7.4% multiplied by RM 14.6k is only slightly less than RM 1100. On average, how much cost of insurance charges is Prudential taking in every year for each policyholder?????

Good enough to make at least RM 1 bil per annum in net profits. Prudential's equity went up from RM 1.7 billion in 2018 to RM 6.6 billion in 2023, and this is after deducting RM 2.3 billion in dividends during the same period (2019 - 2023). And hospitals are the villains????




Does anyone here know if the average Prudential IL policy (with medical) can be bought for less than RM2k ??? Forget the low prices quoted in social media, Prudential is probably at the higher end when it comes to IL pricing and the way these champions market to women, there's a few PHD worth research topics there.

This post has been edited by hafizmamak85: Mar 23 2025, 02:58 PM

Any suggestion or summary ?

What steps can we do in these days so not just the hospitals or insurance company nakes a killing of us ?

Unfortunately, for those currently with long-term medical policies, other that suing the ITOs and BNM for unjustifiable and unfair premium hikes, there is nothing much we, as in the public, can do.

But, there is something that can be done by hospitals and specialist centres. They can approach these fledgling digital insurers and takaful operators with a 'friendly' third party administrator, if there is such a thing, and propose to partner in the provision of high coverage medical insurance products for the general public at affordable prices. Get rid of the Big Three's (AIA, PRU and GELM) monopoly and the other mini kootus (Allianz, Hong Leong Assurance etc.).

APHM (private hospitals association) and the specialist centres can tell the DITOs and TPAs, "we'll 'promise' or at least try to keep our costs low but you guys need to do something for us. Get rid of the inner limits and just compete on annual/lifetime limits and R&B, but make them all above 1 mil coverages with or without deductibles/co-pays for all medically necessary treatments/procedures. Cover all medical devices/surgical implants, advanced treatments/procedures, with no exclusions and include coverage for all age groups and pre-existing conditions - no linking of R&B coverage with coverage for treatments/procedures, every type of R&B gets the same level and type of medical care. In exchange, the hospitals and specialists will lower the margins embedded in hospital supplies and services and push some of it back into R&B pricing."

Something tells me that even if all age groups and lives with pre existing conditions were covered, the product would still be affordable. It only costs RM 3100 for a 35 yr old to have a full cover medical card with 12.1 claimants per 100 policyholders and average medical bill size per claimant of RM 25.4k.








Just look at the ridiculous amounts the BIG three are earning in net profits. Over RM 23 billion within 6 years (2018 - 2023). And they managed to pay out nearly RM 13 billion in dividends/capital reduction during that period. The funny thing is GELM made RM 6.2 billion during the same period and paid out the same amount in dividends. 100% dividend payout - if earnings account for adjustments.




This post has been edited by hafizmamak85: Apr 22 2025, 02:43 PM

How could hospitals dictate especially with the ITOs as paymasters ? In fact a few well known hospitals have been removed from the panel listing of a few big ITOs.

On the premium calculation, i suspect the ITOs computed a low assumption thus when claims went up and the amount soared they quickly revised their premium to a more updated premium.

Perhaps govt could mandate max profit margin for hospitals and ITOs on the very extreme case. Alternatively impose that only allow very high deductible products exist such as maybe 20k so reduces unnecessary claims and hospitals also be weary to charge excessive. Thus changing the entire medical coverage landscape in Msia.

Else i dont see how things will change. Companies will want to profit and consumer behaviours wont change on its on.

The hospitals and specialist centres can, in a sense, 'dictate' because they are the product/resource/service the money will have to follow. The only problem, there's a strong monopoly within the ITO industry due to the agency structure, which allows the ITOs to bully the hospitals.

This issue has been in the making for many years because past and current governments failed at painting for us, the public, the true picture in relation to healthcare costs and the true state of KKM. It's untenable for the government to provide free healthcare for everyone and the ones who have to pay (above 10k households) will have to wake up to the rude reality of having to fork out at least RM6k per annum to cover their families (this is even with high deductibles like RM5k).

