KUALA LUMPUR: The soon-to-be-launched MediAsas (or known as Base MHIT before) will allow some people with existing medical conditions who are presently unable to obtain medical insurance to secure coverage, although treatments relating to their pre-existing conditions may remain excluded.
Bank Negara Malaysia (BNM) said the initiative was intended to widen insurance eligibility without imposing the substantial premium increases that could arise if all known medical risks were fully covered.
“We are pushing onward here to have more people eligible for insurance, but it’s not the same as saying we will cover that condition,” a BNM spokesperson said at a media briefing last week.
Those who could qualify for such coverage include people with early-stage cancer in remission, single-vessel heart disease, certain mental-health and developmental conditions which are stable and well managed, and people with mild and moderate autism; its presentation deck stated.
A cancer survivor, for example, could be accepted for MediAsas and receive protection against unrelated illnesses or injuries, although future claims connected with the earlier cancer could be excluded.
“Today, they cannot get anything at all. By extending this risk, we are accepting them, but at the same time, there will be exclusions,” the BNM spokesperson said.
Some applicants with a higher anticipated claims risk could also be charged additional premiums, the spokesperson added.
BNM said completely covering pre-existing conditions would require premiums to rise by a factor of five to 10 times because such policyholders would be more likely to claim from the common pool.
The Health Ministry (MOH) spokesperson said MediAsas should be assessed against current medical-insurance practices, under which applicants could be rejected entirely even for relatively limited existing conditions.
“The improvement with MediAsas is that now, for some of these conditions, we are able to at least give you that coverage for other conditions,” its spokesperson said.
“The current situation is not that everyone is included and MediAsas is suddenly excluding certain people.
“The baseline is that, by and large, existing insurance coverage is quite restrictive, and if you have even fairly trivial conditions, you are excluded from everything,” the MOH spokesperson added.
The MOH spokesperson described MediAsas as an initial step towards greater inclusion, with the possibility of extending coverage as more claims data become available and medical management improves.
BNM said MediAsas would also introduce a seven-year no-look-back provision intended to give policyholders greater certainty against retrospective claim investigations.
After seven years, insurers and takaful operators would generally be disallowed from investigating claims over suspected non-disclosure, apart from five categories of serious medical conditions and cases in which evidence of fraud had independently emerged.
“Today, even in year 10, the insurer, for reasons undisclosed and not obvious to the policyholder, can investigate at any time just to establish whether there was fraud,” the BNM spokesperson said.
“With the no-look-back, after seven years, other than the five conditions, we don’t even allow them to investigate to establish whether there was fraud. It better protects the customer and reduces the uncertainty for the policyholder.”
Meanwhile, Life Insurance Association of Malaysia chief executive officer Mark O’Dell said the industry supported MediAsas as an affordable option for uninsured people and policyholders struggling with rising premiums.
“It also introduces important features, which we hope will eventually be adopted in the wider marketplace, especially diagnosis-related group pricing. We think that will help level the playing field and align interests between the payers and the providers,” he said at the same briefing.
MediAsas’ basic plan carries a RM100,000 annual limit for policyholders below 60 and RM150,000 from age 60; while MediAsas Flexi has an annual limit of RM300,000 with a co-payment of RM10,000 deductible per year (tier-one hospitals) and RM15,000 deductible per year (tier-two).
Both MediAsas Basic and Flexi have no lifetime limits.
BNM said industry data in the country showed that 99% of medical claims were below RM60,000, while most claims involving cancer, heart attacks and strokes also remained within the RM100,000 limit.
The basic plan imposes a RM500 deductible for each treatment episode (below 60 years old) and a RM1,000 deductible for ages 60 and higher.
