Malaysia Health Insurance Coverage Definitions
For legal purposes, many insurers rely on terms that are not part of the common vernacular to describe their coverage, requirements and limitations. Here, Malaysia Health Insurance provides you with a list of some of the most common terms used by insurers to define the conditions of their policies. Understanding what these terms mean in plain English will make it much easier to make a confident decision about the best coverage for your circumstances.
Insurance – a legally binding agreement in which one party (the insurer) accepts the risk of another (the insured) in return of a prior arranged fee
Health/Medical Insurance – a legally binding agreement in which an insurer agrees to extend protection and financial assistance to an insured to cover included injury and illness or other health-related issues as outlined by the policy
Applicant – the person applying for coverage from an insurance provider
Application – required paperwork to be completed by the applicant for consideration of coverage by a specific provider
Specific Terms – the detailed conditions of coverage that outline levels of care and other information from a specific insurance policy, these terms are sometimes made on a case by case basis
Standard Terms – the usual conditions of coverage for a particular insurance plan
Hospitalization Coverage – medical insurance designed to cover the financial burden incurred by the insured due to required hospitalization and associated treatments
In-Patient Care – medical treatment which requires over-night stay in a hospital
Out-patient Care – medical treatment which does not require over-night stay in a hospital
Policy Conditions – the specific stipulations of coverage agreed to by the insurer and insured for a specific insurance policy
Policy Holder – the individual to whom the insurance policy is issued to and is subsequently responsible for payment. In the case of a group plan, this may be an authorized agent or administrator.
Policy Schedule – the document explaining the amount of coverage provided by a specified insurance policy
Deductible – the amount of financial responsibility, as stated in the policy, an insured person (or in some cases the family) has toward their own good health before their insurance coverage provides assistance with payment
Claim - a formal request, written or otherwise, by the insured to receive compensation or coverage for healthcare or treatments which are covered by their policy
Documents – the formal records (in hard-copy or electronic format) held by the client and provider for a specific policy relating to health, treatments and financial reimbursement. Typically, these are signed and/or sealed and are often part of the insured or insurer's permanent records
Commencement Date – the calendar date on which an insured persons coverage officially starts
Anniversary Date – the calendar date marking one incremental year of coverage for a multi-year insurance policy
Due Date – the calendar date the insurance policy premium's payment must be paid on or prior to
Renewal – the offering by the insurer to the insured to continue insurance coverage for an arranged fee for an agreed amount of time
Waiting Period – the amount of time that an insured must wait after payment has been received before their coverage begins
Region – the geographical area in which coverage is guaranteed by a specific insurance policy
Reimbursement Rate – the total amount of financial coverage available for a specific health condition or treatment as outlined by the insurance policy
Subrogation – the right reserved by the insurer to pursue financial compensation from a third party via legal action or settlement for coverage and/or compensation extended to their insured
Pre-existing Condition – any condition that was knowingly present in the insured health prior to the start date of coverage for a specified insurance coverage policy
Serious Injury – an injury (typically due to accident) which results in bodily harm sufficient to cause inability to perform tasks at the same level or with the same ease as prior to the injury, for either a long or short period of time
Acute Illness – illness characterized by rapid onset, but which typically only last for a short time
Surgery – the treatment administered by a medical professional with the purpose of improving or restoring the patient's health due to deformity, illness or injury
Terminal Phase - the point at which a disease has progressed to where there is considered little or no chance of recovery, and death seems imminent regardless of further treatments
Malaysia Health Insurance Coverage Exclusions
Every Malaysia insurance provider reserves the right to exclude some health or medical conditions or treatments from their plan coverage.
As a general rule, all pre-existing health conditions present in and known of by the insured are usually counted as excluded at the start of a new policy.
The list below outlines some common exclusions of coverage, but each insurer will have their own specific list which may go beyond what is shown here.
- Experimental cures or treatments
- Health conditions resulting from or relating to drug and alcohol abuse
- Female fertility tests and fertilization assistance procedures
- Mental illnesses
- Elective procedures
- HIV and/or AIDS treatments
- Male or female sterilization
- Fetal abortions
- Conditions related to sexual dysfunction
- Treatment due to or for morbid obesity
- Treatments for injury due to terrorist attack
Malaysia Health Insurance Information
Every provider may interpret their terms in a slightly different manner and in some instances one or more conditions can be included with prior arrangement. Furthermore, this list is by no means comprehensive and for a specific plan or provider's complete list of exclusions it is necessary to contact a qualified representative.
Contact Malaysia Health Insurance
Understanding what these terms mean and how they relate to your well-being is crucially important to making a confident decision about the type and level of medical insurance coverage you need in Malaysia. To learn more about the above terms, or if you do not see a term defined that you have concerns about, please contact us. Speaking with an adviser is easy; just complete the request for information at the top of this page and someone will contact you soon, or for immediate assistance click here to reach someone right away.