Means testing is a way to focus limited resources for needy Singaporeans, by channeling it to those who need it most. Means testing has been implemented at the government-funded nursing homes since 2000 and at the other intermediate and long term care facilities since 2001. Lower-income patients receive more subsidies than the higher-income patients at these facilities.

As subsidized wards become more enhanced and better furnished with amenities, we foresee patients who previously selected Class A or B1 to now choose Class B2 or C wards.  This would crowd out the lower-income patients, who cannot afford higher class wards and have no choice but to seek treatment in subsidised wards. Means testing will help ensure that the lower-income still have access to subsidised wards and are not crowded out by those who could afford private care.

Patients will still retain their freedom to choose their ward class. Any patient, regardless of whether they are rich or poor, can choose to be admitted to a Class C or B2 ward.  They will still be heavily subsidised, but at different rates. 

All patients in Class C and B2 will be subsidised, but to different degrees. Higher-income patients will be subsidised less than lower-income patients, but their bills will remain affordable. A higher salaried  patient in Class B2 will still receive higher subsidy in B2, than if he opts for Class B1.

Like Singapore citizens, Singapore permanent residents will have to be means tested for admission to Class B2 and C wards.  Subsidies for Singapore Permanent Residents will be up to 30%-points less than Singapore citizens (from 1 October 2012) of an equivalent income level or residence with similar AV.
Foreigners will not be affected as they no longer receive subsidies at public hospitals since 1 January 2008.

Means testing only applies to Class B2 (including B2+) and C hospitalizations. Services such as day surgery, Accident & Emergency (A&E) services, Specialist Outpatient and polyclinic visits will not be means tested.

Means testing will not affect your follow-up after discharge. If you require any follow-up at the specialist outpatient clinics after your Class B2 or C hospitalization, you will continue to be subsidized.

For those who are working, their subsidy will be based on their income level. The hospitals’ system will extract the income information from the CPF Board’s system and automatically calculate the subsidy level for each patient.

Average Monthly Income of Patient	Class C Subsidy (Citizens)	Class B2 Subsidy (Citizens)	Class C Subsidy (PR) (From 1 Oct 2012)	Class B2 Subsidy (PR) (From 1 Oct 2012)	Class C Subsidy (PR) (From 1 Apr 2013)	Class B2 Subsidy (PR) (From 1 Apr 2013)
$3,200 and below	80%	65%	55.0%	40.0%	55.0%	40.0%
$3,201 - $3,350	79%	64%	49.0%	38.0%	39.5%	32.0%
$3,351 - $3,500	78%	63%	48.5%	37.0%	39.0%	31.5%
$3,501 - $3,650	77%	62%	47.5%	36.5%	38.5%	31.0%
$3,651 - $3,800	76%	61%	47.0%	35.5%	38.0%	30.5%
$3,801 - $3,950	75%	60%	46.0%	35.0%	37.5%	30.0%
$3,951 - $4,100	74%	59%	45.5%	34.0%	37.0%	29.5%
$4,101 - $4,250	73%	58%	44.5%	33.5%	36.5%	29.0%
$4,251 - $4,400	72%	57%	44.0%	32.5%	36.0%	28.5%
$4,401 - $4,550	71%	56%	43.0%	32.0%	35.5%	28.0%
$4,551 - $4,700	70%	55%	42.5%	31.0%	35.0%	27.5%
$4,701 - $4,850	69%	54%	41.5%	30.5%	34.5%	27.0%
$4,851 - $5,000	68%	53%	41.0%	29.5%	34.0%	26.5%
$5,001 - $5,100	67%	52%	40.0%	29.0%	33.5%	26.0%
$5,101 - $5,200	66%	51%	39.5%	28.0%	33.0%	25.5%
$5,201 and above	65%	50%	38.5%	25.0%	32.5%	25.0%

For patients who are salaried employees, their income will be based on the average monthly income received over the last available 12-month period, including bonuses. It will not be based on just the last month’s salary.

Voluntary contributions to CPF will not affect the income information obtained from CPF Board.