Which is why I proposed for hospitals and specialist centres to tie up with digital insurers and takaful operators, the new upstarts, who have a low cost base and are not encumbered by the agency structure. Plus DITOs don't have a large number of policyholders to throw their weight around and dictate terms to hospitals/specialist centres. Both DITOs and hospitals/specialist centres will find it in their best interests to tie up as they are in many ways weak without the other party but stronger together. Of course, goes without saying, they both need to find an acceptable third party administrator.

And oh, I forgot the best part, the hospitals/specialists can sweeten the pot by offering the DITOs to do a medical check up on the potential policyholder prior to onboarding at either low rates or for free. Right now, consumers are not required to answer health questionnaires or do medical check-ups but are still subjected to pre-existing condition exclusions and wrong disclosures with agents may be held against them (e.g. on health condition, weight, height, smoker status etc.). The questions asked by agents, who themselves are not medical professionals, are asked and answered in conversational 'tepuk dada, tanya selera' kinda way where if you 'feel' like your health condition is good, you declare it to the agent to be good and if you feel you're not a smoker, you declare you're not a smoker. There's nothing specific to be answered about family health history, any previous history of blood pressure spikes or readings of high cholesterol /sugar levels and take up of related medications. Rather than having a pointing fingers contest later on, it's just much better for the industry to cover all pre-existing conditions and get a full medical check up done prior to onboarding to gauge overall risk exposure levels













Yes, the entrenched ITOs with their problematic agency force underpriced or mispriced their investment-linked products because they know they can only sell it with medical cover within the RM5k range if they squeezed the hospital coverage component. In many ways this has always been a battle between the producer and supplier/distributor. Most people buy investment-linked policies because they want medical coverage during their old age but soon find that it is not possible without massive top ups due not only to the high and untenable cost of insurance charges, but mainly because their policies' investment/savings component failed to perform in line with expectations. Mispricing/underpricing and failure of contract performance, in line with expectations, are the many ways in which the system has been gamed against consumers/policyholders.

Let's say you are a 'good' actor (ITO wanting to provide medical coverage for all age groups, pre-existing conditions etc. at affordable prices) and I'm the 'bad' actor (ITO wanting to maximize profit). If you practice simplified underwriting, partial community rating, coverage for pre-existing conditions etc., all I have to do to upset your apple cart and gain the upper hand is focus on the younger ages, below 60, and practice competitive pricing, stringent underwriting&claims and provide massive amounts no claim discounts. It's possible for me to suck up all the good lives and leave you with a poorly performing medical portfolio. There is a sweet spot between this good and bad actor that the regulator has to nail. Medical is the anchor product. But this anchor has got a significant social element in it, so can't be amenable to a purely profit maximizing enterprise. The rules may have to be designed or gamed to slightly favour the 'good' actor - e.g. introduce rules saying that medical insurance products must cover all ages and must have partial community rating where the price ratio between the highest and lowest priced policies cannot exceed X and no lives can be turned away, everyone must be provided a quotation for cover and there must be portability of coverage from one insurer to another etc.. This would be preferable rather than limitation on profits but it would also be wise to have minimum claims ratio requirements especially when products are sold on a bouquet basis, e.g. overall claims ratio must be above 85% or something like that.

The problem with a 20k deductible is that it is too high. 5k is only half a month's income in a 10k income per month household and it's possible to take frequent hits, e.g. 3 per decade, with a lower deductible amount without crushing the family's financial resources. This is a volume game and we need as many households to be able to participate. Best to have at least 3 million households. Hopefully the deductible also helps further lower the frequency of claims effectively. And to support these households and incentivise them to purchase insurance, employers should perhaps be mandated to pay extra into EPF maybe something like 2 to 3k per annum for these staff's medical expenses - locked up in EPF and can only be used for purchase of medical insurance and/or to pay for medical bills. Also, we have nearly or more than 7 million IL policies paying over RM 4k per annum. So, there is demand for this and instead of employers paying for group insurance, might as well pay the employee to manage their own family's medical expenses.



