Ultimate Guide to Medical Cards in Malaysia

Best medical cards in Malaysia

Medical insurance is the most important insurance to have among all those insurances that exist in Malaysia. Everyone can get sick or have an accident and need urgent medical help to get well. Medical insurance will cover the cost of you getting well. Our Ultimate Guide to Medical Card in Malaysia will give you an overview of the medical insurance in Malaysia. We have divided the medical cards into 3 categories.

  1. Guaranteed Renewal
  2. No Guaranteed Renewal
  3. Add-ons to existing insurance (Rider)

Standalone Medical cards with Guaranteed Renewal

Here is a list of medical cards in Malaysia that provides medical insurance standalone. This means that if you are looking only for insurance that pays for hospital bills or doctor visits, the below products are the cheapest compared to medical cards that are bundled together with life insurance or investment-linked.

Guaranteed Renewal

All the below medical cards come with Guaranteed Renewal. This means that even though you have made a claim, you can be sure that you can renew your medical card with the same insurance company.

AXA eMedic is Malaysia’s first standalone medical card that can be bought online without medical check.

  • Guaranteed renewal
  • No Lifetime Limit
  • The cheapest medical card in Malaysia
LogoCompany NameProduct NameLinksHow to buy?
Axa Affin LifeeMedicwebpage | FactsheetBuy Online Now
Takaful MalaysiamyClick Medicarewebpage | Product SheetBuy Online Now
Tokio MarineMedic Partnerwebpage | Brochure | Product SheetFind an Agent
Tokio MarinePremier Medic Partnerwebpage | Brochure | Product SheetFind an Agent
Tokio Marine LifeHealth Care Supreme-Find an agent
AIAA-Life Med Regularwebpage | BrochureFind an Agent
ManulifeManuMedicwebpage | BrochureFind an Agent

Standalone Medical cards with No Guaranteed Renewal

The below medical cards do not guarantee renewal. They can be cheaper than Guaranteed Renewable insurance, however, you have the risk that the insurance company will deny renewal when you have a claim.

LogoCompany NameProductLinksHow to buy?
AIAA-Plus Medwebpage | BrochureFind an Agent
Great EasternMediCare 2webpage | BrochureFind an Agent
ZurichMedicaGen 200webpage | Brochure | Product SheetFind an Agent
ZurichMediLovewebpage | Brochure | Product SheetFind an Agent
ZurichOmniHealthwebpage | BrochureFind an Agent

Medical Cards that are Add-ons to existing insurance (Rider)

The below insurance products cannot be bought alone. They come together with an investment-linked policy or life insurance. If you already have an investment-linked policy or a life insurance, then it can be cheaper to buy an add-on (rider) to your policy to cover for medical insurance. Check out the infographics to better understand the difference between Standalone medical card and Rider.

LogoCompanyRider NameLife BaseLinksPurchase
PrudentialPRUvalue medPruwith youwebpageFind an Agent
AllianzMediSafe InfiniteInvestment-linkedwebpage | BrochureFind an Agent
Tokio MarineiHealth+iLifeSecurewebpage | BrochureFind an Agent
Zurich LifeFlex MedicalInvestment-linkedwebpage | BrochureFind an Agent
EtiqaMedical PlusEnrich Life Plan
Triple Lifestyle Protector
webpage | BrochureFind an Agent
EtiqaElite Medical PlusElitelinkwebpage | BrochureFind an Agent
Great Eastern LifeSmartMedic (Enhancer)Investment-linkedwebpage | BrochureFind an Agent

What is a Medical  Card?

Medical card is a card issued by your insurance provider when you purchase a medical plan. This card will enable you to receive medical treatment at specified list of panel hospitals. The medical expenses will be paid by your insurance company as long as the type of treatment is covered in the policy.

Types of Medical Cards:

Standalone Medical Card

Standalone medical card is from a medical plan that can be purchased on its own. You will only be getting medical coverage from standalone medical card. The coverage for standalone medical card is comprehensive and can include expenses for surgeries, room and board, operating theatre, hospital allowance, critical illnesses, consultation fees and so on.
Policy duration: They are usually an annual plan where you will need to renew each year. Renewal is usually not guaranteed.
Premium: Premium (price) is paid only for medical coverage and therefore it is usually cheap. However, the premium rate is not fixed and will increase according to the insured’s age. Insurance providers may revise the rates from time to time according to the increase of medical inflation rate.

