PJusa what is your opinion if I going this way:

-I have company medical card cover up to 15 K limit
-choose AXA Smart care optimum as a topup with deductible of 15 K (40% discount of premium). In case my company stop providing medical card this plan can be converted to full plan. I need to choose the plan properly as the conversion can only to same or lower plan only.
-take Tokio Marine Medic Plus to cover for outpatient cancer and kidney dialysis.

am looking at Tokio Marine Medic Plus as a supplementary medical plan. anyone has any knowledge in more details about this Medic Plus plan/experience dealing with TM?

Mayb different regulation for LIAM (r they governed by BNM?) FYI we did try to do this - exclude high claims customer & were told by BNM we cannot unless we withdraw the whole protfolio i.e. exclude all customers.

Went through the process of drafting a new Medical policy & pricing, furnished with claims statistic and medical cost inflation as a basis. Passed it to an acturial company for sign-off and was quoted RM15k (just to check and sign , all work, pricing and documentation already done by me) before we decided to call it off and just continue the existing product.

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Added on December 10, 2009, 3:03 pmSo u end up with 3 different medical insurance from 3 different insurer? AXA Smartcare oso got kidney dialysis & outpatient cancer. Isit ur company's medical exclude the coverage? Would getting a CI cover (CI covers kidney failure resulting for the need of dialysis & malnignancy cancer hence needing frequent outpatient treatment) be an alternative?

This post has been edited by rakyat: Dec 10 2009, 03:16 PM

yup, that might be a good alternative. but I have CI not with intention to cover that but more towards to cover the lost of income. My company medical card do not cover outpatient treatment and AXA plan is generally good except for dialysis and cancer.

That was what I meantioned about AXA..

I really agree to PJusa to leave TM for certain purpose. If I put TM as the main sources I found the tendency to file a claim is difficult as it has limit per disability.

per disability here means per hospitalization or per disease?

for eg in cancer treatment, you might need to go for multiple chemo shots which easily cost up to 10k per shot.

Just for your information, the Golden Rule when you are talking about insurance/takaful contracts are :-

1. If it is not stated, It does not apply.

2. If it is written there, better take note.

In other words the final document is your policy. You tak puas hati with your insurance, you sue them, the courts will only look into the four corners of the agreement. I personally attended a few disputes where the insurers wouldn't pay. One involved a very suspicious claim where the guy had 20 p.a. policy to his name, taken in the span of three months. Loses a thumb, very suspicously, and insurers refuse to pay. He lost because spesific in the insurance clause is DISCLOSURE. He didn't tell the insurers that he had 20 p.a. policy. (Plus it was proven that its impossible for him to lost his left thumb because the machine he uses only made it possible for him to lose his right thumb.)

One more failed in his claim, because the doctor wrote that he found 20+ undigested pills in his wife's stomach. Insurers argued suicide. Once that fact came out, settled out of court (usually ex-gratia, or kesian payment)

No, Life Insurance operates under the Insurance Act, and takaful operators operate under the Takaful act. Both acts are enforced by BNM. BNM sets certain minimum regulation for insurers to follow, such as the 15 day no hassle return policy. Means that you don't like the policy, you have 15 days to return it (sort of a cooling off period).

Wonder why Co-Insurance / Co-Takaful is being charged by insurers. You guessed it, BNM rules. They wouldn't approve higher limits without Co-payments, to encourage reasonable claim.

That is the beauty of having annual renewals for medical card. Why? Simply because I can withdraw the portfolio, and although everyone would be affected, they would have to renew their policy anyway. So, when your year is up, they say, sorry, new portfolio, u don't qualify. If portfolio is withdrawn, the existing portfolio policy of customers are in force as per the contract. Say your medical expires in feb, insurers can withdraw portfolio in jan, but yours will still be inforce. Come feb, however, when you need to renew, you have to go under the new portfolio lah. That's why there is certainty when you take medical as riders in ILP. Normally, when attached to ILP, the medical portfolio only dies when 1. Claim limit reached or 2. Whole policy reaches maturity, or is returned.

