Background:
I was a non-believer in insurance, mostly due to the aggressive way it's sold, up until I was 30 years old. Then a friend became a Prudential agent and I bought a medical card to support him, which also included life and critical illness protection, and very minimal investment.

Then I started freelancing and also bought a house and a car, so I thought of increasing my insurance - in case something happened to me, the insurance would pay off the loans. Still having doubts about the ethics of insurance companies, I decided to buy extra life and critical illness protection from Great Eastern this time to "diversify the risk".

Over the years, I increased my insurance protection and also bought insurance, including a 15-year education savings which I regret, for my 2 sons. I also started a company that grew to almost 100 people and have been buying company group insurance from Great Eastern - paying a premium of about MYR 70,000 a year.


Critical Illness:
Last year, I was diagnosed with a heart condition that was covered under the critical illness insurance. Due to my fitness level, I was able to undergo non-invasive keyhole surgery (more advanced, less painful, recover faster, smaller scar) to repair my heart, instead of the conventional open-heart surgery where they saw your chest bone and open up your chest.


Claims:
Upon discharge, I submitted all the neccessary reports and documents to both agents and on the SAME DAY. This was what happened:

Prudential
- the agent told me Prudential will respond within 14 working days.
- within that period, Prudential sent me an SMS saying the claim was successful.
- the money was paid into my bank account 2 days later.

Great Eastern
- the agent said don't know how long the process will take.
- a week later GE asked for "certified" docs, which were copied and submitted by their own agent.
- a week later, I was asked to complete a questionnnaire, including which other insurance company I bought from.
- then my claim got rejected.
- GE says based on the policy, I MUST undergo an open-chest surgery to qualify.

My agent was stunned and my cardiologist literally said "what the fuck?". My agent appealed and got rejected - twice. Finally, I wrote a long email to express my disappointment and detailed my entire journey with GE, comparing it with Prudential. My email was escalated two levels up ...and then NO REPLY for a whole month.

Then my surgeon wrote another report and appealed to them. Finally, my claim was approved but GE proudly emphasized that they were ONLY doing it out of goodwill.

I promptly terminated and switched my company group insurance to Prudential. I also did the same with my son's insurance.


Buyer Beware:
It's companies like GE the reason why I never trusted insurance companies. Even my insurance agent who had been selling GE for 13 years was unaware of such a clause, hidden in the fine print.

The insurance policies are supposed to cover us until 100 years old. So between now and then, if there's a new and more advanced medical treatment, we still can't use it because it's not covered under GE's archaic policy?

Over the 13 years, my insurance agent has sold over 500 policies. But including mine, he has only made 3 CLAIMS for critical illness/life to date!

Other issues that I had with GE, was with their online access which didn't work and customer support which takes a minimum of 3 business days to respond, e.g. "we will transfer your request to the relevant department". Seriously? In this day and age of Internet speed? In my last interaction with them, they took 1.5 MONTHS to reply "due to sudden surge of volumes of email" (I wonder why), by which time I'd totally given up.


Conclusion:
Be careful when buying insurance - it's easy to buy but difficult to claim. Based on my personal experience, I would highly recommend Prudential instead (for now). The PruWaiver that I bought meant my son's premium will now be borne by Prudential. My premium will also be borne by them and paid towards my cash value until my policy expires at 100 years old.

Thanks for sharing your experience. I've only used Allianz Medical Card and it was pretty good.

thanks for sharing. i always had an assumption that as long the illness/disease is covered we're good to be covered regardless of the treatment method...hope you've recovered well now.

This post has been edited by vinoth: Sep 5 2019, 09:43 AM

That's also how I was sold. But there are many hidden clauses which we're unaware of. E.g. both insurance rejected my claim last year because they said based on the policy, I have to undergo first, to file for claim - not upon diagnosis.

Thanks. I'm recovering well.

Medical is much easier and I think life too - because there's not much to dispute if you die. It's critical illness that's difficult to claim.

Wow..
Didn't expect GE to be like this..

