HHalphaomega,

you sure about that? i dont know about GE but i spoke with the guys from MSIG before asking them about their yearly renewable feature. they told me straight away that if i make high claim or for example cancer claim they either wont renew me next year or exclude cancer and such. since non-guaranteed is usually a lot cheaper this makes sense for the insurance (bad for the insured....)

As of now, the only discount you get if you buy direct from insurance company is motor vehicle. The commision if you get it from agent goes to the agent, otherwise it goes back to the insurance company. Because of that, why don't you get an agent, since you are paying commision either way.

Ask anyone who needed to make a claim, whether it is easier to go direct or go to an agent. Again, I'm talking about responsible ones here. I have a case where the good doctor wrote a rather exotic diesease as the cause of the 17 day hospital admission. Took nearly 4 months of the insurer asking everything from her birth report, private doctor report, checkup report, neonatal report, prenatal report (you get the drift) before claim approved.

I don't get it why people say Pru policies are more expensive. The reason why it might seems to be expensive is that the agent normally are trained to eliminate possible complaints from all angle. The 10% co-insurance, for example, means that most agent would sign up the client with Hospital Benefits anywhere between Rm150 to RM250, so when all said and done, client does not lose money when they are admitted.

All insurance have pro's and cons. Most that don't do co-insurance does the 20% penalty. Surprisingly, some practice both. (Thanks for the GE info). I do sell GI policies that does this, however, normally I would advice then to take room rates of at least Rm200. Some hospitals I've dealt with ran out of 4-bedded rooms, necessitation 2-bedded. Or you have to be isolated in a single bedded room. Imagine if your bill is RM15k, and you need to pay 20%. That means RM3k. Imagine if it was a 50k surgery? Can you pay 10k offhand?

As for the smart medic, key here is to read the policy and find out the guaranteed renewal clause. Should be (again, not sure about GE policy). All life that says they are guaranteed renewal will say as such in the policy. One thing an insurance broker once told me, for insurance contract, if its not stated, its not given.

I believe why most ppl say Pru prolicies are expensive, perhaps maybe most of PRU med card is attached to ILP. If this is the case of course it is anytime more expensive than any standalone medical card sold elsewhere.

PJusa,

I'm very sure about this one for GE. This is a rider attached to the main policy and I see there's only the usual Portfolio withdrawal condition - the Company reserves the right to cancel the Smart Medic portfolio as a whole if it decides to discontinue underwriting this rider. I believe this to be a standard term included in by almost all insurers.

---

Added on March 16, 2010, 11:05 pmAbout Prulink, I think if you pay a little bit for something then you usually get a little bit more in terms of benefits. The real question here is whether you can afford or need that extra. If you can afford it, I don't see why not.


This post has been edited by HHalphaomega: Mar 16 2010, 11:05 PM

A bit different about pru, although charges they may revise, is that the medical benefit is non-cancellable, except fraud or you have used all the limits, or reach maximum age. They can stop selling to new business, but they can't cancel the medical plan.

Look, maybe you met agent that only sells ILP because he doesn't bother with other pru products. We got for example pruterm, you get death, accidental benefit + medical card with payment as low as RM100 a month and it accumulates cash value. Even the ILP is affordable, because your policy can be tailored to an exact spesification. More savings, more cover, all of this can be tailored to suit individuals of different need instead of one-size fits all policy.

We got retirement accumulator, if you want monthly payout like pension, we got so many. That's why our slogan is always listening, always understanding.

Example, I've tailored policies, ILP with very low investment but high cover, and yearly income rider because the guy works in a pasar malam, travelling all over negeri sembilan in as lorry and his worry is 1. Accident death and 2. If he cannot work, where can he get money and 3. Medical benefits. Why I don't sell him GI separate PA+Medical card? Its because no payor benefit. No use getting RM200,000 if all gone paying for medical treatment after an accident. At least with the policy I tailored for him, he doesn't have to pay premium, he gets yearly income from insurance, he gets the TPD and death benefits.

---

Added on March 17, 2010, 8:43 amThen you can get one attached to term policy. Yes, its cheaper than ILP.

---

Added on March 17, 2010, 8:58 amAXA Affin right? Smartcare Optimum Plan? Page 7 clause 11 (downloaded from www.axa.com.my) clearly states that if you take room that is more than your eligible rate, you pay 20% co-insurance.

Why is room rate so important? Because more likely than not, thats where you will upgrade your room, like it or not. You come to the hospital, they say sorry, 4 bedded all full, no more room, you can't just say kick em out, I'm entitled to 4 bedded only. Like it or not, you take two bedded, and get hit with 20% without any cap.

