Key takeaways
- Under Schedule 9 of Malaysia's Financial Services Act 2013, you must take reasonable care when answering the insurer's health questions, and the duty lasts until the policy is issued, varied or renewed.
- If the insurer shows a misstatement was deliberate or reckless, it may void the policy and refuse all claims; if it was careless or innocent, it can only apply the terms it would have set, cut the claim in proportion, or void the policy and refund premiums.
- Once a life insurance policy has been in force for more than 2 years, the insurer cannot void it over an inaccurate statement unless the statement was on a material matter and made fraudulently.
- Proposal forms usually authorise doctors, hospitals, clinics and laboratories to release your medical records to the insurer, and Great Eastern's health form asks about any blood test, scan or screening in the past 5 years.
- Bank Negara requires an insurer that rejects a claim to give its reasons in writing and to tell you that you can take the dispute to the ombudsman within 6 months of its final decision.
- MediAsas, the base medical plan planned for national launch in January 2027, has a 7-year moratorium on non-disclosure disputes, except for fraudulent, deliberate or reckless cases and listed serious conditions.
Why does the health declaration on an insurance form matter?
Every answer in the health part of a proposal form goes to an underwriter, who uses it to decide whether to accept you and on what terms: standard terms, an extra premium (loading), an exclusion for a named condition, or a decline. Bank Negara Malaysia requires insurers to tell you, when you sign up, about your duty of disclosure, what happens if you give inaccurate or incomplete information, and that the proposal form "forms the basis of the insurance/takaful contract" (Policy Document on Product Transparency and Disclosure). So the form is not paperwork to rush through. It is the version of your health that the whole policy is built on.
The law behind it is Schedule 9 of the Financial Services Act 2013. For a personal policy (a "consumer insurance contract", bought for purposes unrelated to your trade, business or profession), the insurer may ask you specific questions, and you must take reasonable care not to make a misrepresentation when you answer them. You must also take reasonable care to tell the insurer anything else you know is relevant to its decision. Two details catch many people out:
- The duty runs until the policy is issued. The insurer must tell you in writing that your duty of disclosure continues until the contract is entered into, varied or renewed. A doctor's visit or a test result that comes between signing the form and receiving the policy should be reported too.
- Buying for someone else makes their answers yours. If you take a policy on the life of your spouse or a parent, whatever the person insured tells the insurer is treated as if you had said it.
Great Eastern's product disclosure sheets say it plainly. The Smart Health Protector PDS states: "You must answer the questions that we ask fully and accurately. Failure to take reasonable care in answering the questions may result in rejection of your claim or termination of your policy." The Great Medic Shield 2 PDS asks you to disclose material facts "such as medical condition, your occupation and personal pursuits" and to state your age correctly.
What the health questions usually cover
As an example, here is what Great Eastern's health declaration form for adding or changing cover (form PSF02) asks about:
| Area | What the form asks (Great Eastern PSF02) |
|---|---|
| Other insurance | Existing policies, including ones now being applied for with other companies, and any application ever declined, postponed, rated or given extra terms |
| Family history | Whether biological parents, brothers or sisters have had heart disease, stroke, hypertension, diabetes, kidney disease, mental disorders, cancer or hereditary conditions |
| Lifestyle | Any tobacco or nicotine product in the last 12 months, weekly alcohol, drugs not prescribed by a doctor, dangerous pursuits such as diving or motor sports |
| Current health | Medical treatment you are receiving now, any physical impairment, your height and weight |
| Medical history | Whether you have ever been diagnosed, investigated, treated or advised to seek treatment for listed conditions, from stroke and asthma to depression and anxiety |
| Tests in the past 5 years | Any investigation or screening test you had, were advised to have or intend to have: blood or urine tests, ultrasound, X-ray, CT scan, MRI, ECG, scopes and more |
| Women | Current pregnancy, past pregnancy complications, breast lumps, fibroids, ovarian cysts and similar conditions |
The same form says: "If you are in any doubt about whether certain facts are material, these facts should be disclosed." That one line is the most useful rule I know for filling in any proposal form.