Anyhow I heard quite good review on Allianz previously.. now u says good review on Prudential...

ooo no wonder la kot

sorry to hear that bad experience from you. Maybe you can consider term insurance for a limited time coverage?

Aiyoh
Both my insurance policy with GE .

TS can you give the exact Terms and Condition that mentions that GE will not compensate for " non-invasive keyhole surgery".

I think it is important for people to understand terms and condition themselves rather than relying on insurance agent.


This post has been edited by Drian: Sep 5 2019, 11:37 AM

Hmmm, interesting. Thanks for sharing TS.

since normally a heart surgery or a brain surgery would requires "large" hospital bill,
I thought one need to have a letter of guarantee (LOG) from the insurance companies before the hospital agreed to perform them.
yes one can pay for it themselves with money and claim later...but why pay first and not a letter of guarantee first?

btw, do you mind sharing the name of this GE policy?
would like to check it out with my GE agent to regarding that....

Thank you for sharing your experience man. Good to know that you are well and covered now.

Friend of mine also have insurance with GE apparently....

Mind to share which Policy... See if have same one or not...

Good for now at least. I hear they are easy on the approvals - not sure if it's because they're trying to grow aggressively. My medical claims were also smooth and quick.

Based on the description
I think it's one of their Smart Protect investment-linked plan?

Well I guess so...

How many of us are actually given the opportunity to go through the entire document before we sign? It's the same in Malaysia for SPA, will, loan agreements, etc.

I believe you're referring to medical insurance. My problem with GE was for critical illness insurance.

Think mine's called Living Assurance policy.

Another interesting thing to share is that I paid about MYR 90K in total premiums for the 2 Prudential medical cards (which included life & critical illness) over 15 years.

My cash value rose to MYR 53K last month and I managed to withdraw MYR 40K.

Hi just to share my story also about GE.

They seems trying very hard to reject claims by using many excuses/reasons. But i was able to fight for it and won it after a few phone calls with their "supervisor".

Just FYI if they trying to be funny, just tell them u will report to OFS (Ombudsman for Financial Services) and BNM (Bank Negara Malaysia).
Their services are FREE u do not need to pay anything, they will help u to deal with the insurance company.

What is the reason to exclude it? If Prudential accepts it then they should too.
Putting clauses does not means automatically win even client signed the papers.

If anything u can refer to OFS, ISM, and BNM.

Bad experience with GE too, they are kind of funny where I just request to top up rm50 premium monthly and they asked me full medical report. Later on still not satisfied and mail me to post questionnaire on my own cost. I found it is ridiculous and troublesome as I am trying give them more money but they made so many troubles to me so in the end I told the agent forget about it. On the other hand my same request to Allianz for my another son was approved without hassle. I already bought new insurance for my son with Allianz and just wait 4 months cooling period to terminate this GE. And I won't buy GE anymore as very inconvenience

I suspect the reason why Prudential paid and the other insurer rejected the claim is that your CI with Prudential is still on the old contract whereby key hole surgery is not mentioned in the heart bypass CI definition.

If you have the Prudential policy, you can snapshot it to confirm.

CI dispute happens a lot in the year 2000-2006 as there isnt a standardised CI definition. A claim in insurer A is approved but rejected by insurer B due to this.

This is why in 2005 (or 2006?) BNM gives a standardized list of CI to be implemented across the industry to avoid confusion.

You mentioned that you had also switch your son's policy to Pru, you may confirm that under the new definition for the heart bypass, keyhole surgery is not covered.

Yes I am a Prudential agent

My two medical cards were purchased in 2004 and 2012 respectively.

I did not go for heart bypass. Mine's valve repair via keyhole surgery for mitral valve prolapse.

And that's precisely my point... how can you sell a policy that's supposed to last for 60 years but limit the methods used to out-dated treatments? The surgeon obviously chose keyhole surgery because it's the more advanced method. And acccording to my cardiologists, only 2 hospitals have such experienced surgeons - IJN and Universiti Hospital.

