Health Insurance Malaysia

The concept of health and medical insurance came up in Malaysia in the early 1970s. The main focus was to provide coverage for personal accidents. With time, health insurance became a part of a standard employee compensation. A health insurance considers your age, gender, smoking habits, and health conditions to provide you with the right protection you need.

Top Health Insurance Companies in Malaysia

Policy Provider Plans Key Benefits Premium Payment Riders
Allianz Malaysia MediSafe Infinite/MediSafe Infinite Xtra, Allianz Diabetic Essential, Allianz Care Individual, Allianz Booster Care, Allianz i-HospitalCash, Enhanced HealthVantage, and HealthCover/HealthCover Plus.
  • Assured admission at panel hospitals with the medical card.
  • Domestic and international medical assistance.
  • High annual limit of up to RM1.8 million.
- MediEssential, Prime Care, HealthCover Enhancer, Child Guard, Lady Guard, and Man Guard.
AXA Malaysia SmartCare Optimum, HOPE Medic, SmartCare Optimum Plus, AXA eMedic, 360 CancerCare, 110 Critical Illness Care, SmartCancer Cash, AXA 200 CancerCare, and InternationalExclusive.
  • Up to 360% pay out for cancer treatment.
  • Covers the second medical opinion of the doctor if required.
  • International hospitalisation expenses coverage.
Annually. N/A.
Zurich Malaysia Active Living, MedicaGen 200, MediLove, ProLife 36 Super Basic, Zurich Omni Health, and Zurich ProWell Critical Illness.
  • Medical card to facilitate hospital admission.
  • Renewable policy term.
  • Wide network of panel hospitals.
Monthly, quarterly, semi-annually, and annually. Zurich FlexMed 2, Zurich FlexMed 2 PLUS, Zurich MegaMed, Critical Illness Super, Critical Illness Plus, Early Care Critical Illness, Flex Lady Critical Illness, Flex Maternity Care, Flex Junior Critical Illness, MaxMedic, Hospital Income Plus, and Hospital & Surgical Benefit.
Tokio Marine Malaysia Cancer Shield Plus, Medic Partner, Premier Medic Partner, MosBite, iHealth+, and Cancer LoanBreak.
  • No claim bonus available.
  • Zika and Dengue cover.
  • Optional benefits available to build comprehensive shield.
Annually. Medic Plus, TokioMarine-iHealth Advance, CI Rider, and MedShield.
Great Eastern Life Assurance Berhad Great Early Cancer Care, Great Early Triple Care, Great MediCare 2, Great Medic Xtra + Great Extender, and SmartMedic Xtra.
  • Executive second opinion coverage.
  • Outpatient treatment expense coverage.
  • Up to 2 claims for different stages of cancer.
Monthly, quarterly, half-yearly, and annually. Smart Early Payout CriticalCare, Smart Extender, Smart Extender Max, Smart Premier Health, SmartMedic, and SmartMedic Enhancer.
AIA Malaysia A-Life Med Regular, A-Life Medik Famili, A-Life Med Regular, A-Plus Med, A-Plus Med-i, A-Plus Junior Critical Care, A-Plus Junior Critical Care-i, Twin PA, MyFamily PA, and Anniversary PA.
  • Covers the early stage of up to 92 critical illnesses.
  • Claim up to 120% of the coverage amount.
  • Multiple rider options to enhance the coverage of your policy.
  • Get tax relief on insurance premiums.
Monthly, quarterly, semi-annually, and annually. A-Plus MedBooster, A-Plus Med Booster-i, A-Plus HospitalIncome & A-Plus HospitalIncome Extra, A-Plus HospitalIncome Extra-i, A-Plus BabyCare-i, A-Plus BabyCare, A-Plus Critical Reset, A-Plus WaiverExtra, A-Plus SpouseWaiver Extra, A-Plus Multi CriticalCare-i, A-Plus Multi CriticalCare, and A-Plus Early CriticalCare-i.
Prudential Malaysia PRUcancer X, PRUlady, PRUmultiple crisis cover, Crisis Cover Plus, and PRUsenior med.
  • Multiple cancer and critical illness coverage.
  • Pregnancy care & baby care benefit.
  • International treatment benefits in Singapore, Hong Kong, and China.
Monthly, quarterly, semi-annually, and annually. PRUvalue med, Crisis Defender & Early Crisis Protector, PRUmedic overseas, PRUmillion med, and PRUhealth.

