Medical insurance is the insurance that helps you pay your medical expenses incurred in the treatment of illness at the hospital including the cost of room and board, professional and surgery fees, anaesthetist fees,medical supplies and services, operating theatre, Pre-Hospital Diagnostic Test and Specialist Consultation, In-Hospital Physician Visits, Emergency Accidental Outpatient Treatment, Outpatient Physiotherapy Treatment, Outpatient Kidney Dialysis and/or outpatient Cancer Treatment.

There are also additional benefits like Cash Allowance incentive for seeking treatment at Government Hospitals and also accommodation allowance for the parent or guardian who is caring for the child who is hospitalised.  The policy also covers overseas hospitalisation but the insured usually has to pay the bills first and file for claim later and the rate of exchange will be normally be based on the last date of treatment at the hospital.  The cost of treatment will be reimbursed according to the reasonable and customary charges as available in Malaysia for the similar medical treatment and services.

Additionally, most medical insurance plans offer emergency evacuation and repatriation benefits to home country when the insured is critically ill but stable enough to travel with the accompaniment of the medical staff so that the insured patient can be well taken care off with the transfer from overseas to home country and have the peace of mind with their loved ones around at local hospital.

Who can apply for Medical insurance in Malaysia?

All Malaysian Citizens age from newborn to age 70 years old and renewable till age 100 years and are in good health and has no previous claim history or pre-existing conditions.

For foreigners who are permanent residents and are working and in the occupational classification of 1 & 2(Office Executives and Professionals).

The Insurance Premium rates usually increases with age. Female gender are usually having a lower premium rate at the younger age but will be higher rates as the age bracket increases and by then will be much higher price than the male of the same age bracket.

Exclusions

Usually the exclusions are quite similar for most insurance company such as :

• Pre-exisiting conditions
• Maternity or Pregnancy related medical treatment
• Attempted Suicide and self-inflicted injury
• Co-genital abnormalities
• Any medical or physical conditions arising within the first 30 days of the Insured Person’s cover or date reinstatement (whichever is latest except for accidental injuries)
• Specified illnesses occurring during the first 120 days of continuous cover. Specified Illnesses shall mean the following conditions and its related complications:
  Hypertension, diabetes mellitus and Cardiovascular disease
  All tumours, cancers, cysts, nodules, polyps, stones of the urinary system and biliary system
  All ear, nose (including sinuses) and throat conditions
  Hernias, haemorrhoids, fistulae, hydrocele, varicocele
  Endometriosis including disease of the Reproduction system
  Vertebro-spinal disorders (including disc) and knee conditions
• Mental Illness
• Accidental Injuries sustained in illegal racing
• Plastic or Cosmetic Surgery, circumcision, eye examination, glasses and refraction or surgical correction of nearsightedness and the use or acquisition of orthosis external prosthetic appliances or devices such as artificial limbs, hearing aids, implanted pacemakers and prescriptions thereof
• Dental conditions including dental treatment or oral surgery except as necessitated by Accidental Injuries to sound natural teeth occurring wholly during the Period of Insurance
• and others specifically stated in the chosen medical insurance policy

Medical Card or Cashless Admission

In the past, hospitalisation and surgical insurance policy are offered on reimbursement basis.  Today, with present society’s demand and development in the electronic payment systems and market competitions, consumers are preferring the hassle free admission to seek treatment as they just need to show the panel hospitals their medical insurance card which carries the insurance company name and the insured’s policy number and personal details and plan benefit when getting the best healthcare so that they have peace of mind of recuperating and recovery.  This mode of medical insurance claim somehow comes with higher pricing to consumer and lower commission for the insurance agent as there are less servicing required from the agent to the client but there are more direct billings from the hospitals to the insurance company.

Consumers are also advised to be aware of the difference in benefits offered by different insurance companies especially on certain hospital administrative charges like registration fee and service tax that are not covered by the policy.

Co-Insurance

Some medical insurance plans practice co-insurance, meaning that you will have to pay a certain amount of the medical fees, normally at 10% to 20% of the total medical fees incurred, while the balance will be paid by the insurance company. Another similar option is Deductible or excess per disability, which is also the amount you have to bear before the insurance providers claim for you. The difference is that deductible per disability is a stated amount (not a percentage), only the amount exceeding this deductible amount will be payable by insurance providers, usually the Co-insurance medical insurance policies are sold to consumers at a lower premium rates than the medical card insurance policy that pays fully the cost of medical fees incurred by the insured.

