Last Updated: 11 November 2026
Every medical card comes with a product disclosure sheet (PDS). In the “What is not covered?” section, the insurer has to list the main things the plan won’t pay for. If the hospital says your insurer hasn’t approved your claim yet, check this list first.
The list is almost the same on every medical card. Bank Negara Malaysia (BNM) limits how long you can wait before your plan pays. Your plan can also refuse to cover an illness you already knew about before you bought it.
Plans differ in the exceptions they make. Yours might cover dental treatment after an accident, or treatment overseas up to what it would cost in Malaysia.
Common Exclusions And Their Exceptions
RinggitPlus checked the exclusions below in November 2026 against the Manulife EZ-Med Deductible policy contract (version 01/25). We also checked them against the PRUMillion Med 2.0 exclusions sheet. For MediAsas, we used BNM’s MediAsas trial FAQ of 29 July 2026. You buy EZ-Med Deductible directly from Manulife, not through an agent.
| What Isn’t Covered | Exceptions Some Plans Make |
| Illnesses you had before you bought the plan | Depends on the terms the insurer sets when it accepts you |
| Any illness during the waiting period (up to 30 days) | Emergency treatment after an accident is covered from day one |
| Specified illnesses during their waiting period (up to 120 days) | None. Cover starts when the waiting period ends |
| Dental treatment | Treatment needed because an accident damaged your natural teeth |
| Cosmetic and plastic surgery | None |
| Glasses, contact lenses and laser eye surgery | Cataract surgery, with a limit on the lens |
| Pregnancy and childbirth, including complications | Some plans for parents-to-be pay up to a set amount for complications |
| Fertility treatment and contraception | None |
| Conditions you were born with | None |
| Mental health treatment | None on the plans in this guide |
| GP visits, health screenings and check-ups | Visits and tests for the same condition before and after a covered hospital stay and an outpatient benefit if your plan has one |
| Injuries from racing and dangerous sports | Foot races are covered |
| Injuries from alcohol, drugs or breaking the law | None |
| Traditional and complementary treatment | PRUMillion Med 2.0 pays up to RM1,500 a year on some plans |
| Treatment overseas | Some plans pay up to what the treatment costs in Malaysia |
Illnesses You Had Before You Bought The Plan
Under BNM’s rules, a pre-existing condition is one you had, and knew about or should have known about, before your cover started. The insurer has to prove you knew, or should have known. Declare every condition when you apply, even ones you think are minor. The insurer may exclude the condition or charge more for it.
MediAsas is BNM’s basic medical plan. It opens to the public in January 2027 as Teras and Fleksi. It is meant to accept some people whose condition is under control. It can still refuse to pay for treating that condition.
The 30-Day And 120-Day Waiting Periods
Under BNM’s rules, a plan can make you wait up to 30 days before it pays for any illness. For a list of specified illnesses, the wait can be up to 120 days. Manulife EZ-Med Deductible and PRUMillion Med 2.0 both use the standard list and wait the full 120 days. The list includes:
- High blood pressure, diabetes and heart disease
- Tumours, cancers, cysts, nodules and polyps
- Stones in the urinary system, gallbladder or bile ducts
- Ear, nose, sinus and throat conditions
- Hernias and haemorrhoids (piles)
- Endometriosis and other conditions of the reproductive system
- Spine, disc and knee conditions
Both waiting periods start again when you switch to a new plan. The same happens if your policy stops because you missed payments and you then restart it. Before you cancel an old plan, check the date the new plan’s waiting periods end.
Dental Work Unless An Accident Caused It
Medical cards won’t pay for check-ups, scaling and fillings, or for bigger jobs like root canals, braces, crowns and implants. MediAsas won’t pay to remove impacted wisdom teeth or treat gum disease either.
If an accident damages your natural teeth, EZ-Med Deductible, PRUMillion Med 2.0 and MediAsas pay for the treatment that injury needs. For routine dental costs, you need a separate dental plan or a dental benefit from your employer.
Cosmetic Surgery, Glasses And Laser Eye Surgery
Treatment you choose rather than need is excluded, including:
- Cosmetic and plastic surgery
- Glasses, contact lenses and eye tests
- Laser eye surgery such as LASIK
- Treatment to lose or gain weight
- Circumcision done for religious or cultural reasons
Cataract surgery treats an illness, so plans cover it. But they may limit what they pay for the new lens. PRUMillion Med 2.0 pays up to RM8,000 over your lifetime and MediAsas only pays for a standard single-focus lens.
Pregnancy, Childbirth And Fertility Treatment
EZ-Med Deductible, PRUMillion Med 2.0 and MediAsas won’t pay for childbirth, a caesarean or a miscarriage. Help to get pregnant, birth control and sterilisation are left out of all three.
