Hi Emmahazimah,

Please find the answers to your question listed below.

This is based on my personal knowledge and is not conclusive answer from an insurer as medical plan differ in their terms from company to company & even plan to plan.


1. Who can define the term and purposes of having a medical coverage?

Medical insurance provides coverage for hospitalisation & surgical expenses incurred due to illness or accident injury.

2. Why a client claim was advice 'pay and claim' when they already have a valid medical card?

This usually occurs when you're warded in non panel hospitals who don't entertain medical card from the insurer.

3. What is 120 days SI? What are the illness? What other illness that could relate to SI?

Specified illness occurring within first 120 days from the effective date of the plan are excluded together with pre-existing illness. It usually would include things like diabetes, hypertension, tumours etc. This list is non-exhaustive. Please refer to your policy contract for the full list of exclusions.

4. How 20 % co-insurance calculated?

20% coinsurance is usually applicable if there's upgrade of room & applies to all expenses considered eligible earlier.

5. Why the agent said to me that my medical bills will be covered if i purchase a medical card but in the end my claim was rejected?

Again this is something that might have been stated as exclusion on your medical plan and your agent has not mentioned to you.

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?

Some agents just don't go through the very policy they actually market. It's a sad fact. To me, the longer the agent has been in the business the more they accumulate in terms of knowledge & experience. Another advice is to go through your medical policy.

7. How assure that the insurance will issue a GL/ LOG to the hospital for any admission?

This is rather difficult to answer as medical plan usually exclude some types of admissions.

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?

You should contact either your agent or the insurers' customer service line even though this is usually done by the hospital staff.

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

This list is usually quite long and would be specified in your policy document as insured benefits.

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

This is usually due to medical plan you have which calls for your co-insurance.


I hope this has answered at-least some if not all your questions.

Cheers,

HH

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

PJusa

what is the difference between Smartcare optimum and Executive. looking at the word sound that executive is better

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.

My friend got feedback by one of the insurance company: acceptance of the exclusion

The Company will not pay benefits for:

Any investigations and treatment related to Disease and Disorder of Both and
conditions arising therefrom or associated therewith

This post has been edited by cenkudu: Feb 9 2010, 01:52 PM

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.

oh ok my initial thought is that they will ask straight away for check up before making any decision. I will advise her to negotiate, this is not fair for her because she will not be covered for any conditions related to that body part (not only to the current condition)

This post has been edited by cenkudu: Feb 9 2010, 08:34 PM

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.

We are about to write a formal letter. If we are offering medical checkup, the cost should be bear by the insurance or ourselves? Should we also offering something like we are not expecting them to bear the cost for the current condition (such as removal of current lump) but they should at least cover for the same condition if recurrent or any other pathologies in that area.

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.

do you able to speak to the underwriter directly?

PJusa,

so to summarize :

PA 1million
CI 150k

next question:
what are the important questions i should ask an insurance agent before purchasing ?

thanks

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).

Has the medical insurance premium adjusted lately? I heard that ING med card premium has increased +20% this year...Anyone could confirm?

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?

my friend able to communicate directly with the underwriter through email. has offer for medical check up but seem like they are not really interested with check up. underwriter mentioned about when they decide to exclude something they take into consideration the probability someone to admit to the hospital. they said based on their experience with that condition there is a possibility for us to be admitted in future.

but if talking about probability even a healthy person right now also has the probability to be admitted :-)

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

two insurance gave an identical answer. like they are sharing decision

Hi, just wish to add some of my little knowledge concerning insurance and Med card; it's a must as hospitalization can really killed you not the illness but the fees. But, when you have a Med Card, that's a very good reason for the hospital to keep you there and so, a minor problem may lead you to a long stay in the hospital to get to your Med Card.

But then, you must have a Med Card or otherwise, you may find yourself in serious money shortage if you are a salary earner.......sometime, a hospital stay can cost up to Rm50K and that's what happened to me 3 months ago......luckily, I have my Med Card but then, I didn't have; my stay maybe just for a week and not one month lah.

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.