What is co-pay and how does it improve your health insurance?

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As health care costs continue to rise, it is understandable that both health care costs and health insurance are an increasing concern for everyone.

One way to manage health insurance costs is through co-payments; Co-Pay is a mechanism that allows insurance providers to reduce costs and present a win-win scenario for insurers and insureds.

Co-pay health insurance can, under the right circumstances, help you save in the long run. Let’s cover what co-payments are and who they’re best for.

What is co-pay?

Co-payment is an agreement between the insured and the insurer that the insured pays a percentage of the cost of the hospital and the rest is paid by the insurer. The percentage paid by the insured with co-payment can vary between 10 and 30% of the sum insured.

What is the benefit of co-payments?

When you consider that many of us buy insurance because we Not When you’re trying to pay a hefty hospital bill, co-pay may sound counterproductive. However, that is not necessarily the case; Because a co-pay clause reduces risk for the insurer, it often results in a reduction in premiums for your Integrated Protection Plan.

MediShield life

MediShield Life is the essential health insurance plan that protects all Singapore citizens and permanent residents from high hospital bills, regardless of age or medical history.

It is possible for Singaporeans to upgrade their existing MediShield Life coverage with MediShield Approved Integrated Plans (IP). IP’s such as Prudential PRUShield Health Insurance Plan can extend coverage beyond what the basic MediShield Life policy offers.

Additionally, MediSave can be used to pay for your MediShield Life in full and can also contribute to your IP up to withdrawal limits.

Age Withdrawal Limits
40 years old and under S$300 per year
41-70 years old $600 per year
71 years old and older $900 per year

Also read: Key moments in life when you may need an integrated protection plan

PRUShield

PRUShield, along with Prudential’s supplemental plans, is designed to complement MediShield Life and provide you with more comprehensive medical coverage based on your age and budget.

PRUShield offers you a number of powerful benefits even without the free plans, including:

PRUShield Benefits
  • Annual coverage of up to S$1.2 million in medical treatments
  • Covers 180 days of pre-hospital coverage and 365 days of post-hospital coverage
  • No health insurance for new plan purchases for significant life events
  • Emergencies and planned medical treatment abroad are covered

There are 3 main PRUShield plans: default, plus and premierwith different degrees of coverage.

main plans cover Supplemental Plans
PRUShield standard Coverage for medical and surgical expenses in reorganized hospitals (up to class B1 station) No additional plans
PRUShield Plus Coverage for medical and surgical expenses in reorganized hospitals (up to class A) PRUExtra Plus CoPay & PRUExtra Plus Lite CoPay
PRUShield Premier Cover for medical and surgical expenses private and reorganized hospitals PRUExtra Premier CoPay, PRUExtra Premier Lite CoPay & PRUExtra Premier Lite CoPay

Also read: Prudential PRUShield Health Insurance Review

PRUExtra

Image of a hand with IV

PRUExtra plans are supplemental plans that can be used to further expand any PRUShield plans you may be considering to have your coverage meet your needs.
There are 2 highlight features that are part of all PRUExtra plans.

  • The PRUExtra plans cover 50% of your coinsurance
  • There is a S$3,000 stop loss for panel providers and advanced panel experts
Graphic how MediShield, PRUShield and PRUExtra make healthcare bills more affordable

Graphic Based on PRUShield E-Brochure

PRUShield Premier add-on plans

PRU Extra Premier CoPay
PRUExtra Premier CoPay offers the best coverage that PRUShield can offer and offers coverage in all private and reorganized hospitals in Singapore. PRUExtra Premier covers 95% of your excess.

PRU Extra Premier Lite CoPay
PRUExtra Premier Lite offers most of the benefits of the regular Premier version, including private hospital coverage and halving your coinsurance amount. However, in exchange for lower premiums, it only covers 50% of your deductible amount.

PRUExtra Preferred CoPay
PRUExtra Preferred CoPay offers almost all the benefits of PRUExtra Premier CoPay. However, it only includes selected private and restructured hospitals. Luckily, the list of healthcare providers and specialists that PRUExtra Preferred CoPay covers is quite extensive and can be found at PRUPanel Connect website. Aside from that small caveat, PRUExtra Preferred CoPay shares the 95% deductible with PRUExtra Premier CoPay

PRUShield Plus Supplemental Plans

There are 2 PRUExtra add-on plans for PRUSheild Plus, PRUExtra Plus CoPay and PRUExtra Plus Lite CoPay. PRUExtra Plus CoPay covers 95% of your excess, while both PRUExtra Plus Lite CoPay cover 50% of your excess. These PRUExtra supplemental plans have the same hospital/ward coverage as PRUShield Plus and cover all Singapore restructured hospitals (up to Class A ward).

Image of a doctor's hand typing on a computer

Extended Panel (EP)

The expanded panel is an initiative of the Multilateral Healthcare Insurance Committee (MHIC) that allows IP insurers to mutually recognize their panel doctors. Eligible policyholders who seek treatment from EP specialists benefit from a S$3000 stop loss.
For a Registered Physician to be considered an EP Specialist, they should:

  • Be on another IP insurer’s approved panel list;
  • Obtain a pre-authorization from Prudential;
  • Comply with the regulatory fee schedule;
  • Meet the terms and conditions prior to authorization.

Claims-Based Pricing

Both PRUExtra Premier CoPay and PRUExtra Preferred CoPay both benefit from a claims-based pricing model. With this pricing system, you start by paying the lowest premium for your age group and the PRUWell premium, saving you 20% if your policy is taken out without exclusions.
Your award level is determined by previous claims during the review period. As long as no claims are made, you will continue to pay the standard premium.

Conclusion

Co-Pay allows insurers to create a pricing model that is more favorable to us, alongside other mechanisms such as claims-based pricing. This allows us to spend more on the coverage we need and have peace of mind with our health insurance coverage at an affordable cost.

Interested users looking for an integrated protection plan with comprehensive coverage and claims-based pricing can refer to these details PRUShield review or apply for one here.

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