i only know of Malaysia Insurance Online whose plan works like this. the 10% default co-insurance is however capped at RM 500, 10% co-insurance on outpatient kidney/dialysis too.

pruHealth also has a 10% co-insurance with a cap.

20% default r&b co-insurance i have never encountered. which provider and plan is this?

that explains it all. sorry for misunderstanding. the 10% co-insurance comes for individual plans for the companies i listed above. for company plan, it might even be without limits in order to reduce premium due. i guess in a way this example shows that you should not rely on your company plan but get your own one too - one where you know what is paid and where you decided on the cover.

AXA has a limit per disability. be sure not to forget this. this also leads to one of the lowest premium per 1k of cover in the market. if you can afford it you should a) use the higher plan (marginal cost is low) and b) make sure you have a top-up plan without a limit per disability but lifetime limit to maximise cover.

hi,

the thing with axa is that you MUST recover for 3 months from any disability before your limits (i.e. 120/150 days) are reset. this is why i would personally advise that when you choose AXA you should also use a "normal" H&S plan that carries a life time limit. a deductable such as tokio marines per disability fits well to cover exactly this limitation of the policy. but any other deductable policy (pacific, allianz) can be considered as well. if you have both you can first claim from axa and if something exceeds those limits you can claim from the second policy.

bedding configuration for private hospital? i would assume double and single. the higher your limit the better though - cause this usually also means your remaining limits are high and risk of hitting the 20% co-insurance for exceeding room/board is lower.

if i understand the policy correctly, after 3 months any disability will be treated as new and if the policy year has not yet ended you can claim again fully as per your annual limit. the limit is per disability so you can have as many per year as you want.

you dont need to recover within three months but for hospitalisation after your limit is used up you must recover first before you can claim for the same illness again. this is why a second policy should be usefull.

personally i dont think 100k annual limit is enough for serious illness. i would choose a higher plan. the nice thing about axa co-insurance clause is that if you have a higher room and board within the same category of room you are entitled to you only pay the difference in room and board rate and no 20% co-insurance on the other expenses applies.

from a value for money point of view, the higher the cover the cheaper the cost per 1k cover (risk of high loss is lower than risk of medium loss etc.). so aim as high as you can - but dont overspend.

i dont have time to look for the clause in the policy today but if you remind me i can do so over the weekend i think the 120 / 150 clause is in the beginning though.

~Battousai~,

you would need two insurances in this case if you want a hospitalisation benefit. for your health insurance there are many many general insurance options. do you have a budget or preferences? this will pretty determine the choice of H&S that you will (have) to make.

what exactly do you want to cover when you say "unable to work the insurance will cover me". do you require a daily / monthly cash benefit if you are unabel to work? if so how long should the payout take place and under what circumstances. to some extend the lump-sum payment of a CI may be what you want. if you only want cover in case of accident, a good PI policy might be what you are looking for. as far as i know there is no malaysian policy that will cover you with a monthly payment or lumpsum payment if for any reason you should be unable to work. with some luck you might however be able to get such a policy from abroad. but: such a policy (unless its lumpsum) will be pretty expensive, i would assume a couple of thousand ringgit in your case per annum.

cenduku,

the definition of disability is the important thing to note:

"Shall mean a Sickness, Disease, Illness or the entire Injuries arising of a single or continuous series of causes. ANY ONE DISABILITY shall mean all of the periods of disability arising from the same cause including any and all complications there from except that if the Insured Person completely recovers and remain free from further treatment (including drugs, medicines, special diet or injection or advice for the condition) of the disability for at least ninety (90) days following the latest date of discharge and subsequent disability from the same cause shall be considered as though it were a new disability."

the benefits of "IN-PATIENT & DAYCARE SURGICAL PROCEDURE" and "OUT-PATIENT TREATMENT" (sections A & B) are per disability as defined above.

only section C carries an independant payout for
a) Out-patient Kidney Dialysis, lifetime maximum
b) Out-patient Cancer Treatment, lifetime maximum
c) Accidental Death
d) International Emergency Medical Evacuation & Repatriation, per annual maximum

as per your friends questions:

this will totally depend on the symptom and the further explanation. if you can give a detailed explanation which sort of eliminates the risk to the insurer they might still cover this particular problem in total otherwise exclusions are likely. in general the less information besides the ticked box, the more likely the exclusion is going to be. it's best to fully disclose for the past 5 years and to offer further disclosure for periods exceeding this period on demand. that way you can cover yourself against a potential refusual of claims due to the insured having withheld information. bear in mind, false information or withholding important information renders the entire contract null and void and will thus leave the person in question without any cover at all. it's best to disclose as much as possible and offer that they check if any further information wanted with your or your physician. this basically covers you for the future.

