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 Insurance Talk V7!, Your one stop Insurance Discussion

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contestchris
post Oct 14 2024, 04:23 PM

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How does a high deductible standalone medical insurance work?

Let’s say I have a Group medical policy at work that covers me until RM30k. I’m hopeful of being gainfully employed for most of the next say, 20 to 30 years. To supplement my Group medical policy, I decide to purchase a standalone medical policy with a deductible of RM30k.

The idea is that the first RM30k will be covered by my Group medical policy paid for by my employer, while anything beyond that is covered by my personal medical card. My annual premium rates will be reduced by around 70% doing this.

In this scenario, assume life is perfect. Assume no changes in the Group policy. Assume that the policy renewal date matches 100%. And assume that the Group policy is under AIA while the individual medical policy is under Great Eastern. Both have cashless facilities. No exclusions or pre-existing.

How workable is this?

contestchris
post Nov 9 2024, 08:26 AM

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QUOTE(justanovice @ Nov 9 2024, 08:17 AM)
Maybe we get some real feedback.
Abyone who bought ILP, Wholelife insurance  and are satisfied with it ? If yes; why?
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ILP is pure nonsense, but in Malaysia there is one hidden good thing...the tax relief. Rm3k x 25% is a subsidy of rm750 by the government. Next year it climbs to rm4k equivalent to rm1,000 subsidy. It's great to maximise tax benefits and it more than evens out the shitty ILP design.
contestchris
post Nov 9 2024, 01:35 PM

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QUOTE(poweredbydiscuz @ Nov 9 2024, 10:24 AM)
You can get tax relief doesn't matter it's standalone or ILP.
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Yes la but with ILP you can whack gaogao the investment portion. My age group a good medical card (Great Eastern SMS-D-250) is just RM9xx. RM100 for the basic plan coverage. So RM2k goes to investment, subsidised by government. Why not.
contestchris
post Nov 16 2024, 10:39 PM

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QUOTE(kawa_e @ Nov 16 2024, 10:57 AM)
My insurance is summarized as below.  I haven't claim anything yet. I wish I dont have to.
Yes. I hope I could work on it. My salary has been stagnant for some time and below RM3k. There are some stuff happened in my family so I could not even save.

If not mistaken, I did ask for zero fee if admitted to hospital.

Allianz Power Link - RM300/month (will reprice to RM464/month)

Basic sum assured - RM100k. Cover 37y
Total Permanent Disability - RM100k. Till 71y
Prime Care+ - RM50k. Pay & Cover till 100y
Prime Care+ (Cancer Recovery Benefit) - RM17,500k. Pay & Cover till 100y
Prime Care+ (Diabetes Recovery Benefit) - RM10k. Pay & Cover till 100y
Prime Care+ (Catastrophic CI benefit) - RM10k. Pay & Cover till 100y
PACover - RM100k. Cover 37y
PayorCover - RM3600. Cover 37y
PayorCover (ETPD) - RM3600. Cover 37y

Medisafe Infinite (base plan)
Room - RM150
Overal Annual Limit - RM850k. Unlimited lifetime. Maturity 2057. Till 100y
Hospital Asst Fee - Till 100y
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Remove some of the junk like:

Prime Care+ (Diabetes Recovery Benefit) - RM10k. Pay & Cover till 100y
Prime Care+ (Cancer Recovery Benefit) - RM17,500k. Pay & Cover till 100y
PACover - RM100k. Cover 37y
Hospital Asst Fee - Till 100y


contestchris
post Nov 18 2024, 05:47 PM

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Does anybody have Lonpac MediSecure Plus 2015?

Is it a medical card that provides cashless admission, or solely on a pay-and-claim basis?

This policy also comes with a deductible. Can that deductible portion be claimed from another policy, say company's GHS policy (under another insurer)?

Can this policy be stacked on top on an existing policy, be it company's GHS (under another insurer) or own individual medical insurance policy (under another insurer)?
contestchris
post Nov 19 2024, 11:51 AM

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Hi guys,

I'm considering getting a high deductible medical plan (RM20k or RM30k) for my dependents. The logic behind this is:

1. For the next 20 to 30 years, I expect to be gainfully employed most if not all of the time. As such, work would already provide some form of medical coverage via GHS for my dependents.