This post has been edited by hafizmamak85: Mar 24 2025, 01:34 AM

let's say car loan outstanding 80k, but current market value of the car is 100k.. is it ok to just to get bare min agreed value of 80k during renewal?

I was quoted RM500 + RM200 loading for this GE ILP plan.

Is this quotation fair/reasonable for medical insurance based on my profile/background?

Age - 36
Existing conditions - previous history of mild hypertension (currently normal range), blood sugar at pre-diabetic range + slightly high BMI
Existing medical insurance - very old/outdated AIA standalone plan at 110k annual limit and 330k lifetime limit
Insurance/Take home salary ratio - around 10%

This post has been edited by tzxsean: Mar 24 2025, 07:42 PM

Is it possible for you to take medications to control it to within normal range 3 months BEFORE applying for the plan?
If they wanted you to redo the test, then redo it....perhaps you can save 40% of the premium.
Premium 500, loading 200 = abt 40% more.

Just remember to declare them as under medication control. ( or things like that. Just ask the agent??)

This post has been edited by MUM: Mar 24 2025, 07:44 PM

I'm not under any medication for the blood sugar currently

I already applied for the plan unfortunately and had urine test (first test) initially, before being requested for blood test (2nd test) 1 week later.

I can afford it but just want to have 2nd / 3rd opinion whether the quotation is fair/reasonable on the coverage provided

This post has been edited by tzxsean: Mar 24 2025, 07:48 PM

Not a medical adviser, but I think
mild hypertension, blood sugar at pre-diabetic range
Should hv medication or ways to control it.
Remember to check the cholesterol level too. Control it if have to, to be within normal range too.

40% more premium will add up to alot when you are older.

On your this, "I can afford it but just want to have 2nd / 3rd opinion whether the quotation is fair/reasonable on the coverage provided?".
Premium quoted will be subjected to frequent changes. Thus, What is fair or good NOW may become NOT few years down the road.

This post has been edited by MUM: Mar 24 2025, 07:51 PM

why don't you just upgrade your AIA plan? My old AIA plan also 100k annual limit, now upgraded to 1 million. Monthly premium 170 -> 220.

Being pre-diabetic is something that a significant number of Malaysians face. Great Eastern has more than 1 million IL policyholders and, regardless of underwriting stringency, I would be surprised if their medical pool doesn't have the same or similar levels of exposure to morbidities as that of the national population.

You are currently being asked to pay RM 700 per month (which includes an additional RM 200 per month loading) or RM 8400 per annum for medical cover, death/TPD benefits of RM 100k and RM 200k in critical illness coverage.

I'm also assuming you are being offered the Smart Health Protector (SHP) Plan (with RM 500 deductible). While GE has yet to publish the proportion of claimants and the average claim amount per claimant for the SHP plan, I would like to draw your attention to Smart Medic Shield's and GE's overall claim experience.

Based on what you see below, the average medical pool claims cost is only RM 558 for Smart Medic Shield (8.9% multiplied by RM 6.3k) and RM 727 for GE's overall medical pool (8.3% multiplied by RM 8.8k). And the claims cost per policyholder for the rest of the coverage (RM 100k for death/TPD and RM200k critical illness) may only be less than RM 500. Which could mean a total claims cost per policyholder of less than RM 1300. Is it worth paying RM 8400 per annum for such a low payout (RM 1300)???





A plan, with no deductible, that has an average medical pool claims cost of RM 3100 (12.1 claimants per 100 policyholders, with average claim size per claimant of RM 25.4k), death/TPD coverage of RM 200k and critical illness cover up to RM 200k would reasonably cost only around RM 4.2k.

Is the quotation fair? A hard no, for me.



