So based on your explanation above, since the average claim size is small and frequent, and for the product with the exact coverage, but different annual limit, says 1M and 5M, the premium should be more or less the same?

Let's play this out. Assume there is this RM 1.5mil treatment option available with 50 lives in a million population needing such a treatment. That would result in an increase of RM 75 in the average medical pool claims cost per policyholder. Now assume that for below RM 30k bills, average bill size increased from RM 7.8k to RM 16k. That would result in an increase of ~RM 750 in the average medical pool claims cost per policyholder.

So yes, I do think that for products with the same inner limits but different high annual limits, like 1M and 5M, the premiums should be more or less the same.

Unless you guys can come up with some plausible scenarios where the frequency of claims for between RM 1 mil and RM 5 mil medical claims is somehow high and cannot be adequately addressed by sub RM 1 mil treatment options, I'm not sure how else the price could differ significantly.

would like to ask where the 2 tables/data come from?

It's interesting cos I always suspected that the super high annual limits are just for "show" in that for cases that require such expensive treatment, the illness should be either very fatal, excluded or very rare.
And if the data represent the entirety of Malaysia's population, that means no treatment is costing above 1 million ringgit rite?

So it is also for us to be aware that while currently treatments above 1 million do not exists, if we purchase a high limit coverage, once more and more people claim the high upper limits, the medical premium may jump a bit more in the future vs the lower limit coverage medical premium.

He memang passionate. I give him that. But can't do anything unless you are China.

I went with AIA in the end for the following reasons
1. Decent post hospitalization follow up vs generali/lonpac
2. Less problematic vs GE (you can see GE have tendency to reject claims as shown in the news. Yes news and not new.

The tables and data are just for show, from something that I generated using a simple distribution and just tweaking it at the higher ends, to give people a sense of how high medical bill size claims can be and how frequent they can be within a given population level.

It's not to say there can't be treatment options above RM 1 mil. There may very well be treatment options above RM 1 mil in Malaysia. I don't know. I suspect they would involve advanced treatment methods and they may very well be medically necessary and have viable outcomes.

To be clear, I don't have more granular data such as the different types of medical specialties within a hospital/specialist setting and the demand profile for such specialties nor do I have the ability to project their demand.

In order for more people to claim the upper limits there must be such significant numbers within the population exposed to such a disability/disease burden in the first place.

It's more plausible for premiums to hike up due to increase in treatment costs or higher frequency of claims for below 30k bills.

This post has been edited by hafizmamak85: Apr 22 2025, 12:30 AM

🧐China?? How and what issues will China be able to solve?

Chinese govt can order their companies to charity first rather than shareholder first.

Adhering to properly construed contract terms and policyholder rights and reasonable expectations is not charity.

Ponzi schemes also got contract what.
Contract policy doesn’t mean squat when there’s no oversight and enforcement.

Is Hong Leong assurance medical insurance good enough as it is not as famous compared to prudential, AIA, GE etc..

Maybe amount of coverage offered is not good for the premium paid.

This post has been edited by Ramjade: Apr 22 2025, 05:02 PM

Need to clarify this. Two things can be true at the same time. The super high annual limits can be mostly just for show if the ITOs keep denying or delaying high claims but they can also be medically necessary, viable and for infrequent events.

As agents need to sell their products, they would naturally be dying to tell you: "my group/ITO got client, cancer/heart disease claim 1.5 mil, really advanced treatment, la di da da cleared". If you don't hear such stories, they you know it's mostly for show as there is no "street talk" of such cases. Even if the frequency of such claims is really small, it's still a major selling point.

Having said that, you're buying a long term product, and while there may or may not be such high cost advanced treatments now, there will definitely be such treatments in future. So, when you buy a long term policy, you have to, in a sense, gauge whether it is future proof.

Part of the current problem is that it is difficult for a lay consumer to evaluate the product's inner limits to understand how well the policy would cover both their present as well as in future medical needs. Consumers don't understand - nor should they be expected to - what exactly falls under post hospitalisation or outpatient treatments.

It's reasonable for them to expect all medically necessary post hospitalisation and outpatient treatments to be covered, especially if they've bought a really high annual limit product.

No point in just clarifying within the product disclosures outpatient as covering kidney and cancer treatments. What else falls under outpatient but is not covered and hasn't been properly disclosed??? Why limit post hospitalisation to only 3 months? Why time bar it in the first place when it could be medically necessary???

There are lots of expensive outpatient treatments and what if, in future, heart disease treatment can also be done on outpatient basis. Then what? Are consumers expected to wait for the ITO to issue a circular notifying coverage???

And then we have these really silly and unfair exclusions on prosthetics, medical devices, blood/plasma and other medical supplies. There are people out there taking quarter million loans just to purchase prosthetics and the need for blood/plasma can be ever present in many surgical/non-surgical treatment situations and are expensive. Is it a fair contract term to imply "besi implant cover, lain semua tak cover. Blood/plasma kau tanggung"????? Are prosthetics, medical devices, blood/plasma not medically necessary???

So, while attention needs to be paid on whether the high annual limits are actually a gimmick and have no true value, I would argue that it is more important to actually gather info from agents and the ITOs on what sub 100k treatment/procedures that technically, from a contract standpoint, should be covered, but in practice are not actually covered by the ITO. A majority of robotic surgeries can be done between 30 and 100k but quite a number of them have not been covered until recently.

