Hi all, I were approached by one of my friends who just recently join Great Eastern. As I don't have any medical card yet and he advise me to have one. Maybe he is new in this field, after the explanation, I still have some doubts in my mind which I hope someone over here can help me to clear it out.

On the quotation, it stated subject to 10% co-insurance, subject to a maximum of RM500

20% co-insurance, with no max cap for plan sm100 & sm150 if upgrade room and board

20% co-insurance, subject to a max of RM3000 for plan sm200/300/400, if upgrade room and board

So, exactly how much co-insurance I need to pay if i admitted to hospital? If have a kidney failure treatment, the co-insurance apply to the total bill or some of the charges?

I appreciate if someone can help me on this or perhaps provide some example for easy understand. Many thanks.

wow. the answer should be illustrated with examples. easier to make u understand.. let me pm you
Details and example included in pm. Hope it will help u to understand more..

This post has been edited by wwl86: Jul 5 2012, 10:37 AM

Get the product disclosure sheet.

Are they proposing SmartProtect Essential ILP?

This post has been edited by davidlow7: Jul 5 2012, 12:48 AM

The medical plan is Great Eastern Smart Medic

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Added on July 5, 2012, 11:56 pmCo_Insurance Mean Sharing the loss with You, amount that you need to pay.

If outpatient kidney, it should be 10%.

You can get a full quote from your friend.

There are many new plans in the market where there is no co-insurance. If you would like to know more, email me at lcf_1606@yahoo.com

This post has been edited by BIG BB: Jul 5 2012, 11:56 PM

Before you buy any of medical cards from any insurance agent, make sure you know the room rates or board charged by selective private hospital..co-insurance is something which d patient have to share the bill with the insurance company based on percentage or max charged. Another thing is make sure is renewalable after been claimed. And Annual limits is important, make sure your annual limits r big enough for your own needs as that only allow to claims for each year. If you just need a medical card, I suggested you get a term medical card instead of investment or endowment plan. Strongly advise do not bond it with other insurance as most of the agent will give you the cheapest medical protection.

For the sake of discussion, (bear in mind I'm not saying that your post is right or wrong) but lets discuss this openly so that readers have a better understanding. The reason why I am mentioning this is because of experiences I had while talking to people who got term insurance.

1st Scenario

Suppose at age 30, an agent ask you to sign a term policy (that does not accumulate cash value or one that does but the cash values generates very slowly and is not enough to cover for the insurance charges at later years) and it'll cost you RM 100/mth. 10 years later the premium is increased by RM 125/mth and you thought, well its alright cos my agent did mentioned that insurance charges will go up by age.

However, at age 60, the premium shot to RM 200/mth, you'll start cursing the agent for selling you a plan that increases almost 100% from the original amount. Bear in mind at 60 those who is working for people has already retired and have to live with whatever investment/savings that they had accumulated during their working life.

At age 65, the same agent still have to bear the swearing + cursing because the premium now is at RM 300/mth.

2nd Scenario

Term insurance are not as flexible as the ILP product, to the extreme that if you want to increase the medical coverage 10 years later, you're not able to do so. When you want to review, the agent will have to propose another medical plan for you.

I'm not sure if you're aware but older traditional with medical are far more superior in terms of the terms and conditions. For example older plans do cover implants, (implanted pacemaker costs ~RM 43K at a private hospital at Penang) while newer plans as stated by LIAM is to be excluded.

If you get the new plan, you're not covered for implants.

3rd Scenario

Most term insurance have limited riders, the utmost being the waiver of premium if Totally & Permanently Disabled or Critical Illness happens.

As an agent, and most importantly as a human being, wouldn't it be hard if not impossible to go tell the friend that is bedridden due to stroke, with no income that he'll lose his medical cover because he had bought a plan that does not waive if CI!

Please do note that I'm just trying to view your posts in another perspective, no pun intended. If I do say anything wrong, please do forgive me as it is not my intention to do so.

This post has been edited by roystevenung: Jul 6 2012, 08:08 PM

it means that if you admitted into any hospital, 10% of the total bill will be bared by u up to max of RM500.

If you upgrade your room from the room rate that supposed to be covered by ur plan, you will need to take up 20% of your total bill.

becareful on the sm package that u r taking.

Let's us discuss here about co-insurance

Some companies say that although co-insurance is not included in their plan, but the insurance charges shall also be higher.

I supposed we need to have a proposal to carefully study the details and decide.

Every insurance companies are good and they have their plus points. End of the day it is the buyers find some more suitable to their needs.

I once talked to my insurance agent before, that if there is any disease that require you to seek medical treatment on a frequent basis then co-insurance will be pain in the ass since it is counted based on per visit.

Maybe we can list out what are the possible diseases that require you to seek medical treatment on a frequent basis and the frequent is a long term or short term. Some frequent basis, perhaps bi-weekly but maximum 7 times then you are doomed to recover or "bye-bye".

I think we need to list out the type of diseases and how frequent + how long.

Secondly, we can then compare on the insurance charges especially at later year.

Buyers can then do their own judgement to see.


My personal view is...
After all, a high RM300/500 co-insurance may appear to be scary but if we look into a longer term, it may not be so bad.

Still a B&W comparison speaks louder than everything.

I am not insurance agent but I do find having NO co-insurance certainly is an advantage, but neither having co-insurance means disadvantage as well.

I personally already have 1 with co-insurance but will for sure go with 1 without co-insurance if I am going for my 2nd medical card and will use any of them base on the current circumstances.

Although I hope I have a good long life and won't need using them so maybe at later years when I am old, I can choose to surrender 1 of them and get back a decent cash returns. If it does break even during that time or at least close to it, then I know I made a good planning to myself for being protected at that time without even the need of paying.

