TM Medic Plus MPA or MPB? different RM30-RM45 per year only

Does it make any difference? Its a deductible policy, so there are no worries really about the 20% co-insurance if you take higher room rates. Tried looking for the full policy wording, but somehow the website is giving me the runaround.

so many explaination, thanks a lot, those really help, got some term i dont understand, what is co-insurance?

i'm no expert on this, but from what i understand is that co-insurance depending on the % is the amount you have to pay yourself. lets say a surgery cost RM1000 and the insurance has 10% co-insurance, it means you must pay RM100 while the insurance will pay RM900.

Yup, you are absolutely correct about the basic of co-insurance. But different company has different term.

Even though the co-insurance is 10% or 20%, some has a minimum and maximum the insured need to pay.

In some company, co-insurance only apply if you stay in a room that exceeding your room's entitlement, and you need to pay 10% or 20% of the remaining bill plus the different rate for the room.
As example, your room entitlement is RM100 but you stay in a room cost RM120
Your hospital bill is RM10,000
You stay 3 days
The co-insurance you might need to pay: 10% x (RM10,000 - RM360) = RM 964
And you still need to pay RM60 for the room differences

And some company also charge 10% from total bill if you stay in a room exceeding your entitlement.

Please bare in mind that, the room's rate can be increased over the time. Last time when I stay in double bed KPJ Kajang, it was RM90 per day in 2006. Last year in 2009, when my son admitted there, it was RM 120. Please imagine how much will the room rate in 20 years from now.

Please read the product broucher and policy to know your co-insurance charges. Usually, there is a co-insurance for any medical card.

'

yup. depend on the plan how much it offer for the co-insurance.

I've now two policies, one deductible and one full cover. I'm planning to cancel the deductible however the new policy have waiting period 1 month and 4 months (specific illness). should I retain the deductible policy until the waiting period of new policy (4 months) is over. want to save money if possible

Why don't you ask if the new policy can treat you as a renewal? Some players in the industry are now doing that.

For example, as long as you have passed the waiting period from company A, when you switch with company B company B waives your waiting period because you did that with company A.

This post has been edited by mfitri77: Mar 19 2010, 04:57 PM

yes you can get a renewal treatment but only if your existing cover is equal or better if i am not mistaken. and while BNM encourages this "takeover" of policies, insurers dont actively offer it unless you ask for it.

may i add a word to the concern of rising room rates - while this might be worrying please bear in mind that pretty much every policy receives upgrades - usually in tandem with the premium-adjustments for GI products. this includes very regularly the room rate as well for the very reason that room rates increase over time. in other words a comfortable room rate today will most likely not be too shabby in the future either.

That's true also, but I would like to advise that if your insurance have the 20% co-insurance penalty for room upgrades, make sure you get the best room cover available that you can afford.

The reason being these days hospital can very well run out 4-bedded rooms quite easily, forcing you to upgrade and take the penalty.

Quarantine is another reason why you have to get upgraded room.

Yup. true.

Quarantine is charged RM 300 per day at KPJ Kajang.
Quad-room RM70
Double room RM 120
Double room deluxe RM 135
Single room RM 200
Single room deluxe RM 250
I forgot about VIP room charges

If you are concern about to not pay for 20% co-insurance penalty, maybe you should consider buying a plan that has Room & Board of RM300 per day. Influenza Like Illness (ILI) or H1N1 is attacking us back now. So, who know we are next need to be quarantined.

Personally, I prefer to have a plan that have co-insurance with maximum limit of co-insurance. Regardless how much the hospital bill are, I know I will only pay a maximum of certain amount, let's say RM500, RM 1000 or RM 2000. So I can plan my budget to always have emergency fund with this amount of money. And you might also need to consider a hospital allowance. If you always have budget constraint, at least you can use your hospital allowance to pay your co-insurance (usually hospital allowance is paid around 1-2 weeks depending on insurance company effectiveness, but at least if you are using credit card of borrow someone money, you know you will receive a fund to pay back). I did compare insurance charges or premium between this 2 types of co-insurance (from few insurance company), usually it is cheaper with a plan that have min, maximum limit and it has less term and condition.

It happened to me, I didn't realize my company's medical card only allow one doctor visit per day and the doctor was visiting my son twice a day. And if you are really sick, you prefer to have doctor visiting you frequently to know your progress. During dis-charge which I suppose not to pay anything, I end-up paying almost RM300 for this un-coverable item. After that I checked with my HR (she also didn't realize this), we found out there are lots term and condition compare to my personal medical card that has min and maximum limit of co-insurance.

Each product has their own uniqueness and its uniqueness sometimes suitable for this group of people and sometime it is not for other group. You just need to identify in which group you are comfortable with.

