Expats Health Coverage FAQ

Does Malaysian class health cover covers until age 100? Yes, it is possible be covered up to age 100, with higher premium, of course. For health cover expiring at the age of 100, the annual insurance charges for the best plan available right now may cost ~ RM 14K/annum at entry age of 66-70.

Can I use the Malaysian class medical card for overseas treatment? If you receive medical treatment overseas, the benefits are paid according to the costs of treatment that would be customary and reasonably charged by a hospital in Malaysia. No benefit is paid if you reside overseas for more than 90 days per trip.

Malaysian health cover seems cheap, what's the catch? For a lists of items being EXCLUDED and NOT COVERED in the Malaysian class policy please click << HERE >>.

Malaysian health cover seems cheap, is it sufficient to cover me if I need a major heart bypass? Heart by pass in Malaysia costs in the range of RM 100K, Cancer ~ RM 120-RM 150K, Stroke ~ RM 100K (If ICU).

Does it cover dental surgery? No, Dental conditions including dental treatment or oral surgery EXCEPT as necessitated by ACCIDENTAL injuries to sound natural teeth occurring wholly during the Period of Insurance.

Is it Guaranteed Renewal? Prudential's policy is guaranteed renewal. This means that no matter how much you've claimed, the insurer is guaranteed to renew the policy contract. However, once the substantial amount of claims has been made, if you need to upgrade or get a new policy, it is subjected to a new medical underwriting. This practice is industry wide to all the insurance companies in Malaysia.

What happens if I need to be away from Malaysia for a duration of time, say six months or more? The policy will continue to provide coverage as long as the premiums are paid and that the cash values in the policy account is able to sustain the insurance charges. Once the insurance charge is more than cash value there is a 30 days grace period for premium payment before the policy lapse and the coverage will automatically ends.

I just took up a policy, can I cancel it? There is a free-look period of 15 days after the delivery of your policy to allow you to review if it 

meets your needs. If the policy is cancelled within this period, the value of units (at next pricing 

 

day) plus the un-allocated premiums, service charge and insurance charges less medical expenses 

 

will be refunded.

What happens if after several years I decided to leave Malaysia for good? The plan is investment linked type of policy. Should you choose to surrender the policy, you can withdraw the cash values as associated to the fund NAV at the time of surrender. If after you've surrendered and decided to come back to Malaysia within 2 years, the policy is still able to be reinstated. Reinstatement T&C shall apply.

Who regulates the Insurance Companies in Malaysia? Prudential Assurance (M) Berhad is licensed under the Insurance Act (1996) and is regulated by Bank Negara Malaysia (BNM).

The Insurance Policy Riders

Most of the time when I do a review of policy, the clients knew the basis of the insurance, but when probe further, most are in the dark of what each of the rider/benefits does.

Here's a lists of riders that are/can be attached to a policy and/or its purpose:-

1. Life / Death - in the event of the death of the client, this rider will pay a lump sum (up to the sum being covered for Life) to the beneficiary and policy will terminate.
2. 36 Critical Illness - in the event the client is diagnosed with any of the 36 Critical illness, this rider will pay a lump sum (up to the 36 critical illness sum being covered). Do note that generally most 36 Critical Illness plans accelerates the payment of the Life and the 36 Critical Illness cover is not a separate sum from the Life Cover. Once a claim is made from the 36 Critical Illness, the policy is waived if it is being attached with a waiver.
3. Early Critical Illness - in the event the client is diagnosed with any of the Early Critical Illness, this benefit allows you to seek the treatment by covering a wider range of early stage critical illnesses such as early stage cancer, loss of sight of one eye and insertion of pacemaker. Claims from Early Critical Illness will not waive the premiums.
4. Accident  - in the event the client death or permanent disable due to an accident,  this rider will pay a lump sum (up to the sum of the Accident sum being covered). This is a separate sum insured from the Life Cover. In the event of death due to an accident, both the Accident & the Life sum insured will be payable to the beneficiary.
5. Total & Permanent Disability Income - Pays an annual income to the client should he/she is  being diagnosed with Total & Permanent Disability during the term of the policy.
6. Crisis Cover Income - Pays an annual income to the client should he/she is being diagnosed with any of the 36 Critical Illnesses during the term of the policy.
7. Spouse Waiver - If a wife buys a policy and include a spouse waiver (spouse waiver is under the husband's name) and along the years the husband is suffers from any of the 36 Critical Illness, Death or Total & Permanent disabled, the wife's policy will be waived (until the end of the policy term). The same analogy applies for a husband who buys a policy and include a spouse waiver.
8. Parent Waiver -  If a father  buys a policy and include a Parent waiver and along the years the father is suffers from any of the 36 Critical Illness, Death or Total & Permanent disabled, the children policy will be waived (up until the child has attained the age of 25),
9. Double Parent Waiver -  If a father & mother buys a policy and include a Double Parent waiver and along the years the father OR the mother is suffers from any of the 36 Critical Illness, Death or Total & Permanent disabled, the children policy will be waived (up until the child has attained the age of 25).
10. Medical Card - The insurer will cover/pay to the hospital the amount as limited to the annual & lifetime limit. Terms and conditions applies. Do check out the Exclusions on what is not being covered. Claims from the medical card does not reduce the Life/Critical Illness sum insured.
11. Hospital Income - Pays a daily income to the client should he/she is being admitted as an in-patient.