What do people most often leave out, and does a small thing matter?
Very few people set out to hide a serious illness. What I often see go missing is something the person did not think counted. Each item below is asked about, directly or indirectly, on a typical form:
| Often left out | Why it can matter at claim time |
|---|---|
| A company health screening with a "high" or "borderline" result | Great Eastern's form asks about any screening test in the past 5 years, whatever the result, and the form in one FMOS case also asked about abnormal test results |
| A scan or blood test done just before applying, or one the doctor advised that you have not done yet | The question covers tests you had, were advised to have or intend to have |
| Clinic visits for a symptom with no diagnosis yet (chest pain, recurring headaches, a lump) | The LIAM consumer guide on medical insurance says that consulting a doctor for any pain or discomfort is regarded as a symptom |
| Long-term medicine, such as blood pressure or cholesterol pills | Hospital records list your regular medication; in one FMOS case, the insurer built its rejection on exactly that |
| A consultation for stress, anxiety or depression | Mental health conditions are listed by name on many forms |
| Something that happened after you signed but before the policy was issued | Your duty of disclosure continues until the contract is entered into |
| Smoking you stopped a few months ago | The question asks about the last 12 months, not about today |
Does a small item really matter? Under Schedule 9, the insurer only has a remedy if it shows that, had it known the true facts, it would not have issued the policy, or would only have issued it on different terms. A truly irrelevant slip may change nothing. But you are not the one who decides what is relevant: the law presumes you knew a matter was relevant if the insurer asked a clear and specific question about it.
"I told my agent, but it is not on the form"
Schedule 9 says an insurance agent who sells you the policy is treated as the insurer's agent when the contract is formed, and what the agent knows is treated as known to the insurer. That protection does not apply if you and the agent agreed to leave something out. In practice the hard part is proof. In a dispute published from the ombudsman's annual report, a policyholder said he had told the agent about his heart valve problem; the agent said he had not; the form said "No", and the ruling went to the takaful operator (case study on InsuranceInfo). Whatever you say out loud, make sure it is written on the form, and read the copy of your application when the policy arrives.
What happens at claim time if something was left out?
Most people find a gap in their declaration at the worst moment: at the hospital counter while a guarantee letter (GL) is being requested, or while a claim is being assessed. This is how it usually unfolds.
- The insurer looks at your records. Proposal forms include an authorisation for doctors, hospitals, clinics, laboratories and other insurance companies to release your health information and medical history to the insurer, including for processing a claim. Great Eastern's form has this clause.
- The GL or claim can be held or declined. In the ombudsman case above, the GL for admission itself was declined once the investigation found the undisclosed conditions. If an investigation is still going on, Bank Negara's Policy Document on Claims Settlement Practices requires the insurer to update you on the status within 21 working days of your claim notification, and at regular intervals after that.
- The insurer decides what kind of misstatement it was, and what it would have done had it known. That decides the remedy, as the table below shows.
- You get the decision in writing. If a claim is repudiated, the insurer must give you the reasons in writing, and its final decision letter must tell you that you can refer the dispute to the ombudsman within 6 months.
