What is Zurich MediAfya+?
Zurich MediAfya+ is a medical takaful rider from Zurich Takaful Malaysia Berhad that comes with a medical card. It is not a standalone certificate. You attach it to a selected ordinary family takaful plan, and it follows that plan's coverage term. Anyone between 30 days and 70 years old (attained age) can be covered under it, though the participant taking out the plan must be at least 16.
Show your medical card at any panel hospital on admission and your eligible bills are settled directly, rather than you paying upfront and claiming later. The rider can be renewed yearly until the person covered turns 80, with an annual limit of up to RM1,000,000 and no lifetime cap on total claims.
Which plan should I choose?
| Plan 200 | Plan 300 |
| Annual limit | RM500,000 | RM1,000,000 |
| Lifetime limit | Unlimited | Unlimited |
| Daily hospital room and board | RM200/day | RM300/day |
| Daily cash allowance at government hospital | RM200/day | RM300/day |
Both plans come with a choice of two deductibles: RM500 or RM5,000 per year. The RM500 deductible suits anyone who wants minimal out-of-pocket cost when admitted. The RM5,000 deductible brings your contribution down meaningfully, by 19 to 20% on Plan 200 and 29 to 30% on Plan 300, in exchange for paying more yourself before the rider kicks in.
What does it cover?
Inpatient benefits include hospital room and board, ICU or high dependency unit stays (up to 210 days a year), surgical fees, anaesthetist fees, operating theatre fees, ambulance fees, in-hospital specialist visits, and organ transplants with no limit on the number of transplants.
Outpatient benefits include pre-hospitalisation diagnostic tests within 90 days before admission, post-hospitalisation treatment within 210 days after discharge, day-care surgery, outpatient physiotherapy, emergency accidental outpatient treatment within 72 hours of an accident, and outpatient kidney dialysis and cancer treatment, both covered as charged with no deductible applied.
Other benefits include intraocular lens replacement up to RM5,000 per eye once in a lifetime, a second medical opinion benefit for critical illness up to RM1,000 a year, and medical report fees.
When is my deductible waived?
Your deductible does not apply if you are admitted for emergency treatment or if you seek treatment at a government healthcare facility. In both cases, MediAfya+ covers your eligible medical expenses in full.
For context, a government healthcare facility means a facility run directly by the Malaysian government, such as a government hospital. It does not include privatised or corporatised facilities, so a semi-government or private hospital does not qualify for the deductible waiver.
To see this in practice, take two patients. Karim is on Plan 200 with a RM500 deductible and needs hip replacement surgery costing RM30,000 over a five-day stay. At a private hospital, he pays his RM500 deductible, and MediAfya+ covers the rest. At a government hospital, his deductible is waived entirely, and he also receives a RM1,000 daily cash allowance for his stay. Siti is on Plan 300 with a RM5,000 deductible and is hospitalised for emergency treatment after an accident, with RM35,000 in eligible medical expenses over three days. Because it is emergency treatment, her RM5,000 deductible is waived regardless of which type of hospital she is treated at, and her full eligible expenses are covered.
What is the Emergency Assistance Programme?
This runs alongside your medical cover and is facilitated by a third-party provider, Integrated Health Plans (Malaysia) Sdn Bhd. Call 1-800-82-6100 from anywhere in the world for assistance with international medical evaluation, medical referrals and appointments, guaranteed hospital admission arrangements, medication dispatch, medical repatriation, and similar services.
It also extends to non-medical assistance: 24-hour emergency towing and minor roadside repair for your car, plumbing, locksmith, and general repair referrals for your home, and visa, passport, and travel-related assistance when you are abroad. These additional services are referral-based. Any costs from using them are borne by you, and continuation of the service depends on Zurich Takaful's agreement with the third-party provider, so it is not guaranteed indefinitely.
Am I covered for treatment outside Malaysia?
Yes, but only if your attending physician in Malaysia refers you for treatment overseas, and only up to charges that are reasonable, customary, and medically necessary by Malaysian treatment standards. This worldwide coverage stops applying if you reside or travel outside Malaysia for more than 90 consecutive days at a stretch.
What does MediAfya+ not cover?
The rider excludes claims arising from:
- Pre-existing conditions
- Specified illnesses occurring within the first 120 days of continuous cover
- Any medical or physical condition arising within the first 30 days of the rider's start date or reinstatement date, except for accidental injuries
- Attempted suicide or intentional self-inflicted injury, whether sane or insane at the time
- War, declared or undeclared, criminal or terrorist activity, active duty in armed forces, or direct participation in strikes, riots, civil commotion, or insurrection
This list is not exhaustive. The full list of exclusions sits in the Supplementary Certificate.
How is my contribution structured?
Zurich Takaful operates on the Wakalah model. A Wakalah fee of 28% of your contribution is charged upfront throughout the coverage term, covering Zurich Takaful's costs of managing the takaful business, including remuneration to your Wealth Planner.
The remaining amount goes toward Tabarru', deducted monthly from your Participant Investment Account (PIA) to fund your takaful coverage. Your Tabarru' rate depends on your attained age, gender, plan, deductible, and underwriting decision, and adjusts automatically as you get older.
If there is a surplus in the fund at the end of the financial year, it is shared 50:50 between eligible participants and Zurich Takaful, structured as Hibah (gift) to you and Ju'alah (performance fee) to Zurich Takaful. Investment profit earned in your PIA is not guaranteed and depends on actual investment performance, but 100% of whatever profit is earned belongs to you and is credited back into your PIA.
Contribution and Tabarru' rates are not guaranteed. Zurich Takaful can revise them with 30 days' written notice before the new rates take effect.
Is my contribution tax-deductible?
Yes, your contribution qualifies for income tax relief, on top of any relief available for other family takaful or life insurance plans you hold, subject to the Inland Revenue Board's final decision.
Can I cancel within a free-look period?
Yes. If the basic family takaful certificate that this rider is attached to is cancelled within 15 days of you receiving your certificate documents, Zurich Takaful refunds your full contribution, less any medical expenses already incurred.
