THIRD OF A THREE-PART SERIES
IN THIS FINAL instalment of a three-part series on medical and health plan in Malaysia, we take a look at the issue surrounding claims and other common problems faced by policyholders/participants and insurers/ takaful operators.
It is everyone’s worst fear. You are in need of a medical procedure or treatment that requires hospitalisation.
You wait anxiously at the hospital admission counter for confirmation from your insurance company/takaful operator regarding the payment guarantee of your planned admission.
Then you’re told that your insurer/takaful operator has declined to guarantee the payment, leaving you confused, disappointed and decidedly furious!
The experience may leave you with the impression that insurance companies/takaful operators are prone to avoiding paying claims.
On the contrary, the life insurance and takaful industry’s statistics showed that insurance companies and takaful operators paid 5.3 million medical and health claims last year.
This represents 93.9 per cent of claims submitted.
Clearly, the vast majority of policyholders get their claims paid as expected. So why then are some of the requests rejected?
In summary, make a point to understand your medical and health plan, what is covered and what is excluded.
When in doubt, contact your insurance company/takaful operator.
Always declare any and all preexisting illnesses and past treatments at the time of application to avoid disappointment later. Plan ahead for nonemergency admissions.
Finally, keep your coverage in your medical and health plan up to date. Insurers/takaful operators enhance coverage every few years, often offering upgraded or new provisions.
Remember, all insurers/takaful operators want to honour your claim as their good reputation depends on it. In the end, this is their most valuable asset.
This article is brought to you by the Life Insurance Association of Malaysia (LIAM), Persatuan Insurans Am Malaysia (PIAM) and Malaysian Takaful Association (MTA).
To read the first part, click here.
To read the second part, click here.