Should the insurance company ethically define the method used? They're after all an insurer and not medical consultants.

I bet most agents still sell critical illness cover as "we'll pay if you get any one of the 36 or 42 critical illnesses", right? They don't say "only after treatment and only if you used specific methods". If you disclosed this, do you think your customers will buy the insurance?

So what exactly is the reason it is now not accepted just because BNM specifically didnt mentioned about the new procedure?
What if there are newer procedure later? wait for BNM to state out too?


Btw i was wondering how come didnt wait for GL approve before doing the procedure? If hospital did contact insurer im sure they will list out what are the procedures going to be done and insurer would reject it and hospital would have to inform you.

The medical card does not have the above clause that exclude key hole surgeries.

However, For the critcal illness claim under the 36/42 critical illness for heart valve repair or replacement, yes, the keyhole surgery is excluded.

How detailed of a disclosure of the policy document depends on the agent/client during the delivery of the policy.

Some clients are okay to spend the time for a more detailed explanation, some don't.

1. With or without the insurance, I will still have to do the surgery anyway.

2. It's not a panel hospital, so I'm not sure if they'd do that. My agent told me to pay first, claim later.

3. This is for critical illness claim, not medical insurance claim.

I think he answered an almost similar question posted by MUM in post 6, earlier with this

some clients does not really understands or remembered or really pay attention to those medical terminologies used at the time of purchase.
I am one of those client......

The industry is flawed. Instead of helping customers in the time of need, they seem to be greedy and focused on profit, judging by the products and fine prints. Even using agents who have targets and earn solely based on commissions, do we realistically think every agent is going to be honest and ethical?

Referring to my initial post where I mentioned I regret buying the education savings plan for my son, the agent who sold me guaranteed the returns. The new agent told me he never promotes that product to his customers because the returns are very low.

I guess every industries also want to make money/profits....their share prices and shareholders demands it to be so.
even the food sellers would want to sell you "yesterday's" food instead of newly cooked one first.

honest and ethical sellers......I guess there are some in each industries too

is returns of the education saving plan really guaranteed as mentioned by the earlier agent? if yes, then he/she did not lie....

did that new agent recommend an almost similar education saving plan for your son?

Nope. I'm supposed to pay for 10 years (paid 9.5 years already) but only earn interest from 11th to 15th year. After paying more than MYR 100K, the cash value I can withdraw is less than what I've paid - I would've been better off even putting in FD.

He advised to buy unit trust.

There are usually a guaranteed n a non guaranteed returns for insurance saving plans.....just that the actual total amount is not guaranteed
Putting in fd does not hv insurance coverage for yr son

Unit trust????
Without insurance coverage
Without tax relief deduction
Without returns guarantee
Without a more peaceful sleep?

This post has been edited by yklooi: Sep 6 2019, 12:25 PM

This is why it's prudent not to over insured one self. Just insure enough to get by then the rest of the money dump in investment. Coz at the end of the day, insurance company priority is to itself and not u. And not to mention in emergency, cash is always king.

Upon googling about Keyhole surgery, I wonder, why the insurers dont want to cover this? Because of underlying risk? Cost?

Maybe as mentioned by roysteveung in post 23?

His gripes are with the CI payout not the medical insurance.

If you read another post about that, keyhole was excluded circa 2006 from CI claims. Probably because if your illness can be cured via keyhole surgery then it's not "that" critical.

Yes. Prudential is better at handling claims. Professional.

My experience with Great Easter many years ago was they tend to put lots of hurdles to your claim and fine print as they can.
Its just a rubbish insurer. Enough said!

Sounds like GE!

I thought CI once diagnosed will payout d? regardless whether any medication/treatment is being done?
Isnt that how it works?

What is this Risk Commencement Date and date of reinstatement?

Did you pay your premiums late or something?

Yes. GE is very old fashioned. You gotta pay premium through their agent. Very inconvenient

Is that so??????????

Maybe operated by Chinaman.