No insurance in this world can be pressured by the govt to take on high risk prospects. Simply because you could actually bankrupt an insurance with claims. When I was working in the courts, I was stationed at the runner's court, a fancy name for motor insurance accident claims court. On average, 100k worth of judgement is being handed out every working day. Thats for ONE insurance co. Then you have the biggy claim (paralyze, brain damage) that could easily go up to millions. Risk in motor insurance claims are sometimes horrendous. You pay around RM250 for a motorcycle cover, but if that motorcycle cover runs down and paralyze someone from the neck down, you could be looking at RM1 million claim payout. Add to the false claim somemore? Why do you think BNM was so intent in implementing No Fault no Liability insurance for motor vehicle? Because insurers are showing the numbers, they get this much but claim that much. Was in the papers last year I think.

NFL would be simple. Claim tak payah masuk court, but cap at certain amount, like 50k. You paralyze? Sorry, 50k max. Want more cover? Buy more cover, or get life policy.

The US medical bill pushed by Obama is the first to insert a clause that insurers cannot refuse high-risk prospects, and even then that is being vented out at (one suggestion was to have a govt run non-profit insurance for those who cannot afford or high risk? That a good idea you think?) senate. THe line is simple. Take high-risk prospect, you mmg kena high-risk payout. That's why they are pushing it back to the govt.

this sounds feasable. you are right about beeing carefull what plan you choose. there might be underwriting issue if you choose to waive the deductable later i think. better double check with AXA. if you can afford it, better not use the deductable or choose a lower one. also make sure company benefits actually equal AXAs - most times they dont.

my wife actually has your exact same setup left the deductable. we looked at the company plan benefits and they are really basic. only things worthwhile are the annual checkups and dentals we enjoy

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Added on December 11, 2009, 9:57 ammy personal experience with them directly is OK. the call centre ppl are sometimes useless but if you are pushy that wont be an issue. if you have a clear cut case there wont be any issues anyway.

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Added on December 11, 2009, 9:59 amthe reason for TM is that AXAs cover for outpatient cancer and dialysis is too little. TM's purpose is a) burst and b) outpatient cancer and dialysis

CI is a lump sum - to match the cover you get from TM 1:1 you would need to pay a very hefty premium. i prefer to take the higher amount of potential cover for the lowest possible charge. but yes in general CI might be an alternative - but what if you suffer from both cancer and dialysis - CI wont pay for every occurance...

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Added on December 11, 2009, 10:01 amper disease - i.e. got specific cancer it's one disability

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Added on December 11, 2009, 1:20 pmmfitri77, i appreciate the discussion with you - and i do agree that there are some problems within the malaysian H&S system. and yes, the policy wording is the contract and nothing else. how else could it be? that is why everyone should always read, understand and ask questions pertaining the policy wording. get clarifications in writing too - they will then be treated as extensions to the contract if in doubt.


but i cannot help to wonder where the relevance in your examples lies. quite clearly the thumb case is attempted insurance fraud and furthermore is related to CI. what is true though is the importance of full disclosure of your medical history when it comes to H&S policies. fraud however should be combatted and its a good thing too since this will keep premiums lower. i dont want my insurance to hand out money like nobody's business. similar argument holds for the possible suicide. it's excluded - and the insurer has every right to argue if that is suspected to be the case. of course the other party can also argue. this is the natural cause of things. who would expect the insurer to just blindly pay?

your comparison between GI and ILP is simply wrong. ILP has the same portfolio withdrawal option so where is the benefit? they also can change the premium so no use. please name cases where portfolio withdrawal has been exercised in the way you describe by GI. i'd be interested to see them.

this is entirely not true. first of, healthcare for example in europe is mandatory. also insurers have to take everyone by law - no execptions, no loading - the whole of the insured will balance this out is the argument. please take a look for example at the german healthcare system. also note that policies are not bankrupted by doing so - this statement is completly unfounded. premiums however are adjusted. also the motor insurance statement has little relation to the issue we discuss - feel free to discuss motor insurance seperately. you cannot compare an insurance that is regulated by tariff but has "open-ended" claims with a tariff-free H&S insurance which furthermore has capping as to the amount you can actually claim. the latter is properly priced and enjoys real-life risk assesment.

