so, any lawyer that I can contact to join class action?

I dont want to burst your bubble. You dont realize we are living in a shithole country. Class Action, isnt this something only available to  developed countries with respectable judiciary?

I am ready to join.

So, where can I join?

1 Jul is coming soon. All insurance policy owners need to be prepared for this.

And you are right, BNM are making policies detrimental  to its own citizens. It has commit treason to this country.

What happens if, after attending the SMART clinic and receiving a referral to a SMART-affiliated hospital, I choose to go to a hospital that is not on the SMART panel? Will I be required to pay 20% of the total bill? Did a check and found the nearest and my favourite hospital is not in the list.

AIA has no right to discriminate against your choice of health service provider by levying an arbitrary 20% co-pay requirement solely because you did not follow the treatment process laid out by them or opt for their preferred service provider.

They can't impose an arbitrary co-pay for the medical claim if the medical treatment was medically necessary and the fees/charges were reasonable and customary.

Even if hospital groups were to tie up with digital insurers and takaful operators and their preferred TPAs, they can't deny a claim or arbitrarily impose restrictions on claimable amounts if treatments sought outside the group met the medically necessary and reasonable and customary standards.

Just as an insurer or takaful operator would have to approve a medical reimbursement claim, even if it was from a blacklisted doctor and/or medical service provider, if the above standards were met, the same thought process applies.

There is no relationship between the reduction in premium amount and the smart option track other than the expectation the smart option track would help reduce overall claims by hopefully limiting medically unnecessary claims and unreasonable and uncustomary fees/charges.

However, AIA smart option track does not have monopoly on the determination on what is medically necessary and reasonable and customary fees/charges.

The determination of what is medically necessary and reasonable  and customary excludes the AIA smart option track consideration.

The contract underpinning the AIA smart option track is still based on  coverage for medically necessary treatments/procedures based on reasonable/customary fees/charges regardless of who the health service provider is.

It doesn't make any sense to impose an arbitrary and unfair 20% co-pay on non smart option track claims if the claims fulfill the medically necessary and reasonable/customary standards.

There is a very high chance that consumers don't even know that they are being sold or propositioned a smart option track policy. Agents may push it as a default option on account of it being cheaper.

One agent even gave the impression that the smart option track may have been a result of BNM's push for cost containment measures.

Regardless of the option chosen, whether it's a smart or non-smart option track, the point still stands. There can be no unfair terms in the contract and the 20% co-pay for non smart option track medical treatments/procedures is unfair/arbitrary.

Does that SMART Option really require going to the panel clinic first? If there's an emergency case like difficulty breathing, I think it’s better to go straight to the hospital

ILP is designed to hopefully pay for your insurance down the road. So you need something that can compound at least at EPF returns over long period of time.

Unfortunately those funds offered by insurance companies are rubbish.

If you buy a mixed fund, the fund manager suppose to rebalance for you. If you buy a fixed income, then the fund can only invest in bonds.

We now have another Teflon champion. Prudential's net profit for the 2024 financial year has risen to RM 1.13 billion from RM 0.96 billion in 2023.

No sign of medical inflation impacting profits.

Very very strange 🤔.

Still waiting for AIA to upload their annual report.


These champions also paid dividends as well. RM 100 million. The new minority owners may or may not be happy. Wasn't as high as previous years 😂.



Should ban the big three (AIA, PRU, GE) from paying dividends until they've stopped all ILP repricing measures & fully reserved for the negative balance clearance mechanism.

It's not just the big three.

All the other ITOs (Allianz, Zurich, HLA, Etiqa, Tokio Marine etc.) need to be banned from paying dividends.

All ITOs need to stop all ILP repricing measures and fully reserve for a negative balance clearance mechanism.

Gathercare has a 5 year!!!! waiting period before treatments/procedures relating to pre-existing conditions may be claimed.



This is a ridiculously loong period. If you want to minimize the risk to the system from being gamed, wouldn't a 2 year waiting period - or something less than that - for specified pre-existing conditions (PECs) acknowledged by both parties (person covered and the ITO/administrator), be sufficient?

They already accept claims for all kinds of critical illnesses - for which medical bills can be shared after a 180 day waiting period. So why bother with the harsh PEC waiting period and termination penalty for non-disclosure?????





Even if you had been a carer for more than 2 years, Gathercare also doesn't require fraud to be present for a PEC claim to be sufficient grounds for membership termination - a careless or innocent PEC claim is sufficient grounds (in Gathercare's eyes) for membership termination.

Life policies can't be contested after 2 years unless fraudulent disclosure/non-disclosure is present.



Even FSA requires for a differentiated approach for careless/innocent  disclosure/non-disclosure  involving 2 year or less life policies.

Hi all insurance sifus,

Recently i just received love letter from Allianz regarding premium increase for my HealthInsured Zero Deductible medical card , which amounts to 49.0% of current total premium that will be staggered evenly across 5 years.

I won't accept this shit, so I’m planning to switch to a RM30k deductible plan instead. To cover the deductible portion, I’m considering getting a simple standalone medical card from Kaotim (RM50k annual limit, zero deductible). Based on my calculations, the total cost of both plans will still looks more cost-effective than sticking with the Allianz zero deductible plan.

However, I'm unsure about how both policies would interact in a claim situation — especially whether Kaotim’s coverage can fulfill the deductible requirement for Allianz.

