Healthcare in Singapore: MediShield Life is not for you, so you insure yourself

Singapore has a healthcare system that makes Dutch people look up: modern public hospitals, a compulsory basic insurance and subsidy on the bill. The answer to the search question is just short: none of it is for you. MediShield Life covers, according to the Ministry of Health, all citizens and permanent residents, and no one else. The hospital subsidies apply to the same two groups. And from the Netherlands there is no safety net, because Singapore is not on the CAK's list of treaty countries. Whoever comes on a pass insures themselves, and the only question is who pays the premium: the employer or you.

How does the system work for Singaporeans?

It is useful to know what you are missing. MediShield Life is a basic health insurance, administered by the CPF Board, that covers large hospital bills and costly outpatient treatments such as dialysis and chemotherapy, for everyone, regardless of age or pre-existing conditions. The payouts are sized for subsidised care in the B2 and C classes of public hospitals; whoever chooses an A class or a private hospital gets a smaller share reimbursed. The premium is paid automatically from the CPF MediSave account. On top of that the ministry subsidises the admission itself: up to 80% for citizens and up to 50% for permanent residents, depending on household income.

Who	MediShield Life	Subsidy on admission to a public hospital
Singapore citizen	yes, compulsory	up to 80%
Permanent resident	yes, compulsory	up to 50%
Holder of an Employment Pass, S Pass or Dependant's Pass	no	not in the subsidy table

A pass holder is in neither scheme. That means you get the unsubsidised bill in the same public hospital, and that you can only absorb it with your own insurance. How you get to Singapore at all is in the visa routes.

Who pays your insurance: the employer or you?

That depends on your pass. For an S Pass the employer is, according to MOM, obliged to take out medical insurance for you and to report the details online before the pass is issued. For an Employment Pass that duty does not apply. MOM says it literally: insurance is not a requirement for employing an EP holder, most EP holders already have their own cover or choose it themselves, and the employer can choose to include it in the employment contract. For a Dependant's Pass MOM names no insurance obligation; the cover of partner and children is up to you.

Read the insurance clause before you sign. An Employment Pass obliges your employer to nothing. A contract without health cover means that you pay an international or local policy for yourself, your partner and your children, at rates without subsidy. Negotiate cover for the whole family into the package, with a start date on the day you land; the Dutch policy after all stops on the day of deregistration.

What happens to your Dutch insurance?

Your Dutch basic insurance belongs with living in the Netherlands and ends on your emigration; how to arrange that without a gap is in cancelling your health insurance. The Long-Term Care Act (Wlz) stops too: the Belastingdienst writes that whoever has no Dutch income after emigration is no longer insured for the national insurance schemes and no longer entitled to Anw or Wlz.

The route that fills the gap in Spain or Portugal does not exist here. With a Dutch pension or benefit you arrange your care in a treaty country via the CAK, with an S1 form. NederlandWereldwijd says it emphatically: only in a treaty country. The CAK list consists of the EU and EEA countries, Switzerland, the United Kingdom and eight countries from Bosnia to Turkey. Singapore is missing. Whoever retires to Singapore therefore insures privately, just like an employee, and cannot fall back on the Dutch system. What that means for your AOW is in AOW, pension and tax.

What do you watch out for in a policy?

Three things the system itself hands you. First the class: a policy that only covers B2 or C fits the subsidised care on which you get no subsidy; look at what A class or a private hospital costs and whether the policy follows. Second the outpatient cover: MediShield Life counts dialysis and chemotherapy as costly outpatient care, and your own policy should too. Third the link to your pass: insurance through the employer ends with your contract, and with your contract your pass ends too. Whoever changes jobs or leaves therefore needs bridging cover, not just a new pass. How the medical examination on arrival works, you read in registration and numbers.

In Vertrekklaar this is phase 2 of 5 of the journey, step 2.4: the same steps, but for your situation — in your order, tickable, and with the deadlines watched. See the whole journey to Singapore or go straight to step 2.4 in the open plan.