Madam, the MediShield Life Scheme is the Government's response to one of the key anxieties of Singaporeans in an ageing society with increasing healthcare options and costs. I believe it is a game-changer in the national healthcare landscape in many ways; but especially in three areas – coverage for all, coverage for life, and coverage with help.

Coverage for all. According to 2013 data, about 7% of Singaporeans were not covered under the MediShield scheme. That will change under MediShield Life. In the past, MediShield does not cover those with pre-existing medical conditions whether they are born with it, or acquired it later in life. In the past, about one in four in the Pioneer Generation were not covered under MediShield because they cannot work, or cannot be reached or may have opted out. In the past, pioneers above the age of 90 were not covered under MediShield. MediShield Life will now cover all of them.

Coverage for life. In the past MediShield protects members only up to a specific age with a lifetime claim limit of $300,000. With MediShield Life, they will now be protected for life, with no lifetime claim limit.

Coverage with help. Whilst premiums will increase, a slew of measures had been painstakingly put together by MediShield Life team to allay fears of affordability. MediShield premiums can now be fully covered by Medisave, to avoid the need to pay upfront cash. There are also five types of subsidies that will kick in, to ensure the affordability of premiums: one, Transitional Subsidies for all Singapore Citizens; two, Subsidies for Pioneers; three, Permanent subsidies for premiums for the lower to middle-income families and that covers two-thirds of Singapore households; four, Government's footing of bulk of costs to bring in those with pre-existing conditions; and five, additional support for those who need further help.

MediShield Life, to me, is a more appealing updated, more comprehensive and portable package that is personal and usable across all settings, whoever one's employer and station in life is. Let us support MediShield Life wholeheartedly.

Madam, MediShield Life, most of all, is not only about updating a national healthcare insurance scheme. It is the manifestation of the spirit of belonging to a country.

Basic healthcare coverage is an essential part of the safety net in one's life. Every citizen ought to be included and ought to have access to basic healthcare coverage. And not just those who are accepted for access for coverage by insurance providers. The price to pay for that inclusion must be something that we, as the people of Singapore, must determine to pay. True, premiums will increase with this more comprehensive national healthcare insurance package. But we cannot say we are a Singapore family if we leave behind other members of the family when they get older, when they become health-wise vulnerable or when they are born with or later acquire disabilities through accidents or sicknesses.

I have sat through many dialogues including the "Our Singapore Conversations" where so many people spoke about having an inclusive country where the older and the disadvantaged will be cared for. But we cannot claim we want to be inclusive only in word and not in deed. We cannot lament about poverty or poverty lines if we do not support the move to pool our risks, and ensure that those who are poor also receive universal basic healthcare for as long as they live; and those who are disadvantaged as well, in health.

Who knows if one day, you or a loved one should land in circumstances that put you at risk of being excluded from healthcare because you are no longer young, healthy or financially able? Who knows if one day, one of your loved ones is born or acquires some form of disability which a private insurer may not cover or cover only at a very high cost? Who, for that matter, would answer to the national call to have more babies if there is no guarantee that any Singapore baby, born in sickness or health, will have access to basic healthcare insurance coverage?

MediShield Life is Singapore society's response to the call to ensure that no one, now or later, is left behind as far as essential healthcare services are concerned. Whether we will use the service now or never, let us all support the scheme wholeheartedly and be proud that there is such a scheme in Singapore.

Let us also be patient and allow time for any gaps or administrative challenges in the scheme that may still need to be closed or overcome. These imperfections do not call for the baby to be thrown out with the bathwater.

In this regard, Madam, I would like to share three concerns commonly raised for Minister's comments and consideration. These concern, one, pre-existing conditions; two, defaulters; and three, sustainability of the scheme.

Concern one on pre-existing conditions. Madam, clause 4 of the Bill provides that persons who are deemed by the Board to have a pre-existing medical condition will be subject to premium loading. According to the Ministry, such persons will pay an additional 30% on top of the normal premium of an insured for 10 years; after which a normal premium is supposed to be applicable.

I understand that the bulk of the cost of bringing persons with pre-existing medical conditions into the common pool is already borne by Government; and that the additional 30% premium loading is a signal of co-ownership or co-sharing.

But the details of what might constitute a pre-existing condition, and hence subject to premium loading, have not been published or explained in detail. And that is a cause for anxiety for at least two groups of Singaporeans.

One, special needs persons with lower medical risk. Madam, I have been asked by members of the special needs community if any person diagnosed with an intellectual disability or learning disorder or had spent time in a special school, would be automatically slapped with an additional 30% premium loading. Many of them, for example, the deaf, intellectually disabled or those with other learning disorders, may experience challenges at schools and workplaces that relate to their ability to learn, socialise and be included; but physically, health-wise, these persons may not be at risk of requiring more medical treatment or even hospitalisation than the rest of the Singapore population. Hence, the feedback is for persons with special needs who do not have adverse medical claim track record, should not be subject to the additional 30% premium loading.

