Page 71 - MEDICAL AND HEALTH INSURANCE

MEDICAL AND HEALTH INSURANCE

Apart from the standard pre-existing conditions, it is also recommended to

exclude the specified illnesses during the first 120 days of occurrence for a

new individual or group policy.

With the imposition of exclusions it will definitely reduce the insurer's

exposure to a known disability or disabilities that have a likelihood of
dispute during the first few months of cover.

3.2.9 PROVIDER NETWORKS

Most insurers in Malaysia will select specific hospitals as panel hospitals
for their policyholders to facilitate hospital admission, with the

appointment of a Third-Party Administrator (TPA) to administer the

hospital admission and discharge. The selection criteria are generally the
logistics of the hospitals and the charges. However, the choice is also

sometimes dictated by the client to use a high-end hospital and hence the

paneling will defeat its purpose.

As mentioned earlier, the physician's fees are fixed and hospitals do not

give bulk discounts for their supplies except on room and board rates,

which make this approach a poor measure of cost containment if the panel
is open to all hospitals in Malaysia.

On the other hand, a closed panel with only a few selected medium-priced

hospitals for a group, may contain the cost as the charges are lower than

those of high-end hospitals.

There must be collaboration between the hospital and insurer to ensure
transparency in charges and to avoid unnecessary admission for overnight

stay.

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