Medical Insurance Exclusions

2017-07-28T12:25:47+08:00By |Insurance, Q&A|

What are the exclusions or waiting period in your medical insurance?
Note: Please check your policy for detailed information. E&OE. 


Firstly, we will need to define the medical insurance coverage or what is covered in a medical card.

Hospitalization & Surgical Insurance

Coverage pays the hospital & doctor for a hospitalized patient confined for min 12 hours. This also includes specified accident & surgical benefits for accident/illness where there is no hospitalization.

Inclusions: What is usually covered?

  • Room and Board Benefit (R&B)
  • Intensive Care Unit (ICU)
  • Surgical Benefits
  • Anesthetist Fees
  • Pre Hospital Diagnostic Tests
  • Pre Hospital Specialist Consultation
  • Daycare Procedures
  • In Hospital Physician Visit
  • Post Hospitalisation Treatment
  • Emergency Accident Outpatient Treatment Benefit
  • Ambulance Service
  • Emergency Sickness Outpatient Treatment Benefit
  • Government Hospital Daily Cash Allowance
  • Medical Report Reimbursement
  • Outpatient Cancer Treatment, Kidney Failure Treatment (depending on medical card)

Exclusions: What is NOT covered

  • Pre-existing illnesses
  • Specified illnesses within first 120 days
    – Hypertension, diabetes, cardiovascular diseases
    – Tumors, cancers, cysts, nodules, polyps, growths & lumps of any kind
    – All ear, nose & throat conditions
    – Hernias, hemorrhoids, fistula, hydrocele, variococele
    – Endometriosis & disease of reproduction system
    – Vertebro-spinal disorders & knee conditions
  • Medical or physical conditions within first 30 days, except for injury (accident)
  • Services & supplies not recommended, approved or performed by legally qualified Registered Medical Practitioner
  • Investigatory hospitalization, purely diagnostic tests, routine physical health check-up or preventive treatments, sleep or snoring disorders, HRT, sex change & alternative therapy
  • War or any act of war, criminal or terrorist activities, active duty in armed forces, radiation, participation in strikes, riots, civil commotion or insurrection
  • Suicide, attempted suicide or intentionally self-inflected injury while sane or insane
  • Nervous & mental conditions, alcoholism or drug addiction, rest cures, sanitaria care or special nursing care
  • Pregnancy, childbirth, abortion, erectile disfunction & all related complications
  • Injuries sustained from travel in any aircraft except as fare-paying passenger on regularly scheduled flight
  • Procurement or use of special braces, appliances, equipment or other prosthetic devices
  • Dental treatment, eye examinations, eye glasses, eyesight corrections & hearing aids
  • Sterilization, infertility, circumcision, congenital anomalies, cosmetic & plastic treatment
  • Non-medical services (e.g. radio, television, telephone, internet)
  • Medical treatment if Life Assured resides or travels outside Malaysia for more then 90 consecutive days
  • Note: Guarantee Letter (GL) to hospital may not be issued & pending claims checking if issue is medical insurance is 1 year or less (Meaning you will have to pay 1st then only claim)
Follow Us


Admin at MyPF
Helping you to simplify and grow your Personal Finances.

Follow to get the latest Personal Finances updates and insights!
Follow Us

Leave a Reply