| Kind of misstatement | What the insurer may do (Schedule 9) | Your premiums |
|---|---|---|
| Deliberate or reckless: you knew it was untrue or misleading, or did not care. The insurer must show this on a balance of probability. | Avoid the policy (treat it as void) and refuse all claims (paragraph 15) | Paragraph 15 does not require a refund; in the case above, nothing was refunded |
| Careless or innocent, and the insurer would not have covered you on any terms | Avoid the policy and refuse all claims (paragraph 16(2)) | Must be returned to you |
| Careless or innocent, and the insurer would have covered you on different terms, such as an exclusion | Treat the policy as if it had been issued on those terms (paragraph 16(3)) | The policy carries on |
| Careless or innocent, and the insurer would have charged a higher premium | Reduce the claim in proportion (paragraph 16(4)) | The policy carries on |
| Any misstatement on a life policy in force for more than 2 years | Cannot avoid it unless the statement was on a material matter and made fraudulently (paragraph 13) | The policy stands unless fraud is shown |
Two more rules work in your favour. If you left a question blank or gave an incomplete answer and the insurer did not follow it up, your duty on that point is treated as waived. And when judging whether you took reasonable care, the circumstances count, including how the policy was sold to you, the insurer's own explanatory material and how clear and specific its questions were.
The 2-year rule is written for contracts of life insurance, so do not assume it protects a stand-alone medical card. Ask the insurer which paragraph of Schedule 9 it is relying on. If your claim has already been rejected, my guide to appealing a rejected claim and taking it to FMOS goes through each step.
Real cases: what did the ombudsman decide?
The Financial Markets Ombudsman Service (FMOS), the free dispute channel set up on 1 January 2025 when the Ombudsman for Financial Services merged with SIDREC (FMOS), publishes anonymised cases. These three are worth reading before you sign any form:
| Case | What happened | Outcome |
|---|---|---|
| Kidney stone scan two days before signing (FMOS) | A CT urogram on 27 December 2022 showed kidney and ureteric stones. The proposal form signed on 29 December 2022 answered "No" to consultations, investigations and abnormal test results in the past five years. A later hospitalisation claim was rejected and the policy voided from inception. | Decided for the insurer: the omission was treated as deliberate or reckless. |
| Heart valve condition and hypertension (OFS case) | Diagnosed with aortic valve regurgitation in 2017 and hypertension in 2018. The 2019 form, which asked about heart valve disorders and heart murmurs, did not show them. The GL for admission was declined and the certificate voided. | Decided for the takaful operator; there was no cash value to refund. |
| Travel claim blamed on long-term medicine (FMOS) | Admitted overseas for low sodium. The insurer relied on hospital records showing long-term medication (Losartan with hydrochlorothiazide) and called it pre-existing. Two letters from the treating hospital said her sodium had been normal for years on that medicine and the episode was more likely caused by vomiting and poor fluid intake during the trip. | Decided for the policyholder: the insurer carries the burden of proving that an exclusion applies. |
The pattern is the same each time: medical records decide these cases. The insurer reaches them through the authorisation you signed, and your own doctor's letters can also work for you. The third case is about a pre-existing condition exclusion rather than the form itself, but it shows how much a clear medical explanation can change. If your worry is a long-term condition such as diabetes or high blood pressure, my guide on buying insurance with diabetes or high blood pressure covers how underwriting treats it.
I realised I left something out. What should I do now?
- Get a copy of what you signed. Ask the insurer or your agent for the proposal form and any health questionnaire, then compare each question with what really happened.
- Write the facts down with dates. When you saw the doctor, which test, the result and any medicine. Ask the clinic or hospital for the report or a short letter.
- Tell the insurer in writing before any claim. Attach the reports and keep a copy of everything you send.
- Read the insurer's reply carefully. For a careless or innocent omission that is not tied to a claim, Schedule 9 (paragraph 17) sets out the options. If the insurer would have covered you on different terms or for a higher premium, it may tell you it will continue the policy on those terms, and you can accept them or end the policy; or it may end the policy with reasonable notice. If either side ends it, the insurer refunds the premium for the rest of the policy term. If it would never have covered you, it may avoid the policy and return your premiums.
- Do not cancel and buy a new policy to "start clean". A new policy needs a new declaration, the same condition then counts as pre-existing, and waiting periods start again. Bank Negara requires insurers to warn you about the disadvantages of switching for exactly this reason.
