MediShield Life: Pro-Ration Factor, Deductibles & Co-Insurance Breakdowns
- Jiani Chong
- Jun 4, 2024
- 5 min read
In the context of MediShield Life and Integrated Shield Plan (IP), understanding deductibles, co-insurance, and pro-ration factors is crucial for managing medical expenses effectively. Here's how they work together:
Deductibles: Your Starting Line
Think of deductibles as the entry fee to the insurance game. Pay it annually before your coverage kicks in. If your bill is lower, tough luck - no claims. It separates minor bills from major ones needing insurance help.
Co-Insurance: Sharing the Load
Co-insurance means splitting the bill with your insurer after deductibles. In places like Singapore, it's around 10-20% of the total, excluding the deductible you've paid.
Pro-Ration Factors: The Curveball
When your treatment surpasses your plan's coverage, pro-ration factors kick in. Pay your private ward deductible plus a portion of the bill based on your plan's coverage.
If you are unsure how to calculate them, below are examples to show you how to break down your medical bill for illustrative purposes.
Medical Expense Bill Breakdown in Singapore (For Illustrative Purposes Only)
Scenario A-1: Medical Expense Bill of $5,000
Total Bill: $5,000
Deductibles:
Annual Deductible: $1,000
Your Initial Payment: $1,000
Co-Insurance:
Co-Insurance Rate: 20% (of the remaining bill after deductibles)
Remaining Bill after Deductibles: $5,000 - $1,000 = $4,000
Your Share (20%): $4,000 * 0.20 = $800
Pro-Ration Factors:
Pro-Ration Factor: 25% (for treatment in a private hospital ward)
Pro-Rated Amount: $5,000 * 0.25 = $1,250
Final Breakdown
Deductibles Paid by You: $1,000
Co-Insurance Paid by You: $800
Pro-Rated Amount Paid by You: $1,250
Total Amount Paid by You: $1,000 + $800 + $1,250 = $3,050
Total Amount Paid by Insurer: $5,000 - $3,050 = $1,950
Scenario B-1: Medical Expense Bill of $30,000
Total Bill: $30,000
Deductibles:
Annual Deductible: $1,000
Your Initial Payment: $1,000
Co-Insurance:
Co-Insurance Rate: 20% (of the remaining bill after deductibles)
Remaining Bill after Deductibles: $30,000 - $1,000 = $29,000
Your Share (20%): $29,000 * 0.20 = $5,800
Pro-Ration Factors:
Pro-Ration Factor: 25% (for treatment in a private hospital ward)
Pro-Rated Amount: $30,000 * 0.25 = $7,500
Final Breakdown
Deductibles Paid by You: $1,000
Co-Insurance Paid by You: $5,800
Pro-Rated Amount Paid by You: $7,500
Total Amount Paid by You: $1,000 + $5,800 + $7,500 = $14,300
Total Amount Paid by Insurer: $30,000 - $14,300 = $15,700
The bill may seem intimidating, but don't worry; if you are admitted to a ward covered by your insurance, you won't need to fork out a huge sum of the pro-rated amount illustrated above. Check the revised scenarios below, with the pro-ration factor removed from the calculation, and you will see that you save a significant amount 🤑!
Scenario A-2: Medical Expense Bill of $5,000
Total Bill: $5,000
Deductibles:
Annual Deductible: $1,000
Your Initial Payment: $1,000
Co-Insurance:
Co-Insurance Rate: 20% (of the remaining bill after deductibles)
Remaining Bill after Deductibles: $5,000 - $1,000 = $4,000
Your Share (20%): $4,000 * 0.20 = $800
Final Breakdown
Deductibles Paid by You: $1,000
Co-Insurance Paid by You: $800
Total Amount Paid by You: $1,000 + $800 = $1,800
Total Amount Paid by Insurer: $5,000 - $1,800 = $3,200
You Saved $1,250 ($3,050 - $1,800) when you get sufficient coverage!
Scenario B-2: Medical Expense Bill of $30,000
Total Bill: $30,000
Deductibles:
Annual Deductible: $1,000
Your Initial Payment: $1,000
Co-Insurance:
Co-Insurance Rate: 20% (of the remaining bill after deductibles)
Remaining Bill after Deductibles: $30,000 - $1,000 = $29,000
Your Share (20%): $29,000 * 0.20 = $5,800
Final Breakdown
Deductibles Paid by You: $1,000
Co-Insurance Paid by You: $5,800
Total Amount Paid by You: $1,000 + $5,800 = $6,800
Total Amount Paid by Insurer: $30,000 - $6,800 = $23,200
You Saved $7,500 ($14,300 - $6,800) when you get sufficient coverage!
