Is your corporate health insurance providing enough coverage?

Posted on Jul 23, 2015 by rob.mcbroom

One of the most popular benefits companies in Singapore offer expats is company sponsored health insurance. While for some these plans will be top of the line, others may find that their insurance coverage may fall short of the ever increasing medical expenses in the city. The problem is, it can be tough to actually figure out if your employer's health insurance plan will be enough to cover your medical needs.

Below you will find 14 questions - in no particular order of importance - you should ask regarding your company-sponsored health insurance plan to help you determine if it sufficient to cover your needs.

1. Is my plan portable if I leave the company?

These days it is nearly impossible to find an expat who has been with the same company, in the same location, for an extended period of time. When you start your new job, it would be wise to carry the mindset that you will not be there forever and, therefore, should consider this when looking at your company's health insurance plan. The reason for this is that many companies tie their insurance to your contract - so if you leave your job, your insurance coverage will also be terminated; usually on your last day.

Be sure to ask about your plan's portability - whether you can keep it when you leave your company or not - and whether you will need to be underwritten again (as in, do you need to fill in another medical questionnaire) should you get to keep the plan.

The real risk here is if you say join a company on an expat corporate plan which offers excellent coverage for everything imaginable. But say you develop diabetes, or your wife gets cancer in the time you are with your company. If you stop working for this company, and your plan is not portable, the conditions you developed will be counted as pre-existing conditions, and you will struggle to find insurance because most health insurance providers will not insure people with pre-existing conditions.

2. Is there a restricted panel of providers I need to go to for consultations?

Some company-sponsored plans will have a strictly defined panel of providers, or care network, that will take payment from the insurance plan. If you visit a provider who is not part of this network, then your insurance will likely not cover the full, or any, costs.

Before you seek medical care you should check if there is indeed a list of providers associated with your plan. This information can usually be found either: in the documentation provided with your health insurance plan, from your HR department, of from Pacific Prime.

3. Does the policy include coverage for consultations with specialists?

With many insurance plans, specialist medical care (e.g., dermatologists, physiotherapy, etc) have separate coverage limits, while other plans don't actually cover specialist consultations. This means you will need to pay out of pocket should you need to see them.

If your company's health insurance plan does include coverage for consultations with specialists, it would be a good idea to know what the limits of coverage are, and whether you will need to pay first and submit a claim for reimbursement, or if direct billing is supported.

4. Is there an exclusion of pre-existing conditions, congenital disorders, or chronic conditions?

This is an extremely important question to ask, especially if you have pre-existing or ongoing conditions that you will need medical care for. The good news is, some health insurance plans companies secure will actually cover these conditions, so it would be a good idea to check with your plan to ensure you whether these conditions are covered or not.

5. Is there fee schedule or limits for surgery on your Group Hospital & Surgical coverage?

In order to keep premiums affordable for the widest number of companies possible, many corporate plans are uniform in nature and will include a fee schedule in relation to surgeries, which will have a limit - usually up to SGD 15,000 -, with some plans having a limit that may not be high enough to cover large surgical procedures. It would therefore be a good idea to learn what this limit is and any other factors related to it before you need surgery.  

6. Is there Group Major Medical (GMM) Coverage?

Group Major Medical Coverage is a second level of coverage that is included on top of Group Hospital & Surgical coverage that is intended to cover costs above the SGD 15,000 limit should costs go above this amount - which it very well could if you are hospitalised. In Singapore, GMM will usually cover up to SGD 80,000, but you will need to pay a set percentage of costs covered by the GMM.

For example, if your medical bills are SGD 50,000, the first SGD 15,000 is paid for under your Group Hospital & Surgical coverage while the remaining SGD 35,000 is covered under your GMM. Of this SGD 35,000, you will need to pay SGD 7,000 out of pocket.   

You don't want to be caught unaware with this bill, so be sure to ask what the copay is and how it works for your plan.