Rider Medical Card

Medical insurance can also come as a rider (additional coverage) to a main plan, such as life insurance with investment-linked policy. The medical coverage cannot be purchased separately which means that to have medical coverage from a rider plan, you will need to purchase the main policy. The policyholder will not only receive medical protection but also life insurance as well as savings (cash value).
Policy duration: The coverage term for rider plan can go up to the age of 80, 90 even 100 years old depending on product.
Premium: Premium is higher compared to standalone medical plan as you aren’t only paying for the medical coverage but also a life insurance as well as investment. The premium paid is fixed at the age when the insured enters into the policy. Small increase in premium rate may happen when insurers revise their rates due to increase in medical inflation.
Cash vale: Because of the nature of the investment-linked policy, cash value is generated and accumulated. This value will grow over time and depending on the product, the policyholder may withdraw this amount at any time.
More info on rider and standalone find in our infographic: “Medical Insurance Rider Or Standalone – Which Is Better For You? [Infographic]”

Other important terms you need to know about medical cards:

Lifetime limit

This is the maximum amount your insurance company will pay out to you for medical claims during your lifetime. Once the lifetime limit is exhausted, your medical cost will no longer be covered.

Annual limit

This is the maximum amount you are entitled to for any medical claim made for one policy year. It can be as low as RM10,000 to millions year.

Premium

Premium is the payment that you as the insured has to pay for an insurance plan. Payments are usually made periodically – every month, every 3 months, yearly.

Deductible

An amount that you will have to pay for your medical treatment before your medical plan will begin to pay.
To illustrate:
Deductible of Lisa’s medical insurance plan: RM 1,000.
Lisa breaks her leg, the operation cost is RM 3,000.
Lisa has to pay RM 1,000. The insurance company pays RM 2,000.

Co insurance

This is the amount, usually in percentage (10%, 20%) of the total medical cost, which you have to pay on your own. The insurance company does not cover for this amount.
Co-insurance of Lisa’s medical plan is 10%.
Lisa breaks her leg, the operation cost is RM 3,000.
Lisa has to pay RM 300 (10%). The insurance company pays RM 2,700.

Some plans come with both deductible and co-insurance, here’s an illustration.
Lisa purchased a medical plan with RM 1000 deductible and 10% co-insurance. After her admission to the hospital for dengue treatment, Lisa received a bill from the hospital amounting to RM 5,000.

Deductible:              Lisa pays RM 1,000
Co-insurance:         Lisa pays RM 400 (RM 4,000 x 10%)
Insurance company pays RM 3,600 (RM 4,000 – RM 400)

The total Lisa has to pay is RM 1,400.

Panel hospital

Your medical card comes with a list of hospitals that are working together with your insurance company. Having this collaboration means easier and faster admission and in many cases, cashless treatments. It is important to make sure that the medical plan of your choice has a list of panel hospitals that are accessible to you as well as the cashless facility.

Medical examination

Depending on the plan and the age of the applicant, medical examination or check-up may or may not be required. A low health risk 25 year old applicant may not require to submit a medical report while a 55 year old may be required to do so.

Guaranteed Renewal

Depending on the type of medical insurance, some may require the insured to renew annually (term medical, standalone medical). While rider medical plan does not require renewal but will terminate itself once the maximum lifetime limit has been paid out completely.

No Guaranteed Renewal

In some cases, renewal is not guaranteed by the insurer. This is to say that insurance providers have the right to reject the request to renew a medical plan from an existing customer, especially if he has been diagnosed and treated with a certain illness while being covered.

Waiting period

Also known as qualifying period. It is the number of days the insured has to wait before he can be covered for medical benefits. For medical cost due to newly diagnosed diseases, it is usually 3 to 6 months after the policy inception.

Free-look period

This is the number of days you can wait before deciding to cancel your policy after its inception and will receive a full refund of your premium (after deducting administrative and other expenses).

Full disclosure

To apply for a medical insurance, you must provide full personal details relating to the risks involved. This may include pre-existing conditions, past illnesses, smoking habit, occupation, hobby and family medical history. If a non-disclosure or inaccuracy in information is discovered, the insurer has the right to reject any claim made.

What does a Medical Card or Medical Insurance cover?

Most Medical Cards will pay for the following costs (Refer to product sheet for full details):

  • Hospital Room & Board
  • Surgeon and Anaesthethst Fees
  • Intensive Care Unit
  • Day Care Surgery
  • Hospital Services & Supplies
  • Operation Theatre
  • In Hospital Physician Visit
  • Pre-Hospitalization, Pre-Surgical Diagnostic tests & Pre-Hospitalization Specialist Fees
  • Post-Hospitalization Treatment
  • Outpatient Physiotherapy Treatment
  • Ambulance fee
  • Organ Transplant
  • Monthly Outpatient Cancer or Kidney Dialysis
  • Home Nursing care

Why is “Guaranteed Renewable” important?

