Over the years since the basic MediShield plan was launched in 1990, the use of MediSave has evolved to multi uses. One of the latest initiatives is to allow the use of MediSave to co-fund the CPF member's outpatient chronic disease management program. The Chronic Disease Management Programme was started in Oct 2006 and now covers diabetes mellitus, hypertension, hyperlipidemia (lipid disorders), stroke, asthma and chronic obstructive pulmonary disease (COPD), also known as chronic obstructive lung disease (COLD).  The cover for the latter 2 chronic diseases came into effect from April 01, 2008. These common chronic diseases affect more than 1 million Singaporeans. The Chronic Disease Management Programme aims to reduce the out-of-pocket cash payments for outpatient bills, but the amount that can be utilised from MediSave has been capped to $300 per year. Another more recent initiative launched by the Ministry of Health is in the ElderShield supplement scheme for severe disability or known in the insurance industry as a long term care plan. In 2007, the Ministry of Health made the following changes to the ElderShield scheme. (1) The monthly payout is increased from $300 to $400 and the maximum payout period has been extended from 60 to 72 months. (2) Introduction of the ElderShield Supplements, where ElderShield policyholders who wish to obtain higher severe disability insurance coverage can purchase ElderShield Supplements.