Medical Card Waiting Period and Incontestibility Period

The Waiting Period for Specified Illness is 120 days. Do refer to the Exclusion list for the details of what is not covered for the first 120 days when starting the medical card.

Let it be known that there is also an Incontestibility Period of up to 2 years.

There is a difference between these two.

If there are any claim which falls under the Specified Illness within the waiting period of 120 days, the said claim will be duly rejected.

However if a major claim (that has a close relation to a Critical illness)  were to happen within the 2 years from starting of the policy, the insurer may at its discretion use the Incontestibility Period clause.

This means that the insured will have to pay for the hospital bill and then file the claim to the insurer for reimbursement.

The insurer will then investigate as to whether the insured had seek any consultation with regards (to the illness being claim) to determine if a non declaration of material fact had occur during the policy inception.

For example, mild stroke before the 2 years of Incontestibility period.

If admitted due to a mild fever or accident, then most likely there won't be any investigation be triggered.

If the result of the investigation for the non disclosure of material fact is sided on the insured (meaning there is no record in hospital or clinic) then the claims will be duly paid back to the insured.

However if the result of the investigation shows that there was indeed elements of non disclosure of material fact, eg health status (have record in hospital or clinics of the illness eg lumps or tumor or cancer marker high), occupation (lorry driver declared as office worker) , smoking status (smoker declared as non smoker), then the policy will be re-underwrite by the Underwriters.

Should the insured ia not agreeable to the new term (due to the non disclosure) then the policy will be considered as null and void. All premiums paid minus the claims (if any) will be refunded to the insured.

This is why it is very critical to get insured when we are healthy with no records in the hospital.

It is also very important to answer the health questionaires properly. 

Is it advisable to get two medical cards from different Insurer?

One of the main reason why people get another medical card is because the limit on the first card is nearly exhausted or wanting to save cost by applying a high deductible on the second medical card.

For convenience sake, it is advisable to restrict the claims to one insurer and best option is to UPGRADE the existing medical card and not maintain 2 medical cards. 

Unless during the application for upgrade, the client has other health issues which may impose Exclusion. Then it is recommended to have 2 cards. If not, best to stick to one card.

Handling of the claims with second insurer can at times be mind boggling as the second insurer will require the exact medical reports which were submitted directly to the first insurer. Ding dong here, ding dong there, which causes delay in paying the claims.

--
Here is a claims scenario that you may want to consider as well...

Assuming that the first card comes with an annual limit of RM50K, while the second with RM50K deductible and RM1M limit and the surgery costs RM80K.

Since the first card is only able to provide Guarantee Letter up to RM50K, upon discharge, the client is required to pay in cash RM30K and using the original receipt, Letter of Settlement (from 1st insurer) & hospital medical reports, file a claim from the second insurer.

If both cards were from the same insurer, then it is possible to seamlessly have the second medical card to cover the hospital charges variances without having the client to fork out his own money.

--
Another point to consider when getting the second medical card with high deductible is some coverage clauses. For example, older medical cards between the year 2003 and 2015 for the Cancer Treatment & Kidney Dialysis are known to Exclude Take Home Drugs, Long Term Medication and Consultation Charges (THD, LTM & CC).

If it is married together with a second medical card with say RM50K deductible, even though the second medical card do cover the THD, LTM & CC, the total Cancer claim will have to Exceed the RM50K deductible before the above can be claimed.

Health Ministry hikes up hospital fees for foreigners up to 230pc - See more at: http://www.themalaymailonline.com/malaysia/article/health-ministry-hikes-up-hospital-fees-for-foreigners-up-to-230pc

KUALA LUMPUR, April 8 2017 ― Foreigners seeking medical treatment at government hospitals will be charged a far higher rate with immediate effect, the Ministry of Health (MOH) announced.

In a directive issued yesterday, the ministry said ward and surgery rates will be raised from between 130 and 230 per cent respectively, The Star reported today.

From now on, foreign patients will have to pay RM2,800 instead of RM1,200 for surgery.

Those who need inpatient treatment in second-class wards will have to pay a deposit of RM3,000, and RM5,000 for surgery. Formerly the rates were RM900 and RM1,500 respectively.

