Jamus Lim urges fairer CareShield Life assessments; Dr Koh cites data limits, premium concerns

Singapore’s Parliament approved amendments to the CareShield Life and Long-Term Care (Amendment) Bill on 15 October 2025, aiming to reinforce enforcement mechanisms and ensure affordability in the country’s national disability insurance scheme.

The revised legislation empowers authorities to serve notices to defaulters of CareShield Life premiums and introduces measures to sustain premium affordability and scheme fairness.

Tabling the Bill for its second reading, Senior Minister of State for Health Dr Koh Poh Koon underscored that no one would lose coverage because of financial hardship, but emphasised that premium recovery was essential to maintain scheme sustainability and fairness among policyholders.

“Like any other insurance scheme, CareShield Life relies on collective responsibility through risk-pooling within each cohort. All policyholders must play their part by meeting their premium obligations,” Dr Koh told Parliament.

Background of CareShield Life

Launched in 2020, CareShield Life provides monthly payouts to individuals with severe disabilities, defined as the inability to perform at least three of six Activities of Daily Living (ADLs), including washing, dressing, and feeding.

The scheme is mandatory for Singaporeans born in 1980 or later, while older cohorts may opt in voluntarily.

The recent Bill reinstates the underwriting criterion for the optional cohort, thereby lowering premiums for older participants who choose to enrol.

A total of 14 Members of Parliament spoke in support of the Bill, although several raised issues concerning affordability, assessment fairness, and payout adequacy.

Jamus Lim calls for fairness in enrolment and disability assessments

Participating in the debate,Associate Professor Jamus Lim, representing Sengkang GRC for the Workers’ Party, questioned aspects of fairness and administrative consistency in the proposed amendments.

Lim observed disparities between older citizens and new residents, noting that the latter would be automatically enrolled, while the former remained under the older ElderShield scheme.

While acknowledging the economic rationale for excluding those already severely disabled, Lim argued that society has a moral responsibility to care for them. He urged clarification on how exemptions are granted and how those outside the scheme are supported through subsidies or grants.

Concerns over activities of daily living and fairness thresholds

Clauses 7 and 8 of the Bill formalise the six ADLs used to assess severe disability, requiring maximal or total assistance in at least three to qualify for payouts.

Lim contended that Singapore’s definition deviates from global standards, omitting key Instrumental Activities of Daily Living (IADLs) such as managing finances, transportation, and communication.

He suggested incorporating essential IADLs or adopting an index-based disability assessment model, as seen in Australia and the United Kingdom, to capture more nuanced functional limitations.

Lim also questioned whether the threshold—total assistance in three ADLs—was equitable compared to moderate assistance across a broader range, proposing that an index approach could provide a fairer evaluation of disability severity.

Operational and administrative issues raised

Lim referenced operational challenges highlighted in the 2025 Review Council Report, particularly for those born before 1980 who are given a 60-day “free-look” period to decide on enrolment.

He suggested extending this to three months or permitting opt-outs within a year, even with penalties, describing this as a less disruptive alternative.

He also raised concerns about premium support amid rising living costs, asking what proportion of members currently receive subsidies and whether assistance is available for those facing temporary unemployment.

Lim further sought clarity on whether CareShield Life would be administered by the Central Provident Fund (CPF) Board or private insurers.

Drawing on past difficulties with Dependants’ Protection Scheme (DPS) and Home Protection Scheme (HPS) coverage, he recommended that all communication be clearly branded under the CPF Board to maintain public trust.

He cited a recent court case involving Income Insurance, warning against overly rigid interpretations of policy terms that could undermine the scheme’s humanitarian intent.

“The promise of CareShield Life—to help vulnerable citizens live with dignity—must be fulfilled in practice, not merely in principle,” Lim said.

Dr Koh Poh Koon responds to calls for refinement

Responding to Lim and other Members, Dr Koh affirmed that enforcement improvements were vital to preserve the collective risk-pooling model of insurance.

He shared that around 900,000 individuals, or half of the optional cohort, had joined CareShield Life as of June 2025.

Including those who remained under ElderShield, about seven in ten older Singaporeans are now covered by national long-term care insurance schemes.

Dr Koh clarified that ElderShield, the precursor to CareShield Life, had been succeeded by the current scheme, with significant enhancements to financial support such as means-tested subsidies and grants.

Debate over data availability and gender-based insights

In his follow-up questions, Lim asked whether gender-disaggregated data from ElderShield could inform policy refinements for CareShield Life, given limited historical data.

He also renewed his call for an index-based assessment model, referencing international systems like the modified Barthel Index and CATS index, which distinguish between moderate and severe disabilities.

Dr Koh replied that ElderShield’s dataset was insufficiently mature to draw reliable gender-based conclusions but assured that any available data would be shared when appropriate.

He cautioned that expanding the assessment to include moderate disabilities would broaden the coverage pool, inevitably raising premiums and compromising affordability.

“CareShield Life is designed to offer basic protection for all Singaporeans while remaining affordable. Additional subsidies are available for those with milder disabilities,” he said.

When Lim clarified that his index proposal aimed not at expanding coverage but at refining assessment precision, Dr Koh emphasised that the scheme’s current model was aligned with internationally recognised standards to ensure consistency and ease of implementation by clinicians.

Balancing inclusivity, sustainability, and public trust

Dr Koh reiterated that maintaining public confidence in CareShield Life required both administrative clarity and fiscal discipline.

He noted that additional support mechanisms exist for those falling just short of the scheme’s strict disability threshold, including grants and subsidies under long-term care assistance programmes.