Please bare in mind also about upgrading your plan for medical insurance. Some insurer prefer to apply 30, 120 days waiting period back to your new plan. It is like buying a new medical card and subject to new underwriter. Please imagine if something happen to you during your 120 days waiting period of upgrading your policy and you are not covered. You will regret in your life for doing upgrading which suppose to upgrade your coverage.

My advice is when you are buying medical card, please plan ahead and please consider you will carry its coverage for your whole life. Does its current benefit enough for you in the next 20 years, 30 years?

Sorry, I just give an example based on my experience. It happened to me, so I hope someone else is not doing my mistake or my bad experience.

ajau, mfitri77,

i hear you guys and i agree. which is why i take max. plans - they are more cost efficient and usually come with R&B that will be sufficient for most (if not all) cases. but of course you also face the dilemma of affordability. if it's out of your budget there is nothing you can do.

the issue with a max. co-insurance is that from my memory those plans carry rather low annual / lifetime (less than 20 x annual limit) limits. so if you have a high bill and exceed your annual or worse lifetime limit you face another co-insurance issue because the insurance actually only covers a very specific annual/lifetime amount - anything beyond this amount is your hidden co-insurance anyway.

all in all medical insurance in malaysia is not that easy. the more you look at the products, the less attractive they will become simply because in an ideal world we would want to be covered so well that pretty much no matter what we will have someone to pay the bill for us. unfortunately the monetary means required for such cover will be out of the reach of the vast majority and thus are not available on the local market.

for a really extensive cover you might want to check out april mobilité from france. lighthouse.asia offers a medical plan underwritten by them that covers for life, specifically designed for cover in malaysia and with an insane annual (no lifetime) limit of 1,000,000 US$.

premiums are high though starting at 903 US$ p.a. and after age of 70 (till death) 2193 US$. i fear subject to adjustments too. see pic for partial list of coverage.

This post has been edited by PJusa: Mar 20 2010, 10:08 AM


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If you can afford and sustain, go for it. Do not take too much time to think about it. Illness and accident does not smell.

Right, that's my concern too.

2 noob questions here:

1. So, can I like choose to pay the room and board out of my own pocket (and not claim from the insurance) if the total room charges is less than the 20% co-insurance thus avoid paying the 20% co-insurance IF I was forced to upgrade the room?

Eg:
Insurance R&B = RM 150/day.
Forced to stay in a RM200 room for 60 days. R&B = RM 12,000.
Surgery etc RM 80,000 + R&B RM12,000 = RM 92,000. 20% co-insurance = RM 18,400.

So my question is, can I pay RM 12000 for room myself, and claim only RM 80,000 (assumed this is within annual limit) to avoid paying RM 18,400?

2. Is there such thing as you paying the difference in the R&B upgrade to avoid co-insurance? Say your insurance only gives RM150/day but you're staying at a RM200 room, but you only claim RM150 and pay the remaining RM50 yourself?

Sorry to disturb your discussion guys,

My opinion to Q1;
I don't think the calculation would be that way.

FYI, R&B is not affected neither annual limit nor lifetime limit nor co-insurance . So, refer to your e.g, I think it'll be this way:

Scenario (taken from PH150 entitle RM62,500 annual limit)

R&B (Additional): RM50 x 60 Days = RM3,000 (pay separately)
Surgery etc = RM80,000 - RM62,500 = RM17,500 (You Pay)
For co-Insurance (10%):
= RM62,500 x 10% = RM6,250
~however, the max limit of co-insurance that you have to pay is only RM1,000, the remaining RM5,250 will be absorbed by Insurance.

So, the total amount that you have to pay is:
=Addititional R&B + Over Annual Limit + Maximum Co.Insurance
=RM3,000 + RM17,500 + RM1,000
=RM21,500

Say, if the 80K is within annual limit:
Than you have to pay is only:
=Additional R&B + Maximum Co.Insurance
=RM3,000+RM1,000
=RM4,000


Respond to Q2,

My answer is YES.
In PRUHEALTH plan, you can include few allowance /riders in your plan such:
1. Hospital Benefit (Min RM50/day & Max RM400/Day)
2. PRUMED ~ every unit consist of :
a. HB = RM50/day
b. ICU = additional RM100/day
c. Surgery = can claim for surgery up to RM2,500 per event, whereby can claim up to 5 times a year @ RM12,500/year)

or you take PH300 that cover:
1. R&B = RM300/Day
2. Annual Limit = RM100,000
Life time Limit=RM1,000,000
3. If you're healthy, PRU rewards you back with No Claim Bonus of RM400 every healthy year.

