How I'd choose a medical card

I'd want to know what a medical card will cost me at sixty before I cared what it costs now. It's a long relationship, and the first year's price is the least informative thing about it.

Page one is only a starting price

Bank Negara Malaysia (BNM) says policies that reimburse medical bills are generally sold with non-guaranteed premiums. If the pool's medical costs run ahead of what was expected, future premiums go up for everyone in it, even someone who has never claimed. That's the other side of how an insurer makes money even when it pays out: the price has to be right before the bills arrive.

I'd read that sentence twice. A clean record doesn't protect you, because you're paying for the pool.

In BNM's figures for the two years to 2023, the cost of claims rose 73%, and premiums collected rose by far less.¹

That gap got closed the hard way. In the round of rises that followed, BNM says about 9% of affected policies went up by more than 40%.¹

There are two kinds of rise

They're easy to mix up, and the difference is what I'd most want to understand.

One is repricing, when the whole pool's costs get passed on. BNM's interim measures of December 2024 spread those rises over at least three years, and run until the end of 2026.²

The other is your birthday. Move into a higher age band and the premium steps up, and BNM says plainly that its measures don't cover that.²

One 61-year-old's premium rise, in ringgit

That case came to a 50% rise, on a policy bought in 2007.³ Most of it had nothing to do with medical inflation. It was a birthday.

I don't think age pricing is a trick. BNM's sampled product shows 30 claims per 100 policyholders in their seventies, against seven per 100 in their twenties.¹

Older people do cost more, and somebody has to pay. I just want to see the price of that before I sign, not at sixty-one.

So my first request is the full premium table by age. Age bands are defined differently from one insurer to the next, CodeBlue reports, so I wouldn't assume two tables step up at the same points.

I'd also ask how often this product has been repriced, and by how much. I couldn't find a public list of that for each product, so it's a question for the agent, and I'd want the answer in writing.

The limits, for the bad year

An annual limit is the most the insurer pays in a year. RinggitPlus's example is a RM120,000 treatment on a RM100,000 limit, which leaves you RM20,000 short.⁴

A lifetime limit is the total over the policy, and once you reach it, cover ends even if you've kept paying. Some plans also cap each event or illness, and that smaller number can be the one that bites.

For scale, an average hospital stay cost about RM9,300 in 2024, according to the Malay Mail.⁵ I wouldn't size a limit on that. Averages aren't what ruin anyone, so I'd picture the worst year instead and ask how far the limit goes.

There's now a yardstick. MediAsas, the voluntary base plan backed by BNM, is due in 2027 with an annual limit of RM100,000, and premiums from RM65 a month.⁵

I'm not saying it's the right plan for anybody. It's just useful to have a public plan to hold a salesperson's numbers against.

The part you pay yourself

A deductible is a fixed amount you pay first. Co-insurance is a share of the bill: 10% of RM10,000 is RM1,000, RinggitPlus says.⁴ Generally, the higher the deductible, the lower the premium.

My impression is that cards get sold on having no co-payment at all, and there's a fair point in it, because a co-payment lands on the worst day of your year. I'd still look at one first. The premium is the part that keeps climbing every year, and the co-payment only bites when I claim.

What I'd check is the cap. MediAsas charges 20% at non-panel hospitals but stops at RM3,000 per illness or accident.⁵ A percentage with no ceiling would worry me far more than a larger deductible would.

What it won't pay for

I'd read this part before the benefits, because it decides what the rest of the policy is worth on the day I claim.

RinggitPlus lists cosmetic surgery and pregnancy-related costs as common exclusions.⁴ Waiting periods vary, and it gives examples of 30 days for common illnesses and 120 days for things like hernias.⁴ Pre-existing conditions can wait for years, if they're covered at all.

MediAsas's headline safeguard is a "no-look back" clause, which stops insurers using old medical records to deny claims. So I'd ask any other card plainly what it can look back on, and I'd declare everything on the form.

What else I'd ask

These are quicker questions, and I'd put them in one email to the agent so the answers come back in writing.

• Which hospitals near my home and office are on the panel, and what happens at one that isn't?
• Is this a standalone medical plan, or is it tied to an investment-linked policy?
• Does renewal have a guaranteed end age?
• If I switch from a card I already have, do the waiting periods start again?

When I'd walk away

I'd walk if nobody can show me the age table. I'd also walk if I'm told a reimbursement card's premium won't change, because BNM says otherwise. And I wouldn't drop existing cover on a salesperson's say-so: with a health history to think about, I'd want a licensed adviser and the answer on paper.