Medical and Health Care In Malaysia – The Benefit of Having One


Malaysia operates a two-tier system of healthcare. This consists of a government sponsored universal healthcare system and a co-existing private healthcare system. The government has put into place funds to ensure that every Malaysian resident is able to access good and affordable health care in public hospitals within the country.

While the cost of healthcare in public hospitals is the cheaper and more affordable option, most Malaysians still seek treatment from private hospitals regardless of the cost. This is because unlike the public ones, the private hospitals are less crowded, have more doctors, and offer faster services to their patients.

Health and medical care insurance policy helps cover the cost of medical treatment


Medical and Health Insurance (MHI)

A medical and health insurance (MHI) policy help is designed to help cover the cost of treatment in private hospitals. This includes the costs of hospitalization, surgical, and healthcare services if you get diagnosed with an illness that is covered by the policy, or in case you get into an accident.

This coverage is offered by licensed insurance companies in which you have to pay premiums.

Types of Health Care Coverage

There four major types of medical and health insurance being offered in Malaysia. These include hospitalization and surgical insurance, 36 critical illness insurance, and hospitalization benefits.


  • Hospitalization and Surgical Insurance

This is the basic medical insurance. It offers medical coverage to hospital and surgical expenses incurred during treatment of a specified illness, or accident. It is suitable to everyone who wants a medical cover.


  • Critical illness Cover

A lumpsum is provided by the insurance company upon diagnosis of any of the 36 critical illnesses (also known as dread diseases). Some of these illnesses include cancer, heart attack, stroke, blindness, Alzheimer, etc.


  • Long-Term Care Insurance

This offers coverage for long-term care including home care, assisted living, nursing homes, adult day care, and Alzheimer facilities. It is suitable for people who live alone and don’t have anyone to take care of them when they get ill or old.


  • Hospitalization Benefits

This provides an agreed amount of money on a daily, weekly, or monthly basis to you when you get hospitalized. This will ensure that your family is able to cope financially even when you are still in the hospital recovering. It is suitable to get this cover if you have young children, a spouse without an income, aged parents or young siblings that rely on you financially.

It is usually recommended to get all the four type to ensure that you are fully covered. However, if you are at a low-risk age and leading a healthy lifestyle, a basic medical card which offers hospitalization and surgical cover will probably be enough. Depending on your policy, some medical cards also provide insurance on death, and total and permanent disablement.

If you don’t have any dependants, it is not necessary to have a hospitalization benefits cover.



A Medical and Health Insurance cover contains a number of exclusions which are not covered by insurance companies. It is important to know what these exclusions are before committing yourself to buy a MHI cover. Each insurance company has its own list of exclusions which you should find out through your agent, or insurance provider. Some of the most common exclusions are:


  • Pre-Existing Conditions

This simply means that if you suffered an illness in the past before you applied for a MHI policy, the insurance company will exclude that illness from the policy cover.


  • Qualifying/ Waiting Period

You are not able to make a claim for any medical or physical condition which may arise within the first 30 days of the policy. However, the insurance company will cover accidental injuries.


Factors that Determine which Type of Insurance to Buy

Factors such as age, income, marital status, and children will play a big role to determine which type of MHI will be the best suit for you. However, there are still other important factors that you need to consider before buying a medical and health insurance cover. Such factors include premium, coverage, and panel hospitals and reimbursement.

The Premium

While it is important to buy a MHI policy that you can afford, you should also make sure that the policy offers the coverage you need.  You need to list down the most important things that you need to have covered and then find a policy that will be affordable to you.

The Coverage

When you get an idea of what type of MHI you need that is within your budget, you can then start shopping for a health insurance policy.

Some of the essential things that you should look out for are: the room and board limit, annual limit, as well as lifestyle limit.

When considering the annual and lifetime limit, make sure that you are prepared for the future. This is because of the continuous rising of medical inflation cost; the amount that may seem adequate today may not be enough in a few years.

The other Coverage to consider is the out-patient treatment plan which will cover all the other treatments that you will need after hospitalization. Without this coverage, you may find yourself spending a significant amount of money from your own pocket.

