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 Insurance Talk V7!, Your one stop Insurance Discussion

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contestchris
post Dec 9 2025, 03:16 PM

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QUOTE(Ramjade @ Dec 8 2025, 01:33 PM)
My guess is they want to cancel his insurance. See if he commited fraud. Cause lots of people commited fraud by not declaring any illness before hand. Insurance companies never have your best interest at heart.

Cause if he commited fraud, then no need to cover him anymore. Covering him means future losses for insurance company whenever he gets admitted and the bill goes up be due to high blood pressure side effects.
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Dude, for medical business, the claims are paid from a pool of funds made up by your and my funds. The insurance company doesn't suffer losses, unless they fail to price or reprice the product properly. It is we policyholders who bear the burden of fraudulent claims.

This post has been edited by contestchris: Dec 9 2025, 03:16 PM
contestchris
post Dec 9 2025, 03:24 PM

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Word is that Bank Negara is planning to forbid the sale of medical riders with ILP plans, given that the entire fiasco about premiums not being sufficient and sustainability issues is mainly caused by the repricing of the attached medical rider.

Instead, Bank Negara is working with insurers to create a "basic" standalone medical plan for all Malaysians - the basic plan will be largely standardized across all insurers.

For now, my suggestion would be to keep your medical policies in-force. I can only assume those with in-force policies could transition to the new basic medical plan without medical underwriting, while others will need to go through medical underwriting. Hopefully, this measure also makes medical plans more portable, i.e. you can move from insurer to insurer every year without any new/additional underwriting.

https://theedgemalaysia.com/node/784885
contestchris
post Dec 9 2025, 05:00 PM

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QUOTE(Wedchar2912 @ Dec 9 2025, 03:52 PM)
hopefully bnm to make the basic medical plan with guaranteed issue. ie accept everyone regardless... ie no selective exclusion due to age, existing illness, background etc.
almost like open enrollment... a form of NHS?

now that would be great.... i don't mind a large deductible like 100K rm if the coverage can cover the upside...
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I don't think we can cover pre-existing illnesses just yet, though I wish we could. The issue would be anti-selection risk then - no healthy person has any incentive to buy insurance, cause why pay when you're healthy? Just wait till you get sick and buy a policy. There needs to be a mechanism to equalise this. Either force everyone to buy insurance, or follow the American model - you can only buy in December. Still covering pre-exiting illness will increase insurance costs by 3x to 10x as all the very sick, elderly people, terminal illness etc will buy and the young an healthy will have to pay for them.
contestchris
post Dec 9 2025, 08:51 PM

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QUOTE(Wedchar2912 @ Dec 9 2025, 07:12 PM)
actually, since this is a initiative by the gov (and i think also in partnership with private sectors), why not? as is, our GH will accept anyone and everyone regardless (no discrimination on age, existing conditions, sex, employment, etc).

So this coverage can work... of course, the experts have to work it out. I am aware of how powerful deductibiles can be in terms of pricing, hence I just mentioned it.
At worse, like you said, we follow the american model or NHS or Medicare system. But then it becomes a taxation system yet again.
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The question remains, who is going to fund the private healthcare expenses of people with PRE-EXISTING illness? The money doesn't drop from the sky. Currently it is purely funded by policyholders. The only other option is for the government to fund it.

But why will government fund people with substandard health to go to private? Better they put that money to better use and improve the government hospitals.
contestchris
post Dec 9 2025, 09:38 PM

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QUOTE(Wedchar2912 @ Dec 9 2025, 09:26 PM)
It can be government-subsidised, or even self-sustaining if the risk pool is enlarged and super diverse. Ie similar to company group insurance. When claims are high, premiums rise (which are effectively part of employee compensation). When employees are healthier, the savings can benefit everyone.
(which made me wonder: i've never heard of a older sick employee being told that the company insurance will not cover said person... have anyone?)

There are also other ways to support coverage for people with pre-existing conditions: targeted taxes (reduced tax rate for the insurance firm), incentives for hospitals, or basic service obligations for specialists.

The key point of a basic medical card should be affordability with super broad coverage, not just serving those who can already pay. Otherwise, it defeats the purpose.

This would also help ease pressure on government hospitals by shifting those who can afford private care (if the cost is cheap enough) out of the public system, rather than everyone queuing up cos it is only 1rm.
(there are definitely fat to be redeployed... since almost everyone is complaining about medical insurance being too expensive. who knows... take away agent's 1XX% commission and throw that back into the pool... lol)
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That’s not a fair comparison. Group insurance is fairly expensive because it does cover pre existing illness. Also, Group medical insurance is priced in such a manner that it reflects the claims experience of that particular group. So say Company A and Company B both have 10,000 employees. The quotation at every renewal changes depending on their medical claims experience. If Company A claims more frequently and higher average claims size, their renewal premiums will increase accordingly.

Diverse insurance pool is good, but trust me most healthy people will cease buying medical insurance when they are young precisely because they can still buy it later on with no penalty when their health deteriorates

If it is government subsidised, that’s still money the government is pumping into the private sector.
contestchris
post Dec 15 2025, 04:12 PM

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QUOTE(Ramjade @ Dec 15 2025, 03:36 PM)
Why want to be investigated like a criminal when you paid your dues and time for insurance company to pay their part. Their take the money so they must pay out their share as we are transfering the risk.

Sorry I don't want to be treated like a criminal and insurance investigate like I committed some crime. When I want to use the insurance, I expect them to pay out and no delays, deny and asking me to pay and claim first.
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Ramjade sir, that is in an ideal world. But I have family and friends, who openly claim that they applied for insurance AFTER they discovered they had some major underlying health problem. In all case, either they collude with agent/doctor and lie, or lie on their own pandai pandai. Sadly, as far as I know, all these jokers got their payouts. This was around 4-5 years ago though. It is because of these scoundrels, that the medical pool is being put under stress.

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