Malaysia Medical Insurance Coverage Summary

The purpose of privately purchased medical insurance plans in Malaysia is to offer the insured individual, family, or group peace of mind by providing assistance in accessing and affording needed medical treatments in the case of physical injury or covered illness.

Long-term plans are available in many coverage levels and for just about all budgets to meet the needs of any individual, family,or group/business.

For shorter-term visitors, coverage is also available from numerous insurers to protect their health and interests.

In addition, frequent international travelers have the option of worldwide coverage through the many global coverage plans that are available, providing equivalent high-quality coverage anywhere the insured desires to travel.

Contact Malaysia Medical Insurance Organization (MMI Organization)

Understanding all of the ins and outs of medical insurance coverage and the many claim types featured by the health insurance providers in Malaysia can be difficult. Malaysia Medical Insurance Organization (MMI) can help you by giving you access to our vast database of healthcare and medical insurance information. To speak with an adviser right away, or complete the information request at the top of this page and adviser will contact you soon.

Malaysia Health Insurance Levels of Coverage Available

Almost every company will have varying levels of coverage offered depending on the plan selected, in general all coverage starts with selecting between one of two types of protection. To learn more, read as below:

Malaysia Health Insurance Waiting Periods

Waiting periods with regard to insurance coverage usually apply to any health issue that may have existed prior to the start of the policy's coverage. Insurers utilize waiting periods to prevent abuse of their coverage by anyone who is in dire need of care and would not otherwise purchase a plan to cover an upcoming treatment for a condition that has not been claimed as pre-existing.

Usually waiting periods imposed on coverage are not very long, only a few weeks to months, as insurers realize that few people are interested in exposing themselves to potential fraud allegations for seeking coverage or reimbursement they are not rightly entitled to, and the insurer needs to offer the best service possible to their insured in order to maintain excellent client relationships. 

Types Of Waiting Periods

Each insurance provider company has their own specific wait times for certain conditions, so always research the particular plan you are interested in to see how their restrictions will affect your coverage. Below is an overview of the most common waiting periods for Malaysia health insurance plans.

Pre-existing Conditions are commonly dealt with by a waiting period to establish the likelihood of recurrence, severity of symptoms or flare-ups. If the insurer is satisfied that the pre-existing condition does not pose an overly troublesome risk to their coverage it may be included after the predetermined waiting period.

Maternity Coverage almost always carries a waiting period. In some cases, up to one year to ensure that a woman who is pregnant before plan purchase is not accessing coverage for what would otherwise be an excluded condition. Maternity is not always excluded in this manner as other considerations (such as the term of pregnancy) may have a bearing on when coverage can begin. To illustrate, if a woman becomes pregnant in the third month of their plan they would not be excluded because she would be expected to give birth in about the twelfth month of her coverage.

To learn more about the specific waiting periods of a plan you are considering, talk to a qualified MMI adviser for complete details.

Malaysia Pre-Existing Condition Health Insurance Coverage

In some cases, insurance coverage has been denied or restrictions are placed on treatments to be included in the plan due to a pre-existing condition. While this practice is still common today among some coverage providers, there are situations where an individual's pre-existing condition can be included.

While there is no guarantee that any pre-existing condition can be included in coverage, most of the time options are available so that pre-existing conditions can be covered by either an increase in the premium cost (to account for the potential for future care of the condition) or by selecting a plan which can ignore all or almost all pre-existing conditions entirely.

Of course every plan and provider differs and many treat the pre-existing condition in their own manner, so it is best to discuss options for coverage with a qualified adviser before making a purchase.

Malaysia Pre-Existing Health Condition Insurance Coverage Options

While the easiest and most cost effective way to deal with a pre-existing health condition is to exclude it from coverage entirely and extend coverage for the rest of the individual or family's health exclusive of the condition, insurers understand that this is not always acceptable or practical.

Therefore, three primary methods of arranging coverage are available for anyone with a pre-existing health condition, as listed below.

Moratorium For Coverage – simply stated, a moratorium is a waiting period wherein the insured is covered against injury and illness for a pre-determined period of time (commonly around 24 months) while the pre-existing condition is excluded. At the end of that waiting period, if no significant symptoms or medical problems related to the pre-existing condition have arisen that require treatment, the policy will be adjusted so as to include the previously excluded condition in its coverage.

Premium Loading – though not as common as a moratorium, there are instances where an insurer will agree to increase the premium payment amount for coverage in exchange for extending coverage for a pre-existing health condition along with the rest of the policy benefits. This is not a very common practice as estimating the cost for potential treatment (should it be required) is very difficult.

Medical History Disregarded – this option is almost exclusively available through group coverage plans, often including more than 20 potentially insured members, where the need to offer the same coverage options for a wide range of individuals is necessary. As indicated by the name, it overlooks all past medical history and extends coverage as if the insured is in excellent health.

Please be aware that not every insurer offers these options for pre-existing condition coverage, and cost may vary greatly depending on insurer, specific condition involved, and other factors such as age. Most of the time, pre-existing conditions will need to be reviewed on a case by case basis to determine if inclusion is possible. For this reason, it is usually necessary to speak to an adviser prior to any purchase to find out what your options are if you need this type of coverage. 