What is Health Insurance?

A health insurance is a way of providing coverage for medical treatment at private health centres/hospitals. The term “medical treatment” includes several services as listed by each policy document, such as hospitalisation expenses, medicine bills, and critical illness treatment expenses.

In exchange of the medical treatment coverage, you are required to pay a specified sum known as a premium. The premiums and the coverage period varies based on several factors, such as your age, insurance provider, benefits offered by the policy, the coverage term, and many other factors.

Health insurance policies are available as a group plan and an individual plan. A group plan is the one that covers the employees at a workplace. The employer pays the premiums or you pay it yourself. When it comes to an individual plan, you choose the coverage needed for you and your family; and you pay the premium.

In addition to the conventional products, there are many companies that provide takaful cover.

Types of Health Insurance Plans in Malaysia

Health insurance can be categorised into 4 types based on the coverage they provide and the situations they take care of. Here is a list of the types of health insurance:

  1. Hospitalisation and Surgical Insurance: It is the basic health insurance that provides comes into effect when you are hospitalised or when you undergo a surgery. The expenses are covered if the hospitalisation or surgery is due to one of the illnesses listed under the policy.
  2. Critical Illness Insurance: This type of insurance provides coverage if you are diagnosed with one of the critical illnesses listed by the policy. Usually, insurance companies consider a set of 36 critical illnesses for coverage, such as Parkinson’s disease, heart valve surgery, end-stage lung disease, kidney failure, and multiple sclerosis.
  3. Hospital Income Insurance: When you are hospitalised, the hospital income insurance provides a fixed amount on a daily, weekly, or monthly basis to your family. It acts as a source of income to your family when you are receiving treatment in a hospital. The hospital income is subject to an annual limit set at the time of policy commencement.
  4. Disability Insurance: This type of health insurance acts as a source of income to help you if you are unable to work due to an illness or disability.
  5. Long-term Care Insurance: The insurance policy covers expenses, such as home care, adult day care, live-in caregiver, and private nurse. It is helpful if you are living alone away from family caregivers.

Health Insurance Coverage

With a health insurance policy, you can get one or more of the following coverages:

  • Hospitalisation.
  • Surgery.
  • Second opinion on the medical condition.
  • International treatments.
  • Critical illnesses and diseases.
  • Cancer care.
  • Private nursing.

What are the Eligibility Criteria?

Age of Policyholder A minimum of 18 years.
Age of Insured Person A minimum of 15 days up to 60 years.
Others No pre-existing medical ailments at the time of application.

How to Cancel Health Insurance?

  • Submit a written letter to the insurance provider requesting the cancellation of the policy.
  • The insurance provider will process your request and cancel the policy.
  • You may get a refund of the premiums you have paid if you have not claimed so far.

Documents Required for Health Insurance

When you purchase a health insurance policy, you have to submit your NRIC/MyKad as a mandatory document. In addition, most insurance policies would require your medical examination report to confirm that you don’t have any pre-existing medical conditions. In contrast, some policies offers insurance without the need of a medical check-up.

Health Insurance Claims Process

Though the exact process to make a claim may differ with insurance providers, the following set of steps can be considered for a basic understanding of the workflow:

  1. Read your policy agreement and make sure that the claim you are willing to make is covered under your policy.
  2. Submit a written notice to the insurance company within 30 days from the date of receiving treatment.
  3. Collect and attach the necessary documents based on the type of claim. You can consult your insurance provider for the specificity.
  4. The insurance company verifies the documents submitted and goes through the terms mentioned in your policy agreement to conclude on the claim approval.
  5. The medical costs incurred will be reimbursed subject to the limits of the policy.

Some insurance companies consider other gateways, such as official website, mobile application, and insurance agent for you to submit your claims application.

Documents Required for Claims Process

The most common documents you need to submit to make a claim are:

  • Original policy document.
  • A copy of the insured person’s identity proof.
  • All original bills and receipts from the hospital.
  • A complete medical report provided by the treating physician.
  • Physician’s summary on the treatment cost.

For overseas hospitalisation claims, you may have to submit:

  • A copy of your passport.
  • Flight ticket/boarding pass.
  • Admission bill.

Importance of Health Insurance Plans—Why you should Buy?

Many people prefer getting medical treatment in a private hospital rather than a public hospital. Not everyone can afford the luxury of getting treated at a public hospital. Therefore, a medical insurance acts as an affordable means to get the required services at a private hospital.

