Page 5 - MEDICAL AND HEALTH INSURANCE

MEDICAL AND HEALTH INSURANCE

TABLE OF CONTENTS

1.1 THE MALAYSIAN HEALTHCARE SYSTEM (MHCS) ................................................................... 8

1.1.1 HISTORY OF THE MALAYSIA HEALTH CARE SYSTEM (MHCS) ...................................... 9
1.1.2 STRUCTURE OF THE MHCS ............................................................................................... 10

1.1.3 AIMS, PURPOSE AND SCOPE OF THE MHCS .................................................................. 10

1.1.4 DELIVERY OF MHCS SERVICES .......................................................................................... 12
1.2 PRIMARY AND PREVENTIVE CARE ........................................................................................... 13

1.3 SECONDARY AND TERTIARY CARE .......................................................................................... 14
1.4 PUBLIC AND PRIVATE HEALTHCARE SERVICES ..................................................................... 14

1.4.1 SERVICES OFFERED BY PRIVATE AND PUBLIC HOSPITALS AND CLINICS................ 15
1.4.2 OTHER HEALTHCARE PROVIDERS ................................................................................... 17

1.5 HEALTHCARE PROFESSIONALS ................................................................................................. 19

1.5.1 GENERAL PRACTITIONERS................................................................................................. 19
1.5.2 CONSULTANTS ..................................................................................................................... 20

1.5.3 OTHER HEALTHCARE PRACTITIONERS ........................................................................... 21
TUTORIAL .................................................................................................................................................. 23

2.1 PMI POLICIES ................................................................................................................................... 24
2.1.1 OVERVIEW OF PMI MARKET AND ITS RELATED PRODUCTS PMI ............................. 24

2.1.2 BENEFITS ASSOCIATED WITH HOSPITAL AND SURGICAL INSURANCE POLICIES ... 29
2.1.3 MAJOR MEDICAL INSURANCE .......................................................................................... 30

2.1.4 OTHER PMI PRODUCTS AND ADDITIONAL BENEFITS .................................................. 32
2.2 GROUP EMPLOYEE BENEFITS SCHEMES ................................................................................ 41

2.2.1 SMALL GROUP POLICIES ..................................................................................................... 42

2.2.2 LARGE GROUP/SCHEMES POLICIES .................................................................................. 43
2.2.3 EXPERIENCE-RATED AND COMMUNITY-RATED GROUP SCHEMES........................... 44

2.2.4 CONTRIBUTORY AND NON-CONTRIBUTORY SCHEMES ............................................... 45
2.3 INTERNATIONAL POLICIES ........................................................................................................ 45

2.3.1 SCOPE OF OVERSEAS COVER ............................................................................................. 46
2.4 FUNDING METHODS AND PRICING ADJUSTMENT .............................................................. 46

2.4.1 INDIVIDUAL AND GROUP SCHEMES ............................................................................... 47

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