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Health Insurance Malaysia: All You Need to Know and the Types

Health Insurance Malaysia: All You Need to Know and the Types

Over the years, Malaysia has undergone drastic medical advancements, where improvements have been made to its healthcare system. The numerous medical schools and hospitals available reflects the accessibility of healthcare in Malaysia.

This has led to Malaysia becoming a popular stop for medical tourism, especially in the areas of cardiology, dentistry, screenings, general surgery, orthopaedics, ophthalmology, and plastic surgery.

It is true that the Malaysian government has put in a significant investment in public healthcare facilities. However, a large number of Malaysians still show a strong preference for private healthcare institutions.

Unfortunately, due to the ongoing medical inflation that is increasing at a rapid rate of 12% per annum, treatment from private hospitals is becoming a luxury that not many of us can afford. The medical bill is often enough to cause a mini heart attack on its own.

To prevent jeopardising your financial status, you should opt for the best health insurance with sufficient coverage. This is crucial for ensuring that you receive the best treatments without emptying your bank account.

Even so, if you are new to getting medical insurance, you may find the process daunting and complicated.

To help you with that, we have compiled all you need to know about medical insurances in Malaysia. We will guide you through the various types available so that you can decide which medical insurance best suits your needs.


How Medical Insurances work

How Medical Insurances work

Let us begin with an overview of how medical insurances work. Basically, you register with an insurance company and pay a certain amount (called a premium), in exchange for a payout. Medical insurance provides you with coverage to assist you in the payment of hospital bills. 

Before applying for one, there are some terms you should familiarise yourself with:

  1. Annual limit: This is the claimable amount that you are entitled to in a year, and it is refreshed every year upon your policy anniversary date. For instance, a medical card with an RM100,000 limit allows you to claim up to this amount in that year. The annual limit differs across contracts. This can range from RM10,000 to RM2 million.
  1. Lifetime limit: This is the maximum amount you are entitled to claim from your medical insurance over the tenure of your contract. Here, your lifetime limit is deducted accordingly and decrease over the years.
  1. Co-insurance: Co-insurance is the percentage of the cost of your medical care that you have to pay. If you have a clean health record, you may consider opting for co-insurance to reduce your premium.
  1. Deductibles: In deductibles, a set minimum amount must be paid for all covered treatments before the insurer covers the remaining expenses for treatment.
  1. Guaranteed renewal: If you’re aged 50 and above, this is relevant to you. Guaranteed renewal ensures protection is available throughout your life despite a recent diagnosis of illness. However, it is subject to the terms specified in a policy, so renewal premiums payable is not guaranteed or fixed. The age of renewal or entry varies with each contract. Some insurers allow up to 60 years of age, while others offer up to 100 years.

It is crucial to consider these factors when purchasing medical insurance.

 Types of Health Insurance

Types of insurance

There are various types of medical insurances, and the differences mainly lie in areas of coverage.

These are the types of health insurances:

  • Hospitalisation and surgical insurance: This is the most basic form of health insurance. This insurance covers hospital and surgical expenses incurred by specified diseases. Put simply, this insurance offers a wide but shallow coverage which is suitable for those looking for basic medical coverage.
  • Dread disease or critical illness insurance: This insurance caters to specific severe illnesses. Here, you will receive a lump-sum benefit upon diagnosis of any of the 36 dread diseases or specified illnesses. It is suitable for older individuals and those with hereditary illnesses. 
  • Long-term care insurance: Long-term care insurance provides the most extensive coverage out of the three. It offers coverage in areas such as home care, assisted living respite care, hospice care, and Alzheimer’s care. Home care coverage includes compensation for home care, visiting or live-in caregivers, companions, housekeepers, therapists, or private-duty nurses and up to 24/7 care. However, this depends on the policy set by your medical insurance. This type of life insurance is most suitable for those who live alone as well as those with no family caregivers.

Unfortunately, not everyone has the financial ability to afford coverage in all three aspects. Hence, it is essential to choose the most cost-effective yet secure health insurance option.

Factors that Affect your Choice of Health Insurance

Factors that Affect your Choice of Medical Insurance

As seen above, there are various types of medical insurances available. As the medical insurance can act as a form of financial support in times of need, choosing the medical insurance that best suit your needs would become of utmost importance—especially if you have dependents like ageing parents, a spouse with no income, and young children.

In order to decide which health insurance suits you best, you should take into consideration various factors, which include:

  • Marital Status
  • Income
  • Age
  • Married with child(ren)
  • Your health record

Benefits Offered by Health Insurance

Benefits offered by Medical Insurances that you should take note of

Besides the basics, medical insurances also come with benefits. Even so, the benefits may not cater to every scenario, so it is vital to understand the specifics. Some benefits are:

  • Panel hospital: All insurance companies have a list of partner hospitals which have agreed to accept their medical cards. If you are admitted into one of them, the process of admission and claiming will be much easier. Fortunately, even if you receive treatment at a non-panel hospital, you can still make claims. However, the process will be more tedious and time-consuming. To save yourself the trouble, you should make sure that your neighbourhood hospital is on your insurance company’s list of panel hospitals.
  • Cashless vs Reimbursement Policy: There are two options for you to pay your hospital bills—the cashless and reimbursement policy. In the former, the insurer will pay the bills directly to the hospital on behalf of the Insured Person. The latter works under a pay-first-claim-later concept, where you pay for the hospitalisation costs first. The insurer will reimburse all expenses when you make a claim later.
  • Room & Board: All medical insurances cover room charges for a maximum number of stays. However, this duration varies with each plan. If you aren’t aware of your medical insurance policy and request a room upgrade or extension, you may need to co-pay the difference.

In short, it is vital to have a deep understanding of your medical insurance. You shouldn’t focus solely on the premium amount, as the benefits and coverage terms are equally important. We hope that you now have a better idea on how to choose the right medical insurance.


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