Frequently Asked Questions About Medical Insurance

Unfamiliar with medical insurance? If you don't know what "co-insurance" is, or how your premiums are determined, you're not alone! Read on to equip yourself with the knowledge to seek out the best policy for your needs.

If you're not familiar with the jargon that insurance companies use, buying a policy and getting your family covered for basic medical care can be very confusing. Here's our handy guide to the top questions people have asked us about their medical insurance package.

Question 1: How do I use my Medical Card?

Once you've got a Medical Card, getting into a hospital and making claims is a much, much easier process. You only have to present your Medical Card at a Panel Hospital and get a doctors consent to be admitted. There's a lot less waiting and tedious paperwork.

The best thing is that you won't have to worry about settling your medical bills upfront, as most policies allow for cashless admission.  In many cases medical bills will be submitted directly to your insurer for claim evaluation.

Question 2: Am I insured when I am hospitalised outside Malaysia?

If you're traveling a lot it's great to make sure that you're covered for any illness. You should know that there is such as thing as the overseas residence clause that can catch you out if you're studying or working abroad for an extended period of time. This clause let's most medical insurance policies reject your claim if you've stayed overseas for 90 consecutive days. You know insurance companies like to reject claims if they can find a reason!

However, you might be able to get compensation for treatment received abroad under another clause called the reasonable and customary charges provision. For example, if you have had surgery in Australia that cost AUD10,000 (about RM30,000) your insurance company might reimburse the amount you would have paid had the surgery been performed locally in Malaysia.

Question 3: What should I do if I am admitted to a non-panel hospital?

Don't panic just yet! Let's say that you've been involved in a motor accident or a sports injury and rushed to the nearest hospital that so happens to NOT be on your insurer's list of panel healthcare providers.

There are two phone calls you absolutely have to make - first is to your family (if they're not by your side already), informing them that you're doing fine, and another to your insurance agent, to inform him or her of your situation.

This way, your medical bills may still be payable by your insurer - you'll just have to pay out of your own pocket first before you can file for a claim. Remember to keep all original copies of medical bills, medical reports, and letters from doctors as they are important  to make an effective claim.

Question 4: How are my premium payments calculated?

So you want to know what really goes into determining your insurance rates. Well, an insurance company will quote a premium amount depending on your risk - that is, how likely you are to make a claim, and how much will these claims cost. During the underwriting process, there are several factors to look at, and one of them is your occupation. Occupation types come in 4 flavours: Class 1, Class 2, Class 3, and 4. 

Occupations in Class 1 and 2 generally face lower risk, for example work that require employees to only stay in the office - because how exciting can a 9 to 5 desk job be?

Class 4 occupations face the highest risk, for instance crane drivers and firefighters. The higher the occupation class, the higher your annual premium. Other things that are taken into consideration would be your age, gender, and overall health. 

Question 5: What is co-insurance, co-takaful, and deductibles?

Even with a medical card, you can still be on the hook to pay for a chunk of every instance of care you seek, be it for a drug prescription or doctor's appointment.

These kinds of policies are ones that allow you to choose a co-insurance or co-takaful option - the practice of sharing the costs of medical treatment between you and your insurance company.

Similarly, a deductible is the money you pay to the hospital before your policy begins to cover your behind. For example, if you've chosen a deductible of RM2000, and your bill amounts to RM5,000, your insurer will only pay the remaining RM3,000.

The good thing about going for a plan with a deductible or co-insurance is that your premiums will always be cheaper, possibly saving you more money in the long run.

Question 6: What are the common reasons why medical claims get rejected?

You've probably heard from friends and family about how they've been denied insurance claims, but you've only heard one side of the story. Below are some of the most common reasons why you claims may be rejected:

Claim Within Waiting Period

Except for accidental injuries, medical insurance won't cover for any medical cost charged in your name within 30 days from the date of activation of the insurance policy.

Exclusion Clauses

Having access to a medical card will not protect you from every imaginable condition, especially pre-existing illnesses! Read our '5 Things Not Covered By Medical Insurance' guide to find out more.

Unpaid Premiums

This shouldn't come as a surprise - you'll definitely run the risk of lapsing your insurance policy if you've failed to pay your premium past the due date. 

Fortunately, if you have a medical plan riding on a conventional life insurance policy, there will be a cash surrender value which will help to pay for your hospitalisation and surgical bills once your policy has been terminated.

