The case for having no Integrated Shield Plan

 

Ok, I need to close the loop for the last article for my mum's hospitalization. Thank you for all the well wishes and very important folks have read the last article after Investment Moats notified his bosses of my experience.

Before I proceed with my insights, I want to shed more light on my mum's Class C Ward stay. The top line cost is about $37k - 3 days high dependency wayrd + 27 days normal ward, government subsidies reduced it by $19k, medishield reduced by a further $6k and about $12k was deducted from my Medisave account. My final cash bill is a big fat zero, which was a hugely pleasant surprise for me as I actually prepared $6k from my cash reserves to pay off this bill. 

So my Medisave has been fully reloaded, the sums removed from cash reserve have been returned and dividends from Wednesday this week can be fully deployed to expoit the volatility from Trump's administration.

So my insight for today is the question of whether there is a case for having no Integrated Shield Plan or ISP.

For a start, I did not get into this position of having no ISP willingly. My bloodline has been deemed too expensive or impossible to insure, so I could not afford H&S insurance even if I wanted to in my 20s. But over the years, as I grew my portfolio, I watched premiums paid by peers skyrocket. Along the way subsidized Class C wards was what my dad used his entire life and prior to my mum's brain bleed, she is a cancer survivor. In all these cases, I was saved by a full-to-the-brim Medisave account and 1 year of living expenses uninvested in cash.

So I believe very strongly that there is a case for NOT having an ISP. But like buy term and invest the rest philosophy, we need to very clear that there is a price to pay to do so. 

The biggest problem is that there is no commissioned salesman who is willing to support my position, so please forward this blog to your friends to read.

a) Don't listen to your FA, we can absolutely rely on default Medishield

The first thing that we need to be aware of is that we can rely on default Medishield that allows us to go up to Ward B2 in a government hospital. And we don't need listen to fearmongering from financial advisors. At Woodlands Health, my mum's ward was 6 patients, there was a screen to watch Youtube, and air cooler exist. It may be more uncomfortable at older hospitals but I suspect older hospitals get better acute care. 

b) You need to be responsible for yourself and become your own insurer

While ISPs can be costly and you will have more sums for yourself, you will need to imagine what your peers are paying for their expensive Class A or private plans and set it aside for investing purposes. This is similar to the BTIR investment philosophy. You need this discipline to make it work but dividends from this portfolio can cover a greater of range of risks - my cash reserves have paid for my daughter's Invisalign and my mum's proactive angiogram. Try calling your insurer to pay for that. 

c) Rush towards Basic Healthcare Sum as soon as practicable. 

So one of the best moves a young guy can do is to keep moving CPF-OA to CP or RSTU until you hit your FRS. The second best move for folks with marginal taxes above 10% is to push as much of your earned income into CPF-MA until you hit a BHS or $75,500. 

The beauty of ths move is that it reduces taxes, secure 4% interest rate ( better than Chocolate finance ), and when it overflows, excess can be fed into CPF-OA or CPF-SA to give you more flexibility.

Obviously, you probably won't benefit from doing all this until after your 40s where weird operating procedures become the norm, but your future self will thank you for it.

Also, after a hospitalization, have the ironclad discipline to refill your CPF-MA, so that you are ready for the next medical crisis. 

Finally, we need to really see ISP for what it really is. 

It is not a product to hedge your medical expenses because the increase in premiums is so brutal every year after age 50. 

The ISP is a compensation plan: not just for the FA, but for the private medical doctor who has a heavy incentive to practice defensive medicine on you to rack up large bills that is paid by the insurer. But this will ultimately bite you in the ass as insurers are not dumb - they will raise premiums year after year and reduce claim benefits. So in the end - it's the healthy folks who buy these plans who are subsidizing the sick folks who make claims from it. 

ISPs has poisoned the well not just for private patients with ISPs for also for those without insurance. When some private doctors hear that I'm uninsured, they know that I will scrutinise each bill and each scan carefully so some will give me a "sian jee pua" kind of face.  

Anyway, this chapter should be closed after today. 

But life goes on, and a medical crisis is probably just around the corner for my household.