在了解 MediShield Life 和综合保险计划（Integrated Shield Plan，简称 IP）的背景下，理解免赔额、共同承担费用和按比例因素对于有效管理医疗费用至关重要。以下是它们如何共同运作的：
免赔额（Deductibles）：你的起跑线
免赔额基本上是每年在你能索赔之前需要支付的金额，该金额取决于你所住的病房类型。如果你的医疗账单低于免赔额，那么你甚至不能为此账单提出索赔。免赔额有助于区分哪些是较小的医疗费用，哪些是你可能真正需要保险公司帮助的大额医疗费账单。
共同承担费用（Co-Insurance）：分担费用
共同承担费用意味着在支付免赔额之后与你的保险公司分担账单。在新加坡等地，这个比例大约是总费用的10-20%，其中不包括你支付的免赔额。
按比例因素（Pro- Ration Factors）：曲线球
当你的住院规格超过你保险计划的覆盖范围时，按比例因素就会生效。
如果你不确定如何计算它们，请查看我展示的列子以了解如何剖析你的医疗账单，但仅供参考。
新加坡医疗费用账单分解（仅供参考）
场景1-1：S$5,000的医疗费用
总费用：S$5,000
免赔额：
年度免赔额：S$1,000
您的初始支付：S$1,000
共同保险：
共同保险率：剩余账单的20%（扣除免赔额后）
扣除免赔额后的剩余账单：S$5,000 - S$1,000 = S$4,000
您的份额（20%）：S$4,000 * 0.20 = S$800
按比例因素:
按比例因素: 25% (入住私人病房)
按比例计算的金额: $5,000 * 0.25 = $1,250
总结
您支付的免赔额：S$1000
您支付的共同保险：S$800
您支付的按比例计算的金额：S$1,250
您的总支付金额：S$1000 + S$800 + S$1,250 = S$3,050
您的保险赔偿金额：S$5,000 - S$3,050 = S$1,950
场景2-1：S$30,000的医疗费用
总费用：S$30,000
免赔额：
年度免赔额：S$1,000
您的初始支付：S$1,000
共同保险：
共同保险率：剩余账单的20%（扣除免赔额后）
扣除免赔额后的剩余账单：S$30,000 - S$1,000 = S$29,000
您的份额（20%）：S$29,000 * 0.20 = S$5,800
按比例因素:
按比例因素: 25% (入住私人病房)
按比例计算的金额: $30,000 * 0.25 = $7,500
总结
您支付的免赔额：S$1000
您支付的共同保险：S$5,800
您支付的按比例计算的金额：S$7,500
您的总支付金额：S$1000 + S$5,800 + S$7,500 = S$14,300
您的保险赔偿金额：S$30,000 - S$14,300 = S$15,700
账单可能看起来令人望而生畏，但别担心；如果你是入住在保险所覆盖的病房，那你就不需要支付上面所展示的按比例计算的金额。看看下面计算中删除了比例因子的场景，你会发现你节省了相当可观的金额 🤑！
场景1-2：S$5,000的医疗费用
总费用：S$5,000
免赔额：
年度免赔额：S$1,000
您的初始支付：S$1,000
共同保险：
共同保险率：剩余账单的20%（扣除免赔额后）
扣除免赔额后的剩余账单：S$5,000 - S$1,000 = S$4,000
您的份额（20%）：S$4,000 * 0.20 = S$800
总结
您支付的免赔额：S$1000
您支付的共同保险：S$800
您的总支付金额：S$1000 + S$800 = S$1,800
您的保险赔偿金额：S$5,000 - S$1,800 = S$3,200
您的保单为你省下了 $1,250 ($3,050 - $1,800)！
场景2-2：S$30,000的医疗费用
总费用：S$30,000
免赔额：
年度免赔额：S$1,000
您的初始支付：S$1,000
共同保险：
共同保险率：剩余账单的20%（扣除免赔额后）
扣除免赔额后的剩余账单：S$30,000 - S$1,000 = S$29,000
您的份额（20%）：S$29,000 * 0.20 = S$5,800
总结
您支付的免赔额：S$1000
您支付的共同保险：S$5,800
您的总支付金额：S$1000 + S$5,800 = S$6,800
您的保险赔偿金额：S$30,000 - S$6,800 = S$23,200
您的保单为你省下了 $7,500 ($14,300 - $6,800)！
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