Make no mistake, the purpose of medical insurance is especially to cover for these above 30k bills. So please be vigilant and enquire more.

I think it's high time that major hospital groups like Sunway, IHH, KPJ, and Asia Onehealthcare either join forces and get a TPA with some digital insurer to issue their product propositions or these 4 champion horsemen of the apocalypse find their own separate TPAs and digital insurers and get it done. Just issue standard cradle to grave yearly renewable family packages covering medically necessary care and all pre-existing conditions and forget these nonsensical inner limits - have high deductibles as that is pretty much the only way to keep the products affordable.

The ITOs cannot be having a monopoly on medical insurance products when they are being strangled by the agency force and bloated expense and profit structures.

This post has been edited by hafizmamak85: Apr 22 2025, 08:32 PM

I'm not really sure if it is worth while to so called get a "future proof" card as in having medical coverage with high limits...

as you said, many stories about providers rejecting certain "exotic" treatment and now them hiking medical premium exorbitantly... essentially pricing the policyholder out of his medical coverage when he needed it most. And this is despite him paying from start while under-utilizing the insurance all this while.
And that is also assuming if one can survive even one incident that cost 1.5 million ringgit treatment!
plus how many exotic illness would need a treatment of say 2 million ringgit? these are like super rare events. (but providers greed is a lot more common and infinite)

But if one can afford the coverage, sure...

30+ yrs ago, a medical coverage of 150k looks alot.
Now it seem not enough

A 3 million coverage now may seems slot now.
at a minimum 8% pa medical inflation rate, 30 years later this 3 millions coverage will be about how much of current value?

Looks like medical inflation hasn't impacted Great Embarrassment's bottom line at all.

FYE 2024 total comprehensive income of RM 1.27 billion!!!!!!!! - RM 1.24 billion in FYE 2023.



Fellow Malaysians, this is where a big chunk of your IL premiums have gone to - be glad for the GE Gods drink full from thy cup, blessings abound for thy health.

A round of applause for GE for getting through unscathed, unharmed by the very debilitating medical inflation epidemic. No bloodthirsty hospital may sink their teeth and harm the Great GE balance sheet. All hail The Great Embarrassment Balance Sheet🙌🏾🙌🏾🙌🏾🙌🏾🙌🏾



Buggers even dared to pay RM 93 million in dividends. This is even after being exposed for misappropriating RM 2.37 billion from their participating policyholders.

This post has been edited by hafizmamak85: Apr 22 2025, 11:33 PM

now others seem to have already shared their point of view and let me share mine with you.

a Bypass surgery in UMSC, i had to fork out RM90k+ from my own pocket for my mum. I wish she had some sort of insurance even the cheaper ones which most likely she need to pay a couple of thousand at age 65.
RM100k or RM150k covers ALOT of illness that's what i can tell you now. If my mum needs to join the queue in Serdang, most likely she's dead already. The queue alone with take more than a year just for an angiogram another 6 - 8 months to obtain the right amount of stent.

it's a good option for the mass public which doesn't have enough in my books. of course if you can afford those RM400 - 600 monthly premium by all means go for it.. but if you only have RM100 to spare at age 30/40 these are good options.

That's why I said RM100k insurance is sufficient for most people. But if want to cover everything, RM1m coverage.

I'm sorry for what your family has had to go through. Yes, you are right, a significant number of treatments/procedures can be covered within a 150k coverage. But what makes you think RM 100 per month is sufficient to cover sub RM 150k treatments/procedures???

If an ITO did price it as such, without high deductibles like RM 5000, it's my view that they might likely be denying/delaying claims.

You don't have to take my word for it. You can read this write up by one Dr Gunalan Palari Arumugam in CodeBlue

The Private Medical Insurance And Hospital Charges Conundrum: Part 2 — Dr Gunalan Palari Arumugam

The misconception is that our fees are bankrupting patients. Just an example of range of fees, about 60 per cent of hospital bill sizes fall below RM10,000 (mainly medical admissions), 30 per cent between RM10,000 and 50,000 (simple surgeries), and 5 per cent RM50,000 and RM100,000 (complex surgeries),

Only about 3 to 5 per cent of cases actually exceeded RM100,000, and this is when a patient presents with a complicated problem (cardiovascular or neurology) and multi-organ failure that needs end organ support via ventilation, dialysis, interventional radiology (coronary or neuro). These are the bills that generally depletes the savings of our patients, if the insurance is not able to cover the costs.

Using the above bill size distribution and assuming 8 per 100 policyholders make claims (8%) every year, the monthly premium comes up to RM 180 with a 5% loading and RM 280 with a 40% loading (loading for expenses/profit etc.).

It's still going to be somewhat pricy.




This post has been edited by hafizmamak85: Apr 23 2025, 01:02 PM

now let me correct you. a term insurance with RM150k coverage most likely my mum have to pay RM6k+ per annum definitely not RM100.

The point was that even the 30/40 year olds may have to pay above RM 250 a month so that people of your mother's age and above can get a not so pricy premium of below RM 6k

This post has been edited by hafizmamak85: Apr 23 2025, 02:40 PM