Malaysia Health Insurance Coverage Limits

Coverage limits vary widely between insurers in Malaysia and sadly, some individuals have been caught unaware and left with significant medical bills after discovering that their insurance plan's limits were not sufficient to cover their treatment needs.

It is therefore necessary to thoroughly research your options for coverage to ensure you purchase a plan that features coverage limits high enough to always ensure you or your family's needs will be cared for.

Explanation Of Malaysia Health Insurance Coverage Limitations

While some disreputable insurers will offer coverage plans with absurdly low financial limitations, the majority of responsible and trustworthy insurers have very generous coverage limits typically ranging from RM1 to RM 3 million. This limitation, often referred to as the Overall Maximum Benefit, represents the total amount that will be contributed by the insurer to maintain or restore an individual, family or group's total health within a specified amount of time or for a specific health condition.

Coverage limitations come in three primary forms. Below is a review of the common limitations imposed on health insurance coverage plans in Malaysia.

Annual Limit- this sets a predetermined maximum amount of assistance to be offered on a single policy within one policy year for any treatments received to treat any covered injury or illness.

Lifetime Limit – this is the maximum amount of assistance available for the entire life of the policy. Typically, this is applied to multi-year coverage policies.

Per Condition Limit – in some cases, each health condition will have its own maximum coverage benefit for a single policy year. This amount will be explained in the policy schedule and different conditions may have different limits.

It is important to understand up front what amount of coverage you are entitled to prior to purchase of any policy, as waiting until an injury or situation arises (which may come near to or exceed the policy limit) is extremely stressful and potentially financially devastating.

Malaysia Health Insurance Coverage Definitions

For legal purposes, many insurers rely on terms that are not part of the common vernacular to describe their coverage, requirements and limitations. Here, Malaysia Health Insurance provides you with a list of some of the most common terms used by insurers to define the conditions of their policies. Understanding what these terms mean in plain English will make it much easier to make a confident decision about the best coverage for your circumstances.

Insurance – a legally binding agreement in which one party (the insurer) accepts the risk of another (the insured) in return of a prior arranged fee

Health/Medical Insurance – a legally binding agreement in which an insurer agrees to extend protection and financial assistance to an insured to cover included injury and illness or other health-related issues as outlined by the policy

Applicant – the person applying for coverage from an insurance provider

Application – required paperwork to be completed by the applicant for consideration of coverage by a specific provider

Specific Terms – the detailed conditions of coverage that outline levels of care and other information from a specific insurance policy, these terms are sometimes made on a case by case basis

Standard Terms – the usual conditions of coverage for a particular insurance plan

Hospitalization Coverage – medical insurance designed to cover the financial burden incurred by the insured due to required hospitalization and associated treatments

In-Patient Care – medical treatment which requires over-night stay in a hospital

Out-patient Care – medical treatment which does not require over-night stay in a hospital

Policy Conditions – the specific stipulations of coverage agreed to by the insurer and insured for a specific insurance policy

Policy Holder – the individual to whom the insurance policy is issued to and is subsequently responsible for payment. In the case of a group plan, this may be an authorized agent or administrator.

Policy Schedule – the document explaining the amount of coverage provided by a specified insurance policy

Deductible – the amount of financial responsibility, as stated in the policy, an insured person (or in some cases the family) has toward their own good health before their insurance coverage provides assistance with payment

Claim- a formal request, written or otherwise, by the insured to receive compensation or coverage for healthcare or treatments which are covered by their policy

Documents – the formal records (in hard-copy or electronic format) held by the client and provider for a specific policy relating to health, treatments and financial reimbursement. Typically, these are signed and/or sealed and are often part of the insured or insurer's permanent records

Commencement Date – the calendar date on which an insured persons coverage officially starts

Anniversary Date – the calendar date marking one incremental year of coverage for a multi-year insurance policy

Due Date – the calendar date the insurance policy premium's payment must be paid on or prior to

Renewal – the offering by the insurer to the insured to continue insurance coverage for an arranged fee for an agreed amount of time

Waiting Period – the amount of time that an insured must wait after payment has been received before their coverage begins

Region – the geographical area in which coverage is guaranteed by a specific insurance policy

Reimbursement Rate – the total amount of financial coverage available for a specific health condition or treatment as outlined by the insurance policy

Subrogation – the right reserved by the insurer to pursue financial compensation from a third party via legal action or settlement for coverage and/or compensation extended to their insured

Pre-existing Condition – any condition that was knowingly present in the insured health prior to the start date of coverage for a specified insurance coverage policy

Serious Injury – an injury (typically due to accident) which results in bodily harm sufficient to cause inability to perform tasks at the same level or with the same ease as prior to the injury, for either a long or short period of time

Acute Illness – illness characterized by rapid onset, but which typically only last for a short time

Surgery – the treatment administered by a medical professional with the purpose of improving or restoring the patient's health due to deformity, illness or injury

Terminal Phase - the point at which a disease has progressed to where there is considered little or no chance of recovery, and death seems imminent regardless of further treatments.