Hahahahaha
Nobody trying to cucuk you la bro.
I truly enjoy your passion on the subject! Keep it up!
I don't know if you will take my word for it.
And I have handled 167 claims so far (and counting) in my decade-long career.
Here's what I can share with you regarding the first 2 years, aka "contestability period" (this is the actual jargon btw):
For easy reference, let's have a distinction between accidental injuries and illnesses.
(I will be skipping first 30-days, 90 days, and 120 days waiting periods)
Like what @lifebalance mentioned, the first 2 years contestability period is there mainly to prevent any fraudulent behavior.
Considering the very generous offerings of Medical Insurance here in Malaysia, I believe we can all agree that this is fair to the insurer as well, kan?
After all, most people in our society are good folks who understand the value of working within boundaries of contracts and laws, so the legal system then protects our rights and interests. :thumbsup:
So what actually happens during the contestability period?
Yes, the insurer reserves the right to investigate. The term is to put your claims on "HOLD", while investigation efforts take place.
So can we all agree that "being put on hold pending investigation" does not carry the same weight as "reject"?
You may ask "Why need to investigate? My policy issued already leh, approved already leh! Now want to play around with me ka? I sue kao you! (followed by colorful expletives)"
During the application process, there is a "Health Questionnaire" that will ask you about your height and weight lah, medical history lah, your parents medical history lah, if you're pregnant lah, got do health screening recently or not lah, etc.
The expectation is for you to answer these questions to the best of your knowledge, and to be as truthful as the truth can be. This is my best effort at giving the definition of "utmost good faith".
So if you did answer these questions to the best of your knowledge, just let the insurer run the investigation.
How does it work?
The insurer will send a simple letter to all the registered and licensed medical facilities in your area, asking if they have records of you ever being diagnosed for whatever that you are claiming for, or anything related.
When all the replies come back negative, then the amount you're claiming for will be released to you.
Quite a fair process, no?
Let's say the insurer really got a reply from one specialist that say "ya, I treated this mofo for this issue before. Here are all the past records. Why ah?"
Then you might as well just surrender the policy if the insurer doesn't auto-void it lah.
So the above is for the part of "illnesses".
What happens then for accidental injuries?
No such thing they won't cover la, just terus masuk.
Just pay attention to the coverage for "Emergency Accidental Injuries"
Outpatient procedures - something simple like sapu ubat only or some simple dressing to prevent infection are generally not covered.
So what constitutes an "accident"?
1. secara tetiba
2. it is violent - blood exit the body where it's not supposed to.
3. external impact - impact from outside the body.
Any combination of 2 out of the 3 listed above, kira accident.
I dunno about other insurers, but for AIA, dengue also kira accident.
Think about it...
Nyamuk land on you - secara tetiba
then the nyamuk sting you - external impact lah tu
The nyamuk suck your blood - blood exit the body
3 out of 3... accident lah
I hope I did shed some light on the issue being discussed.
Sorry lah, a bit long-winded
Comes with age.
Haiyo. In short, just wait 2 years. If less than 2 years basically GL admission likely decline unless it's accident or say dengue. If die die want to admit, pay and claim first lo.