Some plans for parents-to-be pay up to a set amount if a pregnancy complication happens. Prudential’s PRUMy Child Plus, for example, covers nine pregnancy complications up to RM8,000 and can start from 13 weeks of pregnancy. Before you buy one, check which complications it names and how long you wait before you can claim.
Conditions You Were Born With
Congenital conditions are ones you’re born with. Hereditary ones run in families. Medical cards, including EZ-Med Deductible and PRUMillion Med 2.0, exclude both under the same clause. EZ-Med Deductible counts hernias and epilepsy as congenital. If you’re buying cover for a child, check how the policy defines congenital conditions.
Mental Health Treatment
EZ-Med Deductible, PRUMillion Med 2.0 and MediAsas all exclude mental health conditions. MediAsas may accept some people with a mild one, but it still won’t pay to treat it.
GP Visits, Check-Ups And Tests
A medical card won’t pay for GP visits, a yearly health screening or tests done only to check your health.
MediAsas pays for doctor visits and tests for 30 days before you go into hospital. It also pays for follow-up care for 90 days after you leave. The visits and tests have to be for the condition that put you in hospital. EZ-Med Deductible pays for 60 days before and 90 days after. Check your own policy for its number of days.
You pay for any other GP visit yourself unless your plan has an outpatient benefit.
Injuries From Risky Activities, Alcohol Or Breaking The Law
EZ-Med Deductible, PRUMillion Med 2.0 and MediAsas don’t pay for injuries from:
- Racing of any kind, except foot races
- Dangerous sports such as skydiving, water skiing and diving with breathing equipment
- Sport you’re paid to play
- Flying, unless you’re a fare-paying passenger on a commercial airline
- Being under the influence of alcohol or drugs
- Taking part in a crime, a riot or a war
- Injuring yourself on purpose
If you do one of these activities as a hobby, read how your policy defines it before you buy.
Other Treatment Medical Cards Leave Out
MediAsas excludes the items below:
- Traditional and complementary treatment, such as acupuncture, chiropractic and herbal remedies
- Experimental treatment
- Sleep apnoea and snoring treatment
- Hormone replacement therapy
- Sex change treatment
- The cost of donating an organ
- Sexually transmitted infections, including HIV
- Diseases the law says must be quarantined
- Non-medical hospital items such as the admission kit, TV and phone
EZ-Med Deductible and PRUMillion Med 2.0 exclude most of these too. Neither names diseases that must be quarantined. PRUMillion Med 2.0 names experimental treatment as an exclusion. EZ-Med Deductible doesn’t, but it only pays for medically necessary treatment and its policy says experimental treatment doesn’t count. PRUMillion Med 2.0 also pays for some alternative treatments, such as acupuncture, bone-setting and traditional Chinese medicine. This benefit pays up to RM1,500 a year and is only on plans with a room limit of RM300 a day or more.
MediAsas won’t pay for treatment outside Malaysia. Some other plans, such as EZ-Med Deductible, do pay, but only up to what the same treatment would cost in Malaysia. EZ-Med Deductible stops paying once you’ve been outside Malaysia, Brunei and Singapore for more than 90 days in a row.
Costs You Still Pay On A Covered Claim
On a covered claim, you may still pay a deductible or co-insurance (co-takaful on a takaful plan). You pay the difference if your room costs more than your room and board limit and anything above your annual limit.
What To Check Before You Buy
Read the “What is not covered?” section of the PDS. Then look for the appendix headed “What are the major exclusions under this Policy?”, which lists the rest. After that, read the full exclusions clause in the policy. Look at the exclusions as well as the price when you compare medical cards on RinggitPlus, including plans with a deductible. If your employer already covers you, read Do You Need Your Own Medical Card If Your Company Gives You One?
If Your Claim Is Turned Down
Ask the insurer in writing for its reason and the policy clause, then make a formal complaint. If you still disagree with its final decision, take it to the Financial Markets Ombudsman Service (FMOS). FMOS hears disputes of up to RM250,000 for free. A larger dispute goes to court or arbitration unless you, the insurer and FMOS all agree in writing.
Frequently Asked Questions
Can an insurer reject a claim years later for a condition I didn’t declare?
On any plan, the insurer can refuse or reduce your claim if you didn’t take reasonable care to declare a condition. It can also change your terms or cancel your policy. On MediAsas, this changes after seven years of cover with no break. After that, the insurer can only turn down a claim for an undeclared condition in two cases. One is if the insurer suspects you hid the condition on purpose, recklessly or by fraud. The other is a claim for one of five serious conditions, such as cancer. That exception applies if you had the condition before your cover started or it showed up in your first 30 days.
Can I get cover for pregnancy, dental or mental health treatment?
EZ-Med Deductible, PRUMillion Med 2.0 and MediAsas exclude pregnancy, routine dental work and mental health treatment. Some plans for parents-to-be pay up to a set amount for pregnancy complications, and there are separate dental plans.
