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:Â Â Â Â Â Â Â Lisa pays RM 1,000
Co-insurance:Â Â Â Â Â 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.
Faizal OsmanAugust 25, 2019 7:11 am
Hi, would like to know if Archipelago Insurance is among insurance that is in Malaysia
RaeAugust 27, 2019 3:03 am
No, it is not.
FatihahNovember 9, 2019 1:27 pm
I’ve been looking for information like this for days. Great info! Now I can make an informed decision. Thanks a million!
izamFebruary 2, 2020 8:42 pm
great stuff and informative. It very helpful and worth of reading. Keep up tp upload more info for our reading. Not biased.
RaeFebruary 10, 2020 6:59 am
Thank you for your kind words! We are happy to find that our articles are helpful.
NishaJune 11, 2020 5:25 pm
It’s mcsi was a good insurance company
AndrewJuly 3, 2020 1:36 pm
Is Medisaver membership plan by MXM legitimate and good compare to others medical standalone?
RaeJuly 20, 2020 2:30 am
Maaf kami tidak mempunyai maklumat mengenai MXM.
ERNIE NURSYIEMA BINTI SULAIMANJuly 30, 2020 5:41 pm
Is medisavers insurance any good compared to the above?as i dont see that in the listi understand it doesnt offer medical+investment,but is their coverage good?