MediShield Life is not for private hospital bills. Here’s why.

Key Takeaways:

• Buy the plan for the ward type you want to stay at to avoid the pro-ration factor from being imposed on your bill.
• MediShield Life will not provide sufficient coverage if you are looking to stay at Class B1 and above wards in public hospitals, or at private hospitals.
• Get an Integrated Shield plan (IP) that aligns with the type of coverage you would like to receive. Buy a Private hospital IP if you would like to stay at private hospitals.

Understanding the basics: MediShield Life and Integrated Shield plans (IPs)

Integrated Shield Plans (IPs) in Singapore work alongside MediShield Life and forms a two-tier healthcare insurance system for hospitalisation expenses. Here are the main differences between the two:

	MediShield Life	Integrated Shield Plans (IPs)
Administered by	CPF Board	Offered by seven private insurers
Eligibility	Mandatory for all Singaporeans and Permanent Residents (PRs), coverage is given regardless of age or pre-existing conditions.	Optional add-on to enhance your hospitalisation coverage. Coverage is not guaranteed if individuals have pre-existing conditions.
Premiums payable by	MediSave	MediSave can be used up to the Additional Withdrawal Limits (AWL) after which cash will have to be utilised for the balance premiums.
Ward entitlement	Class B2/C wards in public hospitals	Private hospitals or Class A/B1 wards in public hospitals
Annual limits	$200,000	Up to $2 million. (Note: This limit will differ between insurers.)
As-charged coverage	No	Yes

Coverage and policy limits

Plan Type	Coverage	Integrated Shield Plans available on FSMOne:
Private hospital plan	Up to Private Hospitals and private specialists	Enhanced IncomeShield Preferred, Singlife Shield Plan 1, Raffles Shield Private
Ward A plan	Up to Ward A (private room) in public hospitals	Enhanced IncomeShield Advantage, Singlife Shield Plan2, Raffles Shield A
Ward B1 plan	Up to Ward B1 (shared room) in public hospitals	Enhanced IncomeShield Basic, Singlife Shield Plan 3, Raffles Shield B
MediShield Life	Up to Ward B2 or C (shared room) in public hospitals	-

 (Read more: Simplifying Singapore’s hospital insurance – All about MediShield Life and Integrated Shield plans)

What happens when you stay at a ward type higher than what your plan allows for

While you can stay at a hospital ward higher than what your plan entitles you to, we do not recommend doing so as pro-ration will take place and result in higher out-of-pocket expenses for you.

What is pro-ration:

A pro-ration factor applies when you choose to receive treatment at a ward that is of a higher class, and costs more than what your plan covers. In this case, the pro-ration factor is applied to adjust the bill down to the cost level associated with the covered ward class. This aims to encourage individuals to seek care at their entitled ward class and prevent cross-subsiding those who seek care at costlier ward classes. Pro-ration applies to both MediShield Life and Integrated Shield Plans.

An illustration: Mr Tan has an Integrated Shield plan with Class A ward coverage. Here is how much he may expect to pay for the different ward stays.

Ward Entitlement	Class A ward in public hospitals
Type of ward he stayed at	Private hospital	Class A wards in public hospitals
Pro-ration factor applied	50%*	100%
Eligible bill incurred	$100,000	$100,000
Pro-rated bill	50% of eligible bill = $50,000	100% of eligible bill = $100,000
Deductible required	$3,500	$3,500
Claimable amount (less deductible)	$50,000 - $3,500 = $46,500	$100,000 - $3,500 = $96,500
Co-insurance required	10% of $46,500 = $4,650	10% of $96,500 = $9,650
Claimable amount (less deductible less co-insurance)	$46,500 - $4,650 = $41,850	$96,500 - $9,650 = $86,850
Mr Tan’s out-of-pocket expenses required	$100,000 - $41,850 = $58,150	$100,000 - $86,850 = $13,150

Figures shown in the table are for illustrative purposes only. This table is not a guarantee of claims payable.
*The pro-ration factor will differ between insurers. Please check your policy wording for the required pro-ration factor for your plan.

If Mr Tan chooses to stay at a ward higher than what his plan covers, he will have to pay approximately 58 per cent of his total hospital bill. However, if he selects a ward that aligns with his plan, this out-of-pocket expense will be significantly reduced to just 13 per cent of the total bill. To avoid unexpectedly high expenses, ensure that you choose IPs that matches the type of hospital or ward that you would like to be admitted to.

Mr Tan can also consider adding on riders to cover the deductible and co-insurance required to further lower his out-of-pocket expenses. However, note that there will still be a minimum of 5 per cent co-payment applied regardless of rider(s) added.

Changes to pro-ration factor for MediShield Life

Starting from 1 April 2025, the pro-ration factor used for MediShield Life claims has been revised. This change reduces the proportion of bills MediShield Life covers for private hospital and Class A/B1 ward stays, ensuring that larger payouts are not unfairly directed toward higher-cost care at the expense of subsidised Class B2/C ward patients.

Revision to pro-ration factor for Singapore citizens:

​Ward class	Singapore citizen
	Pro-ration factor  before 1 April 2025	Pro-ration factor after 1 April 2025
Class C	100%	100%
​Class B2	100%	​100%
Class B2+	70%	​100%
Class B1	43%	​34%
Class A	35%	27%
​Private Hospital	25%	​16%

(Source: CPF website)

MediShield Life alone is insufficient if you want to stay at Class B1 and above wards in public hospitals or private hospitals

While MediShield Life is designed to fully cover nine in ten subsidised bills, this only applies to subsidised bills from public health care institutions (i.e. treatment at Class B2/C wards in public hospitals). While you can still make claims from MediShield Life if you choose to stay at a Class A/B1 ward or in a private hospital, a pro-ration factor will apply resulting in a smaller proportion of your bill being covered.

An illustration: Mr Tan only has MediShield Life but chooses to stay at a private hospital.

Ward Entitlement	Class B2/C wards in public hospitals
Type of ward he sought treatment at	Private hospital
Pro-ration factor applied	16%
Eligible bill incurred (ward charges)	$100,000
Pro-rated bill (ward charges)	16% of eligible bill = $16,000
Deductible required	$3,500
Claimable amount (less deductible)	$16,000 - $3,500 = $12,500
Co-insurance required	$930
Claimable amount (less deductible less co-insurance)	$12,500 - $930 = $11,570
Mr Tan’s out-of-pocket expenses required	$100,000 - $11,570 = $88,430

Figures shown in the table are for illustrative purposes only. This table is not a guarantee of claims payable.

As shown in the table above, if Mr Tan were to stay at a private hospital with only a MediShield Life coverage, he would have to pay a substantial $88,430 out of his $100,000 hospital bill. However, his out-of-pocket expenses would be significantly lower if he had gotten treated at Class B2/C wards in public hospitals, which is what MediShield Life is designed to cover.

To prevent such scenarios from occurring, it is important to choose an IP that matches the type of ward you intend to stay in. If you would like to stay at private hospitals, buy a private hospital plan. This helps you to avoid the pro-ration factor and reduces the risk of unexpected medical bills when you are hospitalised.