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.

Hello I just received my premium increment notice from Alliance

Currently it is at RM210 per month, and will be increasing 20% every year with RM420 at the end of 5 years.

What are my options right now apart from downgrading the insurance medical plan?

Hello I just received my premium increment notice from Alliance

Currently it is at RM210 per month, and will be increasing 20% every year with RM420 at the end of 5 years.

What are my options right now apart from downgrading the insurance medical plan?

1 & 3) You have every right to insist on the insurers and takaful operators (ITOs) footing the bill as they have not kept up with your reasonable expectation in relation to the original annual premium amount.  The expectation implied in the pricing of the product was for the original annual premium to be sufficient to sustain the policy until the end of term.

If the ITOs weren't comfortable in taking on this risk, they should not have had the authority to set the minimum amount of sustainable annual premium for given insurance policy coverages nor would BNM be able to make it a requirement for the ITOs to price the IL contract such that it was expected to be sustainable until the end of term. There is legal force and value to this expectation. It is not zilch or zero. It has value. The question is , what is the value? And to me, the value implied is a no lapse guarantee if policyholders keep to their original annual premium payments and didn't make any withdrawals. Also, if the ITOs didn't want to take on pricing risk, they should not have allowed for investment returns to be considered in pricing the IL policies nor should they have sold long term products. The moment the ITOs did that, they effectively implied a certain expectation in relation to the investment performance of the IL unit funds as well as the fixed nature of the cost of insurance and other long term charges in the product.

You, the consumers, do have a choice. You are not at their mercy. You can always band together and haul the ITOs to court for contract non-performance and unfair/unreasonable contract practices. The sorry state of affairs in Malaysia means most, if not all, ITOs have such similar unfair/unreasonable practices.

Closing medical pools every three to four years when utilisation gets near to or breaches 10%, and subsequently opening new ones with better coverage (higher annual/lifetime limits, better inner limits coverage), is nothing but a sham excuse to reel 'healthy' consumers like yourself - those who don't make claims - in from older pools and to re-price the IL annual premiums and medical rider coverage cost of insurance charges.

My bet is that the ITOs are doing this to correct for their initial pricing errors (mispricing/underpricing), the ones that occured during the policies' inception, and to maintain their profit margins. That is not to say that there is no legitimate need for higher annual or lifetime limits, or better inner limits, for that matter.

The limits may seem ridiculous, but will come in handy if advanced treatments (e.g. cell, tissue, gene therapy treatments) are covered and utilized. The question is, while most medical insurance/takaful products with high annual limits must cover such medically necessary treatments/procedures, do our ITOs do so in practice or do they employ deny and delay claims tactics???

Great Eastern's current average medical pool claims cost per policyholder is less than RM 800 - which I think tallies more or less with the LIAM industry average. Prudential's PruHealth is around RM 1.1k. Malaysia's health expenditure per capita in 2023 was around RM 2.5k and is growing at an annual rate of 6%. Let's assume that around RM 1.7 to 1.8k per capita goes to hospitals/specialists for medically necessary treatments/procedures. That's more than a 100% difference when compared to GE's average pool claims cost. For Pru, it's more than a 60% difference.

How many more re-pricing cycles are Malaysian insurance/takaful consumers expected to endure before the average medical pool claims cost can at least catch up to the per capita health expenditure component for hospitals/specialists???

Bear in mind that the current average IL policy annual premium is already above RM 4.4k and there are more than 7 million IL policies paying around RM 29 billion in annual premiums.

You can easily design and price an insurance/takaful product with RM 200k in death and disability benefits, RM 3.1k in average medical pool claims cost, all for RM 4.2k - has a 40% expense/profit margin for the death and disability components and a 5% expense margin for the medical component. RM 3.1k is almost 4 times as high as GE's average pool claims cost.



