Hi,

That's a good suggestion.

do you have any claims experience/heard of any problems regarding medical claims with general insurance companies? the general believe is that general insurance MIGHT be more difficult to claim AND the issue of renewability of the medical plan.

Just wanna to share with you guys, I bought a Prudential IL medical card for my wife and myself back in 2003. Few years back, my wife broke one of her toes and so she made a claim, it was a small amount but because of this claim she has not been offered automatic upgrade for her policy.

Last year (or was it 2 years back), prudential offered to extend my policy from age 65 to 80 but not for my wife. So I asked my agent about my wife policy and he forwarded my request to Prudential where they subsequently extended her's too. Of course both our premium increase substantially too.

Last month was offered by Prudential to increase my lifetime payout from RM300K to RM1M for RM600/year but once again my wife was not offered this "upgrade".

So, do not claim for reimbursement for small medical bills as it will affect your chances for future upgrade offer.

This month got registered mails from Prudential offering to increase 2 of my children's medical max payout by RM20,000 for additional RM10+ monthly. So I asked my agent what is this, and was told that Prudential is worried that the economy might be getting worse in the coming years and that money in the IL with them may not be enough to cover their cost (or something like that). Boy, we should be worried if Prudential is worried that the future (economy) is not so good. I also don't think the coming years will be good too (unit price going down) so have withdrew half of the money from my 2 kids policies 2 months ago and invested it elsewhere that have nothing to do with mutual funds.

Personally seen the service of ING and i would say it's so-so only. Now switch to GE and its much more better service.

jutamind,

GI will generally be the same in terms of claims and all. if you have a guaranteed renewal clause the risk of loosing cover is pretty much the same with GI and Life. personally i never had any issues making claims in the past but this might just be me - i can be very very pushy and usually get in touch directly with the person in charge as i usually dont use any agents if i can avoid them.

Gen-X,

you might find that a GI H&S cover would serve you better as it would be easier to switch within plans and insurance company as compared to IL-Life policies. your problem is one of my main grouses with H&S from Life Insurers. of course with GI you should get a high (the highest actually) cover in the beginning. downgrade is always easier and higher cover early on is cheaper also than with life insurers

have you experienced any difficulties in admission to hospital/getting guarantee letter when using a medical card from GI companies?

nope and i am really quite certain that there is no difference - the hospital wont care where the money comes from. if you choose a big reputable company like allianz, axa, etc. there should really be no problems whatsoever. many of them have a large number of panel hospitals too.

ING is the bestest H&S insurer in the market, GE (OAC) is not even close infact is almost same league as Kur***.... don't mistake AGENT's service with the insurance co.

If ING was 'so-so' they would not have cornered the Medical insurance market within 2-3 yrs. While other co. are losing their pants on medical, ING is profitable. Another thing, most good medical these days are copied versions from ING

This post has been edited by rakyat: Dec 8 2009, 10:05 AM

anyone has experience buying insurance and making claims from banks, i.e. bancassurance?

There is no difference in the claims procedure although it is generally true that some GI process their claims slower then Life insurer but this is more due to efficiency of the claims process.

An insurer cannot prevent you from renewing your Medical insurance unless they withdraw the product completely i.e. every customer oso cannot renew. BNM does not allow insurer to 'pick & choose' who to invite for renewals. They can of course load up your premium and hope that you will not renew.

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Added on December 8, 2009, 9:53 amWhen you have a medical card, u don't need a 'letter of guarantee'. U need to know the panel of hospitals and just present your card during admission.

Should not face any problem in admission unless the hospital is no longer in the panel or your plan/ coverage is deemed insufficient by the hospital. Of course discharge is another matter if you exceed your limit.

Letter of guarantee is used when there is no medical card and usually for Group policies.

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Added on December 8, 2009, 10:02 amBanks don't underwrite insurance. The policy is u/w by an insurance comapny and the bank acts as 'sales agent' of course the policy looks like its tailor made for the bank but it is actually an rebranded & less coverage version of a 'off the shelf' insurance policy. Yes they do earn commission from it.

