Navigating Changes to Cancer Drug List for Integrated Shield Plans (IPs) in Singapore

The recent changes to cancer drug coverage under Singapore’s Integrated Shield Plans (IPs) have introduced a new layer of complexity to healthcare decision-making. As of April 1, 2023, coverage for cancer drugs not included on the Cancer Drug List (CDL) has become more restrictive, requiring individuals to carefully consider their options and make informed choices about their health insurance.

Understanding MediShield Life (MSHL) Limits and CDL Coverage

The coverage provided by IPs is based on multiples of the MediShield Life (MSHL) Limits, which define the maximum reimbursement amounts for specific cancer treatment categories

• Cancer Drug on CDL: $200 – $9,600 per month (depending on the drug category)
• Cancer Drug Services: $3,600 per year
• Cancer Drug not on CDL: Not covered

The CDL, a government-approved list of essential cancer drugs, serves as the benchmark for IP coverage. However, coverage for drugs not included on the CDL varies among insurers, highlighting the need for careful evaluation of individual IP offerings.

Where applicable, for coverage of cancer drugs not on CDL, Raffles Shield cover drug classes A to C of LIA’s ‘Non CDL Classification Framework’, while other insurers cover drug classes A to E.

Coverage Variations across IPs and Influencing Factors

Each IP has its own approach to covering cancer drugs not on the CDL. While some IPs provide limited coverage for non-CDL drugs, others do not offer any reimbursement for these treatments. This variability necessitates a thorough review of each IP’s coverage details to understand the specific drugs covered and the associated limitations.

Several factors influence the coverage decisions made by IPs:

• Drug Efficacy and Safety: IPs prioritize drugs that have demonstrated clinical efficacy and a favorable safety profile.
• Drug Cost: The high cost of certain cancer drugs can affect an IP’s willingness to cover them.
• Availability of Alternative Treatments: IPs may consider the availability of alternative treatment options when deciding coverage for specific drugs.
• Regulatory Approvals: IPs typically rely on regulatory approvals from relevant authorities before providing coverage for new drugs.

List of all IP insurers

• AIA HSG Max
• GE GREAT SupremeHealth
• HSBC Life Shield
• Income Enhanced IncomeShield / IncomeShield
• Prudential PRUShield
• Raffles Shield
• Singlife Shield

Cancer Drug List Changes to AIA HSG Max

AIA’s way of handling the increased coverage is by offering an additional Cancer Care Booster for HealthShield Gold (HSG) Max A customers only (doesn’t matter if you have rider or not. Differences between having riders will be on the amount of co-payment). If you have the accompanying VitalHealth A, A Value or VitalCare rider, this add-on will be automatically attached to the basic plan on your next renewal after 1 April 2023 without underwriting. If you have HSG Max A without rider, you can add this benefit without underwriting as well, subject to a time limit of 6 months from policy renewal.

If you are on HSG Max B, B Lite and C AND have their respective riders; VitalHealth B, B Lite and Essential C, a Cancer Care Benefit is automatically added to it. No further action will be required. This means if you don’t have these riders, the additional cancer coverage from Cancer Care Benefit does not apply to you.

Here’s a summary of coverage for the respective plans:

• HSG Max A, B, B Lite and C cover 5 times MSHL limits for both cancer drug and cancer drug services.
  
• HSG Standard plan covers 3 times MSHL limits for cancer drug on CDL, and 2 times MSHL limits for cancer drug services.
  
• With Cancer Cover Booster, it covers
  • 16 times MSHL limits for cancer drug on CDL,
  • 10 times MSHL limits for cancer drug services, and
  • $200,000 per year for drugs not on CDL.
    
• For the embedded Cancer Care Benefit, it covers
  • 10 times MSHL limits for cancer drug on CDL,
  • 8 times MSHL limits for cancer drug services, and
  • $50,000 per year for drugs not on CDL.

The above is subject to co-payment and this differs for plan type.

1. Cancer Care Booster without VitalHealth A, A Value and VitalCare
   • CDL treatment & Cancer Drug Service:
     • subject to 10% co-insurance for every claim, capped at $50,000 per policy year if treatment is by AIA preferred providers, pre-authorised, or due to emergency confinement.
   • Non-CDL treatment:
     • subject to 10% co-insurance for every claim, no cap for co-insurance.
       
2. Cancer Care Booster with VitalHealth A, A Value and VitalCare
   • CDL treatment & Cancer Drug Service:
     • subject to respective rider’s co-payment and co-pay cap per policy year
   • Non-CDL treatment:
     • subject to 10% co-insurance for every claim, no cap for co-insurance.
       
3. Cancer Care Benefit for VitalHealth B, B Lite and Essential C (same as point 2)

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Cancer Drug List Changes to Great Eastern GREAT SupremeHealth (SHP)

Here is an overview of the cancer coverage for Great Eastern Life’s Great SHP. At the time of writing, the cancer coverage of the legacy SHP is still unknown. This section is for the As-charged plans only.

