The best way in your situation is probably to just stay with your current provider, and ask for an upgrade to the better plans. It should be lower than you switching to an entirely new provider, with a more advance age, and loading.

As for the life assured... Well, it depends on you. Usually from what I see, the thing that kills people financially is not the death of the loved one, but the bills they incur when they still live on. That's why medical is important.

Like the CI, for cancer its only stage 3 and above that CI payout comes in. Medical covers your bill for stage 1 and 2, and 3 and 4. Trust me, when you have cancer, that big lump sump of money is not going to be very big for long.

When you have a medical card, it means that you have a policy with certain insurance company. When you present the medical card at the panel hospital, the panel hospital will contact your provider to know if :-

1. Policy is still inforce.
2. Policy hasn't exceeded limit.
3. You are over the waiting period.

THEN your provider will issue the hospital with a guarantee letter stating that the provider will take care of your bill. I.E. You need a letter of guarantee, if not hospital is going to ask you for money.

Sure, an insurer cannot prevent you from ASKING to renew your insurance, but they could always REFUSE to cover you. That little provision is always written in, in legalese and BNM couldn't never force the insurer to cover you. Why do you think they issue so many license? So you have a choice.

Maybe we are talking about two different things here. For GI that covers CI, Death and disability, they don't really care that you have certain illnesses. Why? Because payout for CI, is when it's really CI, I.E. when you are just waiting for the reaper to come get you. Why many people think insurance is a cheater, is because many who tried claiming CI when they were diagnosed with stage 1 cancer found out that payout is stage 3. Or when you need two blockages in your artery instead of one.

Medical, well that really is another story. Simply because that's the biggest claim in Malaysia today. Reason is simple, private hospitals want insurance money. A client of mine confessed that one doctor in a private hospital, when asked on the cost of a full medical check up, told him to come and say that he's having chest pains. They'll admit him in and bill, you guess it, the insurer. Demam? Admit. For demam also, claims are now averaging 3k per person.

That's why medical also has so many exclusions, syarat, term, inclusion that it is easy to trip up an average person if he or she is not properly adviced by the agent.

Example

Insurance A, no co-insurance (part payment to the bill that you have to make, usually 10%, with a maximum limit like 1k). However, go OVER the room limit, and you pay 20% co-insurance. Don't matter that you have to take a pricier room because no beds available, or you need single bedded because you are quarantined, go over room limit, 20%, don't care.

Insurance B, medical fee is as charged, Subject to reasonable cost and terms. What's the reasonable cost and term. Depends on the insurer mood that day lah, if suddenly your daughter is denied a medication because its too expensive? A client once called me at 5 am (nasib baik during puasa, so I was up), saying that oh, the nurses say before this *** insurance don't cover a treatment for Kawasaki diesease because its too expensive.

You see, so many things you really have to take care when you buy medical cover.

As for the renewal, two terms I picked up from the standard medical standalone policy. Quite popular, from what I heard.

Annual contribution rates are applicable to standard risks only. Contribution loading may be imposed on non-standard risks.

Means if you suddenly have non-standard risk (either you have claimed, or kena something) - LOADING!

The contribution enforced is based on the age of next birthday and is made annually at the rate applicable during renewal. The contribution published in the brochure is for standard life on and contribution loading may be charged to non-standard life. Contribution is not guaranteed and may be subject to change.

This one is better. Non Standard Life - Definately LOADING! Standard - I can hike the price up, anytime I want to during renewal. This one my father already kena. Tak penah claim pun, but because hit age 60, hiked up 50% from original premium!

Tarik portfolio? My company revised medical portfolio twice this year. First time, increase limit. Second time, put NCB (no claim, get no claim bonus). Tarik portfolio so easy lah. Just say to BNM I'm revising the limit, and you can tarik the portfolio already. Just put number only Medisayacover1, then upgrade to Medisayacover2... When people cry foul, Eh! lain portfolio maa.. Higher limit!

So, be careful when you select a plan, and always remember :-

Insurance company are out to make money.

You need insurance because if you are sick, you need money.

If you die, your sons and daughter will need the money.

People like to con insurance company, because they think its free money.

Because of that, insurers lost money.

The put it back to the public, so a policy now cost more money.


Heard on the grapevine an interesting development on the car insurance front. If what I heard is true, then life insurance people will get more ammunition, GI (esp those doing car insurance) may also want to get your C license ready.

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.

There is a plan that your father can join, even at age 59. Protects up to age 80, just for medical card. I know you don't like agents, but if you do want just to discuss, can PM me anytime.

Let's no say specialize. Let's just say that they will process your claim. GI always cheaper, but read through one policy, you will always know why its cheaper. And when you are choosing a provider, it has everything to do with service and claim.

What policyholder has to consider sometimes is that there are three party in an H&S claim. You, the insurer and the service provider (Hospital lah)

Before I joined my current company, I was with another provider. As part of our marketing activity, we contacted a reputable hospital, and asked if we could open a promotion counter like they gave to my current company.

