THE top 10 illnesses most claimed for medical insurance include pneumonia, influenza and fever, says the Finance Ministry.
Its Deputy Minister Lim Hui Ying said that in some instances, the treatment cost for those using pay-and-claim insurance was cheaper than those with guarantee letters.
“Given the lack of transparency in treatment cost, a more detailed study is needed to understand the differences in charges,” she said in response to Sim Tze Tzin (PH-Bayan Baru).
Lim listed the top 10 most claimed diseases as: pneumonia, spine-related issues, digestive system problems, heart diseases, joint and ligament injuries such as dislocations and sprains, acute appendicitis, viral infections and influenza, other respiratory system problems such as bronchitis and upper respiratory infections, ENT-related diseases and fever.
Lim added that the government has acknowledged concerns raised during the public hearing sessions of the Public Accounts Committee (PAC).
She said the government has not considered a national health insurance scheme but could study it in the future.
She told Teresa Kok (PH-Seputeh) that insurance and takaful operators (ITOs) are prohibited from resetting premiums solely to increase profits.
While the insurance operators are required to declare their profits and losses in their annual financial statements, they do not need to detail profits and losses of each medical insurance policy.
“The industry average for the period 2021-2023 is 72%, where for every RM1 of premium paid, 72sen is allocated for claims,” Lim said adding that the details are in the insurance disclosure sheet.
She said those with medical insurance who receive unsatisfactory service from the companies can lodge a complaint with Bank Negara.
