Page 32 - MEDICAL AND HEALTH INSURANCE

MEDICAL AND HEALTH INSURANCE

Major medical insurance policies were designed to cover a broad range of

catastrophic medical expenses with emphasis on the large bills resulting

from a serious injury or prolonged illness. To make the product affordable,

the Insurer normally applies a deductible, which the Insured is responsible
to bear and co-insurance of a certain percentage between the Insured and

Insurer, up to a predetermined figure. The most common co-insurance

sharing is either, 80% or 75% paid by the Insurer and 20% or 25% paid by
the Insured.

The eligible medical expenses cover is the same as any PMI policy and

would include the charges for the care and reasonable and customary

treatments that are prescribed by the physician.

In some instance there may be a limit set for the room & board per day up

to a maximum number of days, as well as for intensive care unit stay. So

the eligible medical expenses of the room stay cannot exceed the set limit
in the benefit schedule.

The 'deductible' is the amount of eligible medical expense that must be

incurred and paid by the Insured before the benefits are payable under the

policy. This is usually a fixed amount ranging from a minimum of RM250 to
RM1,000 or even higher. In major medical insurance the deductible may

be on per disability or per admission basis. If it is per disability, then the

deductible will be deducted once for the same disability. If it is per

admission, then the deductible would be applicable for every admission

during the benefit period.

Similarly, the maximum benefit insured can be by per disability or per
annum. In addition insurers may impose qualifying conditions in order to

activate the major medical payment namely:

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