Key takeaways
- A regular medical card in Malaysia excludes pregnancy, childbirth (including caesarean delivery), miscarriage and prenatal or postnatal care, so it will not pay the delivery bill.
- Great Eastern's maternity rider, Smart Baby Shield Plus, can only be applied for between 13 and 36 weeks of pregnancy, for mothers aged 19 to 45 next birthday.
- It pays a lump sum for 10 listed pregnancy complications (RM2,500, RM5,000 or RM10,000 by plan), plus 20% more if gestational diabetes is also present.
- For the baby it covers NICU stays in the first 30 days, incubation and jaundice phototherapy in the first 60 days, and hospital stays for listed congenital conditions until age 7 next birthday.
- A baby's medical card can be attached from 13 weeks of pregnancy, but its cover and its 30-day illness waiting period only start after birth.
- Normal delivery and planned caesareans are not paid; only the Grand plan pays RM8,000 for an emergency caesarean before 36 weeks.
Does a normal medical card cover pregnancy and childbirth in Malaysia?
Many expecting mums assume their medical card will take care of the delivery bill. It will not. Almost every medical card in Malaysia lists pregnancy as an exclusion. Take Great Eastern's Smart Health Protector: its product brochure excludes pregnancy, childbirth (including surgical delivery), miscarriage, abortion and prenatal or postnatal care. A normal delivery, a planned caesarean and your antenatal check-ups all fall outside the medical card.
The same brochure also excludes treatment for congenital conditions that show up or are diagnosed before the child turns 17 (age next birthday), apart from a limited Special Care Benefit on some plans. Those are exactly the two gaps maternity insurance is built for: serious complications for the mother, and conditions the baby is born with.
| Situation | Mum's own medical card | Maternity rider (Smart Baby Shield Plus) |
|---|---|---|
| Normal delivery or planned caesarean | Not covered | Not a listed benefit |
| Emergency caesarean before 36 weeks | Not covered | RM8,000 on the Grand plan |
| One of 10 listed pregnancy complications, such as eclampsia | Not covered | Lump sum of RM2,500 to RM10,000 by plan |
| Mum admitted to ICU or HDU for childbirth or complications | Not covered | As charged, up to RM2,500 to RM10,000 by plan |
| Baby in NICU within 30 days of birth | Baby's own medical card still has a 30-day illness waiting period after birth | As charged, lifetime limit of RM2,500 to RM10,000 by plan |
Bank Negara Malaysia's insurance and takaful FAQs make the same point in general terms: medical policies carry exclusions such as pre-existing conditions, specified illnesses and waiting periods, and you should ask about them before you buy. A situation I see often is a couple finding out at an antenatal visit that the medical card does not pay for the birth, when the time left to arrange anything is already short.
What does maternity insurance cover in Malaysia?
In Malaysia, maternity insurance (also called pregnancy insurance or prenatal insurance) is usually not a stand-alone policy. It is a rider attached to a policy taken out on your unborn baby. At Great Eastern, Smart Baby Shield Plus is a pair of riders attached to SmartProtect Junior, an investment-linked child plan: one rider covers the mother and one covers the child. Your baby is the life assured while still in the womb, and the minimum sum assured for SmartProtect Junior is RM12,000.
There are three plans: Essential, Superior and Grand. The figures below come from Great Eastern's Smart Baby Shield Plus brochure.
What it pays for the mother
| Benefit | Essential | Superior | Grand |
|---|---|---|---|
| Death due to childbirth or pregnancy complications (up to 60 days after delivery) | RM7,500 | RM15,000 | RM30,000 |
| Any of 10 listed pregnancy complications (up to 60 days after delivery) | RM2,500 | RM5,000 | RM10,000 |
| Extra 20% if the complication comes with gestational diabetes (GDM) | +RM500 | +RM1,000 | +RM2,000 |
| ICU or HDU for childbirth or complications (as charged, up to 60 days after delivery) | Up to RM2,500 | Up to RM5,000 | Up to RM10,000 |
| Maternity cancer (30-day waiting period, diagnosed up to 60 days after delivery) | RM2,500 | RM5,000 | RM8,000 |
| Emergency caesarean for early delivery before 36 weeks | No | No | RM8,000 |
| Major depressive disorder or generalised anxiety disorder diagnosed within 1 year after delivery | No | No | RM8,000 |
The 10 complications are abruptio placentae, acute fatty liver of pregnancy, amniotic fluid embolism, disseminated intravascular coagulation (D.I.C.), eclampsia, placenta increta or percreta, postpartum haemorrhage requiring hysterectomy, pulmonary embolism of pregnancy, uterine rupture and vasa previa. A condition outside these 10 does not trigger this benefit, so read the list before you buy rather than after.
