11 Frequently Asked Questions About Health Insurance

Kali terakhir diperbaharui July 6, 2023 oleh Syazwani Yahya
11 Frequently Asked Questions About Health Insurance

Choosing the right health insurance or medical insurance plan can be difficult and time-consuming because there are so many crucial elements to take into account. The key elements of this protection are explained in this article.

The Importance of Having Health Insurance

If you are a private sector worker, you are likely to have health insurance and medical card. You may be wondering “Need to have personal health insurance if the company has covered for me?”.

The medical plan provided by your employer is known as a group protection as it covers a group of employees under one employer. You as an employee will enjoy the benefits of a medical card for hospitalization.

No doubt, the benefits of medical insurance provided by your company are a very useful benefit but there are some situations that will make you think of your own health insurance:

  • Insufficient protection if medical costs or treatment are too high;
  • If you are removed, your insurance plan with the company will be canceled;
  • Do not protect you after you retire and this may cause you to use retirement money for health insurance.

Therefore, you are advised to obtain your own health insurance or also known as an individual protection plan as it will protect you and your family from situations as described above. To help you choose the best personal health insurance, here are some important questions you need to consider:

1. What Is Health Insurance?

The main purpose of health insurance is to protect you financially. These insurance will provide protection in the event of death, cover your medical bills including hospital room costs, consultations, surgery, treatment and medication if you are sick or accidents.

Because medical costs are a unexpected cost and can be very high, you may find it difficult to explain the hospital bill by using your own money either through cash payments, debit cards or credit cards. Medical insurance will make it easier for you to pay for your health bills.

You can get health insurance coverage from licensed insurance companies in Malaysia. Since there are many insurance plans in the market that offer different protection, you need to do research to find out the type of protection you need. After that, you can make your own assessment and select the best plan for you and your family.

2. How Is the Health Insurance Premium Determined?

For health insurance coverage, you will need to pay insurance premiums to your insurance company. There are several key factors that will affect the price of your insurance premium. Among them:

Type of Protection

The selection of your health insurance plan will affect the cost of insurance premiums. The more protection, the higher the cost. In addition, taking additional protection will also increase the cost of your insurance premium.


Your age also plays an important role in determining your insurance premium price. Usually, older individuals will be subjected to higher premiums due to the risk of higher disease.

Geographical Location

Your home can also affect the costs you have to pay. This is because, each geographical location is exposed to different environmental factors and medical costs.

Medical History

If you have poor health records or have existing illnesses, the insurance premiums are higher.


Your work environment also plays a role in determining your premium cost. If your job is exposed to the risk of injury or accidents, the premiums that will be charged may be more expensive.

Body Mass Index (BMI)

Individuals with high BMI are more exposed to the risk of dangerous diseases and as this is also more expensive premiums.

Smoking Habit

Usually, smokers will be subjected to higher premiums because smoking habits are harmful to health and most individuals who smoke are exposed to the risk of harmful diseases.

Number of liabilities

Your insurance rate will also be determined by your marital status or the number of liability. More people under your liability can cause your insurance premium rates to be higher.

Duration of Policy/Certificate

The duration of the policy plays an important role in determining the premium value. If you choose a policy for a longer period, your premium or contribution is lower.

3. How Many Types of Health Insurance Are There?

All health insurance plans have the same purpose of providing financial protection if you need money for surgery or medical treatment. In general, there are four types of protection that you need to know:

Hospital Insurance and Surgery

Cover your expenses on hospitalization and surgery caused by the disease prescribed in the policy.

Critical Illness Insurance

You will receive a payment of critical illness insurance benefits if you have a critical illness covered by the policy.

Income Insurance

Give you a source of income if you are unable to work due to injury or disability.

Hospital Income Insurance

Subject to the annual limit, you will receive a certain amount of money either daily, weekly or monthly if you need to spend the night in the hospital due to the disease covered in the insurance policy.

health insurance in Malaysia

4. What Do You Need to Consider Before Buying Health Insurance?

Here are some important things to consider before buying the best medical insurance for you and your family:

  • Protection plan
  • The type of allowed insurance claim
  • The process of claiming insurance
  • Medical Card waiting period
  • Annual limit or lifetime limit
  • Protection of existing disease
  • A list of clinics or panel hospitals

5. How Do I Claim Health Insurance?

Insurance claim procedures may vary for each insurance company, the type of claim and the policy feature. You can refer to a company or insurance agent to review your insurance policy.

