There are still people who are mixed up with Medishield and the Privatised "Shield Plans" in the market.
Most of the Singaporeans/PRs have Medishield, and when you upgrade your plan to a private medical plan (e..g from AIA, NTUC or Great Eastern), you simply have better and higher benefits. The deductibles and co-insurances are a little higher if you prefer to go for private hospital healthcare (e.g. Gleneagles). The "Private Medical Plan" is stacked on top of the basic government "Medishield" plan. The intergration of the plans (Medishield and the Private Medical Plan) is done by the insurer and the government, so you don't have to worry too much about it.
For premiums, you only need to pay once/yearly to the insurer if you have upgraded your medical plan.
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