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)
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