You are right to point out that the ITO only wants you for the sweet spot years of between 25 and 55. Their products are, in my view,  intentionally designed to not be able to meet your reasonable expectations of policy sustainability and meaningful coverage. They basically want policyholders to leave after the age of 55 and have intentionally jacked up the medical coverage cost of insurance charges after that age which, as you are well aware, the annual premiums will find difficultly in sustaining. Another trick is to mostly allow small medical claims to go through while denying/delaying a significant proportion of large claims. Above 60 lives currently only constitute less than 15% of the total population. Even if we assume a 30% proportion of claimants for this cohort, the average proportion of claimants for the total population will still only be less than 12% if we assume those below 60 have an 8% proportion of claimants. And the RM 4.2k policy is good enough to cover 12.1% proportion of claimants with an average bill size of RM 25.4k.

Your expectation as an IL policyholder of annual premium sustainability is legit. It's just natural to expect ITOs to price a long term contract with level premiums such that its sustainability until the end of the contract term is ensured. You're not an expert nor have you any accountability when it comes to premium pricing, determining long term medical inflation or investment returns.

Short of expecting the digital ITOs to collaborate with hospitals/specialists in coming up with better product propositions, your best bet is to sue the ITOs & BNM.


Fun fact. Malaysian actuaries usually use a slapdash approach when it comes determining 'reasonable estimates' of long term investment returns in pricing IL level premiums. Two key ingredients: past investment return performance and future expectation of investment returns. Past performance is basically a review of the geometric average annual investment return for the 3yr, 5yr, 10yr and 20yr (if available) periods and prior to this, especially for IL pricing, it would be settled based on the 10 yr equity fund or total return equity index geometric average annual return. Since no one in the investment team would have had the chops or gumption to have any long term view or expectation in relation to equity performance, the assessment was basically limited to this review of historical returns. This was how we ended up having IL annual premiums priced assuming 7%, 8%, 9%, 10%, 11% annual returns for policies with terms of over 30 years.

This brings up an interesting question. Why were actuaries comfortable with imputing a certain investment return expectation - why not 0%? - for the entire duration of the contract in pricing IL level premiums, even though they have had an abysmal run at predicting the long term performance of IL equity funds, but were not comfortable with imputing a certain medical inflation expectation for the entire duration of the IL contract, even though the forecasting signal fidelity from the persistent 6% growth in per capita health expenditure could have been argued to be much stronger???

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Could it be because assuming higher investment return performance for the entire policy term meant lower annual premiums while assuming medical inflation for the entire term meant higher annual premiums???

This rules will apply if I opt for SMART option and it will reduce my contribution. If i to choose not going for this option, I will just have to bear the increment cost each year stated by the letter and i believe I can claim 100% the total bills right?

Kinda suck. But no choice need to face it.

Then maybe opt out of the SMART Option?

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

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

They will in the future down the road (that is where the coverage years is reduce) if you have not sufficient cash balance inside.

Another way to make it as sustainable is be 100% equity. if they have equity with US equity, the largest amount, choose that. Equity will also give more returns Vs bonds over long long term. Yes US market is scary right now but US market have always been easy to make money. Agents will shoot me, but if you know markets you have to face reality.

Unfortunately insurance in Malaysia have very poor overseas exposure as if by design. Most funds are focus locally.

You're buying insurance for protection, not for speculation. Plus, a sustainable ILP policy requires fees and charges to be met as and when due. In order for this to happen, the investment asset return profile needs to stable, not volatile.

Wouldn't it be better for a portion of allocated funds to be in short to medium term liquid, safe assets to meet short to medium term fees and charges as and when due and the rest to be in some sort of a balanced fund to meet long term fees and charges?

Wouldn't this require a continuous rebalancing of allocated assets?

Shouldn't ITOs provide continuously rebalanced low to medium risk allocation strategy options - I think quite a number do, but how often do they actually promote them to policyholders?

The default most of the time is the 100% equity option as the premiums are cheaper.

Whether the investment assets should be in the Malaysian, US, Japanese, Asia Ex-Japan etc. or a mix of those markets, what forex, mix of asset class and counterparty risks to take, do you think the average consumer has the knowledge to make such decisions?

Whatever allocation option chosen, the ITO must be accountable for the return rate assumed for sustainability purposes.

If a negative balance arises, the ITO musn't lapse the policy. They have to take on the liability for it.

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.

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.

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.

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.

Hi, anyone joined Gathercare.com?
What is your view?
Thk you

36% in management fees is just too much.

Fantasy price, fantasy coverage.

Stay Away from these champion.

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.