What it pays for the baby
| Benefit | Essential | Superior | Grand |
|---|---|---|---|
| Death of the foetus, or death within 1 year of birth | RM2,500 + investment value | RM5,000 + investment value | RM10,000 + investment value |
| NICU, ICU or HDU within 30 days of birth; incubation or jaundice phototherapy within 60 days (as charged) | Up to RM2,500 per lifetime | Up to RM5,000 per lifetime | Up to RM10,000 per lifetime |
| Hospital stays for listed congenital conditions (to age 7 next birthday) | Up to RM15,000 a year | Up to RM30,000 a year | Up to RM60,000 a year |
| Child development disorders such as ADHD, autism or speech delay (to age 7 next birthday) | No | No | Up to RM8,000 a year |
The congenital list has 27 named conditions, including ventricular and atrial septal defects, cleft lip and palate, Down's syndrome, congenital cataract, congenital deafness and cerebral palsy; the Grand plan adds all structural congenital conditions. Benefits paid "as charged" are subject to reasonable and customary charges.
On cost: the insurance charges for these two riders are deducted from the policy's investment value in 5 yearly instalments rather than paid as a separate monthly bill, and they are not guaranteed. What you pay overall depends on the SmartProtect Junior sum assured and any other riders, so I do not quote prices here; the sales illustration shows your actual figures.
On tax: the brochure says Smart Baby Shield Plus benefits are generally not taxable and premiums paid may qualify for tax relief, subject to the Income Tax Act 1967 and the final decision of LHDN. The relief caps for each type of insurance are in my insurance tax relief guide. This is general information, not tax advice.
How early must I buy maternity insurance, and why apply early?
Smart Baby Shield Plus accepts applications only between 13 and 36 weeks of pregnancy, and the mother must be 19 to 45 years old (age next birthday). Before you are pregnant, or before 13 weeks, there is nothing to apply for yet; after 36 weeks, the window has closed.
That looks like 23 weeks of time, but I usually suggest starting as soon as you reach 13 weeks instead of waiting for the third trimester. Four reasons:
- Anything that exists before the policy starts is not covered. The brochure excludes conditions that existed before the risk effective date. The longer you wait, the more likely something found at a check-up becomes an excluded condition.
- Your duty to disclose lasts until the policy is issued. The SmartProtect Junior product disclosure sheet (PDS) says you must disclose the medical condition of the mother and the baby, and tell the insurer about any change before the policy is issued, including the birth itself.
- The emergency caesarean benefit only covers delivery before 36 weeks. A policy that starts late protects you for a shorter stretch.
- Maternity cancer has a 30-day waiting period counted from the risk effective date, so an earlier start means earlier cover.
How to apply, step by step
- Confirm your weeks of pregnancy and expected due date (EDD) with your obstetrician.
- Have the mother's IC, the antenatal record book and recent test results at hand so you can answer the health questions accurately.
- Go through the SmartProtect Junior sales illustration and PDS with your agent and choose Essential, Superior or Grand.
- Answer the health questions truthfully. If you are unsure whether something counts, write it down and ask; do not decide on your own that it does not matter.
- When the policy arrives, check the policy schedule. You have a 15-day free-look period to cancel if it does not suit you.
- After the birth, give the insurer your baby's name and actual gender: the PDS explains that charges before birth are worked out as if the baby is a boy.
If you are only planning a pregnancy, the useful step now is to put your own medical card, life and critical illness cover in place. Conditions you already had, or had symptoms of, before buying a plan are pre-existing and excluded, and anything found during pregnancy must be declared on any policy you apply for later, where it may be excluded.
What does maternity insurance not cover, and until when does it pay?