The second group who are anxious are persons who are subject already or going to be subject to additional premium loading. Madam, as details on the subject of "pre-existing conditions loading" are not fully released, affordability for those with additional premium loading is a concern.

There is also ground fear that the return to a normal premium for these persons after 10 years will apply only to those who have good claims records for the initial 10 years. For those who are chronic or more severe, they worry, perhaps unfounded, that they will be made to continue to pay the same or higher premium loading. These are persons who are currently not covered, because they are born with congenital illnesses, or they have acquired chronic medical problems due to strokes or accidents, prior to the introduction of MediShield Life.

Being turned down, being rejected or being made to pay very high premiums was the experience of many of these people with pre-existing conditions in the current healthcare landscape. As many of them may not be employable and their families cannot support them for life, they seek assurance that the government of the day will always ensure affordability and find means to ensure that they are appropriately covered.

I therefore seek the Minister's consideration to codify the principles of MediShield Life's pre-existing conditions scheme. This is so that members will not be subject to the additional loading without good medical reasons; and so that premiums for those who are subject to additional loading will always remain affordable.

Concern two on defaulters. Madam, the MediShield Life Bill has provided a full section, Part 3, clauses 11 to 18, on policies and practices relating to defaulters. I fully agree that since this is a shared scheme of collective responsibility, any member who can afford but wilfully does not pay up, should be subject to punitive measures.

Madam, for those who truly cannot afford, I seek the Minister's assurance that defaulters who cannot pay for good reasons, be treated with not only justice but mercy as well. I am referring to examples of members who live in bigger abodes whose Medisave could have been depleted as a result of serious illnesses or big hospitalisations or business failures or by the sheer fact that they are not employable due to disabilities or chronic illnesses. There may also be households where husbands simply cannot afford to top up the Medisave balances of their non-working spouses, in addition to topping up their own.

So besides treating these special defaulters with mercy, may I also suggest that MOH proactively work with MSF to develop a register of vulnerable persons such as these and pay special attention to them?

Perhaps a Special "TOP UP MY MEDISAVE" Fund could be set up and the relevant Ministries could advocate for annual top-ups during Budget time and/or encourage philanthropists or members of the public to contribute to such a Fund and help them top up.

Concern three is on sustainability. To help Singaporeans with their MediShield Life premiums, the Government, we understand, will provide close to $4 billion over the next five years. Government is bearing the bulk of the cost of extending coverage to those with pre-existing conditions, Premium Subsidies, Pioneer Generation Subsidies, Transitional Subsidies, all these are borne by Government. All these are well thought out, very thoughtful and deeply appreciated.

But what happens after five years and the years after is important food for thought and discussion. Although Transitional Subsidies will no longer apply then, there is still the permanent bill for Premium Subsidies for the lower- to middle-income families and the Pioneer Generation Subsidies. Other factors will also come into play. With a new-found confidence by members that coverage is now for all and for life with no cap to life-time claim limits whatsoever, the potential of higher and over-consumption is real. With lower co-insurance payments by the insured, will there be a temptation to go for more lavish or boutique services and prescriptions? Added to this, as most of us know, that by 2030, one in five will be 65 years and older, and almost a million people belong to that group.

So what can be done to mitigate the high possibilities of over-confidence, over-consumption, over-prescription that will lead to an escalation of healthcare expenditure and therefore premiums in the long term?

Can the Ministry set up a Work Group to look deeper into incentives to look after one's health; to educate Singaporeans on less costly but just as effective medical prescriptions, and to develop solutions to reduce over-consumption of healthcare benefits?

On the supply side, where would future funding and revenue sources come from if healthcare costs are expected to rise? Even if we dip into the national coffer, is that a wise long-term strategy? A lot of these will have, of course, to do with the abilities and the wisdom of the Government of the day; but still, Madam, it would be useful to hear the comments of the Minister on these potential longer-term issues, for the sake of those who come after us.

In conclusion, Madam, at last year's July discussion of the White Paper on MediShield Life in this House, Minister Gan spoke about the important blend of three body parts that would make this important scheme a successful reality. He says the Team needs to Listen with their Hearts, to know what are the worries of Singaporeans; to Think with clear Heads and to be Hands-on during implementation and delivery. The Bill has reflected that the Ministry has indeed deployed well their Heads and their Hearts. It is now the time for the most challenging part of the Scheme to ensure that the Hands now deliver.

I thank the Team for an excellent work and I really look forward to a successful albeit a very challenging delivery of this important birth. I urge all Singaporeans to support the Ministry of Health's Team in this very important implementation phase and constructively help to explain, help to improve and help to make this Scheme work. And with that, Madam, I support the Bill.