In my interactions with clients discussing about their protection needs, one of the questions that occasionally come up is “How can I cover myself and my family for outpatient GP and specialist/pediatrician visits?”
More than half of the working professionals I meet are covered by their company insurance with some form of group hospitalization plan. A proportion of them are also insured for outpatient visits to panel doctors and/or specialists. Usually, the coverage provided may have limits and restrictions (eg. $500/yr for specialists, $50/visit for non-panel doctors) and/or deductibles (eg. First $5 of GP visit borne by employee)
If you belong to the category where your company does not provide (or provides insufficient) outpatient coverage, or if you are self-employed, you may be wondering what you could do to get yourself some additional outpatient coverage.
Below are a few options you can consider:
1. Purchase an Individual private hospitalization plan that comes with outpatient rider options
Unlike the Integrated Shield plans (which can be partially funded by Medisave), private hospital plans are paid fully in cash and are often underwritten by General Insurance companies.
The core plan consists of a hospitalization and surgical plan which must be taken up. Some provide optional outpatient riders which could include GP visits, specialist visits, diagnostic tests, X-rays, MRIs, while some plans may extend to include dental visits, annual body and eye checkups, chiropractor and physiotherapy visits, speech therapy, transplant services, hospice care, maternity and childbirth benefits, home nursing, children’s vaccinations, emergency evacuation, etc.
Some provide an option for global coverage for individuals who travel frequently or would like the option to seek treatment overseas when required. Some also provide the option to cover certain pre-existing conditions.
Due to the extensive coverage of such plans, premiums will generally be higher. However, many insurers provide deductible (co-payment) options which help to lower premium rates.
For individuals who would like themselves and their family to be covered more extensively, such a plan may be an option to consider.
2. Add yourself as a dependent in your spouse’s company group insurance.
This would apply if you are married and if your spouse works in a company which provides outpatient coverage. Ask your spouse to check with his/her HR department whether you and your children can be added on as a dependent to enjoy the same outpatient benefits. Due to the pooling of risk, group insurance typically provides more competitive rates.
Of course, benefits are limited to the kind of plan provided by the company, and once your spouse leaves the company, the whole family will also lose these benefits.
3. If you are self-employed, purchase a company group insurance plan
Most group insurance plans require a minimum of 3-5 employees to effect. If you own a business, this is an option to get yourself and your dependents insured for outpatient benefits. As mentioned above, the pooling of risk for group insurance provides more competitive rates and a choice of various packages subject to your budget.
4. If you want to just insure yourself for outpatient expenses due to accidents (eg. sprained ankle, bitten by a stray animal etc), purchase a Personal Accident Plan
Outpatient expenses are usually incurred due to 2 main causes – sickness or injury. One of the most cost-efficient plans (and also, in my opinion, a must-have in everybody’s insurance portfolio) to insure outpatient expenses would be through a personal accident plan. Such plans typically provide a core coverage of Death or Dismemberment caused by an accident, and may also include reimbursement of medical expenses (which may extend to include outpatient such as physiotherapists, TCM etc) subject to specified limits.
So, which of the above options are suitable to cover outpatient expenses? Or is it necessary at all?
Whether any of these options make sense to you may depend on a few factors. These are some questions you may like to ask yourself:
Am I willing to take the risk to self-insure?
If you already have a comprehensive hospitalisation plan, the remaining expenses that you would need to bear on your own would be GP visits, medication, specialist visits and diagnostic or investigative tests (eg. MRI, CT scans). Some of these costs could accumulate into the hundreds or thousands. For example, an MRI to check on a persistent headache could set one back by more than a $1,000. This excludes consultation visits with the specialist, further investigations, medications etc.
Would your existing plans be able to cover you for these ? If not, would you be comfortable to bear the cost of this versus the amount that you would have to pay for any of the 4 options above?
If you are currently insured under an Integrated Shield Plan which has been enhanced, one of the benefits may include pre- and post- hospitalization costs. This means that if you saw a specialist before being hospitalized for a similar condition, you may be able to claim for some of the costs incurred. At the same time, your plan may also cover you for any follow-up consultations with the specialist after discharge.
If you fall into this category, then the risk you would have to bear would only be GP and specialist visits, medication and diagnostic tests that do not result in hospitalisation. If you also have a personal accident plan, then you only need to bear the risk of visits caused by illnesses.
Do I travel globally very often or want the option to seek treatment overseas? Am I an expatriate currently working in Singapore but may be going back to my home country at some point and would like the option to be insured when I am back home?
If you do, then a private hospitalization plan may be suitable to insure you globally.
Do I need coverage for all the other “extra” benefits?
Most companies that provide outpatient benefits provide the basic specialist and GP visits subject to varying limits. If you would like to also have coverage like maternity benefits, chiropractor and physiotherapy visits, annual checkups, paediatrician visits etc included., you can consider getting a private hospital plan as mentioned above.
For further information or clarifications, please feel free to contact me.