If you want to buy those 200k-1m coverage without agent, not possible. For those 100k coverage can buy fully online.

Generali can be bought online via fi.life

Yes Great Eastern just launched a brand new product with multiple deductible options. If you decide to upgrade to it, make sure you undergo full underwriting (assuming your health is 100%) to be in the healthy pool.

You have it wrong. In Malaysia, "health and surgical" insurance is not actually insurance per se as they are all priced on an "annually renewable" basis. Real insurance is life, TPD, CI, cancer etc that are priced for the long-term. "Health and surgical" insurance is actually a cost-plus insurance model. Given the inflationary nature of the underlying claims, this only makes sense. If they were to price the product "properly" as a long-term product, your annual premiums will be 10x to 20x higher.

Medical Insurance Reform Suggestion

Standalone Medical Insurance

For standalone medical insurance policies, there is possibly only one reform required in the presentation to customers. In the Sales Illustration (SI), insurers must be able to show projected long-term future premiums under a low/medium/high scenario to customers. The low scenario can be 7%, the medium scenario can be 12%, and the high scenario can be 20%. This is not legally binding and purely illustrative. Fundamentally however, nothing will change for standalone medical insurance policies as these are already annually renewable, and premiums are only paid for and coverage is only guaranteed for 12 months.

Investment-linked Medical Insurance Rider

For investment-linked insurance policies with medical riders, there is substantial reform required. All of us who purchased investment-linked insurance policies have been told that we are “overpaying” now to build a reserve to pay for future increases in medical costs. The promise has generally been that the premiums will be level (although, the insurers are smart – this was never communicated in writing). This is all pure bollocks.

The picture is muddied further by the fact that unlike standalone plans, there are two components for ILPs – the premiums themselves, and the “cost of insurance”. The premium is dependent on a host of factors, which include the performance of the underlying investment funds and changes made to the policy (i.e. increase coverage term, add/remove riders etc).

Suggested reforms:

1. The base plan (which usually covers death and TPD) and other riders such as CI, accidental death, income replacement and premium waiver are priced on a long-term basis. While repricing is possible, it is rather unheard of and should not occur unless the insurer mispriced the product. Repricing for these will only occur under exceptional circumstances – e.g. a widespread pandemic far more lethal than Covid-19, or a major catastrophe event that either wipes out or severely infects a significant portion of the population in one go.

On the other hand, medical insurance is priced on a cost-plus basis. They are “annually renewable” in nature, which allows the insurers to capture emerging trends such as medical cost inflation and increasing morbidity in the population.

Given the distinct nature, it only makes sense that the medical rider premiums for ILPs be desegregated from the rest of the ILP and be presented separately. This will take away a lot of confusion and “unfairness” given that many were duped into thinking getting medical ILPs will ensure level premiums for life.

2. Another reform would be similar to the one proposed for standalone plans above. In the Sales Illustration (SI), insurers must be able to show projected long-term future premiums under a low/medium/high scenario to customers. The low scenario can be 7%, the medium scenario can be 12%, and the high scenario can be 20%. However, given that there is already other projections being shown in the SI (e.g. the investment returns projection), this might just get too complicated for consumers to comprehend.

This post has been edited by contestchris: Apr 21 2025, 10:22 AM

Who in the world is feeding you these nonsensical talking points??? You might as well come out as an industry shill. It's not the first time you've said this.

"health and surgical" insurance is a bona fide insurance product written under an insurance contract - it just has its issues due to high claims frequency and our infamous kootu scheme mentality. They are not all priced on an "annually renewable" basis - only medical insurance products covering one year are "annually renewable".

Long-term products with level premiums such as investment-linked policies cannot have rider components priced on an "annually renewable" basis. The main policy and rider components are priced to be sustainable (re: fixed) for the entire term of the contract.

There is no such thing as an insurance contract priced on a cost-plus basis or a "cost-plus insurance model". By definition, an insurance contract involves a transfer of risk. Where is the transfer of risk in this so called "cost-plus insurance model"????