Panel Hospitals

Most of the private specialist hospitals throughout major cities and towns in Malaysia are appointed by insurance companies as their panel hospitals to facilitate the ease of seeking good health care facilities for their insured clients.

Here are the sample lists of medical insurance panel hospitals recommended by insurance companies and insurance agents:

Kedah

• Kedah Medical Centre +604 730 8878
• Putra Medical Centre +604 734 2888
• Pantai Hospital Sungai Petani + 604 442 8888
• Metro Specialist Hospital +604 423 8888

Penang

• Bagan Specialist Centre +604 332 2800
• KPJ Penang Specialist Hospital +604 548 6688
• Gleneagles Penang + 604 227 6111
• Hospital Lam Wah Ee +604 652 8888
• Island Hospital +604 228 8222
• Loh Guan Lye Specialist Centre +604 238 8888
• Pantai Hospital Penang +604 643 3888
• Penang Adventist Hospital + 604 222 7200

Perak

• Hospital Fatimah +605 545 5777
• KPJ Ipoh Specialist Hospital +605 240 8777
• Pantai Hospital Ipoh +605 548 4333
• Perak Community Specialist Hospital +605 241 9000
• Columbia Asia Hospital Taiping +605 820 8888
• Taiping Medical Centre + 605 807 1971
• Sri Majung Specialist Centre + 605 691 8153

Selangor/Kuala Lumpur

• Arunamari Specialist Medical Centre +603 3324 3288
• Assunta Hospital +603 7680 7000
• Columbia Asia Hospital Bukit Rimau +603 5125 9999
• Columbia Asia Hospital Puchong +603-8064 8688
• Damai Service Hospital (HQ) +603 4043 4900
• DEMC Specialist Hospital +603 5515 1888
• Gleneagles Kuala Lumpur +603 4141 3000
• Institut Jantung Negara +603 2617 8200
• KPJ Ampang Puteri Specialist Hospital +603 4270 2500
• KPJ Damansara Specialist Hospital +603 7722 2692
• KPJ Kajang Specialist Hospital +603 8769 2999
• KPJ Selangor Specialist Hospital + 603 5543 1111
• KPJ Tawakkal Specialist Hospital +603 4026 7777
• Pantai Hospital Ampang +603 4289 2828
• Pantai Hospital Cheras +603 9132 2022
• Pantai Hospital Klang +603 3374 2020
• Pantai Hospital Kuala Lumpur +603 2296 0888
• Sentosa Medical Centre +603 4043 7166
• Sime Darby Medical Centre Subang Jaya +603 5639 1212
• Sri Kota Specialist Medical Centre +603 3373 3636
• Sunway Medical Centre +603 7491 9191
• Taman Desa Medical Centre +603 7982 6500
• Tropicana Medical Centre +603 6287 1111
• Tung Shin Hospital +603-2037 2288
• Quill Orthopaedic Specialist Centre +603 77270 6333
• Sentosa Specialist Hospital +603 5162 8814
• Sime Darby Medical Centre Ara Damansara +603 7839 9999
• Columbia Asia Hospital Cheras +603 9086 9999
• KPJ Klang Specialist Hospital +603 3377 7888
• Prince Court Medical Centre +603 2160 0000
• Sime Darby Medical Centre Desa ParkCity +603 5639 1212
• Columbia Asia Hospital Setapak +603 4145 9999

Negeri Sembilan

• Columbia Asia Hospital Seremban +606 601 1988
• Mawar Renal Medical Centre +606 764 7048
• KPJ Seremban Specialist Hospital +606 767 7800
• NSCMH Medical Centre +606 763 1688
• Senawang Specialist Hospital +606 675 1188
• NCI Hospital, Nilai +606 850 0999

Melaka

• Mahkota Medical Centre +606 281 3333
• Pantai Hospital Ayer Keroh +606 231 9999
• Putra Specialist Hospital Melaka +606 283 5888