Dr.Nirmala Bhoo-Pathy, a cancer epidemologist in UM  estimated the cost of breast cancer treatment to rise up to RM 65,000 per year which means that people earning below RM 4,700 will have a rough time paying for it.

ASEAN Costs in Oncology study by the Sydney based George Institute for Global Health found that a 45% of cancer patients in Malaysia suffer from financial hardship within a year after being diagnosed.

Early detection of cancer can help in treatment which can save and prolong the lives of patients.

Panel of Hospitals and Reimbursements

It is not sufficient to just have a cover with high claimable limit if you are not able to easily access the hospitals under your insurer. Look for an insurer that provides cashless health facilities within your region so that you are can access treatment without paying for them with your own money and going through the hustle of filing for reimbursement.

Other Things to Look Out For

It is important to read and understand the terms and conditions of any legal document before signing it, this include the medical and health insurance policy. If there is anything that you don’t understand, ask your agent, or insurance provider for clarifications and details.

Some of the important things that you may find in the policy document and need to understand include:

  • Co-insurance which refers to the percentage of the medical expenses which you will be required to pay. This means that if the medical cost is RM 28,830, and your insurer pays 90% of it (RM 25,497), you will be required to pay the remaining 10 %( RM 2,883).
  • Deductible– is based on the set amount that must be paid for all the covered treatment before the insurance company will begin to pay the subsequent expenses. This means that if the fixed amount deductible is RM 2000, and the annual treatment cost is RM5000, your insurer will pay RM 3000 and you will have paid the RM 2000.
  • Guaranteed renewal– it is important to have a policy that provides guaranteed renewal especially if you are over 50 years old. This ensures that you are protected throughout even despite recent diagnosis of illness.

Types of Medical and Health Insurance Plans

There are several MHI available to suit your situation. These include

Individual health Insurance Plan

This only protects the policyholder. There are two types of individual health coverage: emergency health insurance and comprehensive health.

The individual emergency health provides coverage for accidents and unexpected critical illnesses. On the other hand, the comprehensive cover offers more protection to the insured and also has a large network of medical facilities partners.  

Family health Insurance Plan

As the name suggests, this plan is designed to ensure that each member of your family protected in case of an injury of illness.  There are guidelines that are set by insurance providers that outlines who is considered as a family member. For example, some plans may cover both parents and all the children of the dependant, whilst other plans may require for members to be added individually so as to extend the coverage which will also mean adjusting the premium accordingly.

Group Health Insurance Plan

This is mostly taken by employers who seek to create a more enticing benefit package to attract and maintain workers. Group health Insurance plans ensures that companies and business are able to provide medical cover for their employees.

Other groups that use this plan are sports team, non-government organization, and schools.

Travelers Insurance Plan

This is meant for those who wish to visit Malaysia either for business, tourism, volunteering, etc and do not have an international insurance cover. A traveler’s insurance plan is design to protect you for the intended time that you will be staying in Malaysia.

For those that have relocated and have stayed in the country for more than a year or expatriates who have permanent residence in the country, an individual health insurance plan is more ideal.


How to Make a Claim

In order to avoid unnecessary delays with your claim, insurance companies recommend the following key actions:

  • Before receiving any treatment that is non-emergency, you should call the customer care helpline of your insurer or your agent to find out if the treatments recommended by your doctor are covered in your policy, and whether that particular hospital is part of your insurer’s panel of hospitals.
  • Always request your doctor and specialist to fill and sign your claim form.
  • Remember that different insurance companies and different policy types have different ways of making a claim.
  • Make sure that you submit a written notice to your insurance provider as soon as possible or within 30 days of the treatment period if you get diagnosed with a disability that might incur claimable expenses.
  • Also make sure that you send all the necessary claim documents and supporting documents such as original bills and receipts, physician costs and summary of treatment, and if necessary, referral letter.

Note that payments can either be denied or delayed if you don’t submit all the required and supported documents.



Having a medical and health insurance is very important not only for you but for your family as well. The key to getting a good MHI cover is not about the amount of premium you are paying but the kind of coverage you are getting. It is therefore important to do some research, compare, and choose a cover that gives you more and wider coverage. If you want to make a claim, make sure that you follow guidelines provided by your insurer for smooth and faster processing.

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