7. Are there maternity benefits?

Maternity and birth are not cheap in Singapore, the cost for a normal birth at a private hospital can be as costly as SGD 11,464 for the delivery alone. This doesn't even include visits to the doctor before and after birth along or costs for medicine or any complications. As such, many insurance plans do not normally include this unless you secure an upper-tier plan. If you plan on getting pregnant, it would be a good idea to check your company's insurance plan to see if pregnancy insurance coverage is included, and if it is - the limits associated with it.

8. Are there dental benefits?

Much like maternity benefits above, dental insurance coverage is often optional and normally only available for upper-tier plans, which means some company health insurance plans won't offer complete dental coverage. That being said, almost every plan on the market does include coverage for emergency dental issues. So, if you are going to need dental care in Singapore, it would be a good idea to check if your health insurance plan covers it, as well as the limits associated with it.

9. Does the plan continue if I relocate to another country?

In Singapore, as in much of the rest of the world, health insurance plans are sold with varying areas of coverage. Some cover care in Singapore only, while others might cover care in South East Asia. Others still may have global coverage. As an expat, there is always a chance that you may be required to relocate, and it would not do to relocate and not have insurance coverage in your new city, so it would be a good idea to check whether or not your plan can move with you should you relocate.

10. Can I schedule treatments and hospitalizations in another country?

As mentioned above, some insurance plans include coverage either on a regional or worldwide basis. If you plan on, say, going to Thailand for a small procedure, or going home to have a major surgery, it would be beneficial to know if your company-sponsored health insurance plan will cover this. If not, you will need to stay within your area of hospitalisation insurance cover in order to successfully file claims.

11. Do the benefits extend to dependents and children?

While there are many insurance plans on the market that include coverage for dependents, including children, there is no set law in Singapore stating that health insurance plans offered by companies have to include coverage for your family as well. What this means is that if you are moving to Singapore, or switching to a new job in the city, you should check who is covered by your plan. If you have kids, be sure to also ask to what age they are covered by your plan, as this can also differ by plan type and provider.

12. In case of hospitalisation, do I need to pay upfront and wait for reimbursements?

All health insurers in Singapore offer plans that will follow one of two payment methods: direct billing, or claim reimbursements. Some insurers will have a direct billing network where certain providers have agreed to accept payment from the provider, meaning you don't have to pay as long as your expenses are below the limit. Other providers operate on a claims model where you will need to pay for care first and then submit a claim for reimbursement. It would be a good idea to check your plan and see how payment will work when you are hospitalised.

13. What are the limits of coverage for cancer?

In Singapore, according to the Singapore Cancer Society, 1 in 3 deaths are because of cancer. Simply put, it's a serious health issue for everyone. Luckily, almost all health insurance plans do include coverage when it comes to cancer. However, they will normally place limits on coverage amounts. Due to this, it would be a good idea to find out what limits your plan attaches to cancer care.

14. Do I have any other options?

Olivier Zeller, Country Manager for Singapore at Pacific Prime, has this advice, "You do have other options available to you in Singapore. In fact, we receive requests daily from expats here in Singapore who are looking for comprehensive coverage on top of their company plan. This is generally because they have first-hand experience in unpaid claims or ‘surprises’ in regard to the limitations of their employer-sponsored insurance plan; or have heard horror stories from a colleague in their office.

There are solutions available that aren’t particularly expensive and offer expats ‘peace of mind’ that should the worst happen, you will not be liable for any of the bills. The most common limitation of company health insurance plans is the absence of maternity benefits, but the major risk we see are the low limits for hospitalisation and the 20% co-pay on GMM, as the bills can quickly escalate if you need intensive care or major surgery."

As we noted above, company health insurance plans might be enough for some expats, but many times coverage won't be enough, especially if you have a family or prefer to visit private hospitals (where costs can be extremely high). If you ask the questions above and find any potential issues, the experts at Pacific Prime Singapore recommend obtaining a top-up plan that can help cover any shortfalls. One of the best options is an international health insurance plan. These plans often have high limits and provide better coverage, which means that, should even the worse happen, you will be covered.

Talk to one of our experts today.