Hospital Deposits

This is a photo taken from one of the private hospitals in Penang, stating the deposits that the patient will need to pay prior to admission/surgery.

For those who don't a have medical card coverage, please be prepared to standby up to RM 20K or more if you need hospitalization at the private hospitals.

The Importance of the Medical Card - Sharing by QuickSilverV3

Appended below is a heart warming sharing by QuickSilverV3 on Low Yat Forum. You can read his post HERE

QUOTE(QuickSilverV3 @ Aug 25 2012, 01:27 AM)

I am 20 years old, still studying, but planning to take the test to become an insurance agent as part time job, currently doing diploma will be graduating in about ten months time, by doing this i can say that it wont affect my studies because usually when i got home i just sit in front of the computer and play all day long and yet i manage to sustain a reasonable grade in my studies. By substituting my day long habit to this job i would say it is a wise decision for me to make up since myself has spine issues. 

I do realize the importance of having an insurance because i didn't have it when the time i was admitted in the hospital in critical condition. 

About 200k spent on the whole process of treatment, surgery, hospitalization and more. By the time my parents was about to retire but they got no choice but to spend on the expenses incurred. I feel sad to delay their retirement, just because of my unfortunate situation, they are now still working on behalf of me. 

Since i had suffered from this agonizing pain, i feels that everyone should have an insurance with them in the long run because something inevitable may happen to anyone of us and we don't know it, we can't 100% guaranteed that the next day we will be as healthy as we are today, but if we got the money to soothe the sharing pain of your love ones, then it will not be a problem to us, but what if we got nothing? 

From my experience that i have gone through life and death, what i sees insurance is very enormous because if i bought it before i was in the incident, then my parents burden won't be that much compare to today. And thank god, i am still alive sitting down here. Cheers.

Should I cancel my policy and get a new one?

Question: At times, our friend/relative may become an insurance agent and ask you to cancel your existing insurance policy in order to "support" them.

OR

My medical coverage seems too little as compared to the current plans being offered from other insurer. I would like to cancel my existing plan from Insurer A and get a new one from Insurer B.

Is this a good thing for the client or the agent?

Answer:

Irrespective of whether the first policy is from Prudential or not, an agent who come to you with the intention to get you to cancel the policy (so that you'll have enough funds) to join under the new agent is an act of an IRRESPONSIBLE SELFISH agent who is only out for his personal gain.

When a client cancels a policy, here is a list of benefits that the client stands to lose:-

1. Medical plans are subjected to waiting period. For common ailment that needs hospitalization, there is a 30 days waiting period. There is also a 120 days waiting period for Specified Illnesses. For a lists of exclusions and/or waiting periods, please click Waiting Period & Specified Illness

When a client cancels the policy and start a new, the waiting period starts all over.

What if after 2 months of cancellation the client is diagnosed with a tumor?

2. Most health insurance plans has a "Incontestability" Clause. This means that if the policy has been in force for at least two (2) years (except for fraud or exclusions), most insurer shall honor the claim.
3. Do you know that there are certain terms and conditions in the old policy contract that is considered 'superior' terms as compared to the new policy contract?