A health insurance policy is important because:

  • The policy helps pay your hospital bills.
  • The policy provides you with funds when diagnosed with an illness.
  • The policy helps your family with the required finances if you are unable to earn anymore.

How does Health Insurance Work?

  • You choose a policy and buy it from the insurance company by paying the annual premium at the time of purchase.
  • Say, you are diagnosed with a specific illness after 180 days from the policy issue date.
  • You have to inform the insurance provider regarding your health condition before you get hospitalised.
  • Keep all the medical reports and bills safe with you and submit a claim application to the company as soon as possible.
  • The policy, then reimburses the hospital expenses up to a maximum limit specified in the policy document.
  • If the expenses go beyond the specified limit, you have to pay the difference in amount.
  • You can enrol for e-payment so the claim settlement will be credited to your bank account.
  • Otherwise, a cheque for the settlement amount will be given.

Which Health Insurance Policy is best for Me?

Every individual has a different lifestyle and financial background. Therefore, you must decide on the best policy for you based on a clear understanding of your requirement and the features and benefits offered by the available insurance products.

  • Find a health insurance calculator on the internet to analyse your financial needs in the case of an unfortunate event.
  • Research for the available options based on your need—comprehensive plan, critical illness cover, hospitalisation and surgical cover, or dengue cover.
  • Some policies are investment-linked and provide a guaranteed renewal option.
  • Approach a reliable insurance agent and get some guidance in order to find the best policy for you.
  • Getting guidance does not mean you are entering into a contract to buy a policy from the same agent.
  • Based on the ideas you get from the interaction, you can analyse the products better.

Things to Keep in Mind while Buying Health Insurance

While buying a health insurance policy, you need to check on many sensitive factors other than just the coverage term, payment term, and premium amount. Some of these factors are compiled here:

  • Compare the benefits and obligations of multiple health insurance policies before choosing one.
  • The premiums vary based on your medical conditions and your entry age.
  • It is recommended to buy a single comprehensive health insurance policy than to have multiple plans with overlapping benefits.
  • Discuss about the details of the policy and buy one from a licensed insurance company or agent.
  • Don’t buy a policy only because the agent is asking you to buy it.
  • Pay the premiums by cheque, money order, or auto-debit to the insurance company and avoid paying by cash to the agent. Get a receipt for the payment you have made.
  • Read the policy agreement completely and understand how it works before you sign the document.

How to Choose the Right Health Insurance Company?

  • Research about the insurance company’s history and reputation.
  • Take a look at the company’s stakeholders and the awards and recognition received.
  • Check if the financial stability of the company is good enough.
  • Learn the claims procedure and choose the company that has a simpler process in place.
  • Most importantly, check the claims settlement ratio of the company for the previous year. This is to make sure that your valid claims will be settled by the company.
  • See if the company provides online services. It makes your transactions with the company easier.
  • Check if the company provides any discounts on the premiums.

What Expenses do Health Insurance Policies Cover?

Here is a set of expenses that a health insurance policy cover:

  • Hospital room and board.
  • Nursing expenses.
  • Intensive Care Unit.
  • Surgical expenses.
  • Anaesthetist fees.
  • Operation theatre expenses.
  • Post-hospitalisation treatment cost.
  • Out-patient physiotherapy expenses.
  • Guardian benefit.
  • Home nursing expenses.
  • Medical report fee.

What is Not Covered—Exclusions

There are a set of cases for which the policy may not cover, irrespective of hospitalisation and surgery. Some of the exclusions that you can generally come across with a health insurance policy are listed below:

  • Pre-existing medical conditions and illnesses.
  • Congenital abnormalities, especially for juvenile insured people.
  • Maternity.
  • Dental treatments and oral surgery.
  • Cosmetic/plastic surgery.
  • Selected illnesses occurring during the first 30-120 days of the coverage (varies with the policy) in case of a long-term coverage plan.
  • Injury/illness caused by self-inflicted injury due to misuse of alcohol/drugs.
  • Injuries caused due to active participation in riot, strike, war, civil commotion, or insurrection.
  • Injuries/illnesses caused due to gliding, aviation, motor racing, horse racing, and submarine operations.
  • Private nursing.
  • AIDS, AIDS-related complex, and HIV-related diseases.
  • Hospitalisation for investigatory purposes.
  • Psychotic, mental, or nervous disorders.