This post has been edited by hafizmamak85: Mar 25 2025, 03:55 PM

Our fellow forumer is already less than standard case. Shouldn't your computation factor in the substandard situation ?

Can you help to assess based on his specific condition instead of general pool of GE’s claims % ? Then he would be able to make a better informed decision.

My worry is difficulty in getting additional insurance if his condition or age deteriorates as hes not under medication. Once HBP and DM kicks in, in sure you know the chances of getting even insured.

Along with other complications to the entire system, HBP and DM are no joke. Very common among Malaysians and insurance companies are very weary of the high claims and coat of this two lifelong multi organ multi system impacting disease.

Coming from an underwriting background, i find it impressive that GE was able to offer u a medical card. Some may just straight decline your medical rider.

I am not able to offer u any advise on whether it is fair in terms of pricing, however i did a quick check with my employers rate.

Assuming u (36/male non smoker) with similar sum assured and riders, were offered substd of +50% on only the medical rider costs , the pricing would be similar to my employer's.

I do not know how the rate will change in the future if u decide to wait for better decision (assuming your health maintains the same risk). Pre-diabetes is quite common and is usually treated with just lifestyle modifications. However it is the precursor to diabetes, in which you wont be able to get any medical card.

Future medical researches in terms of morbidity etc may end up convincing the insurance company to give you a better rate. Or maybe along the line, insurance company may act more stingy and be risk averse when it comes to this current economy.

Very good. We need to ask: what is a fair rate for a substandard life?

The current industry practice when it comes to the application of loading factors for substandard lives (high BMI, heavy smoker, present comorbidities) is to rely on loading rates as embedded within their underwriting engine. The underwriting engine and loading rates are supplied by foreign reinsurers operating in Malaysia. These rates have not been tested to see if they are appropriate for our local population. It may be too high - but we can't be certain until a proper study is done.

Having said that, I would like to posit that whether it be for death, disability or medical coverage, community rating can still be acceptable and that there is no need for loading factors to be applied. In fact, the only rating differentials that need be applied can be limited to just age and sex. Age bands for medical coverage, attained age & sex for death & disability coverage.

The most important aspect is for the medical or life pool to have a large base reflective of the population's morbidities.

Cancer incidence rate is less than 50k per annum and even if we boost it up to 150k needing treatment per annum it still is only about 5000 per 1 million population needing treatment.

There are about 50k people needing dialysis every year and even if we assume 100k needing dialysis that comes to only about 3300 per million lives needing dialysis.

About 350k OKUs have visual, hearing and physical disabilities or about 12k per million lives. Let's say about 50% of them need to be kitted out with medical devices/prosthetics and receive further treatment every year, so that's 6k per million lives.

For heart disease, maybe it's less than 100k people needing treatment per annum, and that comes to about 3300 per million lives.

If you take all these high risk groups and tally them together, they only come to around 17600 per million lives or 1.8 per 100 policyholders needing treatment/medical equipment. The pricing I had in mind, which may be on the higher end had accounted for 3 per 100 policyholders needing above 30k medical care, with an average bill size of RM80k. And it only cost RM3100, without deductible, for someone between the ages of 20 and 40.

So, I still think a substandard life can get 200k death/TPD, up to 200k disability, and a really high powered medical card all for RM 4200 per annum.

What choices does he has then ? Argue and get better rate and if fails not to be insured despite being substandard and might not be able to get coverage in future ?

I think u need to see from the lense of case to case basis rather than industry wide, company wide or country wide. I think such opinion are not much appreciated here.

Really no need to quote unnecessarily screenshots of the data whitout the actual source.

Malaysians are not incapable of understanding this data. It just needs to be explained to them. And they have a stake in it.

