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 Insurance Talk V7!, Your one stop Insurance Discussion

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grace_ong P
post Jun 25 2021, 08:07 PM

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QUOTE(ckdenion @ Jun 25 2021, 05:55 PM)
for this case. lets say you have:
company medical insurance 70k annual limit with no deductible
own medical insurance with 20k deductible
Note: Assuming 80k is the claimable portion

you can either:
Option A:
use company insurance to claim the 70k, then the balance 10k claim from your own medical insurance (20k deductible already borne by company medical insurance)

Option B:
you pay the hospital bill of 80k, then claim from own medical insurance 60k, the balance 20k claim from company insurance.

in this case, Option A is a better option to go for.

Scenario 2:
Hospital Bill: 30k (claimable)
company medical insurance 70k annual limit with no deductible
own medical insurance with 20k deductible

you can claim this 30k bill fully from your company medical insurance. then on that policy year of your own medical insurance, the deductible of 20k is already exceeded (have to submit the 30k claim details to your own medical insurer), so whatever subsequent bill you can claim from your own medical insurance (for that policy year only). on the next policy year then the deductible will reset again. wink.gif
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May I know the admission process for option A and B?

grace_ong P
post Jun 28 2021, 10:39 AM

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Hi All,

I would seek some opinions from your guys.
My insurance policy being an orphan policy which the original agent already quit out from insurance industry. A*z company has assigned another service agent. However, when I deal with this service agent among these few years, all the while she do ask me direct write in email to CS or going branch office settle myself. Although she will answer my question, but reject to follow up and do documentation stuff. Some more recently she like annoying and inform that if I am not satisfy with her, I can request to office for change service agent. And, she said she is kind to accept me this kind of orphan policy without any commission. By the way, I have upgrade the policy among these year by attend myself to office, I'm not sure that it is have paid commission or not.

So, shall I request office to change another service agent? Is it the same situation will happen? sad.gif

How I shall do if my policy become an orphan policy? If there have any emergency case, I have no idea contact who... sad.gif



grace_ong P
post Jun 28 2021, 11:04 AM

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QUOTE(lifebalance @ Jun 28 2021, 10:46 AM)
Normally the person who takes over your policy after they resign will be their upline unless the upline assign it out to their downline or elsewhere.

That being said, some agents may not want to pick up other agent's leftover especially if they are not being paid for it but yet need to spend time to fix the mess they made.

However, if they're the upline, they would have earn some kind of overriding commission for it.

If you feel that you are not satisfied with the current agent, you may contact the insurance company to assign you another agent.
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The branch office CS last time has told me that this current agent is the upline for that resigned agent.
If I request to change service agent, will impose any charge by insurance company?
grace_ong P
post Jul 1 2021, 04:03 PM

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QUOTE(ckdenion @ Jun 25 2021, 05:55 PM)
for this case. lets say you have:
company medical insurance 70k annual limit with no deductible
own medical insurance with 20k deductible
Note: Assuming 80k is the claimable portion

you can either:
Option A:
use company insurance to claim the 70k, then the balance 10k claim from your own medical insurance (20k deductible already borne by company medical insurance)

Option B:
you pay the hospital bill of 80k, then claim from own medical insurance 60k, the balance 20k claim from company insurance.

in this case, Option A is a better option to go for.

Scenario 2:
Hospital Bill: 30k (claimable)
company medical insurance 70k annual limit with no deductible
own medical insurance with 20k deductible

you can claim this 30k bill fully from your company medical insurance. then on that policy year of your own medical insurance, the deductible of 20k is already exceeded (have to submit the 30k claim details to your own medical insurer), so whatever subsequent bill you can claim from your own medical insurance (for that policy year only). on the next policy year then the deductible will reset again. wink.gif
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Dear ckdenion, sorry I still confuse about the admission process of option A, could you pls help me clarify? rclxub.gif

Is it I use the company medical card to issue GL first, then when reach 70k, I request the hospital to separate bill, then I call my own insurance to issue GL, then claim the subsequent 10k on own medical card? confused.gif confused.gif confused.gif
grace_ong P
post Jul 1 2021, 06:26 PM

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QUOTE(lifebalance @ Jul 1 2021, 05:18 PM)
No, you don't request a separate bill with the Hospital.

To simplify it.

Total bill 80k
Your company MC annual limit is 70k
Your personal MC annual limit is 100k (Example)

The first 70k is claimed under your Company MC
The balance 10k will be paid by you (since the Company MC can only cover up to 70k)
You file back a reimbursement claim with your personal MC for the 10k that you've paid.
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Let say if my personal card deductible is RM20k pruValue Med (currently considering, can this issue GL?)
Can I use personal card to issue GL first, then I pay the 20k first, and then claim the 20k from company insurance with the bill, receipt and final GL?
So must one card pay and reimburse? Cannot totally cashless admission if want to use company insurance to support a deductible card izit?
grace_ong P
post Jul 1 2021, 07:47 PM

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QUOTE(ckdenion @ Jul 1 2021, 07:05 PM)
ok grace i give you 2 scenarios:

Scenario 1: this is the first claim using your card (meaning it still have 20k deductible)
in this case, when you admit to hospital, GL wont be issue. you have to pay everything then do reimbursement claim. say if the claimable bill is 50k, you have to pay the 50k first. submit this 50k bill to insurance company, then company will reimburse you back 30k (20k deductible is paid by you or could be other insurer)

Scenario 2: say you have already claim the 20k deductible during that rider year OR say this is a 2nd claim followed by Scenario 1
since the 20k deductible during that rider year is already claimed due to previous admission, the next admission you can use this medical card already and GL will be issued. so whatever bill incurred will be paid by the insurance company to the hospital subjected to your plan's annual limit.
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Now I understand, previously I tot I only need to pay the deductible amount upon discharge, just whether can direct claim on other medical card. Rupa-rupanya have to pay the whole bill if use deductible card.
Thank you very much!
grace_ong P
post Jul 2 2021, 08:17 AM

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QUOTE(lifebalance @ Jul 1 2021, 07:12 PM)
I don't think your issue of understanding is on the deductible. Rather your main issue is "you want to have a claims under one roof" which means you don't want to deal with paperworks for reimbursement.

In this case, you should opt for non deductible plans.
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(Just realise probation got limit daily post)

Although I don’t like the hassle of reimbursement, but I willing to learn how it work to reduce my COI.

But when I understand then I know my main issue will be the ability to pay the bills first, can’t imagine if the bills cost RM300k, although company medical card pay 50k, still how can I afford the balance RM250k… where to find the money…

No choice, I think I only can opt for non-deductible one
Thank you for all the sharing~
grace_ong P
post Sep 22 2021, 09:13 PM

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QUOTE(Barricade @ Sep 21 2021, 09:15 PM)
Bought it since last year.
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Must need to pay the excess if claim happen? Mind to share how much is the excess amount in your policy? Different car different amount or will it be the same?

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