Sure, pru pay 10% co insurance at the start. What nobody seems to emphasize here is that the 10% minimum is RM300 and maximum RM1000. Say your bill 50k, you ONLY PAY RM1000 as co-insurance. Upgrade room, you pay only the difference. I cover 100 you take 150 room, you only pay RM50 the difference.

Kena 20%, no limit co-insurance? Pay RM10k. Okay or not.





This post has been edited by mfitri77: Mar 17 2010, 08:58 AM

ok,

first of the co-insurance only kicks in when you exceed your room&board. so choosing the correct rate is a good idea. most plans of decent coverage carry a reasonable r&b rate.
if you exceed it you might be in trouble - so not having this is great, esp. with low cover.

HHalphaomega,
my concern was the poster mentioned its no renewal guarantee. if only portfolio withdrawal condition then it's a renewal guarentee if the insurance cant cancel the policy on me. otherwise i'd be in trouble. a rider normally has renewal guarantee. i havent checked what policy precisly was mentioned. if you have a non-renewal guarantee policy you sit on a time-bomb albeit a very cheap one.

mfitri77,
please double check on axa - the 20% co-insurance ONLY applies if you choose a room and board category above your entitelment with SCO. if you stay in the same category you only pay the difference in r&b and are not subject to con-insurance.

on a side note: of course you can get the agent's recurring comission as a discount if you do a walk-in. i am getting this discount from each and every policy we have. car, fire, householder, houseowner, PA, medical, senior PA and whatnot. all i have to do is ask for it. not a single insurance has refused it. to me it's worth it not using an agent but that is just me as i have said before. i prefer to save and handle the claim. if you dont feel comfy with that, take an agent. to me all the agents i have encountered so far have been little helpfull or not helpfull at all. your mileage might vary. even the only half-way usefull one turned out to be not too helpfull when he was needed so i went direct on that policy as well. i might just be my bad luck with agents though

Provided B does not know you have policy from A.

Principle of Contribution
When a loss is covered by two or more policies,
the principle of contribution provides that an
insurer who has indemnified an insured may
call upon other insurers liable for the same loss
to contribute proportionately to the cost of the
indemnity payment. Contribution is the other
corollary of indemnity, which has been developed
to prevent the insured who has two or more
policies covering the same loss from being more
than indemnified.

- Insurance Handbook, Malaysian Insurance Institute

If B finds out that you have policy from A, they have every right to call A and say, "Hey, this guy make claim, how much from you, how much from me.". Its basically out of your hand while they work out how much each will cover, based on type of policy, the limits in the policy and so on. Since I haven't tried claiming such way before, can you please show me a successfull claim made in such a way? Especially with dedictibles and all. Because if B finds out that you are covered with A, they might just say, oh, I cover half, RM12,500 k only, rest you claim from A. If A got deductible Rm10,000 then A can say, ok, after deductible Rm10,000 I only pay Rm2,500.

Word for word -

11. Upgraded Room & Board Co-Payment
If the Insured Person is hospitalized at a published Room & Board
rate and Room Category which is higher and better than his/her
eligible benefit, the Insured Person shall bear 20% of the other
eligible benefits described in the Schedule of Benefits. If the Room &
Board is of the same category but cost is higher than entitlement, the
Insured Person needs to pay the difference in Room & Board only

If you stay in the same category, no problem. But our collective experience, especially during the H1N1 scare last year shows that this is never the case.

Lets agree, that you get hit with 20% co-insurance if you take room category higher than your entitlement.

I am eligible for four-bedded, I go and get four bedded, no problem. SCO covers all my expenses. If 4-beddded cost 120 in the hospital, no problem also, just pay the the RM20 difference. What if I'm force to take 2-bedded, and upgrade because 4-bedded full? Don't I get hit with Co-insurance 20%?

None of the wording up there makes exclusions for if you are forced to take a better category room, as long as you upgrade for whatever reason (4-bedded full, you kena quarantine, you hate your noisy jaga tepi kain orang neighbour) you kena co-insurance 20%.

This is what many kena during the H1N1 thing, including two of my clients. They were forced to take single bedded because they are under quarantine. Fortunately they only pay the difference.

In the end, what SCO offer is just the same as the other 20% co-insurance clause.

This post has been edited by mfitri77: Mar 17 2010, 10:22 AM

this i agree, the 20% co-insurance on room upgrade will happen as soon as the room rate that you are staying is beyond what you are covered..I think it goes by the actual Rate, doesn't matter what category. A 2-room category may cost only 100 in GH, but it may cost 250 in a private hospital.. So, room cate can't be accurate.

