Hi MNet,

Since you said it's "your" insurance, I'm assuming it's AIA.

According to every insurance contract, there is this clause known as incontestability clause. This means that whatever claims that are submitted during first two years (varies between insurance companies as I know Great Eastern is 1 year, Prudential & AIA is 2 years) will require thorough investigation by the insurance company to see if it's genuine case or not. Hence, the thorough investigation may take up to 2-3 months. As long as it's genuine case, then the claims will be given after 2-3 months investigation.

If the policy is enforced and claims are made after two years, then the claims can be approved within 2-3 weeks.

Hope this clears your doubt.

No, the incontestability clause is 2 years throughout the industry.

For Prudential, even though if it is below 1 year the GL will still be issued and investigations will follow.

If it is found that it is a pre-existing illness prior to inception, then the GL will be withdrawn. However, if there is no evidence showing that it is a pre-existing illness, then the medical card will be accepted.

There is no clause in the policy that mention that the GL will not be issued for policies below 1 year and the client will need to pay and claim for admission to a panel hospital in Malaysia. As long as the waiting period is over, and it is not a pre-existing illness, the medical card will come into force.

I had client who had kidney stones (both sides) 7 months after getting the policy and the bill was > RM30K.



Recently also another client had slipped disc (disc prolapse) 5 months after buying the policy. However, the surgery was only done after 9 months after consulting 3 different doctors. The total bill was RM42K. In both cases the monthly premium was RM 150~RM 160.

But yes, the most important as mentioned by many is that the client will need to be completely transparent on their health status during the application of the policy.

Failure to declare these material facts that may impact how the policy is underwritten may cause the policy to be null and void, irregardless of whether the policy had surpasses the 2 years incontestability period.

This post has been edited by roystevenung: Apr 6 2014, 01:52 PM

Hey Roy,

I don't really understand about your screenshot as I saw that the "registration date" was 1/10/2012 and the "decision made" is 18/12/2012 for the PruHealth hospitalization amount, not pre/post hospilization. Is this the way Prudential show GL as accepted in system?

To all,
Even in Great Eastern do approve GL within the first half of the year for illness that can't be pre-exist. However, I will surely let my client know that GL might not approve prior investigation within the first year. In Great Eastern, once the GL is issued, it won't be withdrawn.

Edit:Typo

This post has been edited by ExpZero: Apr 7 2014, 09:57 AM

Those are for the payment that Prudential need to pay to the hospital. Like I said we will give the GL to the hospital and investigations shall follow. During that process we on hold the payment to the hospital while the client has been discharged and recuperating at home.

The client did not need to pay the Rm18,8xx+Rm6,9xx which was the laser procedure for right and left kidney stones respectively. The rest of the smaller claims were for pre and post (followups) hospitalisation.

There is no clause in the policy document that mention that GL will not be issued for new policies even if it had surpasses the waiting period. Is it not the same for GE?

So far for my clients the GL that has been issued has never been withdrawn as I emphasize that they need to fully declare any material fact that may impact how the policy is being underwritten.

Dear ExpZero,

If what you say regarding Great Eastern Med Card is as it is, and you even claim this is industry wide:

So how am I, as a policy holder trust in your company? I declare my health status and have declared all facts in good faith at the point of buying the insurance from you; all before your company accepts my risks and before issuing me a policy.

In the policy contract, Waiting Period for Specified Illnesses is 120 days. Any other illnesses 30 days waiting period but policy holder to pay first if the admission/ illness is less than 120 days. But according to you even if I am admitted after 120 days, GE may not issue the Hospital a Letter of Guarantee (GL) as your company may do further investigation, so the chance to decline, or partially pay my bills only exists.

So tell me ARE THE WORDINGS ANY GOOD IN THE POLICY CONTRACT.
REMEMBER, THIS POLICY HOLDER HAVE NO PRIOR HEALTH ISSUES BEFORE BUYING THIS MEDICAL INSURANCE. Then this becomes very vague. We do know of course Doctors final report and diagnosis on the policy holder/ patient plays an important role, but this is after the crucial waiting period and the policy holder have no history of health issues..

And yes Incontestability Period is standard of 2 Years.

Being an an agent, the fulfillment of claims is our main priority and the policy contract is our Bible. I would be afraid too, being an agent to sell something that is so vague, 50/50. What happens to the trust.

What Roy wrote above are 100% correct. Refer to Wei Hen Lai's comment above too.

This post has been edited by ChrisGood: Apr 7 2014, 11:36 AM

I am looking into getting a policy - education + hospitalisation coverage, for my 5 year old. Allianz agent can quote me on this?

Thx.

Yeap, there is no clause in the policy document that mention GL will not issued for new policies even if it had surpasses the waiting period, it's the same that in the policy document do not have a clause to say that GL will surely issue after the waiting period.

Utmost good faith by declaring all the actual fact of client's physical health is definitely a must in the whole industry. However, do policyholder have the practise to return the money back to Prudential after the GL is withdrawn after discharge? Or Hospital is the one who will assign someone to collect the money from policyholder if the GL is withdrawn after discharge?

So I dont really see a valid reason why the GL is not issued for policy below 1 year since it is not a clause in the policy document.

Of course if there is evidence of pre existing or holding of material fact during the investigation period, the GL will be withdrawn and the client will need to sort out with the hospital on the charges. This applies to any insurance company.

For the case of the GL issued, of course the billing dept of the hospital will collect from Insurer.

Any agent whom had made claims in Prudential can verify that the GL will be issued as long as the waiting period is over. Its a company SOP

How quick Prudential for the investigation period to check for evidence of pre existing illness?

Edit: Typo

This post has been edited by ExpZero: Apr 7 2014, 01:32 PM

Depends on the complexity of the cases. 1-2 months seems to be the norm.