2. Cost containment. Plans with high deductibles then to be more affordable and also then hit with repricing, tend to have lower quantum of increases. This is because the pool for deductible plans usually comprises of a healthier cohort.

3. Even in the event I am unemployed temporarily, I will have sufficient liquid assets to pay the deductible if the need arises.

My concerns are:

1. Are there cashless plans that allow this? The ones I have seen clearly mention that if I select the deductible option the cashless facility is withdrawn.

2. Can the deductible.amount be claimed from a typical GHS policy?

3. Can 2 GLs be issued, first for GHS policy and then for top up cover from the individual medical plan?

4. What am I missing? What are the other potential drawbacks to this, aside from what I've already mentioned above?

Thanks!

This post has been edited by contestchris: Nov 19 2024, 11:52 AM
contestchris
post Nov 23 2024, 03:34 PM

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QUOTE(mauli74 @ Nov 23 2024, 03:29 PM)
user posted image

Hi everyone , I got an "Guaranteed Upgrade" or "Guaranteed Acceptance Offer" for my medical card from AIA.

Do this upgrade result in excluding protection for pre-existing illness?

Agent said no and it will still cover.

While I am waiting clarification from AIA officials , I'd love to hear from you guys.
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Your pre-existing conditions AFTER your purchased the current AIA medical card (for which you are being offered to be upgraded from) WILL NOT matter.

However, pre-existing conditions BEFORE you purchased the current AIA medical card (for which you are being offered to be upgraded from) WILL obviously continue being excluded from coverage.
contestchris
post Nov 23 2024, 03:42 PM

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QUOTE(Ramjade @ Nov 23 2024, 03:37 PM)
That's the only good thing about AIA. No other insurance company does this. From what I know yes they do cover any pre existing condition.
He is not buying a new one. AIA offers him free upgrade to new insurance plan usually without need to undergo new underwriting. I vae only seen 2 real life examples of such upgrade.
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No, I'm not saying he is buying a new one. I am referring to the purchase date of his current plan.

E.g. if he buy the current plan in 2018. Any pre-existing conditions developed from 2018 onwards will be covered under the newly offered upgraded plan. Any pre-existing conditions from before the purchase date in 2018 will continue to be excluded from the coverage.

This post has been edited by contestchris: Nov 23 2024, 03:44 PM
contestchris
post Dec 2 2024, 04:52 PM

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QUOTE(mauli74 @ Dec 1 2024, 04:32 PM)
Help me understand this.

Say if after I get medical card,
and I will be needing dialysis for the rest of my life which insurer will pay for it.
Do my premium increase due to risk change to insurer?
If not , the insurer will suck the cost by themselves?
If yes , whats stopping insurer to increase my premium slowly/suddenly all the way up to the cost of dialysis?
As other payors in perfect health can get new insurance at lower cost ,  eventually it will be all the unhealthy paying the actual medical expense , premium+fee=medical expense.
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1. As long as you continue paying, the coverage should continue. As such, the insurer will continue paying for it.
2. Your premiums will not increase solely because your risk profile has changed.
3. Nevertheless, the premiums will continue to increase. Known reason: Age band increase. Unknown: Due to medical inflation and claims experience of the cohort.
4. Insurers may temporarily suck losses while they reprice the plan. Insurers are not charity – the end goal is to be profitable and repricing enables them to turn a loss around as the claims experience worsens.
5. As your cohort dwindles due to deaths, lapses/surrenders and switching to newer policies (for those who’s health permits), the claims experience will worsen. Insurers will reprice. And it will worsen further. This is the loss spiral / death spiral of your pool.
6. In a hypothetical scenario, if you were the last remaining member of this pool, then yes the annual premium will approximate the cost of dialysis eventually.

contestchris
post Dec 2 2024, 04:57 PM

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QUOTE(Ramjade @ Dec 1 2024, 06:03 PM)
No. But will increase due to age, medical inflation, decrease of pool money and poor performance of fund (if you take ILP which is like a normal thing)
Some will ask you to pay and claim. Some insurance companies give you GL.
They will increase like recent insurance news. People complaining that insurance increase too much.
Yes. That right. Healthy people can jump to new plan and eventually the pool will just be full of sickly people. Question is are they smart to jump ship?
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You are right that most healthy people don’t know that they can join a healthier pool and reduce their long-run cost of insurance. Often enough, agents scare them into holding 2 medical plans for a 2-year period, known as the “waiting period”.

