed insurers to redesign riders, encouraging clients to seek treatment from panel-approved doctors to manage costs. With this in mind, I advised K to work with a specialist from the insurer’s panel, ensuring the cost of his treatment would remain manageable.
From the outset, K’s expenses were staggering: his initial biopsy was over $77,000, with his first chemotherapy session costing nearly $23,000. By the end of the first month, K had accumulated $100,000 in medical bills, and his $3,000 co-payment limit was promptly reached, leaving subsequent treatments fully covered. By the close of 2022, the insurer had paid out claims exceeding $200,000 on his behalf.
When K’s oncologist recommended a change in treatment to align with the Cancer Drug List, his chemotherapy costs decreased to $10,000 per session. Yet, new regulations meant he was only covered up to 15 times the monthly MediShield Life limit for drugs on the list. For the specific drug he needed, MOH’s cap was $200 per month. With his enhanced IP, K was eligible for only $3,000 monthly coverage. However, as his treatment required two sessions in some months, he faced a monthly shortfall of $17,150—despite holding what he had believed to be comprehensive coverage.
Ironically, had this drug not been listed on the Cancer Drug List, K’s rider would have covered up to $15,000. In response, I encouraged K to consider treatment through restructured hospitals, where the drug is commonly available. While this would mean changing specialists, it would significantly reduce his out-of-pocket expenses, easing the financial burden on his family as he continues his journey.
K’s story resonates deeply with me, especially as he is close to my own age and shares the hope of watching his children grow up. His resilience and positivity, even amidst chemotherapy’s challenges, are a constant reminder of the importance of comprehensive coverage. As policy changes aim to balance healthcare costs with premium affordability, it is essential to stay informed and regularly review your insurance portfolio to ensure your protection remains aligned with evolving needs.
