New insurance plan for claiming twice

  • Fitness
  • Saturday, 22 Mar 2014

Critical illness insurance policies are usually limited to one claim per disease, however, a newly-introduced plan allows its holders to claim twice for certain conditions.

LET us review the numbers. According to the 2011 National Health and Morbidity Survey (NHMS), one in five Malaysians over the age of 30 have diabetes, and only half of them are aware of their condition.

Around one in three Malaysians aged 18 and above have high blood pressure, or hypertension, and only a shockingly low 8% actually have it under control.

The situation with cholesterol is just as bad, with 35.1% of Malaysian adults having high cholesterol levels, or hypercholesterolaemia.

Meanwhile, 15.1% of the population aged 18 and above are considered obese, with body mass indexes (BMIs) of more than 30.

Put all these numbers together, and what you have is a perfect recipe for an epidemic of chronic diseases – in particular, coronary artery disease, which can result in heart attacks and stroke.

Coronary artery disease, also known as heart disease, has been the top killer in Malaysia for the past three decades.

Chew . . . We believe that this product is the first of its kind in Asia. - FAIHAN GHANI/The Star.

So it is not very surprising that the medical conditions resulting from it are among those singled out as critical illnesses by insurance companies.

In fact, heart attacks and stroke were two of the four conditions covered in the very first critical illness insurance product introduced by South African heart surgeon Dr Marius Barnard in 1983.

Then called dread disease insurance, the policy also covered cancer and coronary artery bypass surgery (also known as heart bypass surgery).

Since then, the list of critical illnesses covered by insurers has expanded tremendously, although the number and types of conditions vary from provider to provider.

However, with the exception of cancer, these policies only cover a one-time occurrence of the disease, meaning that if you should be so unfortunate as to experience a repeat episode of the same condition, you will be on your own financially.

The problem is some critical illnesses are not one-strike conditions.

For example, if you survive your first heart attack or stroke, your chances of experiencing another heart attack or stroke respectively are increased, compared to before the first experience.

That is why Canadian insurance company Manulife decided to launch the Manulife Cover-Me-Again plan in Malaysia recently.

During the event in Kuala Lumpur, Manulife Malaysia chief executive officer George Chew said: “The core fear of Malaysians today is that once they have a critical illness, it can occur again, and they have no financial capability to cope with a recurrence.”

He later told reporters: “Modern medical technology and treatments are available (for most diseases), it’s whether you have the money to afford it or not.”

As its name implies, the Manulife Cover-Me-Again plan allows for a maximum of two claims for the same medical condition, subject to certain terms and conditions in the policy, with the total amount claimable up to 200% of the total provided for in the policy.

For example, if a stroke patient should suffer from another stroke two years after the first incident, he can make a second 100% claim on his policy, provided that a neurologist can provide evidence of a new infarction (or tissue death) in the brain and the patient’s current condition meets Manulife’s critical illness definition of stroke.

Similarly, for cancer cases, the second claim can be made if recurrence of the cancer is diagnosed two years after the patient has been certified by a physician to be in complete remission from the first cancer and the case meets Manulife’s critical illness definition of cancer.

Chief marketing officer Kenny Thing notes: “We have one of the shortest waiting periods for (recurring) cancer – two years, versus five years in the market.”

He adds that the policy also provides a “recovery benefit” of cash vouchers worth RM750 to purchase medical items to aid in the policy-holder’s recovery upon the first claim, and a “recovery allowance” for the first two claims, which is worth 5% of the amount claimable, up to RM5,000 per claim.

A total of 10 critical illnesses are eligible for this double-claim policy. (See Claimable critical illnesses)

Policy-holders can also claim for the occurrence of any of another 26 critical illnesses, but only once per disease and up to a maximum of 200% of the amount claimable.

The evaluation process, says Thing, will be as consumer-friendly as possible.

The premium to be paid by policyholders will be comparable to current market rates, with Thing giving an example of a healthy, non-smoking male having to pay around RM150 a month for a RM100,000 policy.

Says Chew: “To the best of our knowledge, we believe this product will do very well because it fulfils a need that is not covered (in the market); it is a product that is the first of its kind (in Asia).”

He adds: “Our hope is that our competitors will copy our product, because this would mean that it will become a staple of insurance products, making it available to everyone.

“It’s not just for us, it’s for the community.”

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