PRUhealth vs PRUflexi med

Whilst the insurance charges may not be an important factor in deciding which medical card to go with when we are young, but as we grow older, especially at our senior age (> 50) the insurance charges is definitely going to be the main factor in choosing the right plan, preferably a plan that we are comfortable paying during our retirement age whilst not being burden by high premium.

Do note if you have a medical card that covers you up to age 80, the premium and insurance charges needs to be paid up until age 80. If the life/Critical illness covers you up to age 100, that too needs to be paid until the end of the term.

PRUhealth Features

1. Lower Insurance Charges - In the long run since the client absorbs part of the bill, ie 10% of the medical bill or the the options to include RM 3K or RM 10K deductibles.
2. No Claim Bonus - Pays a No Claim Bonus should the client did not claim for a policy year depending on the package selected.
3. Automatic Upgrade - Able to attach rider to automatically upgrade to the next available plan on the 5th & 10th year IRRESPECTIVE of your health condition/claim status.
4. Annual Limit Waiver - Able to attach PRUannual limit waiver rider. The client is able to claim more than the annual limit. If your plan is PRUhealth 200 with annual limit waiver, you can claim up one shot up to RM 750,000. How it works: Assuming the medical bill is RM 200K. The first RM 75K is subjected to 10% or maximum RM 1K, while the balance of RM 125,000 is subject to 10%. Hence the client pays RM 1K + RM 12,500 and Prudential will pay the balance of RM 186,500.
5. Deductibles - Able to attach deductibles (extremely useful especially at older age whereby client agrees to absorb the bill higher than the 10% to bring down on the insurance charges) RM3K & RM10K deductible options are available.
6. Overseas Treatment - Able to attach PRUmedic overseas rider, a rider that gives the client an option to seek treatment in China, Singapore and Hong Kong.

PRUflexi med Features

1. Deductibles - Choose between the RM 300 deductible (only pay RM 300 per incident) and zero deductible (full claim). The insurance charges for zero deductible is higher than RM 300 deductible.
2. High Annual Limit - Minimum annual limit of RM 50K up till RM 200K per annum.
3. High Lifetime Limit - Minimum annual limit of RM 1M up to RM 4M lifetime limit.
4. Longer Pre-Hospitalization duration - Keep all clinic bills of up to 90 days as compared to PRUhealth (30 days). Should hospitalization occurs, these bills can be claimed under pre-hospitalization. The bills must reflect the actual symptoms that prompts the hospitalization to occur.
5. Longer ICU duration - PRUflexi med offers longer ICU admission (which can be very costly) of  up to 60 days as compared to PRUhealth (30 days).

Both plans are guaranteed renewal.

What to do should you need hospitalization?

This is useful for those whom have never been admitted to the hospital before as it can be a daunting experience to some.

Most insurance company have standby staffs even on weekends or public holidays, hence getting a Guarantee Letter during those days is not really an issue. Hence getting yourself admitted during weekends/public holidays is just like getting admitted on weekdays.

The first thing to remember should you need to get hospitalized is call your servicing agent. Have him /her on speed dial and on your spouse hand phone number. 

Contrary to popular belief, even without the servicing agent's help you're still able to get yourself admitted. Yes its true. All you need to know is your I/C or passport number and at least know you're going to claim from which insurance company (if you have multiple medical card). Should you are being covered by your company medical insurance, do use that first. Should the hospital bill is RM 10K, and your company only covers RM 8K, the balance of RM2k can be claimed from your personal medical card. However, if you were to opt to use your personal medical card, definitely it is still possible.

You don't even need to remember your policy number nor do you need to bring along your medical card (though it helps to remember to fasten the process of getting admitted). The reason is that PRIVATE hospitals are mostly linked to the insurance company. 

This is also the reason why insurance company can easily check your hospitalization records, should they want to, in the event of non-disclosure.

The second thing you need to remember is hospital deposits. The hospital deposits are being introduced with the introduction of co-insurance concept, meaning based on the hospital bill the insurance company will only pay 90% (or lesser) of the bill. In western countries, this is known as deductible.

Even if your card covers 100% of the bill, you may still be required to pay for a minimal hospital deposits, ranging from RM300~RM600, depending on the hospital. Should you are admitted without a medical card, the minimum deposits could range from RM2,500 or higher, depending on the severity of the case. Anything that involves surgical may need a deposits of RM 5K or more if you're without a health insurance.

Thirdly, do remember when is your cover date. This is important as most health insurance have waiting periods for certain ailments. The waiting period range from 30days to 4 months. For a lists of waiting period, do check out the Exclusion clause.