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Added on February 6, 2010, 11:41 amedit: a lump should usually not be a problem. but of course this is for underwriting to decide not me.

This post has been edited by PJusa: Feb 6 2010, 11:41 AM

cenkudu,

not a problem. you can just not claim the same damage twice since H&S is strictly reimbursement.

if your ILP is not yet in force for a long time it might very well be worth terminating it. it totally depends on the amount already commited (sunken costs) since this is largely a forward payment towards future premiums. a blanket statement "dont terminate" would be as ill-advised as saying "go terminate". one would have to take a close look at the policy.

if too much money is sunken, it would probably be the best solution to "top-up" the existing ILP policy with a proper GI policy despite the fact that ILP policy is not in your best interest.

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Added on February 7, 2010, 10:01 am~Battousai~,

will get back to you. this requires a bit of time and i am busy today. if i dont reply, remind me

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Added on February 7, 2010, 10:05 amweikian,

the arguments made by kclau apply largely only to the issue of replacing an existing life-policy with another life-policy. it does not seem to reflect on the option of replacing a life-policy with GI products alltogether. while the argument does hold validity to some extend, it will totally depend upon the personal insurance cover, duration of exisiting payments, actual vs. covered needs and more. even if you are going to replace an existing life policy with a new life policy there can be situation where termination of the old one is usefull. i dont think a blanket statement will be adequate even though for the majority of policy holders it would be true that terminating an existing life policy for a new life (NOT GI) policy is not in their best interest. replacing it with GI products might however be very well in their best interest.

This post has been edited by PJusa: Feb 7 2010, 10:05 AM

weikian,

i dont think one should limit the focus on the money left in the initial years but one should as well consider how much more money needs to spend for the remaining tenure vs. an alternative. only then you can make an informed decision. sometimes its just more economical to cut losses because the future savings a higher. but this usually will depend on each individual situation.

the trend for normal standalone plans is 10x annual limit but that is not the point alone. a standalone plan is also a lot cheaper - even on a long term average because "clutter" riders are taken out. a whole life policy (ILP or standalone) is only suitable if you really really want and need all the riders combined. usually you dont really need all of them. this is why disecting the cover and then covering as you need is often more efficient. it also allows you to properly weight needs for cover. a very good example would be a CI cover. if you are young you should have a very high cover (cause you hopefully will be needing the money for a long life pension payment). the older you get, the less cover you need. if you bought a whole life cover, you will have a hard time adjusting the various aspects of cover according to your changing needs. so you will have to buy a very high level and stick with it. in otherwise you largely overpay the older you get and because the risk for say CI increases with age you also face much higher premiums. i hope i was not to fuzzy about this

if you change from whole life ILP to a set of GI covers that cover your needs then its not a downgrade but an adequate cover vs. overinsurance.

i'm sorry if i am sounding defensive. i really dont have anything to gain from the discussion. i am also just making my point. while i might agree that some plans fit the needs of some people better than others most whole life covers that fit your budget (and mine)dont really cover your adequately for what you really really need. how many people end up buying the dreaded RM 250 whole life pack with a measely 50k medical cover p.a. for this particular case of insurance package and this particular budget buying whole life and believing one is save is a really bad decision.
i need to set my budget and then fill the coverage options in terms of importantance. the single most important insurance (i think we can agree on this) is a medical insurance. this cover should be as high as possible and remain high. then you might want to a PA/TPD cover which will gradually reduce over time, you might want to add a similar CI cover if you feel like it. now you will simply have to see how do you get the most bang for your buck. because you can easily reduce PA/TPD and CI with GI and remain the level of cover of your GI H&S this is usually a good idea. it's also good to follow the "invest the balance" idea. your ILP plan might not perform as planned and you will need to top it up too. but are you prepared to do so financially? if not, do yu have to terminate the entire policy? with a set of GI policies you can save the premiums in the beginning, switch easier cause of no accumulated value (or lack thereof) issues and you can terminate the least important policies in times of financial distress without loosing the most important covers.

and the cheaper premium for ILP policies only applies because of the average premium issue. the average premium for GI is equally low (or usually lower) if you look at a coverage until the max age. if you ask me, this feature is more eyecandy and a selling point but if you compare with GI or a later entry point it's not much of a difference because ppl like to forget that they already paid the premium for many years (and accumulated invest profits - hopefully). the significant difference in premium structure causes a lot of confusion with customers about those issues i guess.

on a side note: lighthouse asia offers pretty much the ideal healthcare plan for malaysia - with coverage until you die. i think i posted the brochure already. if your budget permits, do look into this - i will most likely switch to their plan later (if no exclusion issues arise). if you're aiming for a really high coverage at reasonable cost this plan is my current favourite.