I hope your insurance agents are sharing to you whatever you need to know such as what can be claimed using medical card and what cannot, what are the necessary riders ...

However all these will really depends on the quality of agent where I have met a lot, either they apply fear factor or they just draft up a simple one (as they try not to confuse you in order to close your sales fast), so problem will be later on for you to face but thankfully for ILP being a flexible product, however still subject to underwriting if you were to increase protection or so on.

So make sure you really know what you are buying. But LYN is always here.

My 2 cents.

This post has been edited by davidlow7: Jul 8 2012, 07:23 PM

Hi David, sorry for the late reply, been sick these few days....

Tit for tat, hence for medical card that is without co-insurance, in a long run you end up paying more premium but of course if you do claim many many times, especially if need to do chemo or worst kidney dialysis for life the co-insurance thingy might come as a hassle.

This is why our PRUhealth plan (for inpatient: 10% co insurance, min Rm 300 max Rm 1000, for outpatient: 10% max RM 2000) was implemented. Under this plan suppose the chemo cost RM 12K, the client will need to absorb RM 1.2k for each chemo done.

This is different from our newest PRUflexi med plan (deductible RM 300 or zero deductible (ZD)), if you choose RM 300 deductible, the deductible is applied after 90 days of the last treatment. If you choose ZD then the client don't have to pay anything. The premium for RM 300 deductible is more expensive than PRUhealth but is cheaper than PRUflexi med ZD.

If one had claim many times, declaration is important if you intend to get a second medical card as this may falls under exclusions for pre-existing illness. Some clients do opt for double medical card and you're able to claim from both cards for example one has PRUhealth & PRUflexi med.

The claim was made on PRUhealth and the co-insurance is RM 1K. He/she can claim the RM1k from the second medical card of PRUflexi med. This is also applicable if you are having GE medical card with co-insurance & PRUflexi med. Documentation required is a summary bill of what is covered and what is not covered along with the discharge note.

This post has been edited by roystevenung: Jul 11 2012, 08:21 AM

Thanks..

You made a very good point on kidney dialysis for life and I really see the importance of without co-insurance/

I was trying to figure out what kind of issue require frequent treatment that co-insurance can kill you off really.

Every new thread even in an existing thread, there will be agent also PM to get sales. This is their job as an insurance agent and TS will usually aware of this when he decided to query his issue in a public forum like LYN.

End of the day if the agent is doing a good job and providing a good service to the client, I think this is not really a bad thing. Either way, TS has his rights to exercise to either reject or accept.

This post has been edited by davidlow7: Jul 10 2012, 10:56 AM

Exactly, David. That's why there is a new website launched a couple of days ago - Compare Life Insurance Malaysia . Here, people can ask questions and agents can respond more systematically via Q&A. And compare different insurance policies. And agents can contribute their knowledge to the comparison charts as well as with Q&A. Best part, agents can't hard sell - so it's not spam to users. So it's win win.

Hi, any specific website that i can refer to?

to look at the payment/treatment charges nowadays?

chemo, kidney,brain tumor etc

Hi,

A rough idea for you to estimate from The Star.

Source: http://thestar.com.my/health/story.asp?fil...4748&sec=health


Source: http://news.asiaone.com/News/AsiaOne%2BNew...705-152781.html

I'd always advise to have a minimum of RM300k Critical Illness coverage and medical card with annual limit of minimum RM120k. Due to the inflation of medical cost, the RM120k annual limit is prepared for you to pay for the medical fees whereas the RM300k payout for your own income replacement including buying some recuperation medicine like ginseng, or the fees to practise Tai-Chi, or even for you to "ask God"(If you are chinese and superstitious ). One of my client used up to RM500k just to travel and practise TaiChi in Bali after diagnose with Cancer, but thank god she has now recovered. Do let me know if you are interested to Great Eastern medical card

thanks for the heads up .

for CI that cost 300k.. what typr of plan do you propose?

^ the medical costs for cancer treatment can go up to RM 300K, hence you need to buff up on the medical card 1st and then the lump sum CI.

The lump sum CI can only be paid upon diagnosis of the cancer (The cancer must be confirmed by histological evidence of malignancy)
by which would normally take a month or more after the reports had been submitted to the insurer.

However, in order for the doctor to write those reports, mammography for example has to be done and thereafter followed by the treatment eg, radio/chemo.

This is where you need to use your medical card and not the lump sum CI. Also, you do not want to claim out the CI to pay for the medical card, would you?

can any one have these answer?? I am having these question also
can pm me also with exm of calculation??
Thank in advance....

can pm me also with example ? thanks

If you are worried of the amount of co insurance you need to pay if hospitalised then a better alternative is DEDUCTIBLE.

For Co insurance it is by PERCENTAGE of the bill, subject to the min and max. For example if the bill is RM3000, 10%= Rm300, but if the bill is Rm10k, then the maximum co insurance that you need to pay is Rm500.

Deductible on the other is a fixed amount that you need to pay, for example deductible RM300.

There are also plans that is without any co insurance, meaning full claim.

Any GE agent can explain the following term to me,I little bit worry about my new purchase GE investment link plan because of this term

4.14 Portfolio Withdrawal Condition

The company reserves the right to cancel the portfolio as a whole if it decides to discontinue underwriting this product.
Cancellation of the portfolio as a whole shall be given by written advance notice of thirty (30) days to You and the Company will run off all policies up to the Policy Anniversary immediately following the expiry of the (30) days advance written notice.

Is it that means GE have the right to cancel my policy just using 30 days notification for any reason?Appreciated if someone can explain more detail about this.