COVID-19 Rules For Unvaccinated or Medically Ineligible Persons

woman wearing mask

Although being vaccinated against COVID-19 is not compulsory in Singapore at the time of writing, unvaccinated individuals make up most of the severe and ICU COVID-19 cases in Singapore. The Singapore government has accordingly implemented Vaccination-Differentiated Safe Management Measures (VDS) to protect unvaccinated individuals from contracting COVID-19.

At the same time, the government will also encourage unvaccinated individuals to get vaccinated by no longer footing the COVID-19 medical bills of those who are unvaccinated by choice from 8 December 2021 onwards.

Nevertheless, the government recognises that there are a few individuals who are medically ineligible for all vaccines under the National Vaccination Programme (NVP). These people will be exempted from VDS from 1 December 2021 onwards, and will still have their COVID-19 medical bills paid for by the government.

If you are unvaccinated or if you believe you are medically ineligible for the COVID-19 vaccine, read on to find out:

Who is Considered Ineligible For COVID-19 Vaccination?

Medical ineligibility

To be considered medically ineligible for COVID-19 vaccination, a person has to meet one of the following situations:

  1. Above 18 years old and unable to be vaccinated due to allergies or a severe adverse reaction to all vaccines under the NVP (i.e. Pfizer-BioNTech/Corminaty, Moderna and SinoVac-CoronaVac vaccines).
  2. Below 18 years old and both of the following:
    • Unable to complete the vaccination regime due to:
      • Allergies or a severe adverse reaction to all vaccines under the NVP; or
      • A severe adverse reaction to a previous dose of a Pandemic Special Access Route-authorised mRNA COVID-19 vaccine; and
  3. Unable to take the Sinovac-CoronaVac vaccine.
    • Note: While persons under 12-17 years old generally cannot take Sinovac-CoronaVac, those in this age band who are medically ineligible for the Pfizer-BioNTech/Corminaty vaccine (this being the only vaccine that they would normally be eligible for at this time) can opt to take the Sinovac-CoronaVac vaccine under a dedicated public health programme, where they will be closely monitored by medical personnel.
  4. Diagnosed with or under the following conditions or undergoing the following treatment:
    • Transplant within the past three months; and/or
    • Aggressive immunotherapy; and/or
    • Active cancer on treatment

From 15 November 2021, medically ineligible individuals can visit any General Practitioner or healthcare institution to be certified as medically ineligible. At the time of writing, this certification will take the form of a standard paper memo, which should be presented along with a government-issued photo identification card (e.g. your NRIC) to be exempted from VDS.

According to the Ministry of Health, it is working with GovTech to reflect medical ineligibility status in the TraceTogether mobile application so that medically ineligible individuals will not need to show a paper memo in the future.

The Ministry of Health has also stated that while those whose situation falls under point 3 above (with or under transplants, aggressive immunotherapy and/or active cancer under treatment) can take the COVID-19 vaccination safely, their doctors may advise delaying the vaccination to a later time.

This is because the COVID-19 vaccination may not be as effective due to such persons being immunocompromised during treatment. For these people, their medical ineligibility status will expire on a date indicated by the certifying doctor.

Ineligibility based on age

It should also be noted that children under 12 years old are also considered ineligible for vaccination.

Note that this may be subject to change as the government considers extending the NVP to children aged between 5 and 11 sometime in January 2022.

Who is Considered Unvaccinated by Choice?

In Singapore, anyone who is unvaccinated and does not meet the ineligibility criteria above for receiving the COVID-19 vaccination will be considered unvaccinated by choice.

Prohibited and Permitted Activities For Those Who are Unvaccinated by Choice or Ineligible For COVID-19 Vaccination in Singapore

Currently, the VDS applies to all unvaccinated individuals, whether unvaccinated by choice or medically ineligible (though children under the age of 12 are treated differently; see below). Starting from 1 December 2021, however, medically ineligible individuals will be exempted from VDS.

This means that these medically ineligible individuals will be allowed to enter places that normally require vaccination for entry, despite being unvaccinated. For example, they can dine in at restaurants, hawker centres and coffee shops, and watch movies in cinemas. This concession does not extend to those who are unvaccinated by choice.

Places with VDS at the time of writing are:

  • Higher-risk/mask-off activities:
    • Dining-in at F&B establishments, including hawker centres and coffee shops
    • Mask-off personal care services (e.g. facials and saunas)
    • High-intensity/mask-off sports/exercise activities and classes
    • Mask-off arts classes (e.g. classes involving singing and wind instruments)
  • Venues and large events*
    • Attractions (including museums)
    • Cinemas
    • Congregational and worship services
    • Live performances
    • MICE (Meetings, Incentives, Conferences, and Exhibitions) events
    • Shopping malls and large standalone stores
    • Solemnisations and wedding receptions
    • Spectator and participatory sports events
    • NLB libraries (from 1 December 2021)
    • Selected activities in community clubs/centres under the People’s Association (from 1 December 2021)
    • In-person visits for hospitals and residential care homes (from 22 November 2021)**

*Generally refers to events with more than 50 attendees. However, wedding receptions require VDS regardless of event size.

