Health insurance terms decide how much of a hospital bill you pay yourself. The three that matter most are the deductible, a fixed amount you pay first each year; co-insurance, a percentage of the rest; and the claim limit, the most the plan will pay. Riders, panels and pro-ration then adjust those three.
This glossary explains each term in plain English, using definitions and figures from the Ministry of Health (MOH), CPF Board and MoneySense as at November 2026.
The Health Insurance Terms That Decide Your Bill
| Term | What it means | Who pays |
|---|---|---|
| Deductible | Fixed amount paid each policy year before the plan pays | You |
| Co-insurance | A percentage of the bill above the deductible | You and the insurer share |
| Co-payment | Your share of the bill when you hold a rider | You, up to a yearly cap |
| Claim limit | The most the plan pays, per year or per item | Anything above it is yours |
| Pro-ration | A reduction applied when you stay in a higher ward than your plan covers | You bear the reduction |
| Exclusion | A condition or treatment the plan does not pay for | You |
Deductible. MoneySense describes it as the fixed amount you pay each policy year before any payout from your plan. For Integrated Shield Plans, it ranges from S$1,500 to $3,500, depending on ward class. You pay it once a year, not once per stay.
Co-insurance. After the deductible, you pay a percentage of the remaining claimable bill.
Co-payment. In Singapore the word is used most for the share you still pay when you have a rider. MoneySense gives it as 5% of the bill.
Claim limit. The ceiling on what a plan pays. MOH lists MediShield Life’s maximum claim limit as $200,000 per policy year, with no lifetime limit. Plans may also have limits for each item, such as a daily ward charge or a type of surgery.
As charged. A plan that pays the eligible bill as billed, up to an overall yearly limit, in place of a separate cap for each item.
Pro-ration. If your plan is designed for one ward class and you choose a more expensive ward or hospital, only part of the bill is counted for the claim. The rest is yours.
The short version: For any plan, find four numbers: the yearly deductible, the co-insurance percentage, the cap on what you pay if you hold a rider, and the yearly claim limit. Those four tell you the most a covered hospital stay can cost you.
A Worked Example
Take a hypothetical plan with a $3,500 deductible and 10% co-insurance, and a claimable bill of $30,000. These are illustration figures, not any insurer’s terms.
- Deductible: you pay $3,500.
- Remaining bill: $26,500.
- Co-insurance at 10%: you pay $2,650.
- The plan pays $23,850.
- Your share: $6,150.
MediSave can be used towards your share, within its withdrawal limits. Our guide to what MediSave can be used for explains those.
The Plans Themselves
MediShield Life. The national basic health insurance for all Singapore citizens and Permanent Residents. It covers large hospital bills and selected costly outpatient treatments, and is sized for subsidised wards in public hospitals. MOH says it covers you for life, including pre-existing conditions.
Integrated Shield Plan (IP). An optional plan from a private insurer that sits on top of MediShield Life. MOH describes two parts: the MediShield Life component run by CPF Board, and an additional private insurance component aimed at higher ward classes or private hospitals. Seven insurers offer IPs: AIA, Great Eastern, HSBC Life, Income, Prudential, Raffles Health Insurance and Singlife.
Rider. An optional add-on to an IP that covers part of the co-insurance. MoneySense notes that rider premiums must be paid in cash, rise with age, and can cost more than the IP itself.
Additional Withdrawal Limit (AWL). The most MediSave you can use each year for the private part of an IP premium: $300 if you are 40 or younger on your next birthday, $600 from 41 to 70, and $900 from 71. Anything above is paid in cash.
Additional Premiums. CPF Board says a person with a serious pre-existing condition pays 30% more for MediShield Life for 10 years.
Our guide to MediShield Life and CareShield Life premiums has the premium tables.
Rider Rules Changed on 1 April 2026
MOH announced new requirements for IP riders, which took effect for riders sold from 1 April 2026.
- Riders can no longer cover the minimum deductible. The minimum IP deductibles set by MOH are $1,500 to $3,500 a year, depending on ward class. The policyholder pays this.
- The co-payment cap is at least $6,000 a year, up from the $3,000 minimum set in 2018. The cap applies to co-payments, not to the deductible.
For people who already hold older riders, MOH’s statement sets out two cases. Those who bought an older rider on or after 27 November 2025 will move to a compliant rider no later than their first renewal after 1 April 2028. For policies bought before that date, each insurer decides its own approach.
If you hold a rider, your renewal notice and insurer are the places to confirm which rules apply to you.
Terms About Doctors, Hospitals and Claims
Panel. MOH describes a panel as the insurer’s network of doctors and providers. Seeing a panel doctor can bring pre-authorisation and lower co-payments.
Extended Panel. An industry-wide arrangement that lets a policyholder keep key panel benefits when seeing selected specialists who are not on their own insurer’s main panel.
Pre-authorisation. Approval from the insurer before a planned admission or procedure, confirming that it will be covered. It is not available for every provider, so ask before you book.
Ward class. Public hospitals have subsidised wards (B2 and C) and unsubsidised ones (B1 and A). An IP is priced for the highest ward class it is designed to cover.
Pre- and post-hospitalisation. Consultations, tests and medication before admission and after discharge. Plans cover a set number of days on each side.
Terms About Buying and Keeping a Policy
Pre-existing condition. An illness or injury you had before the policy started. MoneySense warns that if you wait until you have health problems to buy more cover, the insurer may exclude that condition.
Exclusion. Anything the policy states it will not pay for. MoneySense suggests asking which conditions, treatments or expenses are not covered, and what you would pay for them.
Waiting period. A period after the policy starts during which some claims are not payable.
Long-term and short-term policies. MoneySense says long-term policies cannot be terminated without your consent. An insurer may terminate a short-term policy if it gives notice.
Group insurance. Cover arranged by an employer. It may end when you change jobs or retire, at an age when buying your own policy can be harder.
Other kinds of health insurance. Hospital cash pays a fixed sum per day in hospital. Critical illness pays a lump sum on diagnosis. Disability income replaces part of your pay. Long-term care plans, such as CareShield Life, pay monthly if you are severely disabled. Our article on eldercare and nursing home costs covers the last of these.
What To Do Next
- Log in to the Healthcare dashboard on CPF Board’s website to see whether you hold an Integrated Shield Plan and which one.
- On your policy schedule, find the deductible, co-insurance, co-payment cap and yearly limit. Write them on one page.
- Check your latest renewal notice for the cash portion of the premium, and put it in our monthly budget planner.
- Use our protection gap calculator to see how hospital cover sits beside your life and critical illness cover, and read the life insurance guide for the other half of the picture.
- Thinking of changing plans or riders? A new policy can exclude conditions your present one covers.
