story  | Vasudha Kataruka, Guest Reporter

photo | Justin Ong, Editor-in-Chief

The National University of Singapore (NUS) has changed its Undergraduate Student Health Insurance with effect from Aug. 1, 2017. All NUS and Yale-NUS College undergraduate students are covered by this policy. The previous Health Scheme had faced student criticism, mostly from individual students.

The insurance is contracted under the insurance provider MYCG. The updated version, along with other relevant information regarding the Health Scheme, is now available for perusal through the Student Life website.

The Student Health Scheme has previously been discussed by the Community Living Committee of the Yale-NUS Student Government ’15. Concerns regarding the exclusion of birth-control and pregnancy-related complications from coverage were central to the discussion, which was spearheaded by alumnus Sanjana Tadepalli ’17, and Meredith Jett ’18. Other gaps in the coverage were also quickly identified by the investigation by then-Government members Jay Lusk ’18, Seow Yongzhi ’18, and alumnus Zachary Mahon ’17). This concern was also taken up by the Student Government for the Academic Year 2017-18, said Saza Faradilla ’18, the 2017-18 President.

Dean of Students (DoS) Christopher Bridges has said that, since his appointment to the post, discussions about the Health Scheme have been quite frequent. However, neither the DoS Office nor Yale-NUS College has direct control over the insurance policies, he said. DoS has focused on mediating students’ understanding of the coverage, advocating for increased coverage, and providing support for the claims process. Doris Yek, the DoS Health Coordinator, in particular, has been quite active and has managed to bring in representatives from the University Health Centre (UHC) and MYCG for information dissemination, feedback and training of staff and students.

What’s New?

Increased Outpatient Coverage

The most significant change is the increase of the outpatient cap from $350 to $1000 per annum. This will allow multiple visits to specialist care units, even when treating pre-existing conditions. The average outpatient consultation costs $100 per visit for international students in Singapore (based on the National University Hospital (NUH) rates).

Under the previous policy, this allowed the students no more than 3 visits per year. The increased coverage accords more visits and consultations. The scope also includes x-rays, physiotherapy (through the UHC) and specialist diagnostic scans such as MRI. Traditional Chinese Medicine (TCM) is covered up to $30 per visit with a 3-visit cap. However, a referral from a General Physician (GP) or from the Accidents and Emergency (A&E) is required for the visits to qualify for coverage.

Thus, the system still requires referral from the UHC for a specialist consultation. This system was one of the reasons that he had to wait for three semesters before getting the proper treatment, shares Yonatan Gazit ’18. “What upset me was the fact that I couldn’t get proper treatment in my situation without going through the UHC, where the doctors did not have the know-how to give me the correct treatment. In fact, they gave me treatment that made the problem worse, according to what I was told at NUH,” said Gazit.

Coverage of Pre-Existing Conditions

Another important distinction in the new Health Scheme is the inclusion of pre-existing conditions within the coverage scope. Previously, any complications arising out of pre-existing conditions were not covered, that is, any medical condition that a student had prior to enrollment in NUS or Yale-NUS.

For example, if a student had a hypothyroid condition, and were recommended to get a blood test done by a general practitioner from the UHC, the charges of that test would not be covered under the old policy. The new stipulation ensures that such expenses also merit reimbursement.

It is important to note that congenital conditions are not covered. For example, if a student were to collapse and be diagnosed with atrial septal defect (hole in the heart), they would not qualify for either outpatient or surgery coverage. Additionally, the coverage for pre-existing condition does not cover general check-ups.

The removal of A&E visit cap

In the new scheme, A&E visits are covered under the Specialist and Outpatient coverage and there is no longer any cap to the number of visits. However, only visits to Singapore Government Restructured Hospitals such as the NUH and the Singapore General Hospital are covered. As the Yale-NUS Student Life website says, “local and international students no longer need to save [the emergency visits] for the rainy day or for fear of the co-payment for justifiable hospital emergency visits after hours.” As per the factsheet provided by MYCG, the A&E visit coverage will be reimbursed “as charged”.

Justifiable visits to the A&E include those on public holidays when the UHC is closed, or in the case of extremely severe or life-threatening situations.

Other changes

Another notable change is the inclusion of outpatient mental health services under the Group Hospitalisation and Surgery Insurance for up to $2,000 for international students. However, the policy guidelines around hospitalisation for mental illness are unclear, especially for local undergraduate students.

Moreover, the insurance now extends to cover overseas treatment for international students (returning home during vacations) for 185 consecutive days subject to the coverage limits.

The Way Forward

Even with changes, significant gaps in the health insurance scheme remain. The changes fail to address several of the student concerns about the previous health insurance: the most obvious gap is for the coverage of sexual health, that is sexually transmitted diseases, abortion, pregnancy, birth control, and all complications arising thereof.

It is not clear whether sexual assault is covered under the Group Personal Accident insurance, but according to Ms Yek, a case for injuries arising from sexual assault can be made under this category. However, given the sensitivity of this particular issue, we were unable to obtain any firsthand accounts to corroborate Ms. Yek’s statement.

It should noted, however, that further structural changes to this system depend heavily on the NUS administration. Ms. Yek said that while student feedback has impact, “we cannot expect significant change [in the near future] given that the UHC is working quite separately from Yale-NUS.”

For students concerned about their health coverage, the most immediate option is to buy additional insurance, said Mr. Bridges. “If there is a student who has particular concerns and wants to top up but is in financial need, I invite them to come see me and we will work it out,” he said. Students can also utilize the College’s support resources, such as Ms. Yek, and place equal emphasis on physical and mental health.

Until then, Lusk said, more transparency and conversation about the opportunities, concerns, access, and stigma for mental and reproductive health surrounding the healthcare system and the health scheme are required. “We have an opportunity to influence the culture of not just Yale-NUS, but diversity of places that our graduates go, if we can build a culture of health care.”

For any clarifications or questions, please contact Doris Yek, Health Coordinator, or Vasudha Kataruka, Yale-NUS Health Alliance at vasudha.kataruka@u.yale-nus.edu.sg. If you are interested in taking this conversation forward, please indicate your interest to become a Health Ambassador to health@yale-nus.edu.sg.