Biz first. Customer last.

Absolutely untrue. It's like cancer is cancer, regardless of whether it's treated with chemo, radio or surgery.

Mitral valve prolapse is listed as one of the illnesses. That should be all that matter.

That's how we were all sold the policy but it's clearly not the case. Hence, the point of this post to create awareness.

Think they meant they'll only cover when the policy is in effect, which of course it was.

My payments are all on auto-debit from my credit card.

Yeah

I do not recall anything about the method of treatment.
Once you are diagnosed, you can already apply for the funds. At least that was how they told us.

unker roystevenung can advise?

interesting to know too, thus I will wait for the real sifu to comment.
but while waiting for his responses, I googled and found this article....

Definition of 36 Critical Illnesses or Dread Diseases in Insurance Policy

12. Heart Valve Replacement
The actual undergoing of open-chest surgery to replace or repair cardiac valves as a consequence of heart valve defects or abnormalities that have occurred after the date of issue or date of reinstatement of this contract.
Repair, via valvotomy, intra-arterial procedure, key-hole surgery or similar techniques are specifically excluded.

https://kclau.com/insurance/definition-of-3...surance-policy/

which is similar to what have in TS policy and his condition....

There is a 30 days survival period for cancer and a min of 90 days if permanent Stroke (previously was 6 mths).

So it depends on what illness is being claim...

Wow getting more technical already... i have no idea what that means.

So just recap again, so it does not means eligible payout once diagnosed with CI ?


Do u mean if diagnosed with cancer also will not pay out if still survive after 60 days?

This post has been edited by WaCKy-Angel: Sep 6 2019, 04:39 PM

found this type of exclusion from this type of plan.....

really have to review the plan(s) that we have already bought or about to buy ....




Attached thumbnail(s)

Thanks for creating awareness. Just curious, how much does your surgery cost in total?

About MYR 60K. Note that Universiti Hospital is only semi-private.

WHAT INSURANCE COVER KEYHOLE ?

googled and found this....

read under HEART
Pericardectomy or Keyhole Cardiac Surgery
https://www.hla.com.my/CMS/Product-Services...uct=738&Sub=948

In the old days, agents will do projection that promise the sky. Projection is not a guarantee.

However, to be fair no policyholder should hold the insurance company to what have been projected by them 10 or 20 years ago when the document was signed then.

In simple economics the real returns, net of costs and expenses, can fall to very low levels in a poor investment climate.

https://www.liam.org.my/index.php/library/c...w-sunday-times-

There are reasonable projection and fairy tales projection.

A product illustration is meant to show a potential ILP customer the possible movements of cash flows and the impact of fees and charges on cash values. Under the new rules, when illustrating hypothetical rates of return to a potential customer, insurers must base their illustrations on two types of rates: 2% and 5%.

projected returns of 2% and 5% are "fairy tales" projection?

Anyone can provide a list of non-bumi products which alternatives cannot be easily switched?

It was a bad investment. If I'd put 12K every year into FD for 10 years, I would've seen some nice growth. Instead, I'm now in negative.

I guess someone has to bear the cost of insurance coverages over the years

It is easier for us to talk about individual incidents and illness in hindsight. However in the process of choosing insurance, each product has its own pros and cons and it is very difficult to predict what illness we may face other than based on family history. So for me the main takeaway fron this is how the case was handled by the company.

It seems to me that insurance company are deliberately adding terms and condition knowing that the customers will not be able to read all of it so that they can escape paying.

Insurance never meant to be investment. Just buy term life , CI and medical card ... nvr ILP

Thx for sharing...if not mistaken they boast as fastest reimbursement upon claim...sth to think abt now ....so far my claims were via company insurance...personal ones x touched yet...touchwood...which is ge....hmm...switching insurance co with same perks easy? Depends on age right?

When did this new rule started? Since the 80 or 90s? I believe in those days, there are fairy.

