The insurance upgrade is an offer and acceptance process. If the upgrade process is not accepted or deferred, then the premium will be reverted back to Rm150

First question the condition being claim is too general, therefore i can only reply in general. As you already know, not everything is covered by the medical insurance.

Therefore, if the condition being claimed is not covered in the first card, chances are the claim on the second card will also be rejected.

However, if you are referring the variance in claims due to 1st card already maxed out, then the claim on the second card should not be an issue, provided it has fulfilled the Waiting Period and the condition being claim is not a pre-existing illness prior to inception of the second medical care.

Moving on, do not be alarmed by the term medical underwriting. Medical underwriting means you need to provide answer on all the health questions and it will be scrutinized by the Underwriting dept and a decision will be made. The case can be accepted, accepted with exclusion and/or loading or rejected/deferred.

It is different from medical exam whereby you are required to undergo a routine medical checkup by a Dr.

As mentioned earlier, any upgrades or new application will definitely need medical underwriting and the upgrade is only possible when we are healthy.

Example a client wanted to upgrade her medical and she wasnt offered with GIO or SIO. Past hospital historical claims shows that her sugar level was 8.x

She wasnt even aware of this until she wanted to do the upgrade. The upgrade is not possible due to history of raised sugar level.

Once a person has claimed out the CI, no insurer will want to accept the application, even for upgrading. The definition of CI is CRITICAL ILLNESS and in most instances it may relapse, example Cancer.

When a person files for claim for CI, the insurer will also look at other riders that he had bought, example he is a payor who bought a child policy and also the spouse.

Apart from waiving his own and the spouse policy premium, the child policy will also be waived till the child is age 25.

The waiver is an added rider and IMO, a very important rider.

1. As mentioned, it is very much dependent on what is being claim. For example cataract, most insurer do not cover the Intraocular Lens or has a limit of RM1K. Your second medical may cover it, if you study the brochure properly.

We had seen the bill for Intraocular lens for ~RM8K.

2. Yes, all claims are required to be submitted with an original receipt, tax invoice (due to GST), and/or CTC of the medical report (if any), CTC of the discharge summary and a copy of the letter of settlement from the insurer.

3. If there is a need to use a higher limit of cover, it would be advisable to use the personal medical card instead of relying on your company medical card.

For example, the Medical Card A (MC A) has an annual limit of RM50K and the bypass requires RM90k.

If you insist on using MC A, then upon discharge you will be required to pay RM40K (which explains the original receipt of RM40K) and then file a claim to MC B.

If your company medical is the same with your second medical card, the insurer may not require you to pay and file a claim as both cards could be used to settle the hospital bill.

Do note that at times, your company may change the insurer (due to cost consideration/claims experience). Therefore it is not a mandate to find the same insurer for your second medical card.

Sorry to hear of your predicament. Do you mind to elaborate on the bold part? Did the superior file a claim for you or was the claim rejected?

If the claim was not filed and cant contact his superior, then you can check with the HLA office where the agency that the superior is from.

Pay him a visit and collect back the documents (that is if he still keeps it) and file the claim yourself.

You need to collect back the original documents and submit it at the HLA counter:-

1. Original Receipts
2. Tax Invoices (for GST)
3. The Discharge Summary
4. Medical Report (if any)
5. Completed claim form (which can be obtained at the HLA counter) or you may download it << HERE >>

HLA Customer Website

This post has been edited by roystevenung: Jul 28 2016, 11:11 PM

Hopefully he still keeps the original receipts that you had sent it to him. Good luck!

Not really. Agents are also human beings, cant run away from death or sickness. Your coverage is a legal contract and it is between you and the insurance company.

You may request to change to another agent if you are not satisfied with the current one. As indicated above, worse case scenario is to file in the claim yourself. No biggie.

This post has been edited by roystevenung: Jul 29 2016, 12:16 PM

Not sure why the other forumer is all hyped out as it is a valid insurance question ....

TPD Exclusion

1. Any Pre-existing condition - eg, already amputate the leg/s due to diabetes and buy insurance claim

2. Attempted suicide or self-inflicted while sane or insane. So if want to commit suicide to claim for LIFE Insurance (TPD does not covered suicide), make sure the policy is over 1 year, and must not have prior record of anxiety.

This is why, if suicide, make sure it follows /k standard of 14th floor.

If TPD from the suicide and don't die, the insurer is not liable to pay for the hospitalization charges or the lump sum TPD.

3. Travelling in an aircraft that is not licensed for commercial passenger

4. High risk and non-recreational sports, bungee jumping, sky-diving, ballooning, hand-gliding, diving > 30m

Note:
This list is non-exhaustive. Please refer to the policy contract for more details about the major exclusions under this policy.

This post has been edited by roystevenung: Jul 31 2016, 01:45 PM

Claims wise, you are allowed to do that even if your first admission was to a private hospital and later request to be transfered (due to valid reasons, eg, equipment failure or no competent doctor to treat you). You can also request to be transfered to GH, if need be.

However, most of the transfer cases is very much dependent on the condition of the patient as not all patient is safe to be transfered. In a severe accident cases, most cant be transfered as it is life threatening to do so.

This post has been edited by roystevenung: Aug 4 2016, 11:56 AM

No, it is Waived, not FREE.