Foreign patients warded in the executive and first-class wards will have to pay RM7,000 and RM11,000 for surgery deposits, a staggering increase of RM4,900 and RM7,000 respectively.

The new rates will apply to both children and adults, except for fo­reigners holding permanent resident status.

Those married to locals and children with one local parent and is under 12 will also be exempted.

MOH deputy secretary-general Datuk Mohd Shafiq Abdullah said the new rates were aimed at cutting medical subsidies for foreigners.

Putrajaya first introduced separate rates for foreigners in January 2015 after it was revealed that they took up between 30 per cent and 40 per cent of the subsidy in medical treatment for Malaysians.

It also deci­ded that subsidy for foreigners would be gradually cut.

Source:- 
See more at: http://www.themalaymailonline.com/malaysia/article/health-ministry-hikes-up-hospital-fees-for-foreigners-up-to-230pc

Man's Greatest Asset

Man's Greatest Asset

People say money is not everything, but in reality, everything these days costs money. That is the fact. Things gets more and more expensive and the value of money that we have grew smaller each day. 

This is why in general most of us gets up in the morning and go to work, in pursuit of the income. That in turn helps to pay for the bills.

Life is a journey and everyone dreams of having a perfect life, starting from young we were raised to have a good education so that it may propel us to be a successful adult.

We would then find our soul mate and one day have kids of our own and hopefully one day retire comfortably. Everyone dream of having the perfection in life.

However, as we know, life is a journey, and one of the things that could happen to us is that we fall seriously ill or is involved in a major accident that causes Total & Permanent Disability (TPD).

Should that were to happened to us, it could robbed us of our greatest asset that we have. It is our ability to work to generate an income is in fact the greatest asset, not our car, not our house nor the amount of money in our bank.

Have you ever thought of how much you or your loved ones would need for the next 10 or 20 years if the TPD were to happened to you, yesterday?

We are the golden goose that lays the eggs (assets/house/car/investments/businesses). As such, doesn't it makes sense to 'protect' the most important assets that you have?

Retention of the Medical Records

Medical Records - KEEP THEM!

In many of the instances people tend to forget the details of their hospitalization and/or medical history, especially if the ailment being treated is minor and not life threatening.

Most of us don't even bother to keep these records as soon as the Doctor tells us that we have nothing to worry about or is being discharged with a clean bill.

This article purpose is to relay the importance of having a good record of our medical history.

This is because if we would like to get any insurance (or even upgrades on the current insurance plan), the insurer will want to know what risk they are up against and your hospitalization history is a material fact that needs to be declared.

Failure to declare material fact (during the insurance application or upgrade) may render the insurance policy null and void, thus resulting in having the claims rejected or deferred.

It is highly recommended to scan and keep records of the following documents in your computer or google drive / cloud.

1. Discharge Summary - which states the reason for the admission, date of admission, the doctor's name, the hospital that you went to, the types of medication given (if any), the recovery period and discharge date.

These information are vital during an insurance application/upgrade.

2. All Medical Records/Investigations done - for example the HPE report (histopathological examination) or blood test. These medical reports will need to be submitted to the insurer.

By doing the scan, you can also retrieve the information pertaining to your medical history if it is needed especially if you need to have a second opinion with another Doctor with regards to your medical condition.

Dialysis subsidy drying up

The Star - 7th Nov 2013

KUALA LUMPUR: Thousands of kidney patients are facing a tough time as the Health Ministry has not approved subsidies for haemodialysis treatment thus far this year. Some are reported to have waited for as long as three years for the nod.

The number of approvals for the RM600 monthly subsidy began to decrease in 2011, and became minimal from mid-2012.

NGO-run haemodialysis centres said they were told by the Health Minitry to source for funds elsewhere as it was focusing on new patients.

They also said that some patients had waited for the subsidy approval for as long as three years, instead of the usual one to three months.

In Malaysia, the poor receive heavily subsidised dialysis treatment but due to the shortage of government-run centres many turned to those managed by non-profit NGOs.

Through these NGO-run centres they could apply for RM600 dialysis subsidy (RM50 per dialysis) per month and free injections.