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Added on February 7, 2010, 3:52 pmi'd like to add to some questions:

6. Client came to seek agent clarification on purchasing a medical card but agent only telling the client which plan is the best? they make comparison with other insurance company plan types, co-insurance, deductible. What do agent understand about the medical illness and which illness is coverable or not by the insurer?

Agents will usually only suggest plans they actually sell and earn comission from. Why would a car dealer suggest you check out the dealer across the road who has a better offer for a better car? He would not!
Agents usually dont understand a lot about the actual details of the plans they sell either. It's best to lias with the insurance underwriting department to clarify any questions, read the entire (!) policy wording and ask tons (yes the more the merrier) questions until you understand exactly what is covered and what is not, when and how etc.

i think the rest has been answered by HHalphaomega
7. How assure that the insurance will issue a GL/ LOG to the hospital for any admission?

Impossible with local cover. You can get a comprehensive policy (lighthouse asia, william russel, bupa, allianz worldwidecare) which will do just that. But be preapared to pay much much higher premiums!

8. How to make sure that every time i was admitted to a hospital, the insurer will issue a LG/LOG for me without any hassle or delay?

see 7 - not everything is covered by local insurance so it cant guaranteed for every time you are admitted. it depends on what you are admitted for.

9. Which list of illness can be coverable in within 1st year policy?

better ask the other way around: what is excluded. the list can be obtained from your insurance. the shorter, the better (unless the exclusions are vague)

10. Why hospital staff ask me to pay for a deposit eventhough they already received a LG/LOG?

indeed LG/LOG might be too low to cover for all eventualities.

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Added on February 7, 2010, 4:14 pm~Battousai~

back to you:

i think your plan is good - you are referring to a prudential rider to cover your insurance policy premium i guess. it might be cheaper to increase the CI cover a bit to cover for the premiums and just buy CI and medical card. this way you can afford higher cover. you might also want to add a PA cover since you are very young and well if something happens you want to have some money to life by right.

CI and PA should always be high enough to provide you with a lifelong pension high enough to life by (factor in inflation!!). in other words right now you'd need higher cover.

you need to see what is the cash value given a moderate rate of return (say 5%) of a pension that you pay yourself monthly until say age 100. you also need to increase the payment annualy to adjust for inflation, i'd apply 4% but you might want to increase this.
the resulting amount is what you want your CI and PA to pay out as 100% rate. bear in mind the amount required will become less over time because you save for old age, you need a shorter duration of coverage etc. so you will gradually reduce the level of cover in steps. this assesment is the most complicated and you already noticed i didnt do the calculation for you

(my) rule of thumb: in 80 years you'll surely be needing 8000 RM monthly. at 5% return this means 1,92 million.
you could probably cut it in half or even reduce to third, because in the beginning you need less money and let it accumulate for later usage. so roughly 640-960k coverage would be pretty ideal.

1M PA will be around 800 RM annual (after 25% walk in discount)

500k should be around 500 RM

premium for PA wont increase over age.

CI will increase with age but as said, you'll want to reduce the cover as you grow older anyway. by 65 you should have achieved your pension budget and you can terminate the policy (they usually end then anyway)

CI will cost you right now 121 (pacific) for 125k or 204 (AIA) for 150k, you do the maths. premium is pa.

on average 100k cover throughout 22-65 will set you back 1000 RM p.a.

as for the medical card there are several good plans with 10x annual limit, no lifetime limit and top-up plans around.

please bear in mind - a life plan with medical rider does not really increase the premiums because they charge you the average premium until the policy lapses right from the beginning. if you choose GI, the premium will be much lower but will increase sharply over age. this creates problems because this structure sort of forces you to remain with the policy even if better offers come up or when you want to change your coverage due to shifted needs. since you are very young, you will in my opinion (others might disagree) benefit largely from not buying ILP or life insurance products but by buying the policies you want seperately. of course you will need to keep an eye on your needs then. if you get the highend cover as a all-in-one product you will see this will cost a fortune. but since your need today is totally different from the need in 50 years (when you basically only need H&S) you should allow yourself the flexibility and avoid beeing stuck with a compromise or an ever increasing overinsurance (or worse underinsurance) situation.

at the end of the day if you invest the balance yourself you might (not will - but most likely you will) be better of with a set of GI products.

i hope you will find some of the information usefull and i do hope i didnt confuse you too much either.