I will practise this : Claim max from what the non-deductible policy(A), and when that's used up, can't claim anymore, i will go to my second policy which is the deductible one(B). It is a straightforward case to handle if B gives me ding-dong and runaround.

That works, as I say if A don't know you got policy from B, because for sure they'd go after B. Even worse, if you hide the fact that you have policy from A when you apply from B, B suddenly claim you didn't practice outmost good faith and refuse to honor the claim.

From SCO

Misrepresentation/Fraud
If the proposal or declaration of the Insured Person is untrue in any
respect or if any material fact affecting the risk be incorrectly stated
herein or omitted therefrom, or if this insurance, or any renewal
thereof shall have been obtained through any misstatement,
misrepresentation or suppression, or if any claim made shall be
fraudulent or exaggerated, or if any false declaration or statement
shall be made in support thereof, then in any of these cases, this
Policy shall be void.

10. Contribution
If an Insured Person carries other insurance covering any illness or
injury insured by this Policy, the Company shall not be liable for a
greater proportion of such illness or injury than the amount
applicable hereto under this Policy bears to the total amount of all
valid insurance covering such illness or injury.



This post has been edited by mfitri77: Mar 17 2010, 11:10 AM

Unfortunately for AXA, they go by room category, not room rate. Say if you can get a hospital, 2-bedded room rate at RM100 you still cannot upgrade from your 4-bedded, because SCO looks at the room category, not room cost.

Hi there. Ok over here it says "Unlike Guaranteed renewal type, the yearly renewable type does not have Life Time Limit cap."

Since Smart Medic rider has lifetime limit cap, does it make it guaranteed renewable? My agent said the medical card will be valid till 80 years old provided my lifetime limit is not used up. I'm not very convinced after seeing "yearly renewable" from online resources. I just bought it and the policy is not ready yet so I can't refer to it.

This post has been edited by Aurora Boreali: Mar 17 2010, 11:21 AM

Yearly renewable got one huge problem though - The insurer can refuse to renew your policy. Don't take this.

You do need to check the policy to see what exactly is written though.

first off, i agree with mfitri77 that yearly renewable policies are bad for you. avoid them like the plague.

second: why do i like SCO's upgraded room and board category? because i can (and did take) the maximum plan. it's unlikely i'll ever need a regular room of a category higher than "basic suite". so i can with the highest plan pretty much weasel around the 20% co-insurance issue. it's that simple. of course choosing the lowest plan is not always the best idea as mfitri77 pointed out. but that applies to all policies and the GI in particular. in the sense that you are just stuck to a category SCO this seems better than other GI with just the price tag and the co-insurance. as can be seen: advantage of a certain feature pretty much depends upon plan-selection but it still apply across board too. it's not ideal but its probably one of the best offers around. of course if you take a basic plan you should be expecting to pay partially yourself anyway. the small limits are hardly enough to cover serious issues.

but seriously i dont want to promote SCO per se. there are serious disadvantages with the policy which is why i only use it as primary policy and have 1 or two additional policies to cover me. if you choose just one plan i'd take something else.

as per the limits. most guranteed renewal polices have a lifetime limit. but not every policy with lifetime limit is guaranteed renewable. so it all depends on the plan chosen.

at this very moment my personal opinion is that none of the plans currently available to the general public in malaysia are ideal due to limits and sublimits imposed that do not reflect the current costs of sickness. there are international policies that cover those needs far better but they will be more (much more in fact) pricey. so its boils down to needs and abilities. i like likehouse asia's plan currently the best. its been posted in the H&S thread. the annual limit is very high, it's guaranteed renewable for life and only has three price ranges so the mix is better.

i'll follow numbertwo's practise but it should be possible to do it differently. clause 10) should just translate into "the sum of all claims cant exceed the costs incured by you."

End of the day it all depends on the claim department mood that day. Personally I've seen an insurance company going after a workshop under the subrogration clause, trying to claim back the money they paid to the policyholder, blaming the incident on the shop.

Just an update. I've also asked this in KCLau's site, and he said Smart Medic is guaranteed renewable.

Taking this with a pinch of salt until I see my policy. Thanks.

This post has been edited by Aurora Boreali: Mar 17 2010, 12:51 PM

PJusa, likehouse Asia's plan? which ins company is this?

I thought so. Would be rather suicidal if a big player like GE don't have guaranteed renewal. Somebody did post here saying GE has the 20% co-insurance if you change room benefits, so watch out for that.