Every benefit in a maternity rider has a time limit, and the rider has its own exclusions. Many parents look only at the amounts and miss phrases like "up to 60 days after delivery" until a claim is late.
| Who | Benefit | Covered until |
|---|---|---|
| Mother | Death, pregnancy complications, ICU or HDU, maternity cancer | 60 days after delivery |
| Mother | Emergency caesarean (Grand only) | Before 36 weeks of pregnancy |
| Mother | Psychological consultation for depression or anxiety (Grand only) | 1 year after delivery |
| Baby | Death | From the foetal stage to 1 year after birth |
| Baby | NICU, ICU or HDU | 30 days after birth |
| Baby | Incubation, jaundice phototherapy | 60 days after birth |
| Baby | Congenital conditions, development disorders | Age 7 next birthday |
The main exclusions
- Mother: conditions that existed before the risk effective date; choosing to end the pregnancy for non-medical reasons; self-inflicted injury; being under the influence of alcohol or drugs not prescribed by a doctor; HIV or AIDS; unlawful acts; war.
- Baby: drugs not prescribed by a doctor; HIV or AIDS; unlawful acts; war; experimental treatment that is not proven effective or not approved by a recognised body in Malaysia.
- Living abroad: hospital treatment for congenital conditions received outside Malaysia is not paid if you live or travel outside Malaysia for more than 90 consecutive days.
One more thing to keep in mind: maternity insurance is not delivery-cost insurance. A normal birth, a planned caesarean, routine antenatal visits and confinement costs are not on the benefit list, so budget for them separately. What the rider pays for is the situation that goes wrong: a serious complication, an early delivery that ends in intensive care, or a baby born with a listed condition.
Should I set up my baby's medical card during pregnancy?
You can. Great Eastern's Smart Health Protector medical card accepts an unborn child from 13 to 36 weeks of pregnancy; after birth, the minimum entry age is 14 days. The SmartProtect Junior PDS says that apart from Smart Baby Shield Plus and the two payer premium-waiver riders, every benefit, including the medical card, starts only after the baby is born, and the waiting periods also start counting from birth.
Smart Health Protector has a 30-day waiting period for illness and 120 days for specified illnesses. So even when the baby's medical card is arranged during pregnancy, it does not pay for an illness admission in the first 30 days after birth. The maternity rider's NICU cover (first 30 days) and incubation and phototherapy cover (first 60 days) sit right in that gap. My medical card waiting period guide explains how the days are counted.
The other advantage of arranging it during pregnancy is that the application is done before your baby arrives. If you apply after birth, anything found at or after birth has to be declared and may be excluded or carry an extra charge.
Worked example: how much would the rider actually pay?
This is an illustration only. Every figure marked "assumed" is made up to show the calculation; it is not a real case and not any hospital's price.
| Item (assumed: Superior plan) | Assumed bill | Most the rider pays |
|---|---|---|
| Mum diagnosed with eclampsia at 32 weeks, with gestational diabetes (lump sum) | Not applicable | RM5,000 + RM1,000 = RM6,000 |
| Mum admitted to ICU for eclampsia | RM6,000 | RM5,000 (limit) |
| Baby born early and admitted to NICU | RM18,000 | RM5,000 (lifetime limit) |
| Total | RM24,000 | RM16,000 |
In this example the RM6,000 lump sum can be used for anything, and together with the two reimbursements the family still carries about RM8,000. On the Grand plan the same complication pays RM12,000 as a lump sum, ICU and NICU go up to RM10,000 each, and an emergency caesarean before 36 weeks adds RM8,000. Which plan fits depends on your budget and the risks that worry you most.
Pregnant? How I can help before the 36-week cut-off
I am Lulu Loke, a Great Eastern Life Planning Advisor in Kuala Lumpur and Selangor for 13 years. This is my own guide, not a Great Eastern website. I work with families in Seri Kembangan, Serdang, Puchong, Cheras and across KL, and I explain things in Mandarin, English or Cantonese. If you are pregnant, or planning to be, I can:
- work out the timing with you: how many weeks you are, and whether there is enough time to get the policy issued before 36 weeks;
- go through the medical card, life and critical illness policies you already have, from any insurer, and show you what is and is not covered around pregnancy and birth;
- read the sales illustration and PDS with you and pick a plan that fits your budget, without riders you do not need;
- update your baby's details after the birth, and help you prepare the documents if you need to claim.
If you would like to look at the whole family's cover first, see my free policy review and medical card page. WhatsApp me at 016-914 0086 with your weeks of pregnancy and due date. No hard selling: take your time and decide when you are ready.