However, it is a matter of time before this “loophole” gets closed. For one, it is inherently unfair to the less informed. The difference in the later years is not a matter of 10% or 20%, it is exponential!

I foresee that in time to come, BNM will disallow risk pooling by product, and instead get insurers to do an aggregated pooling by age.

contestchris
post Dec 2 2024, 05:17 PM

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Link: https://www.greateasternlife.com/my/en/cust...e-revision.html

This Great Eastern website link is very helpful to understand medical claims trend. Kudos to BNM for mandating insurers to do this beginning next year.

A quick analysis of SM, SMX, SMM and SMS is presented in the table below. These are all the ILP medical plan riders. SMS replaced SMM, which replaced SMX, which itself replaced SM. Hence, these are roughly comparable products, with minor changes in benefits between each iteration.

Notice how the oldest plan has the highest utilization rate AND the highest average claim size. For those with SM, SMX and even SMM – if you are healthy and have no pre-existing conditions that developed since you first bought the plan, UPGRADE! It will pay dividends in the longer run as you will be within a healthier cohort – your rise in premiums due to medical repricing will not be as painful as choosing to remain in your current plan.


user posted image
contestchris
post Dec 2 2024, 05:38 PM

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QUOTE(MUM @ Dec 2 2024, 05:31 PM)
Was the entry premium be the same?
As I think, just think, with each new plan, they have increased the minimum Coverage amount.
A colleague of mine, 2 weeks ago told me that he had bought a new medical plan to supplement his existing plan. He told me it covers millions. I ask him no lower coverage amount, he said agent said "no".
I reminded him to check the projected premium to be paid after age 62. He is now 52
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Of course, the entry premium for each product is not the same due to differing benefits and also different underlying claims and medical cost assumptions.

And you are also right, SM and SMX have a ~10x lower annual limit compared to SMM and SMS. SMM and SMS also come with a small deductible of RM300, might ward off misuse for minor incidents. If anything, I presume under a similar benefit structure, SM and SMX would have even more severe claim amounts – the lower annual limit helps to limit the claims paid in severe cases.

Regardless, the trend is clear to see from the data – those in older plans are claiming more frequently, and the claim amount is also more severe.

contestchris
post Dec 2 2024, 05:42 PM

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QUOTE(MUM @ Dec 2 2024, 05:31 PM)
Was the entry premium be the same?
As I think, just think, with each new plan, they have increased the minimum Coverage amount.
A colleague of mine, 2 weeks ago told me that he had bought a new medical plan to supplement his existing plan. He told me it covers millions. I ask him no lower coverage amount, he said agent said "no".
I reminded him to check the projected premium to be paid after age 62. He is now 52
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Anyways post-repricing, SM premiums are the highest, SMX closely following. SMM also recently repriced higher. SMS still same price as launch.

Can compare. The older products have inferior benefits (such as 10x lower annual limit) but significantly higher premiums compared to the newer products.

This post has been edited by contestchris: Dec 2 2024, 05:46 PM
contestchris
post Dec 3 2024, 05:27 PM

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QUOTE(tweakity @ Dec 3 2024, 10:03 AM)
I was in the SM pool. Received repricing of 100% premium around Nov 2023. So I contacted agent to ask if I can upgrade to new Medical plan. then feedback was cannot. Then i roughly went to website and saw the 10x annual limit plan only require 50% higher premium than my current.
So I just quietly go buy another company's Medical plan with 30% higher premium than my current only.
But doing that, I anticipated New Policy Premium will increase within 1year because Premium is too low for my age. And it happened within 7 months
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Such a pity. Unless you have some pre-existing conditions, your agent is a fraud. And you wasted so much money by buying another plan.

I had SMX and I upgraded to SMS last year. Screw the fucking agent, do it yourself. It's relatively easy. In the process report your agent and let him get suspended or terminated for his antics.

My family member bought SM back in ~2012, upgraded to SMX in 2016, and then SMS earlier this year.

This post has been edited by contestchris: Dec 3 2024, 05:29 PM
contestchris
post Dec 3 2024, 05:39 PM

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Guys for reference.

