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Facts, Fees and how to get financially insured against Stroke

By Derek Gue

Facts, Fees and how to get financially insured against Stroke

Former Senior Minister of State Lee Yi Shyan, who suffered a mini stroke a year ago, wrote on Facebook that Minister Heng Swee Keat had advised him “to go slow and doing "less is more". Yet Swee Keat works ever so hard himself. I really wish he would recover soon and completely.” Minister Heng, as we know, suffered a stroke during a Cabinet meeting in May. Home Affairs and Law Minister, K Shanmugam, said Minister Heng himself was “carrying an incredible load”. Often, we imagine that medical emergencies (and ambulances) are always for other people (not for ourselves, or our family). But if you have ever considered the possibility of something untoward happening, and would like to prepare in advance for that proverbial rainy day, I’ve written this article just for you.

Firstly, know that an aneurysm can occur in anyone in any age group. The “high risk” age group being from 50 to 60 years old. Women seem to be at greater risk too. What is most alarming is how a person may have an aneurysm with no prior symptoms, and it can rupture very suddenly. This explains why some of the other ministers recalled Minister Heng looking every bit his usual self when they had lunch together a few hours before he suffered the stroke.

Note too that strokes are Singapore’s 4th leading cause of death in 2014, the main cause of long term physical disability, and present a big future burden with a rapidly ageing population.

Next, let’s look at a (brief) overview of the costs involved and how much one can claim from insurance companies:

  1. Hospital And Surgery Related Costs

    From 1 April 2015 to 31 March 2016 , Changi General Hospital (CGH) and Tan Tock Seng Hospital (TTSH) each saw 30 patients admitted into their Class A ward for treatment of stroke with serious complications, with the 50th percentile bill being $14,760 (CGH) and $11,696 (TTSH). 50th percentile means half the patients paid this amount or less. Their 90th percentile bill is $35,002 (CGH) and $41,256 (TTSH). 90th percentile means 90% of the patients paid that amount or lesser. 

    Of course, patients can seek admission into B1, B2 or even C wards which are heavily subsidised. However, there is usually a waiting period for a bed in C or B2 wards and means testing to undergo. Class A ward treatments are also not the most expensive ones as there are patients going for similar treatments at private hospitals and incurring higher costs.

    The new Medishield Life is an improvement over its predecessor Medishield but might still be inadequate for serious strokes, especially for bills that are above the 50th percentile. Brain Aneurysm is classified within table 6C to 7A surgery depending on complications, with Medishield Life covering only $1,850 to $2,000 for costs of surgery. The medisave claim limit is also between $5,650 and $6,200 which is grossly lower than the average bill.

    If you have already purchased a personal hospital & surgical (H&S) plan, on top of medishield Life, most of the claim limits will be upgraded to ‘As Charged’ coverage. The bulk of the premiums can be paid out from Medisave. If your budget allows, do consider purchasing additional riders to cover the deductible and co-insurance components. The H&S plan is also portable and the coverage will follow you unlike Group H&S plans that will cease coverage the moment you leave the Company.

    1 https://www.singhealth.com.sg/PatientCare/ConditionsAndTreatments/Pages/Cerebral-Aneurysm.aspx
    2 https://www.moh.gov.sg/content/moh_web/home/costs_and_financing/hospital-charges/Total-Hospital-Bills-By-condition-procedure/stroke_with_seriouscomplications.html
  2. Recuperation Phase

    This period can last a year or even a lifetime. After the hospital bills are settled, the other concerns, especially if it is a serious stroke, are the costs of ongoing rehabilitation, family’s outstanding liabilities such as mortgage loans, needs of young dependents, the loss of income especially if the patient was the primary breadwinner, etc.

    If the patient had bought term or whole life insurance that pays out a lump sum of money upon critical illness (a serious stroke is one of the 30 to 36 types of illnesses that will trigger a payout) at least the family can draw on that as temporary income replacement. Do note that most critical illness plans bought prior to 2012 in Singapore pay out upon diagnosis or occurrence at advanced stages of critical illness or more serious instances of stroke. After 2012, early stage critical illness plans became more popular with a segment of consumers who wanted insurance plans that pay out the sum assured at an earlier stage (or when the illness extremely severe).

    For a patient who has suffered a serious stroke, the family may also have to engage a foreign domestic worker. That could cost about $550/month in salary on top of the monthly therapy costs, estimated at about $300 to $400 at a rehabilitation hospital with daily transport. These fees do not include other miscellaneous items like meals for the domestic worker and air tickets for her to return home every 2 years, consumables such as disposable diapers if the stroke survivor has difficulty controlling bowel movements, retrofitting of the house with grab bars, etc. 

    Singaporeans and Permanent Residents above 40 years old recuperating from a serious stroke can tap on a scheme called Eldershield which is a severe disability insurance that will pay a cash benefit of between $300/month for 5 years to $400/month for 6 years if the claimant is unable to perform any 3 or more of these 6 activities of daily living independently: Transferring from bed to an upright position, Mobility within the house, Toileting, Washing, Dressing, and Feeding. If you have basic Eldershield currently, my advice is to not opt out from it.

    If you are in good health and between 40 to 65, I would encourage you to supplement/upgrade your basic Eldershield to increase the payout to as much as $1,600/month for lifetime payout (depending on your current age and lifestyle needs). Premiums can be paid from your Medisave account subject to a cap of $600/year/insured person. This cap is independent of your Medishield Life and personal H&S cap.

    If you are currently below age 40, and not eligible for basic Eldershield yet, but very concerned about insuring your family and yourself against the high economic costs of a severe disability, other than purchasing an insurance plan with critical illness attached (early stage is even better if you can afford the premiums), you can also consider term plans that pay out a monthly income if a misfortune or an illness robs you of the ability to work according to your occupation class. There are 3 insurance companies in Singapore which have such plans, and these plans are already very popular in the Western developed countries.

Jack Ma, founder and CEO of Ali Baba Group, famously said that “buying insurance will not change your life, but it can prevent your life and your lifestyle from being changed. An illness with the resulting medical bill can easily wipe out decades of family savings. A person will not become a bankrupt from buying insurance, but a person without insurance may become a burden and bankrupt his family and children due to his ignorance and being selfish.

Right now, while you are healthy, able to work and can get covered with insurance. Are you going to procrastinate and put your family’s security and future at risk? Take the first step to find out more and speak with your trusted financial adviser or send me an email for more information and arrange for a review to check if you have adequate coverage for hospital and surgical expenses, critical illness and Eldershield supplements.

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Derek Gue
Derek Gue

Derek Gue is a Financial Strategist who formulates solutions for his clients to safeguard their income and increase their wealth. He also conducts regular public and lunchtime financial education talks.

Contact Derek to arrange for financial education talks and/or personalised financial planning reviews via bwutbook@gmail.com or visit his website at www.derekgue.com​.