Bank Negara Proposes “No Look-Back” Rule Under New Medical Plan

Samuel Chua

31st March 2026 - 3 min read

Bank Negara Malaysia is proposing a change that could make it harder for insurers to reject medical claims, especially for people with existing health conditions.

Under a proposed basic medical and health insurance and takaful plan, insurers may no longer be allowed to deny claims linked to pre-existing conditions once a policy has been held continuously for a set period, with the same protection extending to past non-disclosure after that period.

The proposal is still being finalised, with details such as waiting periods and eligibility rules yet to be confirmed.

Coverage May Continue Even After Medical History Is Reviewed

One of the main concerns with private medical insurance is whether a claim will be paid when it is needed, particularly if a condition existed before the policy started.

Bank Negara governor Datuk Seri Abdul Rasheed Ghaffour said the proposed “no look-back” rule would limit how far insurers can go in reviewing a person’s medical history once coverage has been maintained over time, which means claims could no longer be denied on the basis of earlier conditions or non-disclosure after that point, as long as the policy remains active.

Current Plans Still Allow Claim Rejections

Private medical plans today can reject claims for a range of reasons, including pre-existing conditions or incomplete disclosures made when the policy was first purchased.

This reflects how insurance works, as insurers and takaful operators pool premiums from many customers to cover uncertain medical costs, while limiting coverage for pre-existing conditions helps prevent people from only signing up after falling ill.

Without these limits, claims could rise quickly and push premiums higher for everyone, including those who are healthy.

Access May Improve For People With Existing Conditions

The proposed basic MHIT plan is designed to widen access to medical coverage, including for individuals with stable and controlled pre-existing conditions who may currently face exclusions or higher barriers when applying for insurance.

Bank Negara is working with medical experts and industry stakeholders to finalise how the system will work in practice, including waiting periods and consistent underwriting rules, with the full mechanism expected to be confirmed before the plan is launched.

What This Could Change For Policyholders

The change centres on what happens after a policy has been kept active over time, rather than just whether someone can get coverage in the first place.

Someone who maintains continuous coverage may have more certainty that claims will be paid even if their medical history becomes relevant later, which reduces the risk of a claim being rejected after treatment has already taken place.

At the same time, insurers still need to manage overall risk, so the final structure of waiting periods, pricing, and eligibility will shape how widely accessible the plan becomes and how much it costs to maintain.

Pilot Phase Planned Before Full Rollout

Bank Negara plans to run a pilot for the basic MHIT plan in the second half of 2026, which will test how the system works ahead of a full rollout expected the following year.

The pilot will focus on whether insurers, takaful operators, and private hospitals are ready to support the plan in practice, while also identifying operational gaps and collecting feedback from early users.

Any changes to coverage structure, benefits, or timelines are expected to be made after this phase, before the plan is introduced at scale.

Samuel Chua

Samuel writes about personal finance and financial news, focusing on how banking updates, policies, and promotions affect everyday money decisions. He enjoys making complicated financial topics easier to follow. Outside of writing, he spends his time watching TV shows and occasionally convincing himself he will only watch one episode.

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