Great Eastern SMX:

1. Launched in 2016
2. First repricing in 2020
3. Second repricing in 2023

Original Pricing:

user posted image

First Repricing (2020):

user posted image

Second Repricing (2023):

user posted image

This post has been edited by contestchris: Dec 3 2024, 05:40 PM
contestchris
post Dec 3 2024, 05:43 PM

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Meanwhile, this is the current rates for SMS. It is superior in every way to SMX, with the exception of a small RM300 deductible. Annual limit is roughly 10x SMX.

It is a no-brainer for all healthy SM, SMX and SMM customer to switch to SMS, since it is cheaper and yet provides superior benefits!

user posted image
contestchris
post Dec 3 2024, 05:56 PM

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The policies are comparable, save for the following differences. Summary of differences:

Annual Limit: SMX annual limit between RM90k to RM200k while SMS annual limit between RM1.0mil to RM2.0mil

R&B: For SMX, no increases. For SMS, 10% increase every 3 years up to 100% maximum.

R&B: For SMX, limit to 180 days per year. For SMS, no limit per year.

ICU: For SMX, limit to 180 days per year. For SMS, limit to 200 days per year.

Pre-hospitalisation coverage: For SMX, 60 days. For SMS, 90 days.

Outpatient Imaging (MRI/PET): For SMX, nil. For SMS, RM5,000 per year.

Intraocular lens: For SMX, RM2k per lifetime. For SMS, RM8k per lifetime.

Medical report: For SMX, nil. For SMS, RM200.

Deductible: For SMX, nil. For SMS, RM300 per disability.

Clear to see SMS is superior in every way except for the deductible.

-------------------------

SMX Benefits:

user posted image

user posted image

---------

SMS Benefits:


user posted image

user posted image

user posted image
contestchris
post Dec 3 2024, 06:45 PM

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QUOTE(hafizmamak85 @ Dec 3 2024, 06:32 PM)


Reply to 5
There is no other reason for cohort to dwindle in size if not because of the closed block approach by insurers. And why do these champions close the block to new business??? Why can't they just give everyone a free upgrade or augmentation to the coverage and continue onboarding new policies. Cause, aside from the reasons in reply 4, these insurers are scared that the block is suey already - e.g. due to being exposed to covid, so they isolate them, hike up premiums / COI to kasi all the "konon healthy" or no claim lives to cabut to a newer block with better experience and pricing. Last-last, the ones that tinggal in the block will scream bloody murder due to the price increase and may have to lapse their policy if they can't afford it or can't jump to a newer pool because kena reject or where the re-underwritten COI charges are higher.

Take GE. This is classic unethical, embarrassing behaviour from the insurer. What bloody nonsense la, first come up with SMM in 2019 and three years later SMS. Before that SMX and SM. There is no good reason on this godly earth to have so many series in the first place. One every three - four years. Look at the jump in utilisation rate. Gila wei. What was the block's initial pricing expected long term stable utilisation? Was it above 5%? They should have never issued such products where the stable expected utilisation is above 5%. Let the insurer bear all the financial  burden. period.


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My friend, this is how the industry does it. BNM is well aware.

I personally believe this is not fair to older customers. By closing the book, you subject them to the loss spiral / death spiral of the cohort.

But BNM gives their tacit approval to insurers. They're all doing it not just Great Eastern.

In the end, loyal long-term less-informed customers will bear the brunt of it. They end up subsidising the pool while they're healthy, only to lose out on the same subsidy from healthy newcomers when they get unhealthy at some point in the future.

How come no media outlet has picked up on this unfair practice? BNM talks so much about treating customers fairly, about vulnerable customers...why are they tacitly approving such underhanded practices from insurers?

Also, BTW all insurers reprice medical with a profit margin in mind.
contestchris
post Dec 3 2024, 08:30 PM

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QUOTE(hafizmamak85 @ Dec 3 2024, 07:25 PM)
.
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Right on.

My ideal proposal is that:

1. there must not be ANY DISCRIMINATION in the pricing between ohorts. No such thing as old or new cohort. No closed blocks. They must all be aggregated in a single block with the only rating factors as age, sex and occupation class.

2. Pre-existing conditions must be covered.

This post has been edited by contestchris: Dec 3 2024, 08:30 PM
contestchris
post Dec 4 2024, 10:25 AM

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QUOTE(Euler @ Dec 4 2024, 10:19 AM)
No right or wrong here, but the more you include, it will be beneficial for the minority, at the cost of majority.
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Today's majority become tomorrow's minority.

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