Hi all sifus and helpful agents - appreciate your input

I had a small surgery in Feb 2020 to remove a 2cm fibroadenoma (benign in nature) in my breast, briefly mentioned this to my insurance agent before the surgery but she didnt tell me to declare it to Allianz.

Fast forward 9 months later (Nov 2020) I wanted to upgrade my Allianz medical insurance to unlimited claim, my insurance agent then declared my breast surgery to Allianz and Allianz excluded ANY breast related matters in the upgraded policy, but i can still claim any breast related matters under old policy subject to the old limit (RM80k).

Now 4 years have passed, have asked my agent to submit an appeal to Allianz attaching my ultrasound report showing no relapse, Allianz rejected my appeal. Asked my agent the reasons and she told me that recurrence of fibroadenoma is high and breast cancer is very common in Malaysia. also told me she has not seen any successful appeal cases for breast matters.

Question - is it true that Allianz won't consider this kind of appeal? any agent here with successful appeal before? hope to hear more from other agents. thanks a lot 

Better to do any surgery overseas so that local insurance company don't know your medical history. When register in clinic, don't give IC. Write your name, but not in full and write the IC number with a few numbers wrong. This way insurance cannot trace you.

adele123 what do you mean it is not realistic? It is not that hard. I travelled down to Singapore to open bank account as a student (no student pass/working pass in Singapore as I don't study or work in Singapore).

All you need to travel one time down to Singapore to sign the contract. That is it. Subsequent payment just make payment from Malaysia  via banks (which I don't recommend). Is that hard to travel down once?

One can travel overseas but cannot travel down there for cheaper and better insurance? You can go by bus, train and plane for goodness sake. Is it difficult to go to Singapore? Not at all. It's all about whether you want to make the drip. It's about giving one the excuse and feel good that oh it's not realistic. It's not like you are going to North Korea.

I am talking about critical illness insurance. It's not the same same as mango. I have compare 2 Singapore insurance. Both same thing. Cheaper premium for more coverage than what we have in Malaysia.
I am talking about more coverage for lesser premium. You want to use mango example, ok let's ok with it.
You pay RM5 for 5kg or mango or do you want to pay RM2.50 for 7.5kg of mango? See easy to understand right?

Btw normal critical illness is cheap. It's those multipay and cover all stage of critical illness and relapses that is expensive. I am not going to go through ILP route. You don't need to bring it up again. I standby and vote with my money. I go by the standalone route. I am person who don't just NATO but walk the talk.

He means well, but unfortunately may end up coming across as somewhat close minded and inflexible with the way he puts it.

He does have a lot of pertinent points for consideration and at the very least, should provide some food for thought.

I’m a very impartial observer with nothing to gain or lose with my statement.

I am posting that one can have cheaper premium with more coverage. All you need is one day trip. Up to one how they want to use their money. They want it to work efficiently or less efficiently? For me, every ringgit I have will have to fight for their place.

Like I said, I am the odd one. So be it. I value efficiency and making money my money work harder.

You initially alleged:

"Yes AIA Vitality does have the right to share your data to the partnering vendors, only with consent. Customers do have the option to opt out of this during application, during every change of insured's details, and during every touch points"

This is false, based on my reading of the terms and conditions. There is no option to opt out of sharing data with affiliates/partners. As I've mentioned in my initial reply to your post, the only options available to the consumer is the ability to opt out of "direct marketing"

Your initial allegations are not the same as your current allegations. A and B are two different things:
A) Ability to opt out of sharing personal data information with partners/affiliates
B) Ability to opt out of "direct marketing" by partners affiliates

As for the why I'm alleging that there is risk of cross subsidization, it's because all insurance policy benefits whether they are vitality or main contract related are met from the same insurance fund within the main life insurance company. The vitality insurance policy benefits are not met directly from AIA vitality.

I've also never alleged that non vitality member details are being shared with vitality affiliates/members. I've only said that there is a risk that even if you terminate your AIA vitality membership, your request to have your data not shared/stored with/by affiliates/partners may be ignored because the terms are silent as to your data rights

I rest my case

Evidence finds that many wellness programs do not achieve cost savings or improve health outcomes

In the absence of cost savings, premiums would need to increase to cover the cost of the wellness rewards.

Maybe this person might meet the credibility standards of MUM and her ilk

Barbara Klever, MAAA, FSA

Chairperson, Individual & Small Group Markets Committee

American Academy of Actuaries

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According to this article, it is a "bad" thing, especially for those having had to fork out the co payment money.

Galen: New Health Insurance Co-Payments Expose Households To Financial Catastrophe
https://codeblue.galencentre.org/2024/07/05...al-catastrophe/

If we pay medical services using Insurance.... it's higher than Cash payment... having co-payment actually make things worse for the Rakyat.

the cost of medical services can only go up....

With the current non co payment plan,, many things are also not claimable.... has the current insured make noises regarding those non claimable items?

How does it make it harder for the hospital to overcharge?

Medical services will not be more expensive with co payment, ...

They are charged by the hospitals.

With out Co payment, premium will increase,
With Co payment, premium will also increase ( perhaps the quantum will be lesser).

With out co payment, insurance pay for most of the hospitalisation bills,
With Co payment, the insured and insurance company do the Co payment for the hospital bills

With the current non co payment, all are also paying for those non-claimable items in the bills.
They pay after the insurance company won't pay for it.
When received the bill, it is too late, ... be it those procedures are necessary or not.