If your insurance cover plan is based on reimbursement; or you do not receive guarantee letter; Or you get treatment at the hospital other than the Hospital Panel, you need to know how to claim this health insurance. You can refer to the simple steps as follows:

Notify an insurance company or insurance agent before receiving hospital treatment or admission.
Provide the required documents such as a copy of the identity card, the health report, the bill and the original medical receipt and the diagnostic report.
Complete the claim form through your insurance company website.
Submit the claim form within 30 days after the discharge.

6. What Are the Reasons Why Your Claim Can Be Rejected?

Did you know that your health insurance claim can also be rejected? To prevent this from happening to you, you need to avoid the following situations:

Claims Within the Waiting Period

Medical insurance will not protect any medical costs incurred on your behalf within 30 days from the date of activation of insurance policies except for accidental injury.

Not Paying Insurance Premiums

You will definitely risk losing your insurance policy if you fail to pay your premium past the expiration date.

Exceeds The Limit

There are two limits that you need to know: annual limit and lifetime limit. If your latest hospital bill is RM80,000, but your annual limit is only RM50,000, you may need to pay the remaining amount.

However, to your knowledge, most medical insurance plans set protection to ‘as charged’ or as charged. This means that your insurance company will pay the total amount charged by the hospital.

insurance health malaysia

7. What if You Didn’t Make Any Insurance Claims?

You need to refer to your company or insurance agent to find out if any incentives are offered if you do not make any compensation claims.

Most insurance plans offer no claims bonus (NCB) that you can claim. The meaning of the NCB is the financial benefit or bonus given to the policyholder for each year without a claim. Rewards are given because you remain healthy throughout the policy period and do not make any claims on your health insurance policy.

8. How Many Times Can You Make an Insurance Claim in a Year?

Most insurance companies do not set the maximum claim for health insurance policies. The main requirement is as long as you do not pass the annual limit. In other words, it depends on the protection plan you take. For more information, it is advisable to consult your company or insurance agent for certainty.

However, let’s say you already use the annual limit or lifetime limit, your health insurance will no longer bear the cost of your treatment or medical. This means that you need to withdraw money from your own pocket to bear any cost of treatment or medicine.

9. What Can You Expect With a Health Insurance Plan?

Basically, it depends on the type of insurance policy you buy. You can know the benefits, things that are protected or not protected and so on. Usually, you will find hospital admission policy and surgery provides the following protection:

Hospital accommodation and treatment expenses
Surgical expenses (surgeon fee and surgical -related costs)
The cost of a medical doctor
Screening test before the patient goes into the ward

10. What Health Insurance Does Not Cover?

Insurance companies do not protect everything. As mentioned, each insurance package offers varying protection and exceptions. Therefore, you need to know the things that your insurance does not cover so you are more careful. Here are some unprotected things:

The cost of childbirth
Congenital disease (a disease that exists from birth)
Injury due to accident or illness for engaging in a race
Cosmetic surgery or plastic surgery
Dental treatment includes oral surgery

11. When Do You Need Health Insurance?

If possible, take a health insurance policy as early as possible. This is because, age factors can play an important role in determining your protection plan. For example, individuals who start taking policies at a young age and while in a healthy state, you can get a more comprehensive plan that meets your needs at very affordable prices.

medical insurance

Always Be Prepared by Choosing the Best Medical Insurance Plan

Undoubtedly, medical related costs can reach up to tens of thousands of dollars. Health insurance is created to protect you when you need medical help. It is hoped that sharing of the above 11 Health Insurance Questions can help you make a better assessment when choosing the best health insurance plan for you and your loved ones.

One of the best ways to buy the best health insurance is through Qoala. Qoala is the best insurance platform in Malaysia approved by Bank Negara Malaysia that will help compare different medical insurance plans to ensure you get a health and medical insurance plan that suits your needs.

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Personal finance management expert to help you manage your finances better!

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