Exceeded Your Limit

There are two limits that you need to keep tabs on: the annual limit, and the higher lifetime limit. If your latest hospital bill is RM80,000, but your annual limit is only at RM50,000, you will have to pay for the difference.

Many medical plans set their coverage to 'as charged', meaning your insurer will pay the total amount charged by the hospital - subject to both limits.

Always Plan Ahead

In the end of the day, you are responsible for your own health and well-being, so it totally helps to be informed about the details of your policy. Before deciding on a medical plan, with some proper thought and planning, you can keep your insurance costs as low as possible and enjoy only the coverage that you need. But most importantly, keep fit and stay healthy!

Do you have any lingering questions about your medical insurance plan? Ask in the comments below! To compare all medical cards in Malaysia, visit our Medical Cards Comparison Page now!

0 comments

Agree or disagree with this post? Questions? You also have your word!

  • solomon

    Hi all I have a question , does medical card premium will increase every 1 year or 2 or 3 or 4 or 5 , pls advise on this , as my premium on medical was rm113.00 previously after about 4 years increase payment to 225.00, they said it was revised due to medical cost increase , which nothing to do with me as my insured remain the same, & I did not claim till tody

    Reply
    • RinggitPlus

      Hi Solomon,

      It is best you go back to your agent and cross check against your policy that was originally issued to you regarding premium issues as different companies and policies may vary.

      Thank you.

      Reply
    • MUKUNDARAJAN SESHADRI

      I am holding a corporate membership and my wife is a co-insured through my membership. She need to undergo an hospitalisation, i find that is more comfortable to have it in India due to various reasons. The membership i am holding is AIA RED. Am i eligible to claim the consultation and hospitalisation expenses once the same is done. If so, what is the procedure

      Reply
      • RinggitPlus

        Hi Mukundarajan,

        We think in this case it's best you consult with the HR department of your company to know for sure whether or not your special condition will be covered.
        Every policy is different and our advice might not be applicable to your situation. We hope this helps!

        Reply
      • Anwar Suran

        Hi, nama saya Anwar Suran, saya sedang mencari kad perubatan insurans yang premium PALING MURAH (walaupun perlindunganya sangat kecil) asalkan tiada co-insurans atau deductible (penolakan) serta saya mahukan term sehingga 99 tahun.

        Saya ingin dapatkan pelan kad perubatan insurans untuk ibu saya yang berusia 61 tahun. Boleh bantu?

        Reply
      • JT

        hi, i used to have medical card coverage from my employer for my family. as part of the cover, my kids were covered for immunisation or visitation to the pediatrician whenever they were down with minor illnesses such as a cold/flu. after i left my employer i been searching for a similar medical card for my family that covers visitations to the GP/doctors and it seems that most insurance companies do not cover that in the medical card unless there is a diagnosis of an illness and requires hospitalisation. why is there such a gap between group insurance and individual insurance? i would be interested to know if there are any insurance company in malaysia that covers that in the medical card for individuals. thanks.

        Reply
      • Gramsci

        Never know we can get so much from medical card. Need totell company HR they cheat us with bad insurance!

        Reply
        • allen

          insurance company dont cheat, all the policy is black and white, just some agent is mislead the client

          Reply
          • Jacky Phoon

            Hi Gramsci, insurance co. Don't cheat. But, sometime is depending on your co. budget to spend on employees benefits. Every single group insurance is customize according to co. Budget and claim history that would affect the premium and benefits given.

            Reply
          • Cheongster

            If i dont have medical insurance, do i have to pay if ambulance come my house if emergency?

            Reply
            • RinggitPlus

              Hi there,

              Yes, at the end of the day you will be charged an ambulance fee. If you sign-up for a medical card, your insurer will most likely pay for these charges - subject to the terms and conditions of your policy. Some will also offer compensation for emergency repatriation and evacuation when you fall ill overseas. Hope that helps!

              Reply
              • allen

                for government hospital no need,
                my father from sentosa to kpj tawakal, ambulance charge 500, but covered by insurance medical card

                Reply
              • AHumbleOfficeWorker

                "because how exciting can a 9 to 5 desk job be?"

                I assure the author that I feel a great sense of accomplishment at my "desk job" everyday I head in. My office is my sanctuary and my contributions to humanity stems from the enclosed space that is my office.