Here’s a summary of coverage for the respective plans:

• GREAT SupremeHealth (SHP) P Plus, A Plus and B Plus plans cover 5 times MSHL limits for both cancer drug and cancer drug services.
  
• GREAT SupremeHealth (SHP) Standard plan covers 3 times MSHL limits for cancer drug on CDL, and 2 times MSHL limits for cancer drug services.
  
• As long as you have GREAT TotalCare, regardless of plan types, it covers
  • 12 times MSHL limits for cancer drug on CDL,
  • As charged for cancer drug services, and
  • For drugs not on CDL subject to 5% co-payment, co-payment cap for this section of coverage.:
    • Classic/Elite P: $250,000 per year
    • Classic/Elite A: $200,000 per year
    • Classic/Elite B: $150,000 per year

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Cancer Drug List Changes to HSBC Life Shield

Here’s a summary of coverage for the respective HSBC Life Shield plans:

• HSBC Life Shield Plan A and B plans cover 5 times MSHL limits for both cancer drug and cancer drug services.
  
• HSBC Life Shield Standard plan covers 3 times MSHL limits for cancer drug on CDL, and 2 times MSHL limits for cancer drug services.
  
• HSBC Enhanced Care (riders) for Plan A and B covers the following
  • 18 times MSHL limits for cancer drug on CDL, [Updated on 18 Oct 2023]
  • 15 times MSHL limits for cancer drug services, and [Updated on 18 Oct 2023]
  • $30,000 per month for drugs not on CDL. There is no co-payment cap for this section of coverage.
    
• HSBC Enhanced Care for Standard Plan does not cover additional for cancer drug on CDL and cancer drug services. It does provide coverage of $5,000 per month for drugs not on CDL. There is no co-payment cap for this section of coverage.

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Cancer Drug List Changes to Income’s IncomeShield & Enhanced IncomeShield

Income’s way of handling cancer cover is more straightforward apart from the fact that different plan types have different coverage. As they’re also one of the first few companies to launch the sub-limit IPs – IncomeShield, the changes apply to these legacy plans as well. If it looks confusing, I’d recommend looking straight at your plan type and ignore the rest.

Here’s a summary of coverage for the respective plans:

• Enhanced IncomeShield (EIS) cover from 5 times to 2 times MSHL limits for both cancer drug and cancer drug services; Preferred [5x], Advantage [4x], Basic [3x] and Enhanced C [2x]
  
• EIS Standard plan covers 3 times MSHL limits for cancer drug on CDL, and 2 times MSHL limits for cancer drug services.
  
• IncomeShield (sub-limit plan) cover from 4 times to 1 time MSHL limits for both cancer drug and cancer drug services; Plan P [4x], Plan A [3x], Plan B [2x], Plan C [1x]
  
• Deluxe Care, Plus Rider, Classic Care, Assist Rider to EIS provide staggered additional cancer coverage as follows:
  • 10 times – 4 times MSHL limits for cancer drug on CDL;
    • Preferred – 10 times
    • Advantage – 8 times
    • Basic – 6 times
    • Enhanced C – 4 times
  • no additional coverage for cancer drug services, and
  • Varied limits per month for drugs not on CDL:
    • Preferred – $15,000
    • Advantage – $7,000
    • Basic – $6,000
    • Enhanced C – $4,000
      
• Deluxe Care, Plus Rider, Classic Care, Assist Rider to Standard Plan and IncomeShield plans provide staggered additional cancer coverage as follows:
  • 8 times – 2 times MSHL limits for cancer drug on CDL;
    • Standard – 6 times
    • Plan P – 8 times
    • Plan A – 6 times
    • Plan B – 4 times
    • Plan C – 2 times
  • no additional coverage for cancer drug services, and
  • Varied limits per month for drugs not on CDL:
    • Standard – $5,200
    • Plan P – $4,000
    • Plan A – $3,800
    • Plan B – $3,500
    • Plan C – $3,200
      
• If you’re under Deluxe Care / Plus rider, the above coverage is subject to 10% co-payment with no co-pay cap. If you’re under Classic Care / Assist rider, the above coverage is subject to 20% co-payment with no co-pay cap.

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Cancer Drug List Changes to Prudential’s PRUShield

The cancer coverage for PRUShield is more direct, and it seems that they are putting in effort to simplify matters.

Here’s a summary of coverage for the respective plans:

• PRUShield Premier and Plus plans cover 5 times MSHL limits for both cancer drug and cancer drug services.
  
• PRUShield Standard plan covers 3 times MSHL limits for cancer drug on CDL, and 2 times MSHL limits for cancer drug services.
  
• PRUShield A and B (older sub-limit) plans cover 3 times MSHL limits for cancer drug on CDL, and 3 times MSHL limits for cancer drug services. PRUShield A has a combined annual limit of $42,000, whereas PRUShield B is $36,500.
  