How if GL issued, but after 1-2months and get withdrawn?

The client will need to sort out the payment with the hospital.

If GE investigations reveals that it is a pre existing, the claims will also be denied, no?

Yes, if GE investigations reveals that it is a pre existing, the claims will also be denied, this is industry practise.

I just called over to Prudential hotline at 03 - 2116 0228, Shanti, Chen and Cui Fong is the customer service officer that served me(yes, I called three times to triple confirm about this issue).

Three of them have told me that Prudential have the waiting period of 30 days, 90 days and 120 days. In fact, 2 of them actually told me that Prudential don't cover minor illness like flu or fever.

All the three Customer Service Officer are consistent with their answer. They clarify to me that there will nothing like GL issued first without investigation and withdrawn afterwards if they found out pre-existing illness. They have triple confirmed to me that Prudential will not issue the Guaranteed letter and will decline the issuance of Guaranteed Letter after the waiting period if they are suspecting that it is a pre-existing illness.

In fact, all the Customer Service Officer told me that even the doctor said the illness happen after the policy inforce, Prudential reserve the right to investigate and declined the Guaranteed Letter. However, client may submit for reimbursement and the reimbursement may take up to 2-3months.

Please call the above number for your own clarification.

I'm here not to jeopardize Prudential, I'm just clarify that all the claim procedure in every insurance company are actually the same. I have my ex-colleague from all the others insurance company and they have told me that the procedure is actually almost the same.

I'm here to stressed out that, Guaranteed Letter is not 100% to be issued out within the first year in every companies, no exceptional.

Edit: Typo

This post has been edited by ExpZero: Apr 7 2014, 02:37 PM

The waiting period of 30 days for common ailment (fever or flu) is a standard, right?

Are you saying that for GE if today the policy is approved, tomorrow the client goes in GE will not decline for flu or fever?

The way you wrote that message is misleading, as if Prudential will not cover for flu or fever. You know that is absurb, right? Of course we do cover flu and fever once it has surpass the 30 days waiting period.

Secondly, during the admission a minor check by crossing reference to the policy holder whether it is a pre existing as declared in the proposal form. Of course if it is a pre existing the GL will be decline prior to admission.

But in this case the claims needs further investigations since there is no way any insurer is able to check your hospital or clinical records within an hour or two prior to admission for pre existing illness.

Thirdly it is very contradictary in paragraph 4 & 5. First say cannot decline, then say have the right to decline.

Like I said, even if the policy is new Prudential and it has surpasses the necessary waiting period, the GL will be issued and investigations shall follow. Its nothing new to us in Prudential, or any other insurer for that matter.

Neither have I heard of AIA refusing to give GL if its new policy and surpassed the waiting period.

I'm not sure why do Prudential's Customer Service Officer Shanti, told me about not covering the minor illness regardless of waiting period, I'm suggesting you to call the Prudential hotline and ask for clarification from Shanti.

In your paragraph 5, In the case of further investigation, there is no way that the insurer will be able to check for hospital or clinical records within an hour or two. Are you suggesting that Prudential will issue the GL, then Prudential will proceed with the investigation for 1-2months? Let's say client discharge after a week, If and only if the investigation result came out after 1-2months to be pre-existing and non-disclosure and since Prudential issued the GL and paid for the bill, will Prudential ask the client to pay back the bill?

For paragraph 4&5, in short, that means Prudential will decline for GL shall they suspecting pre-existing illness non-disclosure.

After I have cross check with 3 customer service officer, I'm pretty sure that Prudential will declined the GL if they suspect there is pre-existing. They will triple confirmed with me that such protocol of issue GL and investigation follows afterward doesn't exist in their protocol.

In Great Eastern, once GL issued, investigation will be ceased and the claim is approved, there will be no withdrawal of GL. Shall Great Eastern is suspecting the claim could be pre-existing non-disclosure, the GL will be declined and client will have to pay and claim. Investigation will start upon claim process and this exact protocol is in-line with the Prudential Customer Service Officers statement.

Just call to the hotline and you will understand the procedure and protocol of claim.

I have never had any claims rejected for flu/fever, be it for child policy or adult once it has surpasses the 30 days waiting period and of course the proposal is properly declared.

We cannot 'suspect' its a pre-existing illness. We need solid proof by checking with the hospitals/clinics/doctors, if the policy is new and its a substantial claim. These takes time and it is impossible do it within an hour prior admission.

This is why we issue the GL if we are not able to determine if its a pre-existing illness during the admission process.

Issuing of GL does not mean the money has been paid from Prudential to the hospital. The payment to the hospital only happens after the hospital has submitted all the invoice to Prudential, which is consolidated. This is when Prudential shall investigate should the claims is substantial and the policy is new.

Prudential approves the GL and investigations to follow if its a substantial claim and the policy is new. Its a normal practice which has been re-iterated so many times and even with snapshot of the claims shown.

The point of issuing GL to the hospital is to avoid having the client to pay huge medical bills upfront.

This post has been edited by roystevenung: Apr 8 2014, 02:10 AM

If Prudential issued GL, policyholder discharge after 2 days, Prudential made the payment to hospital. Prudential continue with the investigation 1-2months and found out to be pre-existing non-disclosure, how do Prudential request the policyholder to return the large sum of medical bill back to Prudential?

During the investigation nothing will be paid to the hospital from Prudential. That is why there is a delay of nearly 2 months needed for the investigation in the attachment i shown.

guys. need an advise. which one is better for a 25 male/teacher plan. an etiqa plan which gives cashback after 3 years or a ILP link plan like AIA or PRU?

much thanks

Bro, hope you can provide more detail what plan you referring (Life, Medical, CI & etc).

Honestly, it depends individual need & requirement.