Medical plan proposal for the uninsured

THE General Insurance Association of Malaysia (PIAM) in its online Medical and Health Insurance page states that a medical and health insurance policy will contain certain exclusions, which are termed pre-existing conditions. It means any illness and condition suffered by a potential policy buyer prior to purchasing the policy would be excluded from coverage by the insurance company.

This has far reaching consequences. An expatriate friend of mine managed to beat his cancer five years ago. Last year while on assignment overseas, he suffered a heart attack and had to bear the treatment costs himself because he did not have insurance coverage.

The crux of the matter is, once you have undergone treatment for a serious illness, you cannot get insurance coverage even if it is meant for other illnesses, including dengue, or treatment for injuries suffered in a car accident for that matter.

The problem is made worse if public hospitals turn away those who had earlier sought treatment at private medical centres. This issue needs to be addressed constructively. Perhaps the solution could be to set up a medical insurance card linked to specific government hospitals like the National Heart Institute (IJN), National Cancer Institute and general hospitals with facilities to treat patients with critical illnesses. Policy holders could pay an annual standard premium, tiered according to age bands, that would allow them to seek treatment in these hospitals.

This scheme could be managed by Socso and the premiums could be based on a formula of the patient care accorded and the cost public hospitals can claim, partially or fully.

Policy holders would have to visit a Socso panel doctor and get a referral as part of the process to seek further treatment.

This scheme should be given as a priority to those who suffer from pre-existing conditions and can show proof that they are not able to get medical insurance.

Such a scheme would help to allay the fears of many Malaysians who do not have enough savings or assets to be able to afford medical treatment when struck with a serious illness.