Page 67 - MEDICAL AND HEALTH INSURANCE

MEDICAL AND HEALTH INSURANCE

If the excesses are low, for example, the first RM2,000 for every admission

or the first RM50 for every outpatient clinic visit, it will discourage petty

claims or reduce the unnecessary one-night stay on admission where

admission may not be necessary and the patient can be treated as an
outpatient case.

Excesses applied can be on a 'per visit' basis, as in the case of outpatient

clinical visits or on a 'per disability' or 'per admission' basis for inpatient

hospitalisation depending on the product design.

In some policies, the excesses can be high on an overall annual basis for
the whole group, as in a stop-loss arrangement. This will encourage the

proposer to take up insurance cover to cover for catastrophic losses by

paying a minimal premium.

Generally, applying excesses or deductibles is a good method of keeping

the cost down, as the policyholders also take responsibility to check if their

utilisation is medically necessary.

3.2.5 GOOD EXPERIENCE REFUND SCHEME

A 'good claim experience refund scheme' is generally applicable for group

PMI policies. This scheme encourages policyholders to play an active part
in ensuring good claim experience, to participate in the profits made by

insurers.

Experience refunds arising from the profit of any account period will be

offered contingent upon renewal of the policy for the following account
period and will be set off against the normal premium charges for the

following period. In the event of the policy being terminated in the

following account period, the refund offered is limited to such proportion

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