They flat out refused to even consider us when I mentioned the company I was with back then. With the help of an acquaintance, went to see the manager of the hospital and it was a very eye opening discussion.

The reason they only allowed my current company to open a counter in the hospital is that they are the best at paying claims. No delays, unnecessary questions, need for referral, counting doctor visits, type of treatment, just show your medical card, Guarantee letter whether accepted or rejected was informed in less than 30 minutes, prompt payment. Patient is happy, they are happy (to be paid), and no headache. He then told me that my former company delays payment to the hospital, sometimes pushing it back as far as three months and above. Because of that, he says, why should I promote you when you give me headache?

Lucky enough he says that my company delays payment so patient don't feel the kesusahan, but some other would want you to submit a medical report first before being admitted. Where's the report from the clinic that referred you to the hospital, we want to see first? Who gets to explain to the patient that their insurance company wanted that report first before you could be admitted? Guess who, its the HOSPITAL, and nanti kena tiaw hospital first jugak lah.

Yes, you can always complain to Bank Negara if you tak puas hati, but when you want to complain? Why do you think some provider have to go to the trouble to announce that Yes! We cover H1N1? (policy states they don't cover epidemic) When that happens, you think you have time to complain to Bank Negara? What if they reject your claim? If you still want to pursue, you have to file summons in court for that, to enforce the insurance contract. You have to money to pay lawyers?

Regardless of what they write, go with providers known and trusted with a good reputation. You don't want this kind of trouble. And it so happens that many of the best medical cards are owned by the lifers. (Best in terms of service, claim payments, and hassle to you!)

This post has been edited by mfitri77: Jan 1 2010, 07:22 AM

Okay then, but always remember, the rights you said you paid for, comes with preconditions, written in contract (the policy), and law (Insurance Act, Takaful Act).

An Insurance contract is a contract of outmost good faith, that means hiding something, trying to defraud, non-disclosure all will VOID the contract. Does not matter if its GI, Life, Marine, Motor, MRTA. Fire or whatever, all insurance contract is the same. And because of this, insurers have every right, and they will frequently exercise that right by requesting anything and everything from a customer to justify their claim.

Should they decline to pay your claim, citing violation of certain provisions in the contract, your best option would be to sue them in court. Cost to you..

And furthermore, does a layman actually understand what's written in the policy contract? Browsing the forum, some are asking whether you can cancel the policy if you don't want it. (Can, there is a 15 day waiting period). Bank Negara prints a ton of this little booklets you could pick up at any insurance center, banks and whatnot. So you might think you can claim, but in reality you can't. We make it a practice at our agency to sit down with the client, go over the policy, explain in detail what your rights are, written in which section. How many do that these days?

What happens when you are 56 years old then, when you retire? To get a GI medical plan almost equivalent to the basic medical plan of a life insurance policy, you pay from a provider RM3005 a year. Age 61, premium goes up to RM3700 per year. Assuming you have no loading imposed on you.

Compare that with getting life at a young age, like 20-30 years old. A complete plan would cost you RM150 a month, or RM1800 per year. You get all the coverage (PA, Critical illness, Disability, Payor riders etc). Medical card, some investent for the policy to be self-sustaining. Policy holiday, policy loan. Many say, Rm1800, is too much, but in the early years, you can work. When you retire?

When you are young, GI is very attractive. GET IT IF YOU CAN'T AFFORD LIFE. Its cheap, end of story, compared to life. BUT REMEMBER, when you are old however, GI can be a nightmare. In a country known for people blowing their EPF withing three years after retirement, can you actually afford to pay the GI premium you'll need then?

pruHealth is a rider, not standalone. If you are looking for standalone from Prudential it would be pruSenior med, applicant age 45-70, protect up to age 80.

Guaranteed renewal used to be a life agent's best weapon. Now everyone's offering that.

Always go for medical card, not the claim later policy. The claim later policy gives the insurance company time to find ways to not pay your claim.

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Added on March 16, 2010, 4:09 pmBefore you go and make statements like this, please back it up. Do you have policy with any of them? Have you worked for any of them? Have you chatted with all three agents for the companies? Have you spoken to outside sources regarding claims?

My take is - Allianz, Pru and Great Eastern are well established, financially sound players in Malaysia, with good support system, so no problems claiming etc.

Pru policies gets upgraded all the time - Now if you don't claim, you get No claim bonuses, but still go Co-insurance, capped at RM1k maximum. However, you can upgrade rooms beyond your entitlement and pay the difference without penalty. Allianz no co-insurance (powerlink) but be very carefull of the 20% co-insurance if you upgrade/force to upgrade your room over your entitlement. Great Eastern not sure. Anyone here care to comment.

This post has been edited by mfitri77: Mar 16 2010, 04:09 PM

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.

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.

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

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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

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

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.

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.

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.

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.