For example, older policies medical card does cover the following of which are not covered under the new contract:-

a. Implants (Implanted pace maker costs RM 43K at a private hospital in Penang and that does not include the surgery).

For Cancer Treatment & Kidney Dialysis (do refer to the policy document if you are uncertain), older medical cards do cover the following.

a. Take home drugs

b. Long term medication

c. Consultation charges

4. Investment Linked Policies (ILP) or some traditional policies do accumulate cash values over time - based on the premium allocation tables. The first year allocation is 40%, and up until the the policy is on the 7th year onward, an 100% allocation. 

This means if the premium of RM 200/mth, for the 1st year, RM 80/mth is used to purchase units for the client in order to generate the cash values.

If the policy is into the 5th/6th year and the client cancels and start a new policy, the premium allocation starts back from 40%! Whenever a person starts a new policy, the agent gets the commission but in this case, the wrong way.

5. If you start a new policy and had claimed before from the old policy, (unless it is a simple case like fever) do expect the condition to be mentioned into the new policy and it'll fall under 'pre-existing illness'.

In the above example the client should consult the first agent to inquire on whether he is able to UPGRADE on his EXISTING policy and not cancel and get a new one.

Do note that some unscrupulous agents are also out for personal gain when it comes to 'upgrading'. Whenever you do upgrade, always make sure that the upgrade is done on the existing policy and not getting a new policy document.

For example, currently you are paying RM 150/mth for RM 100K life and would like to increase the life cover to RM 150K and the new premium would be RM 200/mth.

If you were to 'upgrade' it to the existing policy the agent only earns RM 50 in terms of commission %, but it does justice to the client.

Should you were to cancel and get a new policy the agent earns RM 200 in terms of commission %, while the client lose out on some of the benefits mentioned above.

However, do note that there are times when getting a new policy as oppose to upgrade is better, especially if we develop certain ailments and would like to increase the cover.

If the ailment creeps up after the policy had been in-force for awhile, it is advisable to get another policy so as not to have the 'pre-existing' illness clause added to the old policy which  originally does not have the 'pre-existing' clause.

In the event of claims, if the claim is related to the 'pre-existing' illness, claim it from the 1st medical card that does not have 'pre-existing clause' and claim from the second medical card on illnesses that are not related to the 'pre-existing' illness.

6. Insurance charges will go up by age, which is more evident, especially at older age > 65. One will never be able to buy the same benefit he had 10 years ago with the same premium for the same amount of coverage.

For example, when we're age 20, the premium of RM 100/mth is able to get us a life coverage of RM 100K, but when we are age 30, the premium of RM 100/mth is only able to get us life coverage of RM 80K.

Note: The above figures are for illustration purpose and may differ from the actual plans being offered.

Emergency Hospitalization

I paid a visit to one of the private hospital in Penang on 1st day of Raya and to my surprise there are several Malay families waiting patiently at the ICU ward.

I met a Malay guy at the ICU ward and he was initally taken a back when I introduced myself to him. 

As we chatted, he said that he was celebrating the Raya at the hospital due to his elder sister age 52 was warded at the ICU for Stroke.

It has been 10 days since she had the attack and thank god she had manage to open her eyes. They're waiting for the doctors to finally discharge and bring her back.

The hospital bill amounted to RM 25K in just 10 days of ICU for the Stroke and thank god she has a Prudential BSN medical card (I am not the servicing agent).

Medical card is something we never know when we'll need it, but we have to prepare for it before anything happens.

Dental Surgery Claims

Is it possible to claim on the expenses incurred for Dental Surgery as well as for Outpatient treatment at the certified Dental Surgeon? OR I need to undergo a surgery on my wisdom tooth as it is located at the back of my mouth, can I claim from my medical card?  No, sorry. Any expenses incurred for Dental Surgery is excluded, except as necessitated by Accidental Injuries. (Question contributed by HughieRmX @ Aug 21, 2012 from LYN Forum)

Stand Alone Medical Card - Can I add in riders like waiver?

Can I attach waiver to a stand alone medical card? No, sorry, stand alone medical card is not able to attach any riders (Question contributed by Pandah @ Aug 21, 2012 from LYN Forum).