Dos and Don’ts of Health Insurance

If you fail to understand an insurance product, chances are you may end up buying the wrong plan. Here are some dos and don’ts that you may consider while buying a signing up for a health insurance scheme.

Dos

  • Verify if the insurance agent is a registered with the insurance company.
  • Contact the insurance company/agent if you have any queries regarding the terms used in the policy agreement.
  • Check if the policy is renewable or not.
  • Check the hospital room benefit available per day.
  • Verify if the cost of pre-hospitalisation diagnostic examinations are covered under the policy.
  • Ask if the policy covers in-hospital physician visits.
  • Check if post-hospitalisation treatments are covered.
  • Know if the home nursing expenses will be reimbursed by the policy.
  • Check if no-claim bonus is available under the policy.

Don’ts

  • Do not buy a policy without comparing several policies.
  • Do not purchase a policy without reading the fine print thoroughly.
  • Do not pay premiums in cash.
  • Do not ignore collecting a receipt for your payment.
  • Do not buy multiple policies for different coverages as they incur increased cost and provide overlapping benefits.

FAQs

Q. What is “No Claim Bonus”?

A. No Claim Bonus is a way to reward you if you don’t make a claim within the first few years from the commencement of your policy. You may get a higher basic sum assured or the premium you pay may be reduced if you don’t make a claim in the initial years. Not all insurance policies come with this facility.

Q. What is a waiting period? How long is the waiting period valid for?

A. Waiting period is a specified number of days an insurance policy takes to activate the coverage of the policy from the date of issuing the policy.

Generally, a policy defines waiting time with 3 different criteria:

  • Coverage for specified illnesses will commence after 120 days from the policy issue date.
  • Coverage for all other Illnesses and disease will commence after 30 days from the policy issue date.
  • No waiting period for hospitalisation due to accidents.

Q.  Which diseases fall under “specified diseases” category?

A. Insurance providers specify their own set of diseases under “specified diseases” category. Some common ones that belong to the specified illness group are:

  • Hernias.
  • Hypertension.
  • Diabetes mellitus.
  • Cardiovascular diseases.
  • Cancer, cysts, and tumors.
  • All ear, nose, and throat-related conditions.
  • Spinal and knee disorders.
  • Endometriosis.

Q. Is it possible to change the premium amount after the policy is issued?

A. No. You cannot change the premium amount agreed upon after the policy is issued. However, if you request for an increase/decrease in the coverage amount, it directly affects the premium amount. Even the insurance provider does not change the premium during the coverage period.

Q. What is a medical card? How is it helpful?

A. A medical card is represents your health insurance policy that covers hospitalisation expenses. When you visit a panel hospital, you must present the medical card at the cash counter. The insurance company makes direct payment to the hospital. So, you don’t have to pay in the first place and then submit claims request. In short, a medical card is useful for cashless hospitalisation.

Q. What happens if I am admitted to a non-panel hospital due to an emergency situation?

A. If you are admitted to a non-panel hospital, you will be required to make a phone call to your insurance provider stating the situation. Based on the insurance company’s discretion, your hospital bills can be still covered by the policy. The coverage limit may be reduced. Also, you need to know that the card works only in private hospitals.

Q. How does an investment-linked medical insurance work?

A. An investment-linked medical insurance plan provides 2 benefits—health insurance and investment returns. Insurance companies provide you with the freedom to choose the right proportion of investment and protection you need. You can also choose the type of funds you want to invest in. However, a portion of risk is involved as the unit price of the funds may vary and returns are not guaranteed.

Q. Can I choose the physician for my treatment at a panel hospital?

A. All physicians practicing in a panel hospital may not come under the policy coverage. If you are very particular about a physician, you have to check if the physician is available under the coverage before going forward. If he/she is not available under the coverage, you can still get the treatment from the same physician and pay for the expenses yourself.

News About Health Insurance

     
  • Support Medical Insurance with Top-Up Products: Financial Coach YC Lim

    Managing director of Wings Alliance Sdn Bhd and financial coach, YC Lim, offered some tips on how to plan your health insurance policies in a better way.

    Lim said that it is important to take help of supplementary products to boost your current medical insurance covers. Constantly increasing medical costs and lack of sufficient retirement funds can put you in a financial risk during a later stage of the life. He also said that reviewing your insurance cover is also crucial for your children if you don’t want to put a financial liability on them.