Without the transfer of risk element, it just becomes some form of a service contract, not an insurance or takaful contract. "Cost-plus" pricing is only applicable in a group insurance setting and that too it is clearly delineated as a service contract applicable only for clinic visits. They do this because clinic visits have too high a frequency, are more volatile in nature - which is why clinic visits coverage is marketed as an add on administrative service as part of group medical insurance.

All IL policies have to be priced properly and prudently, accounting for reasonable estimates of medical inflation throughout the entire term of the policy. Whether or not this results in a pricier product or policy is a secondary matter and is not germaine to the proper pricing imperative.

In fact, it could be argued that IL policies should account for long term medical inflation more than it needs to account for long term investment returns. It would be acceptable and prudent for IL policies to assume 0% investment returns in pricing long term IL policies, but it would not be acceptable, prudent or reasonable to assume 0% medical inflation for a significant proportion of the IL policy term.

If the ITO wished to price the IL contract with level premiums assuming 0% medical inflation for a big chunk of the contract term, it should then be comfortable absorbing the risk. Don't complain and burden the policyholders, just bear the burden yourself.

This post has been edited by hafizmamak85: May 1 2025, 01:41 PM

Hafiz, you're not wrong. I'm just staying the truth, medical insurance in Malaysia is not true insurance, rather a cost-plus model. Yes they may not be explicitly annually renewable, but they might as well be given how things have been going on in recent years with regards to medical cost inflation. I agree regarding your ILP critique hence see my suggestion

Your suggestion just makes things worse for policyholders. They are the ones who every year kena with notice on premium hikes. Tak pasal² kena bantai with the ITO. The ITOs are acting like "ibu² kutu" extracting more fees and charges from policyholders. Really unbecoming.

Why are you still insistent on maintaining the ILP business model??? Just get rid of it. Your suggestion still has ILP as the main component in providing medical coverage to the mass upper end of the market. Why not just go full on standalone medical with guaranteed renewability??? You do la what you want then. Up to you how you want to re-price every year. It's the ITOs contractual right. But even then, as I've already pointed out, they still underprice the standalone medical products - they can't even price it to cover for at least the per capita health expenditure on just the hospital/specialist component.

Forget about OKUs and lives with pre-existing conditions, we have completely forsaken this portion of society. Even now, under the ILP model, people buy IL policies so that they can get meaningful coverage during their old age but old people kena kau² di with premium increments.

So why not just close off all of ILP and write it off as a loss making business once and for all??? Why keep expanding this financial health hazard monstrosity???

This post has been edited by hafizmamak85: Apr 21 2025, 01:38 PM

Yes sir that's the best outcome but it won't happen. Let's not kid ourselves, the powers that be have too much at stake here.

ILPs are not unique to Malaysia though, the exist in some form in most countries. What we need to do is carve out the medical riders from there, as clearly they do not gel together.

At the same time, all medical insurance in addition to being guaranteed renewal must also cover and accept pre-existing conditions. Maybe even have a standard rate for age and sex eventually. We will get there, just not yet.

We have to be stronger than this. Don't be afraid of our gomen and the corporates. Especially when we have the contractual rights on our side. They can't just willy nilly bully their way through. Haul BNM and the ITOs to court.

Haul them up for misappropriating RM 2.37 billion from Great Eastern policyholders as well.

Right now there are more than 7 million IL policyholders and more coming on the way.

The re-pricing will keep occuring, unless we stop them, as they have really kept a tight lid on claims for quite a number of years. They will likely have to loosen their control on the spigot sooner or later so that the medical claims component can at least get to the level of the per capita health expenditure for hospitals/specialists. There may currently at least be an RM 800 ringgit per capita/policyholder gap between the average medical pool claims cost per policyholder and the per capita spend for hospitals/specialists. Bear in mind that the per capita spend for health is also still growing at 6% per annum. It's a moving target that they have to catch up to.

Average IL premiums have already breached RM4k. Don't let them increase the premiums any further and hold them to account for their past underpricing/mispricing errors.

It's best for ITOs to cry uncle now than suffer later.

This post has been edited by hafizmamak85: May 6 2025, 01:46 AM

Since nothing much the public like us can do, what's your advise on reducing the impact for high-cost and forever increasing premium?