Medical Claim Questions

If I have claimed out RM 20K from my medical card, and I have a RM 100K Life/CI sum insured. Will the RM20K claim reduces the RM100K life/CI to RM 80K? No, it will not reduce the Life/CI amount as the medical card has a separate annual & lifetime limit. Any medical claims will only reduce the annual/lifetime limit and does not affect your cash values or Life/CI claim (Question contributed by Pandah @ Aug 21, 2012 from LYN Forum).

Multiple Policies

If the life assured have several policies, for example a Personal Accident policy of RM 20K, a life policy of RM 100K. If the policy holder pass away due to an accident, how much is his nominee entitled to claim? 1. For the Life/PA portion, the nominees will get to claim RM 120K. 2. If the life assured is a husband and a parent that buys policy for his 5 children with a waiver, all the 5 children's policy will be waived until they has attained the age of 25. 3. If the husband adds in spouse waiver to his wife's policy, her policy will also be waived until the end of the term, for example age 70 or 80 for the medical. Do note that waivers are riders that is able to be attached to Investment Linked Policies (ILP) and is not available on stand alone policies (Question contributed by Pandah @ Aug 21, 2012 from LYN Forum).

Payment of Premium

The agent's role is never to be a debt collector for the insurance company. It is NOT advisable to pay the premium to the agent directly.

Instead, please opt to pay the premium using Auto-Debit (directly to the insurance company account) or opt for a Credit Card payment.

In which area do you want your agent to be proficient at? Being a good debt collector or being swift at handling your claims.

There have been cases that the agent collected huge amount of premium and while on his way to pay the premium to the insurance company, he got robbed and lost all the premium. 

There are also cases where the agent absconded with the premium and cause frustrations and lost of trust for the general public on the insurance company as a whole.

** PLEASE DO NOT PAY THE PREMIUM DIRECTLY TO THE AGENT **

The importance of Health Declaration

If you have a pre-existing condition, please make sure that the agent clearly writes it into the proposal form during inception. 

If the agent fails to declare this in the proposal form and should there be any claims arises due to the medical condition that was not disclosed, the insurer may not be liable to pay for the claim as it falls under non-disclosure clause of pre-existing illness. 

If you have declared it, when you received the policy document, please check and verify that the health condition is being properly declared in the proposal form. The proposal form is normally attached to the policy document.

The outcome of the declaration would help the underwriters to view the case as 1. Accepted but with an exclusion for the health condition, or  2. Accepted as it is (no exclusion) or 3. Reject the application.

Even if it is being rejected, please do not be dismay as it is good to know now rather than having not to disclose, get the case approved and later after years of paying the premium gets the claim rejected because the insurer found out about the pre-existing illness.

Prudential Panel Hospital

To all Prudential Medical Card holders, please be informed that Loh Guan Lye Hospital will be re-appointed as Prudential panel hospital on the 10th Sep 2012!

For a list of panel hospitals please click HERE

Regards

Roy Steven Ung

Email: stevenung1971@gmail.com

H/P: 016-451 5957

Searching for a medical? Read here

Here are a few pointers whenever one need to search for medical insurance cover.

1. Always make sure that the plan that is being proposed is Guaranteed Renewal. This means that no matter how much you've claimed, the Insurer is obligated to renew your policy, so long as there is premium paid.

2. Compare the plans apple to apple. Most of the time when layman compare plans they only tend to look at the surface as other information are most of the time not disclosed. The most common mistake being the co-insurance. Co-insurance is a cost sharing concept between the insurer & client. For example if admitted the client will need to bear 10% of the expenses.

Do note that plans with co-insurance, in a long run the premium tends to be much cheaper than plans without co-insurance. Hence if you want to compare plans, make sure you compare plans with co-insurance vs another with co-insurance. If you want to compare a plan that has co-insurance vs one that don't, then compare their insurance charges as well at older age.

Do note that medical plans needs to be covered till age 70/80/90. It is a very long time commitment.

3. Look at the coverage carefully, there are certain limits that you can claim based on the plans selected. For example plans with cancer treatment limit of Rm 20K (lifetime) should be question vs the current medical inflation. The consultation alone for cancer could range from RM 7-8K. Should you were to seek second opinion from another doctor, the balance is not even enough to undergo two or more chemo.