1st Policy
Assured Wendy
Waiver Wendy (if Wendy is diagnosed with 36 CI or TPD)
Spouse Payor John (if John is diagnosed with 36 CI, TPD or Death)
Policy Holder (trustee) John
Nominee (assumed is) John

2nd Policy
Assured John
Waiver (None)
Spouse Payor Wendy (if Wendy is diagnosed with 36 CI, TPD or Death)
Policy Holder (trustee) Wendy
Nominee (assumed is) Wendy

Scenario: John is TPD
1. The 2nd policy TPD sum insured is payable to John and since there is no waiver on John's life, he will still need to continue to pay the 2nd policy premium.

2. The 1st policy is waived (not free) of the premium and the insurer will take over the policy payment and the insurance charges will still be charged in accordance to the cover / risk.

Should at older age when the insurance charges is insufficient to cover for the premium paid + cash values, Wendy is still required to do top up or risk losing the cover.

3. Upon John's death after (claiming the TPD), Wendy is entitled to the remaining cash values (if any) from John's policy

Scenario John's Death
1. The 2nd policy death sum insured + cash values (if any) is payable to Wendy

2. The 1st policy is waived (not free) of the premium and the insurer will take over the policy payment and the insurance charges will still be charged in accordance to the cover / risk.

Should at older age when the insurance charges is insufficient to cover for the premium paid + cash values, Wendy is still required to do top up or risk losing the cover.

This post has been edited by roystevenung: Aug 9 2016, 10:45 AM

Yes, the insurance charges is not fixed at Rm5k and is subjected to increased in later years.

One of the way is to get a high (but yet affordable) deductible plan, for example Rm20k or Rm50k in order to keep the insurance charges low.

Yes it is very normal for an insurer to add loading for being underweight. The reason for loading for underweight is that their immune system may not be as good as a normal weight person, thus resulting in claims occuring.

I believe it is just a mild loading unless of course your friend has been admitted before due to being underweight, then the loading may be more. Well at least it is only loading, and no exclusion.

Once your friend has gain the normal weight (normally after 1 year) he/she may apply for removing the loading, provided there hasnt been any admission to the hospital in regards to weight issue.

--

No, even if your friend were to "try" another insurer, the loading is still necessary due to the above reason. In the insurance application there is also a health question on whether have you applied for any insurance before and whether it is accepted at standard or special rate.

Tick "no" at the second insurer construed to having not to disclose material fact that may impact how the policy is being underwritten. Therefore if a claim were to arise which directly or indirectly related to your friend weight issue, it may be rejected.

No, it wont affect the earlier insurance, but for the next renewal, the NCD will be zero.

If now you are paying RM100 for RM100K and on the 7th year you increase it to RM200K and additional premium is RM120 (for the additional RM100K), then only the RM120k is subjected to another 7 years of cash value allocation.

This is why it is not beneficial to cancel the old policy just to start a new.

If there is no health issues at the point of upgrade then just add it on top of the existing policy if the policy allows for upgrading (eg, if it is an ILP policy). The reason for upgrading it on the existing policy is because there is a policy fee being charged annually for every policy that you own.

However, there is an instances that if there is a health issue, and if the upgrade was performed on the existing policy, the earlier RM100K will now have a loading.

Therefore a new policy is recommended to co-exist with the old policy (without loading/exclusion) together with the new policy (with loading/exclusion).

The Agent No or agent code is used by the insurance company to identify the agent. LIAM registration is a different no.

Its best to use the agent IC no to check.

All insurance works on the same principle, you need to select how long you want to be covered and the sum to be insured based on your comfortable premium.

If you want to be covered till age 100, then the cost will definitely be higher, at times it is too much that we arent able to afford at that point of time.

At her age, just concentrate on the medical will do and a medical checkup with resting ECG is necessary before coverage can be offered.

1. If you allocate more towards PLO, then it is to buy more life or TPD cover. PruSaver is more towards building up the cash values as the first year allocation starts from 95% (not 100% as someone mention).

Thus whether to allocate more towards PLO or PruSaver, it depends on your needs. If you want higher cover, then PLO.

2. It is somewhat boils down to your needs. For example, in future if you have more dependents and your expenses increases, you may want to increase the PLO sum insured so to care for the family expenses if you are not around.

3. If you had paid 10 years and had not made any claim before, that means you had saved Rm10,800. It is not everytime you need to be hospitalized.

The deductible method is also being used by international insurer to lower the insurance charges. Of course your agent earns lesser if he were to propose the one with deductible, which is good, no?

See above.

If the surgery can be done as Day Care Surgery, it is better as it saves costs.

Most of the insurer is also able to provide the Letter of Authorization for Day Care Surgery if the surgery can be pre-planned.

Correct me if i am wrong but it seems that the reason why your bf bought it is because he thought it is an investment plan (it is afterall known as the Investment Linked Policy).

When you buy insurance you are actually buying the associated coverage that comes with it. The coverage provided is not free and it comes with a cost - the higher the cover, the higher the insurance charges.

The reason why only 60% is left is because the 40% is paid towards the insurance charges, the agent commission and admin fees. Only after the 7th year, the allocation will be 100% towards buying you units.

As to whether to maintain the policy or not is much dependent on whether he needs the coverage and definitely not because he thinks he can make good investment out of it.

Buy insurance with protection in mind, not investment.

Your medical card wasn't top up at all even by adding the RM150?