I don't think we can cover pre-existing illnesses just yet, though I wish we could. The issue would be anti-selection risk then - no healthy person has any incentive to buy insurance, cause why pay when you're healthy? Just wait till you get sick and buy a policy. There needs to be a mechanism to equalise this. Either force everyone to buy insurance, or follow the American model - you can only buy in December. Still covering pre-exiting illness will increase insurance costs by 3x to 10x as all the very sick, elderly people, terminal illness etc will buy and the young an healthy will have to pay for them.

actually, since this is a initiative by the gov (and i think also in partnership with private sectors), why not? as is, our GH will accept anyone and everyone regardless (no discrimination on age, existing conditions, sex, employment, etc).

So this coverage can work... of course, the experts have to work it out. I am aware of how powerful deductibiles can be in terms of pricing, hence I just mentioned it.
At worse, like you said, we follow the american model or NHS or Medicare system. But then it becomes a taxation system yet again.

If you commit fraud, did not disclose full information, even after 3 years 4 years, insurance companies can choose to not pay. Just fyi. Whether the insurance company can find out or not, separate issue. But they can.

The more claims insurance company pay, the cost will eventually pass back to you. Your premium will just increase more and more. To a point where the idea of insurance just does not make sense.

You can be right about where to find the cheapest way to convert your myr to any foreign currency but nope, on this, it is like ajaran sesat.

Insurance companies job is to pay the right claim to the right person. When this person, it is benefit every single policyholder.

The insurance model is flawed, for sure. But to say pay every single claim, then you dont need insurance, you can setup your own kutu.

Dont forget, the person approving the claim is an employee, not business owner. Just like the guy working at zus, kalau coffee terlebih bagi, cost is on zus. Gaji masih sama. Of course they are incentivised not to make mistake, but they do not have kpi on who pays the less claims.

For your info, they have KPI to reject case. I got one friend family member work there. And yeah their bonus is depending on how many cases they can reject.

Even I saw on job street description, to save the company money, denying claims where appropriate. It is literally written there on the job description. If you believe got no KPI to reject claims, I don't know what to say.

Our job is play according to insurance company rules so that they cannot deny our claims when we need them. Do not give them reason to deny the the claims.

The question remains, who is going to fund the private healthcare expenses of people with PRE-EXISTING illness? The money doesn't drop from the sky. Currently it is purely funded by policyholders. The only other option is for the government to fund it.

But why will government fund people with substandard health to go to private? Better they put that money to better use and improve the government hospitals.

It can be government-subsidised, or even self-sustaining if the risk pool is enlarged and super diverse. Ie similar to company group insurance. When claims are high, premiums rise (which are effectively part of employee compensation). When employees are healthier, the savings can benefit everyone.
(which made me wonder: i've never heard of a older sick employee being told that the company insurance will not cover said person... have anyone?)

There are also other ways to support coverage for people with pre-existing conditions: targeted taxes (reduced tax rate for the insurance firm), incentives for hospitals, or basic service obligations for specialists.

The key point of a basic medical card should be affordability with super broad coverage, not just serving those who can already pay. Otherwise, it defeats the purpose.

This would also help ease pressure on government hospitals by shifting those who can afford private care (if the cost is cheap enough) out of the public system, rather than everyone queuing up cos it is only 1rm.
(there are definitely fat to be redeployed... since almost everyone is complaining about medical insurance being too expensive. who knows... take away agent's 1XX% commission and throw that back into the pool... lol)

That’s not a fair comparison. Group insurance is fairly expensive because it does cover pre existing illness. Also, Group medical insurance is priced in such a manner that it reflects the claims experience of that particular group. So say Company A and Company B both have 10,000 employees. The quotation at every renewal changes depending on their medical claims experience. If Company A claims more frequently and higher average claims size, their renewal premiums will increase accordingly.

Diverse insurance pool is good, but trust me most healthy people will cease buying medical insurance when they are young precisely because they can still buy it later on with no penalty when their health deteriorates

If it is government subsidised, that’s still money the government is pumping into the private sector.

Just some interesting stats.
MOH spends around 45 billion per year... on 30m people... so if split equally on all 1.5K rm per pax.

From google (I did not verify):
it stated Medical and Health Takaful/Insurance funding reached 6.7 billion rm covering 7.7m people. (I am surprised so low)

and google also offered this info (should be all insurance prod rev):
Great Eastern: RM7.49 billion in revenue.
AIA Bhd: RM7.22 billion in revenue.
Prudential: RM5.07 billion in revenue.
Allianz: RM2.17 billion in revenue

There are definitely too much fat everywhere.