Let me ask you, if everyone is dehydrated due to not having enough water to drink, what use is it pointing to a poisoned well? That's the unfortunate state of life & medical insurance in Malaysia. They bleed you dry for small token payments. The industry needs a complete overhaul.

https://www.moh.gov.my/moh/resources/Penerb..._2023_Final.pdf

https://www.dosm.gov.my/portal-main/downloads-log?id=9057

https://nci.moh.gov.my/images/pdf_folder/SU...T-2017-2021.pdf

https://www.malaysianheart.org/news-updates...year-2020-20212

As for the forummer's immediate predicament, I can only wish that the government and industry quickly finds a fair and acceptable solution to this unjust situation. 8400 ringgit is just too much and there is another danger, when premiums are hiked later on in a medical repricing scenario, there will be an additional compounding effect due to the loading factors.





If not for the profitability of medical insurance products, they would not be promoting it WITH GOLD BARS!!!!!!!

This post has been edited by hafizmamak85: Mar 27 2025, 04:29 PM

I hope you can understand where im coming from. Im not arguing with you how the ITO landscape is, how you wanna influence and share your deep understanding how they are mistreating us consumers.

There are times u need to come and see from the lense of an individual especially in this case of the forumer. I still dint see a concrete suggestion to secure his coverage and protection. Instead tens and tens of links and citations.

There are times we should discuss and voice your beef about ITOs, but there ate times to come fown from your high horse and share applicable and useful in real life not “political kopitiam” kind of talk.

GE offered upgrade to Smart Health Protector Exclusive (SHP), but significant diff in premium.

Top: From SmartMedic Extra (SMX) to SHP
Female, born in 1974.
Current premium (monthly): 337.50, increment 20, new prenium 357.50

Bottom: From IL Health Protector (ILHP) to SHP
Male, born in 1977.
Current premium (monthly): 232, increment 303, new prenium 535

How come the increment is so different : RM20 vs RM303 ?? Any clue?

Agent reply: this is the campaign. We can’t adjust anything or the offer. We can only either to accept or decline.

Thank you for posting this. It's invaluable in educating the public.

For a better analysis, it would be helpful to have further info on the other coverages within those two policies. Perhaps the difference in increment could at least be partly explained by the policies' difference in coverage.

You might wonder, why would both policies' initial coverage (prior to upgrade) have any impact or influence the amount of increment?

The answer lies in how long term level premium IL policies are priced, both in terms of their premium amounts as well as cost of insurance and other charges. Cost of insurance and other charges are set during the product's design & pricing stage based on the ITO's past claims/expense experience and expectation of its future development, for e.g., by accounting for medical inflation.

Once set, an individual IL policy's annual premium is then priced (or supposed to have been priced) such that the policy is expected to meet all its future cost of insurance and other charges - in short, the policy is priced, in terms of its premium, to not lapse during the term of the contract.

This is where factors used in deriving the premium amounts come in. Key factors include the expected future investment return rates. The higher the future investment returns assumed, the lower the annual premiums.

Both the ILHP and SMX policies could have been priced assuming different future investment return scenarios. Perhaps the ILHP policies had assumed very high return rates (e.g. 11% per annum), much higher than SMX (e.g. 9% per annum) and when both were repriced during the upgrade, they were repriced based on a lower rate (e.g. 7% per annum or lower).

This is wrong. Both policies should have been repriced (for upgrade) using the future investment return rate assumed in the policies' initial pricing (11% and 9%).

The other reasons, as alluded to earlier, could be the difference in policy coverage, e.g. difference in sum assured, and difference in charges for the same coverage (the SMX and and ILHP riders would have had different cost of insurance charges).

Important to note that the SMX and ILHP policies both currently have presumably lower sustainability periods than the original term of the contract. Your original expectation, as a consumer, was for the contract to have been sustainable until the end of the contract term.


Sustainability period for ILHP


Sustainability period for SMX

Please also check if either of those policies, post upgrade, would be subjected to additional allocation charges on the premium increment amounts.

This post has been edited by hafizmamak85: Mar 27 2025, 09:05 PM