A random check revealed that the National Kidney Foundation had 200 patients still waiting for subsidy, 50 patients in St John’s Pt Selangor in Klang, 40 in dialysis centres run by a religious body that declined to be named, 22 at Pontian Rotary Haemodialysis Centre, and five patients in KL Lions Renal Centre.

The actual number of the affected poor was not known but it could be in the thousands going by the estimated 5,000 new kidney patients diagnosed with end-stage kidney failure each year in the last three years.

Patients affected appear to be from NGO haemodialysis centres as those in private and government dialysis centres did not have to deal with subsidy applications.

According to the National Kidney Foundation, treatment for a patient who undergoes haemodialysis at an NGO or a private clinic costs between RM150 and RM250 per session.

The Malaysian Registry of Dialysis and Transplants said that as many as 7,088 (26.9%) end-stage renal failure patients had haemodialysis treatment at NGO centres out of 26,404 patients receiving dialysis treatment last year.

The remaining 13,159 patients (49.8%) sought treatment at private dialysis centres and 6,157 patients (23.3%) at public facilities under the Health Ministry, university hospitals and Defence Ministry hospitals.

A nurse who declined to be named said that Muslims had less issues with getting the subsidy as they could apply for aid from the Baitumal or zakat foundation.

Some NGO haemodialysis centres were not happy that the Government had pushed patients to them without providing the needed subsidy.

The halt in subsidy was also depleting the rolling fund of the centres since some NGOs help to pay for their patients’ dialysis treatments, a dialysis centre manager said.

“If they make it difficult for patients to get the subsidy, they should just get the patients to do it at government dialysis centres,” she said, adding that such centres were limited.

Private hospitals unable to meet criteria imposed for organ transplants

Source The Star: Private hospitals unable to meet criteria imposed for organ transplants

PETALING JAYA: Malaysians hoping for an organ transplant find themselves having to go overseas because private hospitals here are struggling to meet the new criteria imposed by the Health Ministry (MOH) two years ago.

Several private hospitals used to do transplant surgeries until there was a death and the ministry shut down their operations.

A new requirement is a hospital must have a dedicated transplant team.

“A transplant procedure needs a complete team, not only of transplant surgeons, but of radiologists, pathologists, and anaesthetists to provide total continuum of care to the patient,” said Ministry deputy director-general Datuk Dr Jeyaindran Sinnadurai.

“The team must also work on a regular basis, with at least two people on the team at any given time, because imagine what would happen if there is only one surgeon, and he goes on leave after operating on a patient.

“What happens if the patient suddenly has post-surgery complications?” he asked.

But it does not make financial sense to a private hospital here to have such a team because the amount of work it gets does not justify it.

As a result, the number of patients seeking kidney transplants at teaching hospital Universiti Malaya Medical Centre (UMMC) has swelled.

Making the situation worse is the fact that Hospital Universiti Kebangsaan Malaysia (HUKM) stopped its transplant programme after its surgeon left.

Although government hospitals like Hospital Kuala Lumpur (HKL) and Selayang Hospital are able to do transplant work, much of the brunt of the MOH directive has apparently fallen on UMMC as transplants have either slowed down or ceased in HKL and Selayang a few months ago.

Dr Jeyaindran said the ministry was doing its part to reduce the long waiting list for transplants by collaborative partnerships with overseas institutions to train local talent.

“We are open to private hospitals taking up organ transplant procedures, but they must fulfil the minimum criteria which was drawn up two years ago by a team of experts.”

Transplant work started in 1999 in private hospitals such as Subang Jaya Medical Centre and Gleneagles followed by Prince Court Medical Centre in 2009.

Until the clampdown in 2012, private hospitals contributed up to 19% of kidney transplantation in Malaysia, with 17% from Prince Court. However, because of the new criteria for private hospitals, patients who have previously gone to private hospitals here are now seeking help in UMMC.

Those who have the means, go to Singapore where a kidney transplant costs between S$100,000 and S$200,000. The cost has increased as a result of the weak ringgit this year.

Another option is to buy a kidney and do the surgery in China or India, which costs between RM500,000 and RM600,000 now.

Those with a ready donor will try to avoid this illegal route. The World Health Organisation estimated in 2007 that 10% of organ transplants performed worldwide involved unacceptable activities that endangered the poorest and vulnerable groups