Can I use my Medisave for dental and jaw surgery in Singapore?

Can I use my Medisave?

Very often, patients asked me what percentage of their treatment fee can be paid using Medisave. Some even ask if the full amount can be deducted from their Medisave account without them having to fork out any cash. Many patients do not think of Medisave as their own money when in fact, it is their own hard-earned savings. Today, the Medisave minimum sum is set at $43,500. To a healthy person, it seems like a lot of money sitting there, money which he cannot use. However, with rising healthcare cost, this amount does not really go very far if you are afflicted with some major illness. I view with considerable concern that Medisave, which was originally designed for use for expensive hospitalization, is now expanded to fund many outpatient procedures and chronic illnesses. But that's another story. What I want to talk about here is to clear some misunderstandings that many of my patients have concerning the use of the Medisave to pay for the whatever treatment they need. 

Medisave is a national savings fund that was started in 1984. A part of each worker's salary is deducted at source and deposited into his Medisave account. The scheme has evolved over the years and today, use of Medisave is subject to a prescribed daily limit AND the surgery that is done. All approved surgeries are listed in a document known as the Table of Surgical Procedures (TOSP) published by the Ministry of Health. In this TOSP, each approved procedure is accorded a code and each code is assigned a ranking called a "table". The table is indicative of the length of time required for the procedure, the level of skill needed, the risk and severity of potential complications as well as the need for assistants. There are thousands of codes and a total of 21 tables, ranging from table 1A to 7C. The higher the table, the more complex the surgery and the higher the Medisave withdrawal limit. Surgical dental procedures like impacted wisdom teeth removal, dental implant surgery and corrective jaw surgery are listed in the TOSP and can be funded by the patient's Medisave.

Prior to 2005, Medisave can only be used if these approved procedures are done in a hospital. Since 2005, patients can choose to use their Medisave to pay for any approved procedures that are done in dental clinics as well. This additional source of funding is a great boost to a patient's cashflow management. Let's look at some of the common dental procedures. 

1. Surgical removal of impacted teeth

Depending on the number of impacted teeth and type of impaction, the amount that can be withdrawn from your Medisave account varies from $350 (Table 1B) to $2850 (Table 4A). Your dentist need to document the diagnosis which is supported with radiograph/s. For example, if you have a partially erupted impacted wisdom tooth that requires cutting of the gum, drilling bone and tooth for its complete removal, the typical amount that you can use from Medisave is $950 (Table 2C). Therefore, if your dentist charges you $1000, you will have to pay $50 in cash. In practice, there may be some minor variation in charges due to GST, Medisave admininstration fees, etc. On the other hand, if your dentist charges you $900, Medisave will only pay $900. You will not be able to withdraw the remaining $50 from your Medisave for use in other procedures. 

2. Surgical insertion of dental implants

Medisave can be used for the surgical part of dental implant treatment only. For each implant placed in the same sitting, $950 (Table 2C) can be withdrawn from your Medisave, up to a limit of 7 implants. If your dentist place two implants for you today, you can withdraw $950x2 ie $1900 from your Medisave. In addition, you can also withdrawal an additional $300 for implant material. This is fixed at $300 regardless of the number of implants. Therefore, if you dentist charges you $5000 to insert two implants, you pay $2800 in cash and $2200 with Medisave. You will not be able to use Medisave to pay for the implant crown as there is no code for that. 

3. Bone grafting for dental implants

Very often, bone grafting is needed for dental implants due to resorption of the jaw bone. If bone grafting is done simultaneously with the implant, no separate claim from Medisave can be made. It is only when bone grafting is done as an independent procedure that you can use Medisave.

4. Corrective jaw surgery

Medisave can be used to pay for corrective jaw surgery. Typically, for a double jaw surgery, the amount that you can withdraw from your Medisave is about $7500 while a single jaw surgery is about $4000. 

There are many other surgeries that can be financed with your Medisave. There has been much confusion over the years about which codes to use for which surgeries. The latest revision of the Table of Surgical Procedures was published by the Ministry of Health in January 2014. Along with that, the College of Dental Surgeons, Singapore published a Best Practice Manual to guide dentists in the use of the new TOSP.  

More importantly, you should note that the majority of dental procedures are not surgical in nature and are not included in the Table of Surgical Procedures. If there is no TOSP code for that procedure, Medisave cannot be used. Procedures like simple tooth extraction, crowns and bridges including those that are implant-supported,  dentures, fillings, root canal treatment, etc cannot be paid with Medisave. The Ministry of Health conducts regular audits of Medisave claims submitted by clinics and erroneous claims may result in puntive measures being taken against the clinic and dentist. In practice, the Medisave withdrawal limits for each procedure is set below the normal cost of that procedure. Coupled with the fact that most dental procedures are not Medisave-claimable, it is unlikely that your entire treatment fee can be paid by Medisave, without you paying out-of-pocket. Naturally, this post only serve as a guide and you'll need to have a proper physical examination and treatment plan formulated before a proper determination of fees and Medisave eligibility can be confirmed.