                I wish the author would not imply that desk jobs are boring, else how will we ensure that future generations would endeavor to such noble pursuits?

                Reply
                • RinggitPlus

                  Hi there AHumbleOfficeWorker,

                  Glad you're having an awesome time at work, we assure you that we know how that feels. But working at a construction site or as an extreme sports athlete is alot more physically challenging and "exciting" don't you think? You won't worry too much about breaking a leg or falling concrete in the office do you? Thanks for the feedback!

                  Reply
                • Azlan

                  Thks, Editor. I find this article very helpful. 1) So, in order to carry a medical card, I should have insurance cover? If myself, wife & kids are insured, are they also entitled for medical card each?

                  Reply
                  • allen

                    depends what type of family package of medical card you buy, all term and condition is on your policy,
                    check with you insurance agent, if you still have doubts call to customer services to check before something happen :)

                    Reply
                    • Jacky Phoon

                      Hi, Azlan. Each of your family members will entitled to get individual medical card and own limit to use. Every insurance plan can customize according to your budget and your need to achieve your objective.

                      Reply
                    • jenloi

                      where can I get insurance that covers dental ?

                      Reply
                      • RinggitPlus

                        Hi there,

                        Some medical insurance will provide for extra dental benefits, and yes, generally they are only covered if caused by accident or injury. However, there are dental insurance plans that specifically covers all oral health treatment including filings and extraction. Hope that helps!

                        Reply
                      • Liyana

                        My current insurance pan covered by my company has no limit to claims and coverage.
                        I have yet to come across a personal insurance policy that offers unlimited coverage. Is there one out there?

                        Reply
                        • RinggitPlus

                          Hi there Liyana,

                          Personal medical insurance will usually provide coverage 'as charged' meaning you'll only get compensation subject to your annual or lifetime limit - some companies offering upwards of RM1 million! However, other insurance policies such as motor insurance do provide umlimited coverage for third party bodily harm. Currently, we only cover personal insurance policies, but may we know which insurance you currently have? Thanks a bunch!

                          Reply
                        • Liyana

                          *insurance plan

                          Reply
                          • Jacky Phoon

                            Hi, Liyana. In the market, there i insurance company call their medical card unlimited however you must watch out the T&C because some have internal limit. Basically, the term of "unlimited limit" just a marketing strategy tactic. Every single claims you claim or hospital claim are the same because is under control MMA. In another hand, you have mentioned your co. have no limit claims and coverage. Please bear in mind that that's no free lunch in this world. Group Insurance is renew yearly and your co. have the right to change the coverage for the staffs and you shall check with your co. please don't so happy 1st. Because I have come across a client said her co. got no limit coverage but unfortunately she diagnose with breast cancer then only found out she only got 100K to use for the treatment. And, she feel surprised and sad. Due to lack of awareness, she have to bear her own medical cat around 35K excess of limit for the treatment.

                            Reply
                          • Dr GB

                            I am a foreigner staying in Malaysia (long-term visa but not PR). It seems a lot of the policies have 'home country exclusions' i.e. if I become ill while visiting my country of nationality the medical insurance would not cover me (even though I have been resident in Malaysia for many years and only go back to my original country to visit family). Are there any policies which do not have such an exclusion?

                            Reply
                            • Ringgitplus

                              Hi Dr GB, that's a very good question, thanks for asking! As far as we know most (if not all policies) do have that or a similar clause in relation to non-nationals. Some insurance companies may reimburse on a discretionary basis and the amount will not usually be in full. In such a situation, many expats choose to take travel insurance when traveling or opt for an international policy (not offered by Malaysian insurance providers) if they are frequently away for long periods of time. Hope that helps!

                              Reply
                            • Richie Chew

                              Do children need a medical card?

                              Reply
                              • Ringgitplus

                                Hi Richie, many parents simply take a family policy that covers their children as well but depending on your budget, you can opt for a separate medical card/insurance policy for your child. Hope that helps.

                                Reply
                              • NA

                                In ur opinion with regards to children medical card. Which is better (i.e coverage, convenient, csot saving). either get a separate medical card or enroll a family package that cover the whole family?

                                Reply
                                • IbM

                                  Hi, maybe you need to provide a feature to search by takaful, conventional or both. Looks like in your list, only MBB is giving the takaful option

                                  Reply