Better check the pricing as it might be 'cheaper' to go directly to the insurer. The DM (direct marketing) game is normally to strip off the coverage and offer bare minimum in oder to present a very cheap monthly premium. Mind you the cost & service fees are higher then direct source or agency source hence some adjustment to the rates are required. Although in the long run it is very profitable for the insurer as most ppl buy & forget hence the claims ratio is relatively low.

For Banca claims, u do not liase with the bank, u liase with the underwriter (insurance co.)


This post has been edited by rakyat: Dec 8 2009, 10:02 AM

When you have a medical card, it means that you have a policy with certain insurance company. When you present the medical card at the panel hospital, the panel hospital will contact your provider to know if :-

1. Policy is still inforce.
2. Policy hasn't exceeded limit.
3. You are over the waiting period.

THEN your provider will issue the hospital with a guarantee letter stating that the provider will take care of your bill. I.E. You need a letter of guarantee, if not hospital is going to ask you for money.

Sure, an insurer cannot prevent you from ASKING to renew your insurance, but they could always REFUSE to cover you. That little provision is always written in, in legalese and BNM couldn't never force the insurer to cover you. Why do you think they issue so many license? So you have a choice.

PJusa or those with Tokio Marine, hope can answer my enquiry. if a person admitted to hospital within the first 12 months and pay all the fees by himself (including the deductible 10K), is he/she qualifies for the 12 months 'claim free' period to obtain renewable guarantee?

cenkudu,

yes they are. i have this from TM directly.

mfitri77,

i dont get what you try to say at all. there are numerous GI policies available that offer a guaranteed renewal without loading on personal claims experience meaning they cannot simply refuse the insured if the insured chooses to continue the cover nor can a loading be imposed. plans that dont offer this feature are - pardon me for saying so - worthless paper only and dont deserve to be called insurances.

Maybe we are talking about two different things here. For GI that covers CI, Death and disability, they don't really care that you have certain illnesses. Why? Because payout for CI, is when it's really CI, I.E. when you are just waiting for the reaper to come get you. Why many people think insurance is a cheater, is because many who tried claiming CI when they were diagnosed with stage 1 cancer found out that payout is stage 3. Or when you need two blockages in your artery instead of one.

Medical, well that really is another story. Simply because that's the biggest claim in Malaysia today. Reason is simple, private hospitals want insurance money. A client of mine confessed that one doctor in a private hospital, when asked on the cost of a full medical check up, told him to come and say that he's having chest pains. They'll admit him in and bill, you guess it, the insurer. Demam? Admit. For demam also, claims are now averaging 3k per person.

That's why medical also has so many exclusions, syarat, term, inclusion that it is easy to trip up an average person if he or she is not properly adviced by the agent.

Example

Insurance A, no co-insurance (part payment to the bill that you have to make, usually 10%, with a maximum limit like 1k). However, go OVER the room limit, and you pay 20% co-insurance. Don't matter that you have to take a pricier room because no beds available, or you need single bedded because you are quarantined, go over room limit, 20%, don't care.

Insurance B, medical fee is as charged, Subject to reasonable cost and terms. What's the reasonable cost and term. Depends on the insurer mood that day lah, if suddenly your daughter is denied a medication because its too expensive? A client once called me at 5 am (nasib baik during puasa, so I was up), saying that oh, the nurses say before this *** insurance don't cover a treatment for Kawasaki diesease because its too expensive.

You see, so many things you really have to take care when you buy medical cover.

As for the renewal, two terms I picked up from the standard medical standalone policy. Quite popular, from what I heard.

Annual contribution rates are applicable to standard risks only. Contribution loading may be imposed on non-standard risks.

Means if you suddenly have non-standard risk (either you have claimed, or kena something) - LOADING!

The contribution enforced is based on the age of next birthday and is made annually at the rate applicable during renewal. The contribution published in the brochure is for standard life on and contribution loading may be charged to non-standard life. Contribution is not guaranteed and may be subject to change.

