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 Insurance Talk V7!, Your one stop Insurance Discussion

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kazekage_09
post Jun 6 2025, 03:19 PM

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Hi can anyone explain what is AIA Smart option is? Will it reduce the premium if I opt for it?
kazekage_09
post Jun 9 2025, 07:03 PM

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QUOTE(JIUHWEI @ Jun 6 2025, 04:10 PM)
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Yes it does reduce your premiums.
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What happens if, after attending the SMART clinic and receiving a referral to a SMART-affiliated hospital, I choose to go to a hospital that is not on the SMART panel? Will I be required to pay 20% of the total bill? Did a check and found the nearest and my favourite hospital is not in the list.
kazekage_09
post Jun 11 2025, 10:51 AM

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QUOTE(hafizmamak85 @ Jun 10 2025, 07:23 PM)
AIA has no right to discriminate against your choice of health service provider by levying an arbitrary 20% co-pay requirement solely because you did not follow the treatment process laid out by them or opt for their preferred service provider.

They can't impose an arbitrary co-pay for the medical claim if the medical treatment was medically necessary and the fees/charges were reasonable and customary.

Even if hospital groups were to tie up with digital insurers and takaful operators and their preferred TPAs, they can't deny a claim or arbitrarily impose restrictions on claimable amounts if treatments sought outside the group met the medically necessary and reasonable and customary standards.

Just as an insurer or takaful operator would have to approve a medical reimbursement claim, even if it was from a blacklisted doctor and/or medical service provider, if the above standards were met, the same thought process applies.
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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.

 

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