Once the hospital staffs gets confirmation from the insurance company, the insurance company will issue a Guarantee Letter (GL) to the hospital.

Other things to remember:

1. Prior to the event of hospitalization, you may have seek treatment at a local clinic, eg for flu and later was admitted as the flu did not subside. Keep those bills as it is claimable under Pre hospitalization. Bills up to 30days could be claimed. However the admission and the previous bill must tally in terms of the sickness. Should the sickness of flu was treated at the clinic, but admission was due to an accident, the bill for the flu is not claimable.

2. Upon discharged, most of the time the doctor will ask you to come back for a few follow ups. This is known as Post hospitalization and is a pay and claim process. Hence please bring your "plastic" to the hospital if needed.

Upon the last follow up, do check with the hospital insurance counter whether there are still balance for the hospital deposits. The hospital will reimburse to you should there be left over for the hospital deposit.

As usual, keep the bills for the post hospitalization and pass it to your agent to help with the claim process once you're done with the last followup.

Day Surgery

At times when the medical conditions are not that serious, you may want to ask the attending Doctor whether you can opt to do the procedures as day surgery instead of staying in the hospital.

Here are a Day surgery List:-

ENT & Ophthalmic Procedures
a. Cataract with or without intra occular lens implant
b. Retinal Detachment surgery
c. Surgical excision of pterygium
d. Removal of foreign body from Ear, Nose or Throat (applicable to child below 12 years old only)
e. Myringotomy & Grammets insertion

Orthopeadic Procedures
a. Antroscopy knees
b. Removal of orthopeadic implants
c. Manipulation / reduction of joints under GA
d. Excision of growth / tumours under GA
e. Release of trigger fingers, carpal tunnel/tarsal tunnel syndrome

O&G Procudures (Exclude all pregnancy & infertility related conditions)
a. Marsupialisation / Excision of Bartholin's gland
b. Laparoscopy
c. Diagnostic D&C
d. Excisions biopsy / I&D abscess breast lump

Genito-urinary Procedures
a. Cystoscopy
b. Insertion / Removal of J stent
c. Ultrasound guided renal biopsy
d. Urethral dilatation
e. ESWL (Lithotripsy)

General Surgery Procedures
a. Gastroscopy / Colonscopy
b. Branscoscopy with or without washout
c. Insertion of Hickman line / chemopart
d. Creation of AV Fistula
e. Haemorrhoidectomy (stapled / rubber banding)
f. Ultrasound guided liver biopsy
g. Therapeutic aspiration of abdomen / pleural cavity
h. Chemotherapy/Radiotherapy for cancer
i. Kidney dialysis

Cardiac Procedure
a. Coronary angiogram

Please note that the procedures are Day Surgery as recommended from the insurer. The decision and any necessity for any in-hospitalization shall be at the discretion of the attending Doctor.

Cancer & Kidney Dialysis Treatment Benefits

Cancer Treatment Benefits

If the Life Assured is diagnosed with Cancer (as defined in the 36 Critical Illness List), we shall reimburse for the Medically Necessary treatment of the Cancer. The total payments we make for this Benefit shall not be more than the maximum amount of Cancer Treatment Benefit shown in the Table of Benefits (if any).

The treatment (which is radiotherapy or chemotherapy, excluding consultations, examination tests or take home drugs) must be received at the outpatient department of a Hospital or a legally registered cancer treatment center immediately after the Life Assured is discharge from the Hospital for Cancer.

Kidney Dialysis Treatment Benefit

If the Life assured is diagnosed with Kidney Failure (as defined in the Critical Illness List) we shall reimburse for the Medically Necessary treatment of the Kidney Failure using kidney dialysis. The total payments we make for this Benefit shall not be more than the maximum amount of Cancer Treatment Benefit shown in the Table of Benefits (if any).

The kidney dialysis (excluding consultations, examination tests or take home drugs) must be received at the outpatient department of a Hospital or a legally registered dialysis treatment center immediately after the Life Assured is discharge from the Hospital for kidney failure.

Investment Linked Policy (ILP) Or Universal Life Policy (ULP)?

This article was written specifically by the request of V12 and it is based on my own opinion. Thoughts and comments are welcome.

There seems to be a myth that ILP tends to be more expensive than ULP especially at older age. Like I've said, its a myth. It's just slightly higher, nothing much to shout about.

Insurance charges definitely will go up by age, irrespective of when you get it (this statement has been repeated once too many times, I should probably trademark it). Insurance charges also goes up irrespective of  whether it is ILP or ULP, as we grow older.