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This post has been edited by MUM: Sep 9 2019, 02:34 PM

Then you must have known those fairy tales figures used...what are those figures?

new disclosure rule started recently, 1 July 2019.

http://www.bnm.gov.my/index.php?ch=en_anno...uncement&ac=720

my abt 15 yrs policy are using the 4.5% and 6% projected returns

Correction 1 january 2020. The guideline is complicated. Very hard to explain in a simple manner. Projection rates also set by bnm, but at least bank negara set a new more realistic rate

Uncle looi. Try to ignore those projected returns. Most importantly focus on what the insurance company is giving you. But keep in mind look at it super long term.

It is always not advantageous to switch insurance companies.


Back to the original topic...

This is no fault of GE. In fact... feeling funny why prudential paid the critical illness (CI) claim. My own policy does exclude that keyhole procedure

Insurance company are not running a charity. Terms and conditions are set because the insurers genuinely cover those what is called critical illnesses.

The purpose of CI is to cover for your cost of treatment and possibly lost of income if and when you are really sick.

If you ask, how is it fair to put all those t&c? Well then your insurance gonna cost twice as much. Yes, in a way, the industry is not very healthy, given the heavy reliance on agents and their salary is % based not fixed fee.

Consumers and hospitals alike are also abusing medical insurance. Sikit sikit diarrhoea, fever masuk hospital. Then exactly these people pulak ask why my premium increase? Agent say wont increase one.

Cut the story short, truly i sympathise but yes, read what you buy. You buy property, you do your due diligence. You buy phone also you compare the models and prices. Why cant take time to read the t&c of your insurance policy?


This post has been edited by adele123: Sep 9 2019, 10:50 PM

The chamber in my heart swelled by 20% in 9 months. The 3 cardiologists and 1 surgeon I saw, estimated I had 6 months at most before the heart started to fail.

My surgery took 6 hours. The heart was stopped and my lungs collapsed. After that I was in ICU for 5 days.

Was GE therefore reasonable with the t&c? Just because it wasn't open-chest surgery, therefore it wasn't critical enough?

Put it this way, my cardiologist who lectures, publishes and also featured in the newspapers reacted with "what the fu*k?"

P/S: I dislike seeing doctors and I've never made a single claim on my insurance since 2004 until now.

This post has been edited by wirelessdude: Sep 9 2019, 11:07 PM

First, thank you for posting and sharing what you've went through.

I have 2 questions...

1. Were you claiming from 2 insurance companies for the same medical bill?

2. Based on the surgical cost and all other medical cost, which is about 60k, and with hindsight in mind, would you be better off without having any medical insurance and instead pay the cost out of your own pocket?

Your answer to (2) would be helpful since I don't have medical insurance and believe in self financing my own costs.

From what I heard, the potential medical costs are often exaggerated and overblown to inflate the amount of coverage and hence paying a higher premium than absolutely necessary.

Yes, I did not buy those insurance policies with a "returns" expectation....from the bonus or special bonuses that the insurance companies will gives me at the end of the contract.
I bought into it with that "possible jackpot amount" in mind knowing that my dependents could get from those policies in the event of me getting into any of those illnesses or life/income changing events during the contract terms.

The 1st one I got was in 1992, i got into it bcos I am enticed by ..."we will pay you a sump of at least xxx if you get yourself into any of these yyyy"'s sales pitch then.
Through the years after having seen and judging from health histories of my family members and those that of my friends and colleague's; I think I made a right choice in paying those premiums as part of risk mitigation as part of financial planning tool. I only know about insurance as a risk mitigations and its term/tool used in financial planning last few years (yes from lyn forums )

yes, it is a super long term commitment like marriage.....
have to make adjustment along the way just like marriage too....reviewing and adding more as time goes by....

so far, no complain about low rates of returns except for one time I got the shock of my life when I checked the surrender value in 1997, as a just in case contingency plan during the working insecurity period in the midst of Asia Financial Crisis......
I guess someone had to pay for those "possible jackpot" pay out insurance coverage and the income of those agents and those of the stake holders of these insurance companies.
Just think about the profit margin of those bubble tea we drink, the food we ordered or the durian we eats....I am sure the % of profit margin are very high too if not higher than those of insurance...