**For visits to hospitals and residential care homes with enhanced VDS-related measures in place, both the patient/home resident and the visitors must be fully vaccinated. However, visits will be allowed for medically ineligible patients/residents and visitors. If the patient/resident and/or visitor are not fully vaccinated, in-person visits will be allowed only under exceptional circumstances on a case-by-case basis as advised by the hospitals and residential care homes. In addition, visitors must show a valid negative ART result within the last 24 hours of each visit regardless of vaccination status. For non-fully vaccinated visitors (who are not medically ineligible), results from unsupervised self-administered ART tests will not be accepted. For more details, please see Annex B of the Ministry of Health’s press release on 20 November 2021.

As mentioned above, children under 12 years old are also treated differently under VDS as compared to other unvaccinated individuals. For example, after 22 November 2021, groups of up to 5 unvaccinated children below the age of 12 may dine in together at F&B establishments despite not being fully vaccinated.

It should be noted that the Ministry of Health still strongly encourages medically ineligible individuals to minimise such activities. As these individuals are unvaccinated, there is still a very high risk of them becoming infected with COVID-19 and/or becoming severely ill.

In addition, the ordinary rules relating to COVID-19 that are not vaccination-differentiated, such as requiring the use of TraceTogether/SafeEntry, wearing of masks and safe distancing still apply to everyone, whether or not they are vaccinated, unvaccinated by choice, medically ineligible or otherwise.

It should also be noted that while there have been some concessions that allow unvaccinated individuals with a negative PET result to enter a VDS setting, such as entering a shopping mall, these concessions will be removed from 1 January 2022 onwards.

For more details on each of these measures, please visit our article on COVID-19 rules and restrictions in Singapore.

Are You Allowed to Travel?

All persons, regardless of vaccination status, may travel out of Singapore. However, only fully vaccinated persons, and the children under 12 years old accompanying them, may qualify for the Vaccinated Travel Lane scheme and be exempted from quarantine upon return to Singapore from certain countries.

This means that travellers who are unvaccinated (whether because they are medically ineligible for vaccination or unvaccinated by choice) will be subject to quarantine requirements upon arrival in Singapore from abroad.

Are You Allowed to Return to the Workplace? 

From 1 January 2022 onwards, only employees who are fully vaccinated, or have recovered from COVID-19 within 270 days, can return to the workplace. Unvaccinated employees must produce a negative Pre-Event Testing (PET) result, which must be valid for the duration that the employee is present at the workplace. Unvaccinated employees must also pay for the costs of the PET and show their employer the results when going to the workplace.

However, employees who are certified as being medically ineligible may be exempted from such requirements. For example, the employer may consider exempting such an employee from producing a negative PET result if the employee needs to work on-site (subject to any prevailing COVID-19 rules that require employees to work from home or to provide a negative PET result).

See our other article on COVID-19 vaccination in employment settings for more details about measures employers can take at the workplace regarding vaccinations.

Do You Have to Pay For Your COVID-19 Medical Bills?

As of now, and until 8 December 2021, the government has been paying the full COVID-19 medical bills of all Singapore Citizens, Permanent Residents and Long-Term Pass Holders (SCs/PRs/LTPHs), other than for those who tested positive soon after returning from overseas travel.

However, from 8 December 2021, those who are unvaccinated by choice will have to pay their own medical bills if they contract COVID-19. In other words, if such patients are admitted on or after 8 December 2021 to hospitals and COVID-19 treatment facilities after being diagnosed with COVID-19, their hospital bills will not be fully paid for by the government.

It should be noted that this does not prevent such patients from tapping on healthcare financing arrangements like MediShield Life, government subsidies and private insurance.

The government will continue to pay the COVID-19 medical bills of vaccinated persons until the COVID-19 situation is more stable. The government will also fully pay the COVID-19 medical bills of persons medically ineligible for vaccination, and children under 12 years old.

To allow more time for persons to get fully vaccinated, the government will also pay the COVID-19 medical bills for those who are partially vaccinated until 31 December 2021.

This means that from 1 January 2022 until further notice, the only people who will have their COVID-19 medical bills fully paid for by the government will be SC/PR/LTPH COVID-19 who are fully vaccinated and have not recently travelled.

While some may believe it is best to get vaccinated to protect yourself and your loved ones from COVID-19, not everyone is able or willing to do so.

If you are unable to be vaccinated, be sure to visit a doctor to get certified for medical ineligibility before 8 December 2021 to avoid having to foot any medical bills for COVID-19. This will also enable you to be exempted from VDS. Take note, however, that your risk of contracting COVID-19 and becoming severely ill is still very high (especially if you are immunocompromised). Therefore, remain cautious and use this privilege wisely.

If, instead, you are not vaccinated by choice, it is a choice you are legally entitled to make. However, take note that by doing so, you will be subject to VDS and possibly have to foot a hefty bill if you end up in the hospital with COVID-19. Most importantly, you will be subjecting yourself to the arguably avoidable risk of contracting severe COVID-19 in a time when the healthcare system is already significantly strained.

If you are partially vaccinated, schedule your final dose of the COVID-19 vaccination on or before 31 December 2021 to avoid having to pay for medical bills if you contract COVID-19 from 1 January 2022 onwards.

By extension, if you are unvaccinated by choice but now wish to take your vaccination, it may be prudent to schedule your first dose before 8 December 2021. In this way, if you contract COVID-19 between the date of your first dose and 31 December 2021, you will not have to pay your COVID-19 medical bills yourself. Thereafter, aim to schedule your subsequent dose(s) of the COVID-19 vaccination to take place on or before 31 December 2021, bearing in mind the minimum intervals or “waiting time” between doses.

This article was co-authored by Wyz Kim-Chan