Johor

• Columbia Asia Hospital Nusajaya +607 233 9999
• Hospital Penawar +607 252 1800
• Kempas Medical Centre +607 236 8999
• KPJ Johor Specialist Hospital +607 225 3000
• Kluang Utama Specialist Hospital +607 771 8999
• Pantai Hospital Batu Pahat +607 433 8811
• Puteri Specialist Hospital +607 223 3377
• Putra Specialist Hospital Batu Pahat +607 413 3333
• Regency Specialist Hospital +607 381 7700

Kelantan

• KPJ Perdana Specialist Hospital +609 745 8000
• Kota Bharu Medical Centre +609 743 3399

Terengganu

• Kuala Terengganu Specialist Hospital +609 624 5353

Pahang

• Kuantan Medical Centre +609 514 2828
• Kuantan Specialist Hospital +609 567 8588

Sarawak

• Columbia Asia Hospital Bintulu +6086 251888
• Columbia Asia Hospital Miri +6085 437755
• Kuching Specialist Hospital +6082 365777
• Miri City Medical Centre +6085 426622
• Normah Medical Specialist Centre +6082 440055
• Rejang Medical Centre +6084 330733
• Timberland Medical Centre +6082 234466

Sabah

• Damai Specialist Hospital +6088 222922
• Sabah Medical Centre +6088 211333

Waiting period 

The waiting period means during the first 30 days of period of insurance after the approval of the application, the policy excludes medical treatment for illness. However, there is no waiting period if hospitalisation is due to an accident.

For other specified illnesses, the waiting period is usually more than 120 days and longer depending on the nature of specified illnesses or the medical conditions of the insured person such as hypertensions, diabetes mellitus and Cardiovascular disease, Hernias, haemorrhoids, fistulae, hydrocele, varicocele, tumours, cancers, cysts, nodules, polyps, stones of the urinary system and biliary system, Vertebro-spinal disorders (including disc) and knee conditions, Endometriosis including disease of the Reproduction system, all ear, nose (including sinuses) and throat conditions.  These are some of the conditions which some insurance companies have underwriting guides that differ from one another.

Annual limit and Lifetime limit

There is a limit amount on your policy coverage annually and over your lifetime. If you spend over your annual limit in a month, then you are not eligible for benefit the rest of the year. As such, you have to wait for the following anniversary year when you renew your policy. Some insurance companies have the option to waive the annual limit, but total benefits payable cannot exceed your lifetime limit. With some additional payment of premiums, some insurance companies have upgraded their medical insurance card plans to even have unlimited lifetime limit or reward the healthy clients who have not make any claims on their policies, an automatic renewal bonus increase in their annual limit for the subsequent year.

Some of the medical insurance card plans are stand alone individual plan or family plan that can be attached to a life insurance plan as a rider.  Most general insurance companies offer the medical insurance plan as stand alone plans and renewable annually.

Guaranteed Renewal or Conditional Renewal

Some medical cards are renewable yearly (that means renewal is subject to the approval of the insurance company), while others normally offer guaranteed renewal for life especially those that are attached to life insurance policy for investment and retirement plan or whole life plan.  Some insurance companies will not renew the policy for the insured if there have been “bad” claim experiences during the preceding years and deem a not profitable account to maintain.  In such circumstances, the insured person have to find alternative coverage with another insurance company who may be willing to accept his/her risks but with impositions of loading on the premiums or excess on the claim of exclusion on the specific illness of the past year.

For today’s high medical fees and longer life living expectancy due to the advancement in the health care and medical technology, medical insurance is a necessity component of your financial planning and health care program if you plan to live with peace of mind and protect your wealth.

Buying a Medical Insurance with medical card which is popularly known as hospitalisation and surgical insurance from an insurance agent is equivalent to you opening a bank account with an ATM cum Credit Card facility with all the private hospitals willingly accepting you on board their hospital beds when you need one.

Please check and conduct a review with your insurance agent and company when it is time to renew your medical insurance policy as the plans you bought for yourself and family sometime ago may not be adequate to cover present day’s medical fees.

For enquiry on Malaysia medical insurance card and hospitalisation and surgical insurance policy services, please contact us.