CMFAS HI Healthcare System & Financing question: Integrated Shield Plan holder entitled to a standard Class B1 ward

CMFAS HIHealthcare System & Financing

An Integrated Shield Plan holder entitled to a standard Class B1 ward is admitted to a private hospital. Pro-ration factor is 35%, the annual deductible is S$3,500 and co-insurance is 10%. His total bill is S$40,000, all within plan limits. How much does the insurer pay?

A S$10,500
B S$9,100
C S$9,450
D S$32,850

Show the answer and explanation

Answer: C. S$9,450

Pro-rated amount = S$40,000 × 35% = S$14,000. Co-insurance = 10% × (S$14,000 − S$3,500 deductible) = 10% × S$10,500 = S$1,050. Insurer pays S$14,000 − S$3,500 − S$1,050 = S$9,450 (his out-of-pocket is the S$26,000 lost to pro-ration plus S$3,500 deductible plus S$1,050 co-insurance = S$30,550).

Common mistake

Skipping pro-ration and computing on the full S$40,000 (S$32,850), or applying the 10% co-insurance before deducting the deductible (S$14,000 − S$3,500 − S$1,400 = S$9,100).

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Related CMFAS HI questions

A MediShield Life member in Class C is admitted twice in the same policy year. The Class C deductible for those aged 80 and below is S$1,500 and, under MediShield Life, the deductible is payable only once every policy year. His first admission has a claimable amount of S$5,000 and his second S$6,000 (both fully exceed the deductible). On which admission(s) is the deductible applied, and what total deductible does he bear for the year?Which statement correctly describes how MediFund operates?Which feature distinguishes CareShield Life from the older, now-closed ElderShield scheme?

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Original study material mapped to the public CMFAS HI syllabus. Unofficial, not endorsed by MAS or SCI. Verify figures and rules against current guidance before relying on them.