Can Medisave or Insurance Be Used for Cataract Surgery?
Cataract

Can Medisave or Insurance Be Used for Cataract Surgery?

By LSC Clinical Team

Cataract is the most common eye condition in Singapore and surgery is the only method to treat it. Cataract surgery is performed as a day surgery procedure, which means you do not have to stay in the hospital after the surgery. The procedure usually takes 30 minutes to complete.

While it is a day surgery procedure, cataract surgery is Medisave claimable, subject to the approved surgical limit. In addition, if you have an Integrated Shield Plan, you can claim part or all of your cataract surgery bill, depending on your private insurance coverage, for both private and public hospitals.

How much Medisave can be used for cataract surgery?

Medisave is Singapore’s national health savings plan for all Singaporean citizens and Permanent Residents. While you work, a certain percentage of your monthly earnings will be diverted to your Medisave account for future healthcare needs.

With regards to cataract surgery, every Singaporean and Permanent Resident can claim up to $2450 per eye from their Medisave account, or from an immediate family member’s Medisave account. The process of using your medisave is a simple one, with the administrative work done before your surgery.

What’s the procedure to use your Medisave for cataract surgery?

Firstly, the clinic arranging for your surgery will require you to fill up the medical claims authorisation form. Once completed, you need only to pay the balance amount (after deduction of the Medisave claimable amount) via cash or credit card. The rest of the administrative work will be done by the clinic after your surgery, where an e-file will be performed to claim the amount from your Medisave.

Can you use your Integrated Shield Plan (IP) for cataract surgery?

Integrated Shield Plans are private insurance plans that you can choose to add on to your basic MediShield Life plan, which all Singaporeans and PRs have. Depending on your choice of IP, there will be additional coverage for B1 and A class wards in public hospitals and even for private hospitals.

MediShield Life Plan

If you have purchased a rider for your Integrated Shield Plan, depending on your rider plan, the claim limit would be higher. For individuals with full riders purchased before 1 April 2019, you will not have to pay anything out of pocket for the surgery*.

*If your full rider is purchased after 8 March 2018 but before 1 April 2019, you will have full coverage on co-insurance and deductible portions of your bill until 1 April 2021. After this date, a 5% co-payment will apply. All full riders sold after 1 April 2019 all have a 5% co-payment minimally.

What’s the procedure to use your Integrated Shield Plan for cataract surgery?

The process to use your Integrated Shield Plan is simple, and can be performed concurrently with the process required to use your medisave for the surgery. Once again, you have to first fill up the medical claims authorisation form. After which, you will need to pay a deposit (the amount of deposit required depends on the type of IP you have) via cash or credit card.

Again, the rest of the administrative work will be done by the clinic after your surgery, where an e-file will be performed to claim the amount from your IP and/or Medisave. If your insurance has full coverage, the deposit paid earlier will then be refunded to you in a few months.

Can I use both Medisave and Integrated Shield Plan concurrently for my surgery?

You can use MediSave, up to prevailing limits, to pay for the deductible and co-insurance portions that are not paid by your insurance policy. The deductible is the initial fixed amount of the medical bill that you need to pay before you can claim anything from your insurance (the deductible is reset each policy year). The deductible ranges from $1,500-3,500, depending on plan and ward class.

After paying your deductible, you may still have to pay for co-insurance. Co-insurance is the amount that you have to split with your insurer after subtracting the deductible from your medical bill. It is usually expressed as a percentage. For example, if you have a co-insurance of 10%, you will pay 10% of the medical bill after the deductible, whereas your insurer pays the remaining 90%.

For individuals with full Integrated Shield Plan Rider purchased, it will cover your co-insurance and deductibles.

Estimate your out-of-pocket expenses after using your medisave and IP:

Fill in the fields according to your policy plan and estimated surgery cost.

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$0
* Required

For example:

Treatment cost $10,000
Deductible
(for private hospital)
$3,500
Co-insurance 10% (of the balance amount from deducting the deductibles from treatment cost)
Total out-of-pocket $4,150
($3,500 deductible + $650 co-insurance)
Medisave claimable limit for cataract surgery Up to $2,450
Nett out-of-pocket cost $1,700
(payable by cash or credit card)

*Treatment cost used in the example is only for easy illustration, it does not reflect the actual cataract surgery cost.
**This example will not be applicable for individuals with no Integrated Shield Plan.

The remaining cost of the surgery will be covered by your Integrated Shield Plan (IP). As mentioned above, co-insurance and deductibles are fully covered for individuals with full Integrated Shield Plan Rider purchased.

Do all Integrated Shield Plans cover private hospital services?

Yes, all integrated shield plans include coverage for private hospital services. However, the coverage amount depends on the plan you buy. Different insurers will have a slightly different percentage in terms of coverage.

For example, if your integrated shield plan states that it covers “Restructured hospital for ward class B1 and below” then it only covers up to 50%* of the private hospital treatment fees after co-insurance and deductible portions. For integrated shield plan that states “Restructured hospital for ward class A and below”, then it only covers up to 65%* of the private hospital treatment fees after co-insurance and deductible portions. If your integrated shield plan covers “Standard room in private hospital or private medical institution” then it covers up to 100% of the private hospital treatment fees after co-insurance and deductible portions.

*The percentage of coverage is referenced from NTUC IncomeShield website. To fully understand your coverage, please check with your insurer.

If you are intending to go for a cataract surgery but remain uncertain about your Integrated Shield Plan coverage, or if you would like to know the estimated payable amount after the Medisave and Integrated Shield Plan coverage, please contact our friendly Patient Relation Coordinator.

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