Worked example (assumptions only, not a real case)
Assume a 45-year-old bought a stand-alone medical card in March 2025. In 2024, an ultrasound at a company health screening had shown fatty liver, and the doctor advised a follow-up that he never went for. On the form he answered "No" to tests in the past five years, thinking a screening did not count. Assume the insurer says it would have accepted him with a liver exclusion, and that the omission is found to be careless, not deliberate.
| What happens next (assumed) | Likely route under Schedule 9 |
|---|---|
| He tells the insurer in 2026, before any claim | The insurer may offer to continue with a liver exclusion, which he can accept, or he can end the policy; or the insurer may end it with reasonable notice and refund the unused premium |
| He says nothing, and is admitted for dengue in 2027 | The policy is treated as if it had the liver exclusion, so the dengue claim is assessed under the normal terms |
| He says nothing, and is admitted for a liver problem in 2027 | Treated as excluded, so that claim is not paid |
| Same facts, but the insurer shows the "No" was deliberate or reckless | The insurer may avoid the policy and refuse every claim, the dengue one included |
The real result always depends on the insurer's underwriting and the facts. What the example shows is that coming forward early leaves the choice with you, while being found out at a claim leaves it with the insurer.
Is there a time limit? The 2-year life rule and the MediAsas 7-year rule
People often ask whether an insurer can look back forever. The answer depends on the kind of cover:
| Cover | When the insurer can no longer contest for non-disclosure | Exceptions |
|---|---|---|
| Life insurance (death, TPD) | Once the policy has been in force for more than 2 years during the life insured's lifetime | A fraudulent statement or omission on a material matter (Schedule 9, paragraph 13) |
| MediAsas, the base medical plan (national launch planned for January 2027) | After a moratorium of 7 continuous years from the risk commencement date | Fraudulent, deliberate or reckless non-disclosure, and Pre-Defined Medical Conditions that existed before, or first showed within 30 days of, the start date |
| Regular medical cards and other personal cover | No fixed moratorium in Schedule 9; the remedies above apply | A wider "no look back" rule is only being considered |
The Pre-Defined Medical Conditions in the MediAsas pilot FAQ include all cancers, end-stage organ failure, major heart conditions such as coronary artery disease and heart failure, major neurological disorders such as Parkinson's disease and epilepsy, and systemic autoimmune disorders such as SLE and rheumatoid arthritis. That FAQ is the pilot version dated 29 July 2026, and its terms may still be revised for the national launch. The same FAQ says plainly that a failure to declare accurately "could result in claims being delayed or rejected". My MediAsas guide explains the plan itself.
For other medical cards, the Bank Negara Governor said in March 2026 that a "no look-back" clause was being considered for the basic MHIT plan, so that claims would not be refused over a past medical history that was not declared (China Press). In July 2026, Deputy Finance Minister Liew Chin Tong told the Dewan Rakyat that Bank Negara is considering a "no look back" policy to stop insurers and takaful operators rejecting claims over conditions that policyholders unintentionally failed to disclose (The Star). Until rules are issued, treat your existing policy as one that can still be checked against what you declared.
How I help you get the declaration right
When I sit down with a family, the health questions are where I slow down. Bank Negara's medical and health insurance policy document expects insurers and their agents to use plain language and to help you meet your duty of disclosure, and that is how I work:
- We go through every question together, in Mandarin, English or Cantonese, before anything is signed.
- We collect the reports first: screening results, specialist letters, the list of medicines you take.
- If you are unsure whether something counts, we declare it and attach the report, and I make sure what you tell me is written on the form.
- When the policy arrives, we check the copy of your application within the 15-day free-look period, when you can still return the policy for a refund of premiums, less any medical examination costs.
If you already have a policy, including one bought through someone else, and you are worried something was left out, send it to me. I will help you read the questions you answered and, if needed, draft the letter to the insurer. My free policy review is a good place to start, with no hard selling.
This is general information, not legal advice. The outcome of any case depends on your policy wording, the questions you answered and the insurer's assessment.