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. 

medical-care

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)

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