Lusmays, your answer is irrelevant as I was responding and asking questions with regards to what mfitri77 said "That's true also, but I would like to advise that if your insurance have the 20% co-insurance penalty for room upgrades, make sure you get the best room cover available that you can afford." Bear in mind the 20% co-insurance is DUE TO R&B upgrade and has NO limit.

Perhaps mfitri77 can answer my questions.

What Lusmays say is true. I believe the medical card he is referring to is Either from Allianz or Prudential.

For your question, you cannot opt to pay for the excess room and board charges yourself. Because most insurance companies in M'sia covers room and board and once a person is admitted, the room and board will be borne by the insurer and if overstay the room and board limit, insurer will impose a Co-payment (i would rather use the world co-payment than co-insurance coz co-insurance is the % amount on the surgical cost) depending on the terms and conditions of the card. As far as i'm concern, I know GE's Smart Medic co-payment is up to no cap. Allianz is 20% up to max of 1000. I believe this applicable to Pru Health too (Pru agent pls verify this).

Thanks

Hi Syamsul,
How much does it cause say for R&B of 300 and age 50

Yup. chew ronnie is right. Unless you can negotiate with hospital regarding the bill before the hospital send the bill to insurance company (I doubt you can), the insurance company will calculate how much they will pay and the rest need to be paid by you (co-insurance, etc). How much they will pay is totally depend on the policy.

For PruHealth (Prudential) and Takaful Heatlh (PruBSN Takaful), the co-insurance is 10% from the bill and subject to minimum of RM 300 and maximum RM 1000. If you upgrade your room regardless the reason, you just pay the different as exactly as what Aurora Boreali wanted.
As example, if your bill is RM20k, you just need to pay the maximum co-insurance of RM1,000, even tough 10% of RM20,000 is RM2,000. Plus the different of R&B.

If your medical card is using 20% penalty if you are upgrading your room, as Aurora Boreali calculated in given scenario, yes, you need to pay RM 18,400 if there is no maximum limit. But you may also need to pay more because so far, I have not found any medical card with R&B RM150 per day has annual limit of RM92,000. Usually it is around 60k-70k annual limit.

As a customer, you better to get clear about the co-insurance of your policy so that you will not blaming your agent when you need to pay some amount before you are discharged from your ward. Please double check when you receive your policy and you have 15 days to return your policy and get all your money back if you are not satisfy with the policy.

Chill, Chill, here to share.

For those who are wondering who I am, yes, I am Pru agent also, I am also a GI agent, currently with Kurnia, and I have quite a background in law.

Okay, lets begin to answer some questions.

1. Can I pay room myself? Or can I nego with hospital about what's in the bill?

Short answer is no - If you have a medical card, its all or nothing. Either use the medical card to pay everything, or don't use it and pay yourself. Nego with hospital concerning bill also, unless your cable is quite strong I don't think you can do, because insurers can easily kick you off the panel if they are caught, and no hospital in the right mind would care to lose panelship (imagine potential patient going to another hospital because they have to pay first at your hospital). Another reason why its damn hard to get a copy of your official receipt, needed to make a claim from another insurer, because insurers only accept original receipt, and hospitals are told not to issue copies to avoid double claiming.

2. Whats up with the R&B

I see two difference, one with GI medical cards and the other with Life medical cards.

GI medical cards usually go for deductibles, or cashless with 20% co-insurance room upgrade charge. Problem with some GI's with 20% co-insurance charge is there are usually no capped limits on the charge. The other is the fact that some don't talk about room upgrade, some only talk about room charges. This is even more dangerous because you can get hit with 20% if your four bedded exceed say for example RM100, say RM120. Dah la have to pay the difference..

Life however is a bit different, because the usually cap the charges. Take Allianz for example. Sure, got 20% co-insurance if you upgrade, but its capped at RM1000. If you follow the room rate, you don't pay co-insurance at all makes it a better option then say Pru, (I sure kena with my leader on this), which hits you with co-insurance regardless.

The only thing I don't know about Allianz is their reputation in paying out claim.

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Added on March 22, 2010, 9:16 amAnother aspect of Pru polices is the frequent upgrade. In one year, it went from PMM4 to PMM5 to PruHealth - Three upgrades in the span of one year. PMM4 low lifetime limit compared to PMM5, with high lifetime limit to PruHealth which is plus NCB for no claims.

The thing I'm not happy about PruHealth is its exlusions are now the same with everyone else (adds knee and spinal condition), and concerning epidemics, plus the NCB. What it means that before this, you get a nice policy for RM100, now you don't.

This post has been edited by mfitri77: Mar 22 2010, 09:16 AM