Is Cataracts Surgery in Singapore covered by insurance and Medishield or Medisave?

"Is Cataracts Surgery in Singapore covered by insurance and Medishield or Medisave?"

This is a surprisingly common question - but perhaps in a good way, since cataracts removal surgery is a 'once in a lifetime' matter.

Insurance - can it be used for cataracts surgery in Singapore?

In Singapore, cataracts-removal surgery, or cataracts surgery, is a common and vital surgery (and a life-changing one) done mainly for older patients as age is a risk factor, restoring clear vision by removing the eye's natural lens that has turned cloudy (cataracts).

The cost can vary, depending on the surgeon's expertise and years of experience, the type of artificial lens implant that is used to replace the eye's original (but cloudy) lens, the facility that the surgery is performed in, and the form of anaesthesia used.

Read more about: How much does a cataracts surgery cost in Singapore.

MEDISAVE

Yes,. Medisave can be used for your cataracts surgery done in Singapore.

For the surgical fees, the Medisave claim limit is $2380 (based on Table 4A - indicating the complexity of the surgery). You can also use up to $830 per day for hospital charges for day surgery (in addition to the surgical fee), which include daily ward charges, daily treatment fees, investigations, and medicines.

The Medisave claim limit is dependant on the complexity of the surgery, and in general, most adult cataracts-removal surgeries are rated as Table 4A. A more simple procedure, such as an injection, would be Table 1 with a lower claimable limit, while a highly complex procedure like a vitrectomy (which goes into the back portion of the eye ball and is typically done under general anaesthesia) would be Table 5 or 6 with a higher claimable limit.

INSURANCE

Generally, in most cases, cataracts surgery can be covered by insurance, although it may or may not be fully covered, depending on the individual plan, circumstances, and choices that the patient makes (e.g. on the artificial lens implant, hospital, etc.).

MediShield Life:

This mandatory 'universal' health plan managed by the Government is basic but provides much coverage, especially for public sector health care. While it gives some coverage for private healthcare, the coverage is pro-rated. This is one of the reasons why people buy integrated insurance plans (IP) that 'tags' onto this basic MediShield Life plan.

IPs and Riders:

Integrated plans are plans that are 'added-on' the basic MediShield Life plan, that some people have opted for in order to provide greater coverage and benefits, such as being more covered for private hospital stays or for higher-tier wards in public hospitals (Government Restructured Hospitals). Some riders may lower your co-pay or deductible, while different insurers may work with different doctors or surgeons, as well as hospitals or surgery centres. Hence, coverage can differ from insurer to insurer, and plan to plan. You can read more at our Insurance Page.

Private Health Insurance:

Some private health insurance plans may provide for more comprehensive coverage, especially for private sector medical care. There may also be international insurance plans that provide for such benefits, although the process of claiming or applying for an LOG or GOP (letter of guarantee, guarantee of payment) would be different from the local insurers who have systems integrated into our healthcare billing systems.

Corporate Health Insurance:

Some corporate insurances may provide not just for surgical coverage but also standard clinic visits (without procedures). If you are covered under corporate insurance, you should check the benefits with your HR department. Corporate insurance is often administered by a third-party administrator (TPA).

How do I know my coverage?

The best way to understand your coverage is to contact your insurer or insurance agent, or your HR department if you are under a corporate health insurance scheme.

It is important to understand about deductibles and co-payments:

• A deductible is the fixed amount you must pay first before your insurance starts to contribute. If your deductible is $2,000 and your hospital bill is $10,000, you pay the first $2,000, and the remaining $8,000 is then eligible for insurance claims (subject to co-payment).

• A co-payment is the percentage of the remaining bill that you share with the insurer after the deductible has been met. Continuing the above example, if the co-pay is 10%, then of the $8,000, you will have to pay $800 while the insurer covers the rest.

The cataracts surgery is done in an operating theatre.

What will I have to do regarding insurance, before the cataracts surgery?

While planning for cataracts surgery, one of the steps involves financial counselling, where we present to you the estimated costs, including the surgeon fee, anaesthetist fee, facility fee, and so on. While these costs are an estimate, common procedures like cataracts surgery (phacoemulsification) are very often done, allowing us to give a relatively accurate estimate.

Do note that any additional requests (e.g. for an overnight stay in a suite with private chef and limousine service) or complications during the surgery may cause the costs to increase.

For some insurers, we are able to submit for a Letter Of Guarantee or Pre-Authorisation, which seeks to inform the insurer of the upcoming surgery, of which the insurer will be able to pre-approve the procedure, thus reducing your upfront payment (if any). There may be some process required on your end, such as signing of the application forms, or logging into an insurer's app to allow us to submit the details on your behalf.

We are committed to transparency and making things as smooth as it can be for you - so come talk to us.

Talk to us.