Photo of a blind man with cane (Andrey Popov/Shutterstock.com)

Eldershield policy holder denied payout by insurer despite being certified blind by medical assessor

Following much fanfare about how the new CareShield Life – a plan to replace ElderShield – will stand to benefit Singaporeans in offering higher payout in claims and a lifetime payout, Mr Teo, a member of public shared his claim experience with The Online Citizen. He provided his medical assessment form along with the reply from NTUC income, showing that the insurer had denied his claim for the Eldershield payout despite being certified as being blind.

ElderShield is a severe disability insurance scheme created by the Singapore Government which is said to provide basic financial protection to those who need long-term care. Under the current system, all Singapore Citizens and Permanent Residents with MediSave accounts are automatically enrolled in ElderShield at the age of 40, unless they opt out of the scheme.

According to the Eldershield's definition, “Severe disability” is said to be the inability of an individual to perform three or more Activities of Daily Living (ADLs) independently, with or without mobility aids (e.g. walking aids, wheelchair). This means that the individual will require the physical assistance of another person for the ADL.

The ElderShield website writes, "You are covered for life. Once you start paying premiums, you can make a claim at any age, should you suffer from severe disability. Even after your premium term is completed at age 65, you remain insured for life."

Anyone with common sense would agree that someone like Mr Teo – who was certified to have had loss of vision in his right eye and only can see shadows in his left eye – was disabled or at least handicapped in his daily activities, but not NTUC income. Despite Mr Teo being blind, it deemed him able to carry out ADLs independently.

Currently, there are three authorised insurers to offer ElderShield. They are; Aviva, Great Eastern (GE) and NTUC Income.

As the system has been, Mr Teo was auto-enrolled under NTUC Income and he tried to file a claim with the Eldershield insurer at the age of 54. He was then made to go for an assessment of his medical condition.

Assessment form filled up by the physician in Raffles Medical Group

According to the doctor's observation of Mr Teo on 24 March 2015, it is said that Mr Teo:

  • Needs supervision to prevent falls and tripping during bathing
  • Will need assistance to knew which side to put on for T-shirts and shorts.
  • Need food preparation. Need scooping as he cannot see.
  • Need wife to check if properly clean after wiping after passing motion.
  • Needs constant supervision at home when moving.

The doctor specifically wrote in the assessment form that it is in his opinion that Mr Teo's disability of ADLs commenced in Dec 2014

However, when NTUC Income wrote back to Mr Teo on 8 April 2015, it stated that he did not qualify for the benefits as he is still able to perform more than three ADLs.

Reply from NTUC to Mr Teo

To add irony to Mr Teo's situation, he managed to claim permanent disability under his other insurance plans – three in total – except for Eldershield which claims to provide for one's future long-term care needs.

Mr Teo said, "I think this ElderShield is a scam. Normal disability only cannot claim - only severe disability - must be more like a vegetable in order to claim. What kind of disability - most people not sure - many think can claim, but 2 legs chopped off also cannot."

A professional nurse whom TOC spoke to, noted that most severe disability – which would qualify under ElderShield or CareShield Life's definition – is a result of late-stage cancer or other serious illness and that the period which the patient has left is not long. Therefore, the lifetime payout with higher premiums might not be that attractive after all.

Is Eldershield or Careshield a money making scheme?

Minister for Health Gan Kim Yong revealed in 2017 that from 2002 to end-2015, about $2.6 billion was collected in premiums for ElderShield insurance and around $100 million were paid out in claims, adding that about $130 million in premium rebates have been given to policyholders so far, the first tranche in 2007 and another in 2012.

Given that the new CareShield Life will be mandatory as one cannot opt out from the scheme, one will have to wonder how much premiums will be collected from its policyholders and actually pay out as claims. So far, no actuarial report has been made available for the scheme and it would be important and crucial that such information be made public before it is to be applied to everyone in 2020.

Before anyone starts to argue that current claims against premiums collected cannot be said as profiteering, considering the premiums collected are meant to meet claims requirement in the future. Please note that such considerations are meant for private insurers who are not certain if there will be enough new or existing subscribers to foot the claims, which is different from a government-run scheme where it is mandatory for citizens to partake – therefore less the worry of claims exceeding premiums collected – and it should fundamentally be non-profit driven.