Should you are constrained by the budget, note this down and when your income has got better, review on it.

4. Generally most of the plans nowadays do generate cash values. Most agents would tell you that the plan have savings as well and you can withdraw once you have substantial cash values.

Always be aware that insurance charges GOES UP by AGE IRRESPECTIVE of when you get it. This means the older you get the higher the insurance charges is going to be.

For example a person, male age 30, the insurance charge for a RM 200/room & board daily may cost RM 1300 per annum.

However, when he is age 60, the insurance charge may go as high as 2800 per year. Even though he seems to be paying the same amount of premium of RM 150/mth at age 60, the insurer actually deducts the variance from the cash value.

Hence, if he were to withdraw out the cash value, the plan may be prematurely terminated.

The Importance of the Medical Card

I'm sure that if you visit any hospitals nowadays you're sure to bump into an insurance agent. It is our job to be at hospitals and sometimes as agent's not only we have to talk to a complete stranger but also to hear them out.

Just for sharing, I met a guy whose sister was in Intensive Care Unit at one of the private hospitals in Penang. The sister is 55 years of age, and had been ICU for 25 days for Stroke.

It was her first time being so sick in the hospital for that long. The family was frantically gathering all their resources they had in order to pay for the medical bill which eventually amounts to RM 90,000 in just 25 days.

She had completely drained her Employee's Provident Fund in order to pay for the hospital bill, something which she had worked for, for the past 30 years, all being used to pay for the hospital bill IN 25 DAYS!

According to the brother, the sister used to have a medical card from one of the insurer but later cancel it because she paid to the agent and the agent did not bank in the premium on her behalf. Ever since she had never trusted in insurance and thought it is a scam.

However there is good news after the 25 days of ordeal in the ICU. She was finally able to open her eyes once again and although bedridden, she is able to see her 7 other siblings, the ones that she cared for all her life....

Note to readers: Please make it a point to pay directly to the insurance company via auto banking or credit card as to prevent unscrupulous agents to absconded with the premium.

What is Investment Linked Policy?

The term Investment Link Policy (ILP) can sometimes be very misleading and the main purpose of an ILP in the insurance context is definitely not for the investment value, but rather the protection value.

Older types or traditional types of policies are not as flexible as ILP, for example if 20 years ago you have a Life coverage of RM 20K and subsequently would like to increase the cover to RM 100K, you'll need to purchase another policy to supplement to that policy.

However, with the introduction of ILP, the client does not need to cancel the policy but rather just add/upgrade on to the existing ILP. This gives greater flexibility to the client, while not having to pay for two or more admin policy fees.

Most of us knows that insurance charges goes up by age irrespective of when we get it and when we are retired with our dependents all grow up, we can swing our life or critical illness cover to the much needed medical. Much like the motor vehicle insurance, if one day we decided to stop payment for the car insurance, the coverage will cease. 

Motor vehicle insurance have loading for older cars, an example is if a car is older than 10 years the insurer may load as much as 100%. The same goes to health/life insurance. The older we get the higher the premium it is going to be.

An example would be for a person age 30, the insurance charge for the medical card may be as low as RM 1500/year. This means that if he is serving a premium of RM 150/month, it is sufficient to pay the insurance charges.

However when he is 65, the insurance charges may go as high as RM 4K/year and even though he still continues to pay RM 150/mth, the variance is actually being deducted from his cash values in order to maintain the policy.

In a long run, policies that accumulate cash values tend to last longer, even after we are retired as the cash values in the ILP can help to pay for the insurance charges. 

The main purpose of the ILP is also to be able to generate higher cash values than only relying on dividends as declared by the insurance company. Investor savvy policy holders are able to do funds switching, withdrawal, profit locking, port folio re-balancing etc as if it is Mutual Funds.

Do note that even though you are able to withdraw from the ILP it is HIGHLY NOT RECOMMENDED. If you were to withdraw and when the insurance charges goes up, the policy may be at risk of lapsing at older age.

This is crucial as generally working people tend to lose their company benefits like car, car allowance and most importantly their medical benefits.

Always remember that generally people buy insurance for the PROTECTION value, never for the Investment value.

Since the cash values are tied to the underlying funds, there is a risk that at older age, the cash values may need to be top up should the fund does not perform as it should.