The doctor may suggest to do some test for investigation purposes to have a better understanding of the illness. The patient can tell the doctor, please don't do that tests or procedures,??

If the co payment amount is "little", (alot less than the total hospital bills) then I believes these "leakages" will still happens.

That's what the news article is trying to blind side you.

For the same medical plan, one with 5% co-payment and one without co-payment, the premium for the one with 5% co-payment will be cheaper? How much cheaper i dont know. But you can think of it as buying 2 apples vs 1 apple. 1 apple= rm1. 2 apples = RM2. So you get what you pay for. Anyway, BNM say RM500 deductible or 5% co payment. In the grand scheme of things, RM500 is not a huge amount.

The cost of medical services is going up with and without insurance in the picture. I am not in the medical industry but i guess just like other industry they also have inflation and cost price increase yada yada.

If 5% seems to huge, the option for RM500 deductible is still there.

Need to be abit clear on the right terminology.

I am not familiar with actual cost but inflation is referring to this -->

If in year 2019, the cost of an appendix surgery is RM5000 and in year 2024, the cost of the same surgery is RM7500 for example.

The cost increase from 5k to 7.5k. This is inflation

What you are complaining about is... many people masuk hospital over probably not medically necessary surgery or procedure. While i think my appendix surgery is not a good example, what you are saying many people should not be going for this 7.5k procedure or surgery or admission because probably not needed in the 1st place.

And i personally agree there are people who simply claim cause insurance pay. So there is definitely abuse and the doctors also behave like sales man. I have been subjected to unnecessary endoscope and colonoscopy because i am also one of them. Dr say do, i do lo. Insurance pay. Better to be safe right?

The option provided by BNM for insurance companies to still sell the 100% reimbursement plans is just a away for the regulator to cover legal risk. Otherwise they will be rightfully accused by of affecting consumer outcomes negatively.

What is clear is BNM and the industry are working hand in glove to ensure that newer consumers take up the co-pay/deductible option. You must understand that under most circumstances, to ensure fairness, the co-pay and no co-pay pools will be separate. With not many new policyholders coming in and more policyholders surrendering, the insurer will find it a convenient excuse to reprice these dwindling legacy no-copay pools. Further pushing more policyholders into the newer co-pays pools. It is irresponsible of BNM to come up with this new policy without addressing the sustainability of the legacy no-copay pools. They should have just mandated a closed block approach with no more repricing for these legacy pools and be done with it. Otherwise, sooner or later, the old block policyholders will be forced to get into the newer co-pay pools.

If I’m not mistaken hospitals will still charge u their exorbitant fees regardless if you are on co payment terms or not. That’s between the patient and the insurance provider, nothing to do with the hospital…if patients complain a lot they might be a risk of transfer to gov hospital and I’ve seen cases like that happen before.. hospital don’t care it’s take it or leave it to them..if u can’t pay they will not admit you.
Secondly, most Malaysians are already very “anti insurance” in a way especially the b40 group, now with this mandatory co payment it will hinder more ppl from signing up for a plan. I have to pay ludicrous premiums and same time if admitted need to pay another 5%? Might as well take their chance with gov hospital plus majority of Malaysians don’t even have proper savings and majority struggling to even settle their premiums.
I just see it as insurance companies taking this opportunity to jack up their already high premiums even higher. When I first started paying it was only RM110 now I’m paying RM410..quite ludicrous if u ask me. I do not see any benefit from introducing this mandatory co payment policy rather it’s just to protect insurance companies

Update.

Today, i managed to ditch the old medical plan and replaced it with a better medical coverage of 2mil

Therefore, my insurance budget has jumped to RM727.88 with the following new line-up:

1.Etiqa Ezy-Secure - Life & TPD 500,000 coverage (RM59.16 monthly)
2.Kurnia PA Supreme Plan 6 - Acci Death & TPD 1,000,000 + 500,000 coverage (RM105.83 monthly)
3.Prudential PruMillion 2.0 Investment-linked plan without booster Medical RM500 Deductible for 2,000,000 coverage (RM210.00 monthly)
4.Etiqa e-CancerCare Takaful - Cancer/CI 300,000 coverage (RM73.33 monthly)
5.Etiqa AafiahCare Takaful - Cancer/CI 200,000 coverage (RM113.50 monthly)
6.EPF i-lindung Etiqa Critical Care Takaful - Cancer/CI 50,000 coverage (RM10.83 monthly)
7.EPF i-lindung Prudential PruCareLife - Cancer/CI 200,000 coverage (RM43.33 monthly)
8.EPF i-lindung Prudential PruBSN Cegah - Cancer/CI 200,000 coverage (RM43.33 monthly)
9.EPF i-lindung FWD eCritical Illness Plan - Cancer/CI 100,000 coverage (RM31.41 monthly)
10.FWD i-Protect Plus Plan A - Cancer/CI 100,000 coverage (RM30.91 monthly)
11.MSIG EZ Cancer Care 365 P50 - Cancer/CI 50,000 coverage (RM6.25 monthly)

Combined coverage:
Life/TPD 500,000 coverage
Acci Life/acci TPD 1,500,000 coverage
Medical 2,000,000 coverage
CI 1,200,000 coverage

Is it possible for high deductible policy to share the same pool as low or non-deductible?

I understand if different product/plan. But some plan have options for non deductible or 1k/5k/10k deductible for example. Same plan but different options. I doubt they really separate each of them when it comes to repricing.