I've seen you've mentioned :
1. Don't take ILP Medical Plan.
I've check with a few agents, nowadays most of the available plan is ILP, not much Standalone plan available nowadays.

2. Take something with Co-Pay or "High-Deductible". (Which is not available in most of the lower tier plan)

3. Any ITO to avoid? I've seen you've mentioned GE , despite they are the cheapest in the premium.
What about the other companies, PRU? AIA?

This post has been edited by 1234_4321: Apr 21 2025, 05:44 PM

I think you already know my answer. I'm sorry if my answer may seem bleak.

It's up to you which ITO you would like to go with. But the following are the key indicators you might need to ask your agent for:

There are standalone available.Only agent not promoting it. You need to ask for it.
AIA, GE, Generali and lonpac have it.
For those 1m coverage above, need to use agent.

For those 100k coverage lots of options available. All can buy online.

Please for god's sake, let's stop promoting these 100k products. Just get rid of them. They are not effective at stopping losses. One time kena accident, kena 250k bill, what you gonna do then???

Actually for the standard of the agent that I've seen, I really doubt that they can really answer those indicator you've mentioned claims ratio, combined ratio (claims + expenses), average claims size per claimant

They are effective for people with no money. Not everyone can afford 1m coverage.

Unless you landed up in ICU or have extensive surgery, RM100k coverage more than enough.

So dramatic, but what happens is that private hospital will send you to government hospital once 100k runs out. No worries about 250k bill.

There is no continuity of care. That is the point. It's incredibly disruptive. We don't know what level and type of care can be provided at the government facility. This happens in cancer treatment. You run out of insurance coverage then you end up in the government system and there may be issues and other complications due to this. Maybe you might not be able to continue on the same treatment plan as when you were under coverage.

It's ok, for those who can't afford it, by all means please go the government facility. But why should anyone go through this when you have insurance coverage????

This post has been edited by hafizmamak85: Apr 21 2025, 07:05 PM

Because insurance is based off the coverage and premium you can afford. It's like if you pay for economy ticket, no way you can fly business right? Same thing la. You want business class, need to pay business class price. You want higher coverage, you need to cough up.

Its fair as in the one who pay the higher premium have access to higher coverage. it is like no way a house insurance premium have same coverage for sat a RM1m house and a 5m. Definitely the 5m will be more expensive as the insurance company is taking on more risk/payout so they demand higher premium as compensation.

If you are non profit, it's a different sorry .

Remember insurance is about you paying insurance some money to transfer the risk to them. If you don't claim they make money. If you claim they lose money. But they cannot lose money too much or else shareholder will bising. Many soveign wealth fund or pension fund have insurance in their portfolio to pay for country development or people retirement. But now insurance also wants to make money so package multiple products so that can make more money.

This post has been edited by Ramjade: Apr 21 2025, 07:49 PM

This has been explained before. It's not the big claims that are an issue, it's the more frequent small claims that are causing premium prices to increase. The difference in annual limits at the higher end don't make much of a difference. It all depends on the types of treatments, procedures available. It is not the case, to my mind, that there is a RM 500k treatment option under the 1 million annual limit and another RM 1.5mil treatment option under the 2 million annual limit for the same type of disease/disability burden - and even if that was the case, the frequency of such a disease/disability burden would be minimal enough to not make much of a difference for the purpose of pricing premiums. It would be more impactful from a premium pricing perspective if there were two treatment options, with one being RM 2k and another RM 5k, both covered under the 1 mil and 2 mil annual limit options for the same disease/disability burden, as the smaller claims tend to have a much higher claims frequency and variations in claims severity for the same type of disease/disability burden.

This post has been edited by hafizmamak85: Apr 21 2025, 08:29 PM

hafizmamak85 bruh I feel your passion, I really do. and you can champion the good fight.

Laymans like me? I still need insurance lol, whether they are evil or not. Health insurance is required because it can be crippling, both physically and financially.

Ramjade medisavers underwritten by Lonpac macam yes. But they first sell via MLM, then now Metafin, and everything is spun off by Pathlab, I don't know why they make it so damn dodgy when the product is solid.