Hence when BNM wish to create a group insurance policy covering 10m people, it would not make sense to allow the providers same margin and terms as covering a company A of 10K people.

wrt your second statement... maybe got misconception... allowing everyone to be insured doesn't mean everyone pays the same medical card fee. One can have tiering say based on age, or different deductibles. So someone of age 20 maybe pay 100rm pm, while someone of 50 pays 300rm pm, with deductible of 20K. something like that.
(leave it to the experts from BNM and industry to figure the specific... there should be more tricks they can come out).

And no harm gov subsidizing this (via tax rebate, or free basic service obligations for specialists, or CSR by hospitals, etc).

I think you're making this up. No insurer would risk breaching compliance because that would mean risking their license to operate.
If utilizing claims officers to deny as many claims as possible is the modus operandi, it wouldn't make sense to have programs such as AIA Vitality to reward customers to stay active. Why invest so heavily into such programs when the insurer can just deny the claims?
Do you actually know how difficult it is to deny a claim? How much justification is needed in order to deny a claim?

Can you show the job street JD where it explicitly says to deny claims where appropriate?
Otherwise, I'm calling BS here.

Want to talk cock sing song, borak yg bukan2, there's another section in the forum for that.

If the gov gna push this through, it will have to be a tax system.
Are we ready to cough up an additional 5% to 8% in income taxes (across every bracket) for a universal healthcare program to be implemented?

Marketing ma. To make people think AIA care. Wah insurance company don't want me to fall sick. If it's goodwill, why charge client RM10/month for it. Give it for free la.

I know what I saw. The exact words was something like this. Help company save cost. Process and analyse every claims. How to save cost and why process and analyse every claims? Only logic is so no need to pay claims.

Why would a company hire you if you cannot help the company to save cost? It's technically embedded in all job description, even if not formally written.

But process and analyze very claims = denying claims as one of the KPI?

That's just a baseless accusation. Unless you can show us the proof of the JD, you are just making things up.

That's why it's written denying and approving claims where appropriate. Means you have to follow guides to approve and reject claims.

Here are 2
https://my.jobstreet.com/job/89031692?type=...ae41760c319f263


AIA
https://malaysia.indeed.com/m/viewjob?jk=c2aaf7931cd69124

You have to read in between the lines. I see cost containment = save money for AIA. How? By finding fault with the claim so that AIA doesn't need to pay out lo. Maybe I am bias.

This post has been edited by Ramjade: Dec 10 2025, 01:38 PM

And what's wrong with accessor approving and denying claims according to the guideline?

Are they supposed to approve all claims? Then we wouldn't need claim assessor and system can just auto approve all submitted claim.

And your policy premium will increase to the point of no return. That's what you are suggesting, isn't it?

I pay my premium and when the time comes I expect the insurance company to pay up when I want to claim. No delay or deny. Honour their part as I honoured mine. You take my money, you need to pay up when I need it. Not trying to find thousand and one excuse to delay paying me, or deny paying me.

What insurance are trying to do is take your money and try their best not to pay out. Good example is united healthcare. Their denial is like 40-50%

This post has been edited by Ramjade: Dec 10 2025, 01:46 PM

Sounds more like lawyer approved statement. Haha.

Like how university acceptance is based on merit and yet...

LOL.

If you see another job post
https://aia.wd3.myworkdayjobs.com/zh-TW/Ext...ialist_JR-37179

I wonder what team target savings benchmark is. 🤨

This post has been edited by Ramjade: Dec 10 2025, 01:49 PM

You mean if you have a history of heart disease and you did not disclose it during policy application (even when requested), and two years later you are admitted to the hospital for the same condition, the company has no right to investigate you and reject your claim if necessary?

You mean if someone has been paying prompt premium, the insurance company has no right to reject the claim under any circumstances, including fraud?

Wow.

I am saying I got no illness, I pay my premiums and now you want to reject me because I use the insurance at 17 months for high blood pressure and then later on for tongue cancer. It was shown that poor guy didn't have high blood pressure before he bought his insurance.

If you think you are right and that the insurance are wrong by not accepting your claims, ....can always go voice your grievance to
The Financial Markets Ombudsman Service (FMOS)
https://www.fmos.org.my/en/