An example a RM 400/Room & Board:

To illustrate the insurance charges going up, the premium for an ULP medical plan (PMM5) at the age 21-25 is RM 1,659/year whereas the ILP with the same age range is RM 1,726/year.

As we grow older, the premium for an ULP medical plan (PMM5) at the age 56-60 is RM 5,397/year whereas for the ILP, the premium is RM 5,451/year (premium was extracted from the PMM5 & PRUhealth brochure).

Do note that in ULP (PRUvantage product) there is a no lapse guarantee feature meaning the policy will not lapse, no matter how bad the market is performing so long the premium is being paid.

Whether the ILP can be sustained during a market crash or not is much dependent on when you start the policy, how much cash values it has VS the insurance charges at that time. Hence for a young adult (20+age), considering the insurance charges are low, even if the market were to crash, most likely the cash values + the premium paying is sufficient to cover the insurance charges to prevent policy lapse.

For an ILP, should the market crash suddenly and if the premiums paid is not enough to cover for the insurance charges, the agent will need to request for an additional top up, in order to maintain the policy. Having said that, so far, all of my ILP customers don't need to do that, even though the policy was new and the market crashed in 2008. The reason is because I only propose an ILP to younger ones, and for the seniors (over 45 age) I'd propose an ULP.

That is why if you plan to only get a policy at older age (above 50+), it would be advisable to go for  an ULP OR if you still insist on getting an ILP, put in more on the savers to generate cash values, just in case the market were to suddenly crash. Example for the RM 500/mth premium, RM 400 is used to buy protection, whereas RM 100 is used to buy into the savers to buy you units.

In conclusion, I'd say that ILP is for someone who is below the age of 45 and is open to risk. High risk high returns/loss but if he/she is conservative one can also choose ILP with the options of choosing the bond funds, which in general does not fluctuates that drastically.

Secondly, it pays to have an agent who is well verse in both the medical claims and investment portion if your policy is an ILP. When the funds are at its peak, best to move them to a more secure funds like bonds to secure profit in the event of a market drop. Should the market drops to the lowest, gradually move them back to equity/high risk in order to ride on the wave.

One thing that differentiate pure Unit Trust vs the funds in insurance is that no matter how bad the market performs, people still continue to pay premium. As oppose to pure UT, most investors shy away and prefer to play the wait game before investing. When there is premium paid, the funds are most likely recover faster.

Example would be in 2008, Prudential Equity drop to RM 2.20. However, within 6 months, the equity goes up to RM 2.80. Today, its standing tall at RM 3.60 (which is a good time to switch it to bonds and do premium redirection).

Note to readers: The above is just an illustrations on how ILP can work for you and is NOT my intention the insurance product is being promoted as investment product. The word INSURANCE means focusing on PROTECTION, and NOT INVESTMENT.

The purpose of the ILP is to definitely not purely for investment, but rather to generate more cash values (by taking a bit of risk) so as to be able to prolong the policy holding, especially at later years.

Introducing Prudential PRUclinic care

PRUclinic care is a regular premium investment linked medical rider that can be added to your Investment Link Policy. 

1. It can be used at any of the clinics (cannot be used at hospitals for admission) that has the PRUclinic care Logo and can claim up to RM 1500 / year. 

2. The plan is cheap and is guaranteed to be renewed up to 2 years. For the rates, click HERE

3. To use this card, just flash it at any CLINIC that has the PCC logo. If you flash your PCC card at the clinic, you don't need to pay anything up to the RM1500/year limit. However should you were to exceeded the RM 1500/year limit, you need to absorb the excess limit. The following year another RM 1500 will be made available.

4. Who can apply? Anyone from age 1-60 of age can apply. Foreigners whom are qualified to get the PRUhealth & PRUfleximed medical card can also apply for this PRUclinic care card.

5. Since the PCC is expiry for 2 year if 1st year did not claim, for the 2nd year will it roll over to RM 3K? Answer: No, the balance of unclaimed amount will not be carry forward.

6. After 2 years, the PCC automatically expires, and there won't be any balance carry forward.

7. Long term medications/illnesses, vitamins, supplements, sex stimulants, sleeping disorders, v i a g r a, is not cover able for the PCC.

8. If you happen to go to the clinic and do the X-ray & Ultrasound, it is covered under the PCC plan, if the clinic has such equipment.

9. Customer whom had already purchase PCC can check their annual limit balance << HERE >>

10. Agent commission for this: 1st year 4.5%, second year 6.0%


11. You must already have PRUhealth or PRUflexi med medical card before you can get PRUclinic care card (PCC).