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Did You Know That Some Medical Insurance Offer UNLIMITED Lifetime Limit?

Updated 16 Oct 2018 – By Loanstreet


In collaboration with  

If there’s one thing about us that we always take for granted, it’s our health. We might sharpen our minds and nourish our souls, but it’s easy to forget about the very vessel that carries our entire being.

How do we change this? Aside from consciously maintaining a healthy lifestyle, getting a medical insurance has also become a necessity for Malaysians. Accidents or illnesses can happen without warning, and the last thing we want to worry about when trying to recover from is “Can I afford the hospital bill?” 

So if you’re looking for your first medical insurance, here’s a concise yet comprehensive article on what you need to know before getting one. We got in touch with our friends at Prudential in writing this piece. Let’s start with…

1. Types of medical insurance

The first thing that you need to consider is the kind of coverage you need. Different plans will give you different types of compensation:

  • Medical plans: Also known as Hospitalisation and Surgical Insurance. This is the type of medical coverage everyone knows best. It’s when your insurance helps pay for your hospital & treatment bills – depending on what your plan covers.
  • Hospital income plans: Pay fixed amount on a regular basis while you are being treated in the hospital.

So which one would you go for? For most people, a medical card is considered sufficient.  Sometimes you might need more than one. We’ll elaborate on the factors that will influence your decision.

2. How much premium should you pay?

Premium is the amount of your monthly payment. By default, you might just want to go for the cheapest plan or the ones that you can afford in the long-run. 

HOWEVER, did you know there are a few key factors which will affect your premiums? For example: 

  • Age: The older you get, the higher the premium you may have to pay, so it’s advisable to start young.
  • Family/past medical history: Do you or your family have a history of an inheritable disease? 
  • Lifestyle: Do you happen to be a smoker, drinker, or obese? Some of your lifestyle choices may affect your premiums.
  • Occupation: Are you working in a high-risk occupation?

It’s very vital that you understand your needs & your budget. Don’t be afraid of asking too many questions! 

3. Annual coverage and lifetime coverage

There are two types of limits under the usual medical plan that you need to understand:

  • Annual coverage: The amount that you can claim per year
  • Lifetime coverage: The total amount that you can claim throughout your policy period

It may sound straightforward at first glance, but do take a closer look at the policy. Some plans offer low annual coverage with higher lifetime coverage and vice versa. Which one is better for you?

Say you have a capped annual coverage of RM100, 000 with unlimited lifetime coverage. You get into an accident that costs RM200, 000 so you have to fork out extra money to cover the rest. In this case, it would’ve been wiser to opt for a higher annual limit, regardless of the lifetime limit.

Sometimes, a policy can be flexible enough for you to have the best of both worlds. Some Prudential plans (like PRUmy medical plus for example), you can choose a plan with a very high annual limit up to RM1.98M and no lifetime limit.

4. Fully-insured plans payment vs cost-sharing plans

However, when you need to actually pay the cost of your medical expenses, your plans might not cover the cost right away. This depends on whether your scheme is a:

  • Fully insured plan that pays the full amount of your medical fees (subject to benefit limits).
  • Cost-sharing plan where you have to pay some amount before the benefits come into effect.

Wait, hold up. Do you mean with cost-sharing plan I still have to pay for my medical bills? Then why do I need insurance! Relax, cost-sharing plan only requires you to pay a small fraction of the medical bills and in return you’ll potentially be getting better coverage at a lower monthly premium. It’s a great way to ensure you’re getting coverage while still keeping things affordable. 

Typically, fully insured plans have a higher premium, but you’ll be assured of an instant coverage especially if it’s an emergency.

5. My company already offers medical insurance

Your job may come with medical insurance for yourself (and if you’re lucky, your family), so why would you need another medical coverage? It’s to ensure you have enough coverage, of course.

Usually medical coverage provided by workplaces are quite basic with low limits. Maybe it’s enough for minor issues but might not be sufficient for more serious conditions and your workplace coverage wouldn’t be customized towards your personal needs. 

In addition, having your own medical plan means you don’t need to worry about being covered even after you’ve changed jobs! 

6. Hospital treatment & room and board entitlement

So far we’ve mostly talked about the financial side of medical insurance and its coverage. But should illness strikes, the first thing you want to think about is which hospital you want to go to. Which ones are accessible? Is it comfortable? How much does it cost? Also, what happens if you go to a non-panel hospital?

Most medical plans come with Room and Board entitlement, which will cover daily room charges & meals. If you think you’ll need general nursing care, you can even have that feature adding as part of your policy.

And contrary to popular beliefs, some medical insurance also cover outpatient treatments that are done without staying in the hospital. Some plans even covers outpatient kidney dialysis, outpatient cancer treatment, and day surgery. 

As an added bonus, some medical plans even come with exclusive benefits such as outpatient dengue fever treatment, complications arising from maternity or rewards you with no claims bonuses. So look for the criteria that best suit you in a policy.


7. Availability of Rider Options


We know not all of us have the same medical needs or are exposed to the same health risks. Thus when shopping for a plan, keep your eye out for those which allow you to customize your plan with suitable riders to ensure you get the most out of it. 

For example, do you want to:



So why settle for a generic plan when you can have one which one catered specifically to your needs? 

Choose ones that don’t just fit your needs and lifestyle, but are financially sensible.

In this article, we’ve talked about the major aspects of medical insurance that you need to research before getting into one. Solutions like PMM+ are designed to provide flexibility in terms of affordability and the amount covered (and can even reward you for staying healthy). More importantly, is that it is a solution that can be designed to cater to your various needs. 

This is why it’s really important for you to have a good and trustworthy insurance agent that can answer any questions that you have in mind, or you can also contact the insurance provider directly. We wish you luck, and stay protected!
 

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