and one last word to the high-risk issue: if we forcefully enjoy all malaysians in a single policy system like in europe, the numbers will provide ample of cushion to allow for everyone to enjoy great health benefits without excluding anyone at low premiums. the way the system works now is that the affluent (and usually healthy) ones can enjoy even good healthcare. i really wonder if the european approach would not be more beneficial and cheaper to the society especially if we dont allow for private insurance and only maybe private top-up. probably it would but that is a political question and most likely out of the scope of our attempt to find reasonable h&s cover at a decent price. and an ILP rider is most certainly never the best option.

This post has been edited by PJusa: Dec 11 2009, 01:26 PM

PJusa, I have checked with AXA and the answer for the conversion to full premium from deductible is as follow:


For conversion without underwriting this conditions need to be adhered to:

1. The deductible policy must be at least inforced for 2 policy yrs.

2. Conversion is to be done at renewal time.

3. At the time of conversion, the age next birthday of the insured at the time of renewal must be on or before 59 years old.

4. The conversion is to convert to same plan or lesser plan.

5. The conversion is allowed once only per life time meaning you cannot convert it back to deductible plan or lower plan.

cenkudu,

in this case you should aim as high as possible - just to keep all options open. i did remember something like this but could not remember entirely how the waiver of underwriting would work.

i think in general AXA is a good choice as a H&S provider - they have a good reputation in europe and they do know what they are doing. also they are not a profit-oriented as other providers so this is an added benefit.

btw: i looked for non-profit insurance companies earlier cause i thought i did remember there are some private healthcare insurance companies that operate on non-profit basis. and they do exist: for example in germany a company called debeka offers private healthcare insurance while the company itself seems to be run on a "community basis" principle. in a nutshell their aim is to break even and that is that. i also found some notions that similar companies exist in france and other parts of europe. how absolutely wonderful - i want this here too!

Hope to hv A non-profit insurer in m'sia would be like having a day dream in one of the wonderful beach in M'sia.. heh

hehe, well one can dream right? my wife is actually making me think about this french insurance. seems that their fees are not that bad if you look at for long term. i just wonder what the premium is like beyond age of 65...

but then again its not that long ago that there were talks of a general healthcare insurance for malaysia - then everything went silent again. for the sake of the ones who cant afford private care, there should be a mandatory cover from an insurance body (preferably non profit) but i think we rather see pigs fly than having this happening here.

This post has been edited by PJusa: Dec 11 2009, 05:32 PM

i aim for the second or third plan depending on my budget. I really happy to hear that the plan can easily be converted after 2 years without underwriting as I haven't yet to test my company medical card. At least I can take the deduction for first few years and whenever the time comes and the least is before 59 y/o to convert this policy.

budget has to be observed of course - the better cover you get now, the more protection you can enjoy later on

next plan is to get standalone MC for my son who currently having medical rider under ILP for just 5 months. is it ok to apply for new stand alone card and once approved cancel the whole ILP or if possible to modify the plan. of course money will burn but it is better to burn now rather than in the future

any plan in mind? my son is on the cheapest plan for ING IMPlus which i think is not very cost effective. might review it should there be a viable alternative.

i think you can do that. i am not sure if you can just cancel the medical part of the ILP but it's most likely a good idea to pull the plug entirely since the policy is not that old. the loss is still acceptable to some degree. you could also qualify for a partial refund of premiums.

in general low-end plans are the least cost effective ones. you could either upgrade to at least the 100k plan or look for a plan with a lower cost per 1k/cover over a specific period of time that you want to pay for your son's cover.

sorry for the late repl..

it is a rider in the ILP...

need to contact this insurance company whether I can cancel the policy through them without agent. otherwise might be difficult because agent will try to convince us to stay as they will lose 25% of their commission. I was thinking to buy medical card only for my son and not very sure about the rest