KUALA LUMPUR: Bank Negara is considering introducing a “no look back” policy to prevent the rejection of medical insurance claims due to inadvertent non-disclosure by policyholders, says Liew Chin Tong.
The Deputy Finance Minister said the proposal was among the measures being considered to strengthen protection for policyholders who unintentionally failed to disclose a medical condition diagnosed after they had obtained coverage.
He noted that insurers and takaful operators (ITOs) offering medical and health insurance and takaful (MHIT) products must adhere to policies set by Bank Negara.
Under the current policy, he said, ITOs are not allowed to cancel a policy or takaful certificate, or refuse to renew coverage, simply because a policyholder has made a claim or has been diagnosed with an illness after obtaining coverage.
“ITOs are also responsible for reviewing and managing claims fairly in accordance with the terms of the contract, including determining whether claims fall within the scope of medical coverage,” he said.
Liew said policyholders with concerns about their medical insurance claims should first raise the matter with their respective ITOs.
“If they are still dissatisfied, they can lodge a dispute through Bank Negara’s online portal and subsequently refer the matter to the Financial Markets Ombudsman Service at no cost,” he added.
Liew mentioned that another measure under consideration is to refer claim disputes to the Healthcare Partners Protocol & Solutions Committee.
The committee is spearheaded by the government together with stakeholders, including the medical industry, ITOs and Bank Negara, he added.
He was responding to Cheras MP Tan Kok Wai, who asked about the measures being taken by the Finance Ministry to strengthen insurance regulations to protect policyholders with critical illnesses, including cancer patients, from arbitrary policy cancellations and claim rejections due to unclear disclosure requirements.
Liew noted that ITOs generally only cancel insurance policies if policyholders stop making premium payments or fraud is detected.
“However, if there are cases involving claim rejections, policyholders should first discuss the matter with their respective ITOs, lodge a dispute with Bank Negara and, if necessary, refer the matter to the Financial Markets Ombudsman Service.
“If the issue remains unresolved after going through these channels, the Yang Berhormat may bring the matter to the Finance Ministry,” he said.
Meanwhile, Liew said data from ITOs showed that the industry maintained an average claims payout rate of more than 90% last year.
“Collectively, insurance industry players consistently approve more than one million claims each year.”
