Wednesday, June 22, 2011

Back to Basic Series 1 - Medical Card

Medical Card – Part 2

The last thing you’d want when you meet with an unfortunate event or life changing illness is to be left with unexpected medical bills. Having a medical card will gives you the medical protection you need and eliminates your worries.

Understanding terms used in a Medical Card Policy

Co – Insurance

What is co- insurance? Co- insurance was first introduced in year 2004 by Bank Negara Malaysia and which enables insurers to offer plans with lower premiums while promoting individual responsibility in health spending by creating an incentive for consumers to be more discerning when considering medical treatment.

With the practise of co-insurance, policy holders have to pay 10% of the medical bills, up to a maximum of RM500. 20% co-insurance and no maximum capping if upgrade Room & Board. (This scenario is base on Great Eastern Medical Card- GMC2)


a)   Mr. Q admitted to hospital due to dengue, he is having a 200 room & board medical card, he was staying in the twin sharing room which cost RM200 per night. Total medical bills was RM7,000.00. So, after the co-insurance charges, Mr. Q only has to pay RM500 out of the RM7,000.00. Great Eastern will settle the balance of RM6,500.00.
b)   Miss P had a minor surgery in the hospital, she stayed for a night and the bill was RM2,100.00. So, the amount of 10% co-insurance was RM210.00 for her to pay. Great Eastern will take care the balance.
c)   Mr. G is having a 150 room & board medical card, and he was admitted to the hospital due to an serious car accident. When he arrived at the hospital, the nurse told the family that the RM150 rooms are all full. He has no choice but to stay in the RM250 room. After 5 days of the treatments and surgery, his total medical bills was RM34,500. Because he was hospitalised and the board rate was higher than his eligibility, he has to bear 20% co-insurance and no maximum capping for his medical bills. So, the total amount that Mr. G has to pay was RM6,900.00.
        (all scenarios based on GE GMC2)

Some others company do offer cashless Medical card, but the premium will be much higher and this kind of medical cards are becoming less available due to misuse and very high claim rate.

Have you upgraded your Medical Card for your current needs?

I'm sure everybody will agree with me that Medical Card is a basic need to all of us now.. BUT, do you have enough coverage to beat the current medical inflation? When was the last time you review your Medical Card coverage and benefits? What are the latest room charges in all the major hospital now?

I remember one of my colleauge once shared her experience with us. She told us that one of her client met a car accident near the Jalan Pahang round about, he was unconscious and the passer-by sent him to a private hospital that was very near to the round about. His condition was quite bad, and the nurses wouldn't get to contact his family, but they found a medical card from his wallet, so they tried to admit him.

Not long later, the nurse came back and told the passer-by whom sent him in that his medical limit was too low for his current condition, and they refused to admit him!! They asked them to send him to General Hospital which is also nearby.

We were so shocked, but that's the reality. I am sure we have seen some similar stories from the newspaper or somewhere before. We MUST make sure our medical card has enough limit for the current market 'price tag'.

Usually hospitals have limited 4 bedded room

Guaranteed Renewable

As a Medical Card policy holder, please make sure your Medical Card policy is GUARANTEED RENEWABLE.

‘Guaranteed renewal’ means that the insurance company guarantees the renewal of the policy. The renewal premiums payable, however, is not guaranteed nor fixed.

In practice, the renewal of the policy is guaranteed until certain events occurred, such as:
·    You did not pay your premium or did not pay it on time;
·    You have misrepresented a material fact, e.g. age or a medical condition during your application;
·     You have cancelled the policy;
·     The total claims of the policy have reached the lifetime limit specified; and
·     You have attained the coverage age limit.

Importance of Disclosure

Policy holders must give all the facts in the application form fully and faithfully. When the agent is filling in the form, read and understand the requirements carefully. Otherwise, the policy could be void or unable to claim in the future.


Medical Card policy also contains certain exclusions, just like other insurance policies. Some common exclusion are the following:
·         Pre-existing condition- Conditions and illnesses experienced prior to applying for the policy. These conditions and illnesses would be excluded from coverage.
·         Specified illnesses- These are defined as 12 disabilities (e.g. tumours & gastritis) and their related conditions. Policy holders will not be covered for these illnesses if the illnesses have been treated or occurred during the first 12 months of the policy.
·         Qualifying/ Waiting period- Specified Illnesses occurring within the first 120 days from the Risk Commencement Date, except for accident injuries. (based on GE GMC2)

Why Great Eastern??
Great Eastern Life Assurance (M) BHD is poised for continued growth in its second century is off to a good start at achieving its goal to continue its reign as the market leader in the industry. With more than 100 years of experience in solid financial foundation and innovative infrastructure. The Company was certified by the Malaysia Book of Records in 1998 as the "Oldest & Largest Life Insurer" in Malaysia.

Great Eastern has assets in excess of 44 billion as at 31 December 2009. The head office, 21 operational branch offices nationwide and a network of 17,000 agents serve over 2.84 million policies in force. Great Eastern continue to remain true to our stand that health, wealth and meaningful relationship make life great. Great Eastern has earned our customers’ loyalty throughout the years and believe that this trust is cultivated from our excellent service.


Ever wondered how much Great Eastern pays out in medical claims? According to the summary of claims from January to March 2011, Great Eastern has paid out 52.7 million just for health & medical policies. That’s about RM572,826.09 every day (refer to Medical Protection & Product Page)

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