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 am

Another 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.

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

What i heard is that GE's smart medic do have max cap, which is 20% and RM 500 max. Besides, GE's smart medic also have annual limit of RM 90k and lifetime limit of RM 720k for RM 150 R&B. Correct me if i'm wrong

Hei WeiKian,

Thanks for your feedback. What you say is true. But this is only applicable for surgical cost and expenses (subject to 10% co-insurance, max RM500.)
What i'm referring up there is if u upgrade the room to say RM200 if you are holding RM150. what is the consequences? I am holding their brouvhure here and it says [20& co-insurance and no maximum capping if upgrade room and board]. Mate do check this out!

Do post here if you still dun understand what that mean - so we can share.

Thanks

Oh, then its true i think. I misunderstood ur previous post. What other companies that have max cap for upgrading R&B?

Allianz has co-payment of 20% up to max RM1000 if upgrade R&B but no co-insurance on surgical fees and expenses. Others not too sure. So you can just check around.

Thanks

But how do the annual and lifetime limit of Allianz's medical card look like? And is it standalone or rider?

Allianz has co-payment of 20% up to max RM1000 if upgrade R&B but no co-insurance on surgical fees and expenses. Others not too sure. So you can just check around.

Thanks

Another aspect of PruHealth to look out for is the co-insurance for outpatient, eg Dialysis & cancer treatment is subject to co-insurance. 10% with a maximum of RM2000.

Allianz doesn't say anything about co-insurance, just reasonable and customary charge.

GE?

Oh, then its true i think. I misunderstood ur previous post. What other companies that have max cap for upgrading R&B?

If i'm not mistaken for GE its 10% up to no max capping for outpatient dialysis and cancer treatment.

Allianz is as charged.

ok. thanx ronnie.

I assume reasonable and customary charge is a charge that sound normal maybe something like market price. Means Allianz will not pay something that sound very ridiculous.

Ajau,

Reasonable and customary charges is based on the 2006 Regulations for PrivateHealthcare and services - meaning there is a limit set for an injury or treatment say Dengue fever (cost RM 8000 in the regulation) and if the hosp would to charge RM 10K, then the insurer will only borne RM 8000 and the remaining RM 2000 the policyholder has to pay. I believe all medical cards are based on this guideline to get rid of those money minded doctors.

I'm suprised that you are a Pru agent and you don't notice this customary charges in your Pru policy which makes me feel that you don't understand your products. I'm actually holding a Pru policy with me that says all benefits are subjected to reasonable and customary charges.

Thanks.

Ronnie are right in this point. More information about "Reasonable and customary charges" refer to this link :
http://health.howstuffworks.com/reasonable...mary-charge.htm
Hope the article will clear up all the confusion regard this term.
As I'm an AIA agent, I hav check my brochure of medical card as it also stated "Reasonable and customary charges up to co-ins free amount."
No offence as it really stated in the brochure of AIA medical care plus.

waiyeap,

Good site here that explains the whole thing. Keep it up.

Thanks

I just want to check with you guys and share information. I am not here to offend anybody and I think my involvement only to provide information and up to people out there to choose which product are best for them. I never said Pru is the best but so far what Pru had is best suit me and I foresee it will suit for me in the future. Everybody need is different and nothing in this world can be best for everybody in this world.

I am also here to educate people, you should have insurance, regardless with which company and I am happy to share my experience so that I hope no one will experience my bad experience. Even though you hold lots of policy and broucher with you, it doesn't mean you are the best. There are too many details in each product and I dare you 'hafal' all the terms. I was asking you the term because it keeps highlighting in your brouchure and I just want a short and quick answer from you. But you do not reply straight to me. And I believe you just do your home work only after I ask you the question, 2nd time. But maybe 3rd time because mfitri did ask earlier.

I become an agent is not for me to make lots of money from commission. I found it is good to have insurance after my sons and I need to be hospitalized and at that time I used my company's medical card. Since most agent is not so transparent (mostly just want to collect commission regardless which company), I decided to become an agent so that I can access lots of information and learn more about insurance. And I love to share something good with others. Sorry if my habit disturbing you.

We are here no to offend anybody. I believe we are here to share and the most important thing for people outside to have more information regarding the insurance. There is no competition here to be won.

I just want to check with you guys and share information. I am not here to offend anybody and I think my involvement only to provide information and up to people out there to choose which product are best for them. I never said Pru is the best but so far what Pru had is best suit me and I foresee it will suit for me in the future. Everybody need is different and nothing in this world can be best for everybody in this world.

I am also here to educate people, you should have insurance, regardless with which company and I am happy to share my experience. Even though you hold lots of policy and broucher with you, it doesn't mean you are the best. There are too many details in each product and I dare you 'hafal' all the terms. I was asking you the term because it keeps highlighting in your brouchure and I just want a short and quick answer from you. But you do not reply straight to me. And I believe you just do your home work only after I ask you the question, 2nd time. But maybe 3rd time because mfitri did ask earlier.

I become an agent is not for me to make lots of money from commission. I found it is good to have insurance after my sons and I need to be hospitalized and at that time I used my company's medical card. Since most agent is not so transparent (mostly just want to collect commission regardless which company), I decided to become an agent so that I can access lots of information and learn more about insurance. And I love to share something good with others. Sorry if my habit disturbing you. I did compare few insurance company especially its medical card (but not AIA - I wish I can learn more from AIA) and at the end I choose Pru because of its flexibility to upgrade policy and its service in making claim and also Pru has Takaful.

We are here no to offend anybody. I believe we are here to share and the most important thing for people outside to have more information regarding the insurance. There is no competition here to be won.

Bro,

Cool down. Not offending you or whatever. But just feel that you should know the term reasonable and customary charges the 1st day you sell a medical plan. It is because all insurance companies that sell a medical plan should follow the 2006 guidelines. I am in no position to say which product is best. Even if a product is best it doesnt mean that suits all people as what you've mentioned up there. The reason i did not answer you the 1st time is that to me as an insurance agent, you should not be asking around what is reasonalbe and customary charges. The 2nd i answered because i think the forummers want know the clear definition of reasonable and customary charges. (no offend again)

Thanks.