This one is better. Non Standard Life - Definately LOADING! Standard - I can hike the price up, anytime I want to during renewal. This one my father already kena. Tak penah claim pun, but because hit age 60, hiked up 50% from original premium!

Tarik portfolio? My company revised medical portfolio twice this year. First time, increase limit. Second time, put NCB (no claim, get no claim bonus). Tarik portfolio so easy lah. Just say to BNM I'm revising the limit, and you can tarik the portfolio already. Just put number only Medisayacover1, then upgrade to Medisayacover2... When people cry foul, Eh! lain portfolio maa.. Higher limit!

So, be careful when you select a plan, and always remember :-

Insurance company are out to make money.

You need insurance because if you are sick, you need money.

If you die, your sons and daughter will need the money.

People like to con insurance company, because they think its free money.

Because of that, insurers lost money.

The put it back to the public, so a policy now cost more money.


Heard on the grapevine an interesting development on the car insurance front. If what I heard is true, then life insurance people will get more ammunition, GI (esp those doing car insurance) may also want to get your C license ready.

Thank you. how about any exclusion or loading, can they increase premium or refuse to renew upon 12 months claim free period even we do not make any claims in the first 12 month?

cenkudu,

only on portfolio basis i.e. no individual loading or exclusion.

btw: found a cover from lighthouse.asia yesterday that by far exceeds all other medical plans. price is around 1,2k US$ p.a. will attach the plan here.

sorry, cant get the stupid attachment to accept the PDF. here is the link: http://www.joy-stay.com/files/InsurancePla...at_Benefits.pdf

This post has been edited by PJusa: Dec 9 2009, 12:49 PM

No-la, u paint a picture that is so gloomy......

For medical products (CI, H&S, Hospital income) cannot refuse renewals even if the insurer have bad claims experience. This is the 'safe guard' mandated by BNM. The insurer can only exclude the diagnosed & paid illness and/or load the premium. The only way the insurer can stop renewal is via Portfolio Withdrawal but MUST offer the customer a substitute product hence whta you mentioned about 'Medisayacover1, then upgrade to Medisayacover2' is partially true but BNM oso got a say hence if the changes is purely cosmetic, they will not approve.

FYI drawing up the product specification and premium rating for a MHI product is not so simple. It will involve an actuary sign-off which will then be vetted by BNM's own actuary dept. The whole process takes months and require insurer to provide the basis and statistics.

BTW u r right bout the motor insurance revision. It is being revived (there have been a revised motor tarrif since 1998 and all insurers were told to get their system ready) and discussed but due to political expendiecy not sure whether can implement.

Thanks PJusa. I read Tokio website and found deductible per disability of RM 10 K. Does it means we need to pay the first 10 K for each illness before can make any claim. how about the outpatient cancer or kidney dialysis, is it requires those deductible 10 K before we can ever used it? Would be great to read their policy I can't find it at their website

rakyat,

thanks you saved me a lot of typing

also if all the points mentioned by mfitri77 would actually be entirely correct, they would also apply to life.

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Added on December 9, 2009, 12:54 pmcenkudu,

10k applies for every one disability - since cancer is a complex sickness you will usually already have paid more than 10k in treatment before you go for outpatient. same applies for dialysis but you can always double check with them. they will be more than happy to send you a copy of the policy too if you ask for it.

This post has been edited by PJusa: Dec 9 2009, 12:54 PM

not entirely true.. I've a letter from an life insurer telling his client that his Medical policy will not be renewed due to claims experience.. I'll post it up if needs be.. The things is policy contract is the only legal binding documents, if your policy contract does not say 'guarantee renewal; or portfolio exclusion', insurers surely can kick anyone out in the next renewal as and when they see fit. So, check your policy contract before you sign. I know many of those medical policy (ie. rider in the ILP) will never has these clauses stated... But for some general insurers' plan you can see these terms stated quite Clearly...ask PJUSA.

does this case that you know of, the medical policy is from stand alone medical card or as a rider as in an ILP?