Let's me put a simple scenario with a hospital bill RM50k to illustrate:

Option 1:
- First, use Kaotim card to settled the RM50k bill
- Second, submit RM30k deductible to Allianz
Question: Will the amount settled by Kaotim qualified as "deductible" for Allianz?

Option 2:
- First, pay RM30k out of pocket and the another RM20k settled by Allianz.
- Claim back the RM30k paid before from Kaotim on reimbursement basis
Question: Will Kaotim accept my claim since i already use the Allianz medical card for admission?

Appreciated if any insurance sifus here can advise whether if both option or any one option above will work. Is this a practical setup? Anyone has done this before in the industry? P.S. I'm aware that a EB (Employee Benefit) plan will work this way but I'm not having EB.

Thanks in advance!

Questions

1. Anyone using Etiqa Medical Card? Is it good?

There are two main choices:
- OneMedical
- Critical Care Plus

I am thinking of getting OneMedical. Got coverage 150k up to 85yrs old. Hopefully died peacefully before then, but will it be sufficient?

2. TripCare 360 Insurance - For Intl travel with elders, is silver or gold better? I feel silver RM100k is sufficient.

Just because you or a few others think my posts are 'unreadable' does not mean that there aren't others who see value and find them readable.

I've put plenty spoilers to shorter the posts.

We don't want the insurance talk V7 thread to be a place where only points of views championing insurers are paraded.

Otherwise this thread is just going to be a one note where everytime medical repricing or some other major insurance related matter gets mentioned, it's always championing the insurer's rights or viewpoints.

For the past few weeks not many of you have posted much. Just one or two matters related to insurance, there rest were all just small talk.

How do my posts hinder anyone else from posting or reading other posts???

You are just creating a problem when there is none because you clearly don't jive with my views.

You think insurer's aren't really out there cheating people but I'm sorry to tell you that that is just plain wrong.

Just because there exist a regulator doesn't mean the regulator has done its job.

We are here to be a voice for the people.

To give them the relevant information they need so that they can take action and I'm sorry to say, this may actually mean suing the insurer and / or regulator.

So please, stop laying blame on me. I'm not hindering anyone from posting anything about current insurance policies or other alternatives.

This thread is called insurance talk. All the matters I bring up are relevant and are of interest to the public.

Let's try to get Koh Yaw Hui or Great Eastern to respond to all the issues I'm raising if he and GE think they are right.

Why are they so afraid. Freedom of Information Act will be tabled soon.

Sooner or later they will have to come clean.

Guys, want to know how much % portion of your cash value based on monthly premium?
For example, your medical will retain certain amount of cash value (based in certain %) since 1st month of purchase.

I noticed certain insurance plan will have different cash value allocation.

You do your calculation and whether all of us having similar cash value allocation or there are big gaps. My table is for illustration only.

saw on rednote many bought a plan called wealth elite AIA from public bank, bank staff promised pay for 5 years only then can enjoy the coverage till 99 years old and after 5 years u can withdraw anytime with the interest of around 5-8% pa

but I witness many cases on the 5th year when they want to withdraw, loss about 30%

sadly the product sell by bank on behalf for insurance compay all are as investment product
cuz banker need to hit high sales target which is impossible to achieve by selling medical card alone

end up agent is actually more ethical

maybe this has mentioned before somewhere in this thread, but I guess won't hurt to ask again 

basically, AIA has sent revision letter recently, and you'd guessed it, it's about price hike. they're giving reason along the line of "rising medical costs", and not the first time this has happened (precisely this will be the 2nd time).

back in 2024, my insurance premium rose from 3k/annum to 3.6k. aight fine. then very shortly after, BNM released interim measures to curb premium adjustments till 2026 (I don't have full knowledge of what was outlined in the list of measures taken)

this month AIA sent this revision letter about another readjustment, stating that for the 26-27 premium payable will be increased by ~6% to >3.8k/annum. then further forecasting that in 27-28, it'll be >4.1k (7.5% hike relative to the previous year), 28-29 it'll be >4.4k (another 7% hike relative to the previous year).

it's even worse for older age people like my parent (>60yo, also using AIA), the relative hike is >10% for 2027 and 2028, and on 2028 onwards the premium hikes to >10k/annum, compared to 6k/annum in 2023 (2024 hiked to 7.5k). it would grow to almost 70% hike for 2028.

though, there's a statement mentioning "please note that the premiums payable from policy anniversary in 2027 and 2028 are indicative and not guaranteed and may be subject to change"

the vague question that I wanna ask, is this really normal? the hike is way too high and I don't think it's actually following the inflation rate (ofc I don't think, but reality may be different)
has anyone also received similar revision letter around this year, in a format where they forecast the premium hike for the next few years?

more info: this is about A-Plus Health, part of A-LifeLink 2 life insurance.

trust me those bank staff are not train to help client to process claim
in fact majority of them will just ask client to call the insurance company themselves 

Im talking about the majority here

Majority bank staff don't know a single thing at all regarding insurance claim
They can't even handle simple medical card claim

those who bought from bank actually not planning to buy from the start
they just walk into bank and wanna put fd but got sweet talked by bank staff who presentation focus more on return & investment

then when client want to withdraw only realised they bought insurance or realise the money they can get back is far less from what they have deposited

especially the chinese bank