This post has been edited by yklooi: Sep 10 2019, 08:02 AM

1. Nope, AFAIK, you can only claim from one. I only have medical coverage with Prudential.

2. Nope, I think medical insurance is worth buying and highly recommended (make sure you buy the waiver too) because the claim is more straightforward. There are fewer T&Cs like certain things not claimable (e.g. consumables, admin fee, etc) and can only claim if xx days before/after the surgery (e.g. my 6-monthly follow-up echo scans will not be claimable).

The total cost at a semi-private hospital is already MYR 60+K; I won't be surprised if it cost MYR 100+K in a fully-private hospital. I read somewhere else on LYF where this guy says he doesn't need medical insurance because he can go to public hospitals. For those which such perception, I urge you to pay a visit to hospitals like HKL and see for yourself first.

However, for critical/life insurance (considering the amount of caveats), I may not buy it on hindsight.

If you look at my medical insurance from a "financial" perspective (approx. values):

Total premium paid = MYR 90,420

What I got/will get in return:
1. Medical claims = MYR 65,000
2. Critical illness = MYR 295,000
3. Cash Value = MYR 53,000
4. Waiver on my policy (up to 100 yrs old) = MYR 409,000*
5. Waiver on my son's policy = MYR 12,000

Total returns = MYR 834,000
ROI = 9.2x

*excluding investment returns.

I hope this thread will help Malaysians make a more informed decision on your insurance needs. Do not believe everything you're sold and do not buy more than you should.

P/S: PM me if you want the contact for my Prudential agent. He's a young, honest and hardworking boy whom I can trust and recommend. He takes care of both my personal and my company's group insurance.

I have the same feeling. And I think hospitals charge higher amounts if they know you are covered ... so the 60k TS was covered could be less if self -paying... another thing is I really question whether certain surgeries are in fact needed.... e.g. many angioplasties are questionable ...

Generally, yes and also depends on which hospital, surgeon and how many opinions you get.
- I had opinions from 3 different cardiologists, who had no vested interest in my surgery.
- the hospital I went to is semi-private.
- my surgeon is an academic.
- of the MYR 50+K surgery cost, my surgeon's fee was only MYR 9+K.

This post has been edited by wirelessdude: Sep 10 2019, 10:30 AM

Before you buy, they happily give you.

Many years after you bought and ask for another copy, they seems reluctant to do so.

you mean it is NOT stated in your printed policy the projection rate used?

Actually the critical illness definition in Malaysia is streamlined across all life insurance companies.

Based on this individual story, I would think that the claim made under Prudential is medical claim while the claim made under Great Eastern is the Critical Illness claim.

While medical claim will cover the surgery cost, critical illness policies stated explicitly that keyhole surgeries is excluded for coronary artery by-pass surgery. This would be the same even for any other life insurance companies in Malaysia, including Prudential.

I would say that the agent does not understand the policy well and did not provide the appropriate advice. Getting the right agent is very important.

earlier there was a post mentioned possible due to the changes to the policy between year where new guidelines were regulated by BNM

Perhaps you should read the thread in its entirety before commenting. I claimed for both medical and critical illness under Prudential.

I thought Critical Illness is paid out upon confirmed diagnosis of any of the 36(?) illnesses stated in the policy.

Only Medical cards will likely has exclusions of type of treatment.

Did Prudential pay your claims for both policies?

^ This

Pls read before comments. Don’t be lazy.

Wow, this sounded like buying insurance for invesment (huge return) instead of protection.
Anyway, you are lucky that you get to claim the critical illness for your key hole surgery as it is clearly and explicitly stated that "Key hole is excluded" for all life insurance.
So, blaming on GE in the first place is not correct as you did not read the T&C of your disclosure properly.

This post has been edited by xiaobaiwm: Jan 16 2021, 10:44 PM