    Talking about the medical expenses in Malaysia, Lim informed that since 2016, the medical costs in the country are constantly on a rise. Therefore, it is necessary to revise your health insurance policy as per your health, budget, and existing insurance plans. In this case, upgrading your policy with top-ups or by adding benefits can be good options rather than buying a new policy with your current state of health.

    Lim also advised policyholders to consider the exclusions in their policies as these eliminations tend to become more extensive with increasing age or deteriorating health.

    BBazaar Malaysia

    19 November 2018

  • BNM Governor Asks Foreign Insurers to Divest Their Funds or Contribute to the B40 Fund

    Bank Negara Malaysia (BNM) Governor Datuk Nor Shamsiah Mohd Yunus has recently made an important announcement for foreign insurers in the country. The foreign insurers will have options of divesting their stakes or to contribute the B40 National Health Protection Fund.

    This statement was made for the foreign insurers to comply with the BNM’s ruling to sell a minimum of 30% their stakes to the local entities.

    The governor further said that the objective of the divestment remains the same, which is to promote long-term benefits for the country and providing broader insurance cover to the bottom 40% household group (B40).

    Talking in a media briefing, she further said that the foreign insurers are given with the options and they need to revert with their choice. Under the financial liberalisation policy, the foreign ownership limit for Malaysian insurers was set at 70% in 2009. However, higher foreign shareholding was permitted on a case-by-case basis.

    The B40 National Health Protection Fund will be announced early next year. The scheme is expected to bring in many benefits related to various insurance covers for the B40 group.

    BBazaar Malaysia

    19 November 2018

  • Support Medical Insurance with Top-Up Products: Financial Coach YC Lim

    Managing director of Wings Alliance Sdn Bhd and financial coach, YC Lim, offered some tips on how to plan your health insurance policies in a better way.

    Lim said that it is important to take help of supplementary products to boost your current medical insurance covers. Constantly increasing medical costs and lack of sufficient retirement funds can put you in a financial risk during a later stage of the life. He also said that reviewing your insurance cover is also crucial for your children if you don’t want to put a financial liability on them.

    Talking about the medical expenses in Malaysia, Lim informed that since 2016, the medical costs in the country are constantly on a rise. Therefore, it is necessary to revise your health insurance policy as per your health, budget, and existing insurance plans. In this case, upgrading your policy with top-ups or by adding benefits can be good options rather than buying a new policy with your current state of health.

    Lim also advised policyholders to consider the exclusions in their policies as these eliminations tend to become more extensive with increasing age or deteriorating health.

    BBazaar Malaysia

    19 November 2018

  • Malaysian Government Announces New National Health Insurance Plan for B40.

    As part of Budget 2019, the Ministry of Finance announced a health insurance scheme for the bottom 40% of the population (B40). The B40 Health Protection Fund will be a joint initiative by the government and private life insurance providers. Coverage will be extended against the top four critical illness and up to 14 days of hospitalisation. Starting January 2019, individuals who constitute the bottom 40% of the population can receive up to RM8,000 towards treatment of critical illnesses. Hospitalisation cover will be capped at RM50 per day or a total of RM700 p.a. Great Eastern Life Insurance will contribute RM2 billion to this fund which will be managed by Bank Negara Malaysia.

    Finance Minister, Lim Guan Eng also said that, going forward Employee Provident Fund (EPF) and life insurance will be treated as separate entities. Previous tax relief of RM6,000 will now be split into RM4,000 for EPF and RM3,000 for takaful. The tax relief was welcomed by Life Insurance Association of Malaysia. This move is aimed at increasing the percentage of insured population from 55% to 75%.

    BBazaar Malaysia

    05 November 2018

  • Budget 2019 to Reveal the Details of Social Health Insurance

    Datuk Seri Dr Dzulkefly Ahmad, the Health Minister, said that the details about the Social Health Insurance (SHI) for the B40 low-income group will be revealed during the Budget 2019. The upcoming budget is scheduled for 2 November 2018.

    He said that the ministry is keeping up with the statements made by Pakatan Harapan in the general election portfolio, i.e. the primary healthcare of low-income groups will be made a priority. He also specified that they will focus on screening and diagnosing diabetes and hypertension among the group will be handled in the coming days.

    Meanwhile, a foreign-based insurer has proposed to provide a huge sum, RM2.3 billion to RM2.5 billion, to set up an insurance plan for the country’s poor people in exchange for a deal. An additional RM500 million to RM600 million will be set aside for healthcare sector scholarships.

    BBazaar Malaysia

    31 October 2018

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