This post has been edited by PJusa: Feb 7 2010, 04:14 PM

cenduku,

executive is much much lower end, max. annual cover 50k, min. cover 30k. the policy also comes with a max. payout per disability (7,5 -12,5k). the 50k plan is thus a a bit cheaper than the 50k plan from SCO (long term you can save 1/3 of the premiums compared to 50k SCO). i personally dont think its a worthwhile policy due to sublimit and low annual limit but of course if your budget is limited this policy is better than no cover at all.

cenkudu,

i would try to get back to them and negotiate. often they are much more willing once you provide them the option to do proper risk assesment. offer a checkup by a doctor they appoint if required. you just might get the exclusion to go away.

cenkudu,

from my experience, insurance will exclude and only ask questions if you get in touch and make an effort. went through with getting a very broad exclusion waived myself around 3 years ago. took some calls, a letter and the provision to contact previous insurance to verify i never claimed on this issue + offering them to get in touch with my doctors (which they never did). offering and giving a statement was enough to remove the exlcusion totally. if you just accept it then they will just exclude and exclude broadly just to be save.

cenkudu,

you can do all the things you mentioned. basically it will all depend upon your nego-skills and what the medical experts say. i would offer to pay for the examination though to show goodwill and confidence that the outcome will be favourable.

cenkudu,

nope - had to lias with the very helpfull customer service. i was actually quite glad i skipped the agent cause the agent was telling me have to accept their decision. i just went over agent's head and called CS, had a couple of talks with the ppl who are in charge, they lias between underwriting and me and everything could be sorted out within about two weeks only.

~Battousai~,

CI 150k was just a fees illustration. i would cover a higher amount - this will depend on your needs. as per my illustration an ideal cover (albeit expensive) would be around 1M as well - you should however be fine when you settle for 400-500k.

as you might have noticed i dont like agents that much because they will never give you comparison between different isurance's products simply because they wont earn comission if i dont choose "their" insurance. either go for a broker or do your own comparison. tell them your risk and then ask why is this policy good for me? why are others not as good? what is the difference? read the contract, get it explained. i find it's easier to do it myself and call the insurance co's. they are usually more versed than their agents when it comes to their own products also they dont need to make targets and wont earn from me - so their answers are less biased (a bit at least).

havent gotten hold of a new premium. revisions last year were pretty moderate but it depends on the product i guess. 20% across board would be pretty drastic. might just be for certain age groups (i.e. the older ones)? anyone has a current premium brochure?

cenkudu,

i'd try a different insurance then - or a different underwriter. tell them if they are not willing to consider you'd take your business elsewhere. it might just help. the argument is they gave your friend is indeed pretty basic. by the same argument they should not insure anyone due to the risk they might get sick

interesting - for a completely harmless issue this is strange. maybe there is something non-medical experts dont see? from my experience with the insurance co's this should not be an issue (and i dealt with allianz, axa, msig, tokio marine and two international ones before).

which companies are those? you might also give calling CS a shot and talk to the person who liases with underwriting. they might be more helpfull.

joelietz,

you did notice that this is a broker from california, US right? no coverage for malaysians.

cenkudu,

better than nothing. i'd still try to negotiate further once you have the results and you can vaporize their (financial) worries. i can understand they would want to exclude lumps per se but you still might have a chance with getting it only for the current one. it's all a matter of negotiation and threatening to not insure the whole family surely helps

cenkudu,

basically i'd use your line of argument. further supported by a statement there have never been any kind of medical claims for this issue (only if it*s true of course). you could also offer that this particular issue be excluded but all other lumps should be covered. i think at this point it all boils down to your negotiation skills and the mood of the guy on the other side to listen. a very credible threat to use a different insurance company will only work if you talk to someone who is in charge of handling the accounts since underwriting could not care less if they insure you or not.

it would also help if you have exisiting cover where there is no such exclusion. if you really want this company to insure you then you will have to try to negotiate further. otherwise you might really want to explore other options. if the budget is there, one of the international insurances will take you and will cover pre-existing conditions (including the lump). this would definitely apply to allianz worldwide care and i think april mobilité as well.

hence the medical report but one never can be 100% certain. with H&S many can be negotiated and if all else fails european insurances dont do exclusions on a lump if no treatment has ever been required and a doctor certifies it's harmless. some wont even bother to have it reveiled. i went through 4 european H&S insurances before and 4 local ones by now and i never had any problems getting full cover despite suffering from a small allergy. with the locals it was however always a negotiation run while the euro insurances took note and covered it anyway. are you sure there is no way to get it covered if its certified harmless? i never had the problem so i am just relating from other experience - do you have more details on what is a "must" exclusion situation? would love for you to share that info for us to learn