For patients who are self-employed, their income will be based on either:

(a) the monthly income derived from the last available net trade income assessed by the Inland Revenue Authority of Singapore within the last 2 assessment years; or
(b) the income declared to the CPF Board or the income assumed under the CPF laws within the last 2 years.

The subsidy level based on your income will be stored in the system for a period of 12 months.  If you require another admission within the 12-month period, you will not need to be means tested again.  The system will retrieve the subsidy level of the previous admission.

As patient’s income will not be based on just the last month’s salary but the average salary of the last 12 months, this will address the concern about month-to-month fluctuations in pay arising from occasional instances of overtime.

Patients who have been retrenched will be able to receive the maximum subsidy. You will need to show proof that you have been retrenched by your employer.

If you suffer a loss of income since your last admission, you can inform the hospital staff to retrieve your latest available income information from CPF Board. You will need to provide consent for the hospital staff to do so. Your subsidy level will be based on the latest information retrieved.

Patients who do not have an income will receive full subsidy (65% for Class B and 80% for Class C) unless they live in a property with AV exceeding $13,000.  The latter will receive subsidy at 50% (at Class B2) at 65% (at Class C).

The assessment will be based on the address as registered on their NRIC.

Children under the age of 21 will be assessed based on the AV of their residence. For those who have not obtained their NRIC, it will be based on the residence as stated in their Birth Certificate or NRIC of the parent.

It is only after you give consent that the system can more accurately estimate your bill based on your situation. If you do not wish to provide consent, your hospital bill will be based on 65% subsidy for Class C (or 50% subsidy for Class B2).

No, family members are not allowed to give consent on the patient's behalf. The patient needs to be the one to give consent for the system to get his information from CPF Board. This is to protect the individual's privacy.

The hospital staff will follow up with you subsequently to obtain your consent. In the meantime, your bill will be estimated based on the lowest subsidy for the ward class chosen. Your hospitalisation bill will be finalised based on the information from CPF Board after consent has been obtained from you.

No patient will be denied medical treatment because he cannot afford it. Means testing will be implemented flexibly and appeals for re-assessment will be considered. If you need additional help, you may wish to speak with the medical social worker at the public hospital for Medifund or other forms of financial assistance.

As most patients are not affected by means-testing and will continue to enjoy full subsidies of 65% at Class B2 and 80% at Class C, most patients’ claims from MediShield will also not be affected by means-testing.

However, as MediShield premiums are the same for all insured members in the same age group, MediShield payouts are therefore similar for all insured members, regardless of subsidy status.

To ensure a fair payout across all MediShield insured members for the same treatment received, Class B2 or C patients who are affected by means-testing will have their claims adjusted such that it would be similar to that of patients receiving maximum subsidy.

Should you be affected by means-testing, you may wish to consider applying for an increased coverage under a Medisave-Approved Integrated Shield Plan. Integrated Shield Plans are offered by the following participating insurers: AIA, Aviva, Great Eastern, NTUC Income and Prudential.

As MediShield premiums are the same across all insured members in the same age group, MediShield payouts are therefore similar for all insured members, regardless of their subsidy status.

From 1 October 2012, SPRs who are admitted to Class B2/C wards will receive up to 30 percentage points less subsidy than Singapore citizens of an equivalent income level or property AV. MediShield claims for SPRs admitted to Class B2/C will also be adjusted such that it is similar to that of Singapore citizen patients receiving maximum subsidy.

If you wish to have higher coverage than what MediShield provides, you may apply to any of the participating insurers for a Medisave-Approved Integrated Shield Plan. Integrated Shield Plans are offered by the following participating insurers: AIA, Aviva, Great Eastern, NTUC Income and Prudential.

There will be no change to claims for Integrated Shield Plans after means-testing. This is because Integrated Shield Plans are meant for higher ward classes, e.g. Class B1 or Class A wards.  

For more information on Integrated Shield Plans, please check with your Integrated Shield Plan provider.

Medisave will continue to pay out according to the prevailing Medisave claim limits. Please check with the hospital business office for the estimated amount of Medisave that can be used for the hospitalization.

You will need to check directly with your employer if there will be any change in your medical benefits.