The Ministry of Health (MOH) is studying portable private insurance (MOH study on portability of private insurance could be completed in 2024: Ong Ye Kung, April 28) to help policyholders wishing to switch insurers do so despite pre-existing medical conditions.
As past president of Singapore Medical Association and a general practitioner for around 40 years, I hope people will understand better why portability is essential as we grow older, when more illnesses manifest.
Many illnesses progress through four stages: early suspicion, early signs requiring only outpatient treatment, hospitalised medical intervention, and finally continuing treatment after discharge.
For example, a young person with high blood cholesterol levels may appear well when first diagnosed upon routine check-up, will require statins for years, then perhaps need hospitalised treatment for stent or bypass surgery, before medical follow-up for the rest of his life.
When buying an insurance policy early, he may have to pay a higher premium because of his higher risk (“loading”). Bought later, the new policy will not cover cardiac-related illnesses (“exclusion clauses”). When changing insurers, he faces the same limitations, which portability is intended to address.
Similarly, will portability allow insurance cover regardless of how advanced an illness has become?
For example, a patient with breast cancer may choose to change insurers after surgery is completed, but she may still require expensive medicine for years to come. Will the new insurer say, “this is not insurance; it is subsidy for existing treatment”?
Most importantly, health insurance coverage provided during employment is unlikely to be portable upon changing employers, retrenchment or retirement. When a person starts a new policy, conditions that had surfaced over past years will be “pre-existing” and therefore excluded from cover.
Hardest hit will be those who need to stop working prematurely because of a serious illness – they lose both their insurance benefits as well as the salary to pay for continuing treatment. Ensuring portability of employer-provided insurance is therefore important. The worker should be allowed to “take over” by “self-payment” without penalty.
We need to understand when our insurance will no longer cover our needs as we age. I urge MOH to look beyond portability during voluntary changes in insurers, to include forced changes when changing employers, and most importantly loss of insurance coverage upon loss of job or retirement.
Lee Pheng Soon (Dr)