• As long as you have PRUShield Extra, regardless of plan types, it covers
  • 15 times MSHL limits for cancer drug on CDL,
  • 15 times MSHL limits for cancer drug services, and
  • $150,000 per year for drugs not on CDL. There is no co-payment cap for this section of coverage.

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Cancer Drug List Changes to Raffles Shield

Raffles Shield seemingly has less cancer coverage compared to other insurers. Let’s hope they make adjustments along the way. In addition, they cover Drug classes A, B and C only.

Here’s a summary of coverage for the respective plans:

• Raffles Shield Private and A plans cover 4 times MSHL limits for both cancer drug and cancer drug services.
  
• Raffles Shield Plan B and Standard plans cover 3 times MSHL limits for cancer drug on CDL, and 2 times MSHL limits for cancer drug services.
  
• Raffles Shield has two riders that can be purchased separately or combined together. For Key Rider, it covers $5,000 per year for drugs not on CDL. There is no co-payment cap for this section.
  
• For Premier Rider, the coverage is
  • 2 times MSHL limits for cancer drug on CDL,
  • 2 times MSHL limits for cancer drug services, and
  • $20,000 per year for drugs not on CDL.
    
• If you add the Cancer Guard Rider, the coverage is: [Updated on 18 Oct 2023]
  • Raffles Shield Private and A+ plans cover:
    • 18 times MSHL limits for cancer drug on CDL
    • 15 times MSHL limits for cancer drug services
    • $250,000 per year for drugs not on CDL
    • $100,000 per year for TCM for Cancer Treatment at RMG
  • Raffles Shield A plan cover:
    • 12 times MSHL limits for cancer drug on CDL
    • 12 times MSHL limits for cancer drug services
    • $200,000 per year for drugs not on CDL
    • $80,000 per year for TCM for Cancer Treatment at RMG
  • Raffles Shield B plan cover:
    • 10 times MSHL limits for cancer drug on CDL
    • 10 times MSHL limits for cancer drug services
    • $100,000 per year for drugs not on CDL
    • $50,000 per year for TCM for Cancer Treatment at RMG
  • Psychological Counselling due to Cancer: $100 per visit up to $1,000 per year

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Cancer Drug List Changes to Singlife Shield

Here is an overview of the cancer coverage for Singlife Shield.

Here’s a summary of coverage for the respective plans:

• Singlife Shield Plan 1, 2 and 3 plans cover 5 times MSHL limits for both cancer drug and cancer drug services.
  
• Singlife Shield Standard plan covers 3 times MSHL limits for cancer drug on CDL, and 2 times MSHL limits for cancer drug services.
  
• If you have Singlife Health Plus, regardless of plan types, it does not cover additional for cancer drug on CDL and cancer drug services. For drugs not on CDL, these plans cover $30,000 per year, subject to 5% co-payment with no co-payment cap for this section of coverage.

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Making Informed Insurance Decisions: Key Considerations

Choosing the right IP is a critical decision, especially in light of the evolving coverage landscape. Here are some key considerations when reviewing IP options:

• Current Health Status and Cancer Risk: Assess your individual risk factors for developing cancer and prioritize IPs that offer comprehensive coverage for relevant drugs.
• Family Medical History: Consider your family’s history of cancer and select an IP that provides coverage for a wider range of cancer drugs if applicable.
• Financial Situation: Evaluate your ability to pay out-of-pocket expenses and choose an IP that aligns with your financial constraints.
• Needs and Preferences: Identify your specific needs and preferences regarding coverage. Consider factors such as the breadth of drug coverage, additional benefits like cashless hospitalization, and premium affordability.

Seeking Professional Guidance for Personalised Solutions

Navigating the complexities of CDL changes and managing your insurance portfolio effectively can be daunting tasks. If you’re struggling to make informed decisions or have any questions about your coverage, consider reaching out to a financial planner for expert guidance. They can help you:

• Review your current insurance portfolio and identify any gaps or areas of concern.
• Analyze your unique healthcare needs and risk factors.
• Recommend personalized strategies to optimize your coverage and minimize financial risks.
• Develop a comprehensive insurance plan that aligns with your overall financial goals.

Proactive Approach to Health and Financial Well-being

Taking a proactive approach to managing your insurance portfolio is crucial for ensuring you have adequate protection against potential healthcare expenses while maintaining financial stability. By seeking professional guidance, diversifying your coverage options, and regularly reviewing your plans, you can make informed decisions that safeguard your health and financial well-being.

Remember, the healthcare landscape is constantly evolving, and it’s essential to stay informed and adaptable. By taking proactive measures and seeking expert advice, you can navigate the complexities of CDL changes and maintain optimal insurance coverage that meets your specific needs now and in the future.

Don’t leave the future of yourself or loved ones up in the air – take action today.