Guaranteed renewable means that as long as you pay for the policy on time and you want to continue with the insurance, the insurance company is obliged to renew the policy (if the lifetime claim limit has not been exceeded). The insurance company, however, can raise insurance price as long as the change affects everyone and does not single you out.

For non-guaranteed renewable insurance (where policies are renewable on yearly basis), the renewal of these policies is subject to the insurers’ approval. This is bad because when you have an illness that is likely to happen again, the insurance company will deny you the renewal. Now, when you want to buy insurance from a different company, it will be difficult to get, because you have a past illness that you need to disclose. An illness in the past, is also called pre-existing condition.  The new insurance company will either load your premium (the insurance is more expensive) or will exclude the illness from the new medical card. This means that when the illness happens again, the insurance company will not pay for any treatment.

This is why it is important to buy medical insurance early in life so that when you start buying medical insurance you do not have any pre-conditions and can be fully covered by a medical card.

What are Exclusions?

Exclusions are illnesses or medical conditions that are not covered by a medical card or medical insurance.  Here are some examples of common exclusions. Refer to the insurance products for specific details.

  • Pre-existing Conditions. However, Disabilities that are declared to the Company in the proposal form and for which the Company does not impose any condition will be covered after 12 months of your insurance coverage.
  • Specified illness occurring during the first one hundred twenty (120) days of a continuous cover of an Insured Person
  • Cosmetic treatments
  • Dental conditions or refractive errors of the eyes except due to accidental injury,
  • Congenital abnormalities
  • Pregnancy-related conditions
  • AIDS or sexually transmitted disease,
  • Self-inflicted injuries,
  • Drug addiction, mental or nervous disorders

What are Pre-existing Conditions?

Pre-existing Condition means Disability that the Insured Person has a reasonable knowledge of on or before the effective date of insurance. An Insured Person may be considered to have a reasonable knowledge of a Pre-existing Condition where the condition is one of which:

  • The Insured Person had received or is receiving treatment;
  • Medical advice, diagnosis, care or treatment has been recommended;
  • Clear and distinct symptoms are or were evident; or
  • Its existence would have been apparent to a reasonable person.

What is Specified illness?

Specified illness means the following Disabilities and its related complications:

  • Hypertension, cardiovascular disease and diabetes mellitus
  • All tumors, cancers, cysts, nodules, polyps, stones of the urinary and biliary system
  • All ear, nose (including sinuses) and throat conditions
  • Hernias, hemorrhoids, fistulae, hydrocele, varicocele
  • Endometriosis including disease of the Reproductive System
  • Vertebro-spinal disorders (including disc) and knee conditions

How do I use the medical card? How do I claim?

In the event that you need to go to the hospital, you should try to go to a hospital that is covered by the medical card. Hospitals that are covered by the medical card are also called Panel Hospital. You can also go to other hospitals, but you will then need to pay the hospital first and then later claim back the money form the insurance company. In a panel hospital, the insurance company will pay directly the hospital.

In the event you are hospitalised at a Panel hospital, you will need to present your medical card (if any) and fill out the hospital forms with all your personal and insurance/ takaful information. Your insurance company then pay directly the hospital. You do not need to pay cash upfront.

In order to minimise any unnecessary delays, the insurers recommend that the following key actions are required as part of the claims process:

  • Before receiving any non-emergency treatment, call the customer care helpline of your insurance company and check whether your doctor’s proposed treatment is covered in your insurance and whether your hospital of choice is panel hospital
  • Do request your doctor or specialist to fill in and sign your claim form. Your doctor may charge a small administration fee which may not be covered by your medical card
  • Do submit a written notice to your insurance company as soon as possible, or within 30 days of the treatment period if you are diagnosed with a disability that would incur claimable expenses
  • Do send all claims documents together with the original bills and receipts, full doctor’s reports, physician’s cost summary of treatment and referral letter, if any. Don’t forget to make a copy of all original bills and receipts.

When is the best time to purchase medical insurance?

The best time to purchase insurance is when you are still young and healthy. This is because of several reasons:

  • Insurers calculate premium based on the age of the insured. This is based on the assumption that the older a person gets, the higher is his risk of being diagnosed with illnesses. Therefore the older the insured, the higher is his premium.
  • Once diagnosed with an illness, you:
    o May not be able to find a company that will insure you due to your existing condition
    o May have to pay higher premium for medical coverage due to your existing condition
    o May not get coverage for any medical expense relating to your existing condition (exclusion)

Where can I purchase medical insurance?

You can purchase a medical plan easily through a qualified insurance agent. Alternatively, many insurance companies now offer medical plans through their websites. Search for the company you wish to purchase from on the internet and determine if you are able to purchase the plans you’d like online.

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