Medical card: 29 questions about hospital stays, claims and price increases
The medical card is the policy people care about most and have the most questions about. From “can I claim for a GP visit?” to “why did my premium jump this year?”, each question is answered directly.
29 questions
What does a medical card actually cover? Can I claim for outpatient GP visits?
A medical card mainly covers hospital and surgical costs: room, surgery, doctors’ fees, medicines and tests during the stay. Ordinary outpatient visits, such as seeing a GP for a fever, are usually not covered. Only specific outpatient treatments such as cancer treatment, dialysis and emergency accident treatment are included.
Do I need to be in hospital for 24 hours to claim?
Generally, hospitalisation benefits require a medically necessary admission on a doctor’s advice, for at least 6 or 24 hours depending on the policy definition. Day surgery can be claimed without an overnight stay. Check your policy’s definition.
Is day surgery covered?
Most medical cards cover day surgery even if you go home the same day, for example some endoscopies and cataract surgery, as long as it is medically necessary and within the policy’s cover.
What are co-payment and deductible? Do I still have to pay something myself?
A deductible is a fixed amount you pay first, per year or per claim. A co-payment is a percentage of each bill you pay, usually up to a cap. If your plan has either, you do pay part of the bill, in exchange for a lower premium. Without them, you normally pay nothing within the limits.
How much annual limit and lifetime limit do I need?
The annual limit should cover a serious illness at a private hospital, and treatment for cancer or heart surgery can now reach hundreds of thousands of ringgit, so many people choose a high annual limit. For the lifetime limit, higher is better and none is ideal, especially for young buyers who will hold the plan for decades.
Is a medical card with no lifetime limit worth it?
For young people and those with a family history of illness, yes. Long-term conditions such as cancer recurrence or dialysis can need years of treatment, and a lifetime limit can run out. Plans without one may cost more, so compare the difference with Lulu.
Should I choose RM150, RM200 or RM300 room and board?
Match it to the standard single room rate at the hospitals you would use. Rates vary a lot across private hospitals in the Klang Valley. A higher room rate costs more premium, so you don’t need the highest option.
What happens if I stay in a room more expensive than my plan covers?
It depends on the terms. Some plans only make you pay the room difference, but many apply a proportion to the whole bill, including doctors’ fees and medicines, so you could pay far more than the room difference. Ask before admission, or have Lulu check your policy.
What is a panel hospital? Can I claim at a non-panel hospital?
A panel hospital works directly with your insurer, so you can request cashless admission with your medical card. You can usually still claim at a non-panel hospital, but you normally pay first and claim reimbursement after discharge.
What is a GL (guarantee letter) and how do I get one?
A GL is the insurer’s letter to the hospital guaranteeing payment, so you don’t pay a deposit. At a panel hospital, show your medical card and IC at admission, and the hospital’s insurance counter applies for the GL.
The hospital asked me for a deposit. Isn’t my insurance cashless?
Common reasons: the GL is still being approved, the hospital is non-panel, the condition may be within a waiting period or excluded, or the plan has a deductible. Ask the hospital for the reason, then contact your agent to follow up. If the claim is approved, the deposit is usually refunded or offset.
Why does “waiting for insurer approval” take so long?
The insurer checks the diagnosis, the policy status and your medical history, and sometimes needs a further report from the doctor, which can take hours. Night and weekend admissions can take longer. Your agent can help push and supply documents.
My medical card premium jumped this year. Why, and will it keep rising?
Two main reasons: moving into a new age band, and insurers repricing because of medical inflation. Malaysian medical costs have risen quickly, and many medical plans have been repriced. Whether it rises again depends on medical costs and the insurer’s reviews, and no one can promise it won’t.
Can I downgrade my plan to reduce the premium? Will I lose cover?
Yes, for example with a lower room rate or by adding a deductible or co-payment. But be careful: switching to a brand-new plan may restart waiting periods and exclude conditions that developed since your old plan started. Adjusting within the same policy is generally safer than cancelling and buying new.
I’m 50. Can I still buy a medical card? Is there an age limit?
At 50 you can usually still apply. Maximum entry ages are often between 60 and 70, depending on the insurer. The older you are, the stricter the underwriting and the higher the premium, and existing conditions may be excluded, so sooner is better.
Until what age does a medical card cover me? Will it become unaffordable?
Many medical cards can be renewed to age 80 or even 100, depending on the plan. Premiums do rise with age, which can be heavy after retirement. Plan ahead, for example by setting aside savings for future medical premiums or adjusting deductibles later in life.
Are pre-existing conditions never covered?
Generally, conditions you had before the policy starts are excluded or written into the exclusions during underwriting. Some policies have specific rules for conditions you genuinely didn’t know about, but don’t rely on that. Declare honestly and buy while you are healthy.
Can I buy a medical card with high blood pressure, diabetes or asthma?
Often yes, but the insurer may exclude that condition and related complications, or charge more. Well-controlled conditions get better results. Recent test reports help. Lulu can check underwriting requirements before you apply.
Is pregnancy or childbirth covered?
Standard medical cards usually don’t cover normal pregnancy and delivery. Some plans or riders cover specified pregnancy complications or newborn care, with their own conditions. If you plan to have a baby, look into this before you become pregnant.
When can my newborn get a medical card? Do jaundice or premature birth matter?
Many insurers accept babies from 15 or 30 days old. Jaundice, premature birth or an NICU stay must be declared, and the insurer may ask for the discharge report, postpone the application or add an exclusion. Apply as soon as the baby is stable.
Are chemotherapy, dialysis and outpatient treatment covered?
Most medical cards cover outpatient cancer treatment (chemotherapy and radiotherapy) and kidney dialysis, which are important parts of a medical card, but limits and conditions vary. General outpatient care is not covered.
Are follow-up visits and medicines after discharge covered?
Yes, within time limits. Diagnostic tests before admission (for example 30 to 60 days before) and follow-ups and medicines after discharge (for example 60 to 90 days after) are usually covered if they relate to the same condition. Check your policy for the exact days.
Can I claim for treatment overseas, in Singapore, China or Thailand?
It depends on the plan’s area of cover. Many Malaysian medical cards cover emergency treatment while travelling, for a limited number of days. Travelling abroad specifically for treatment is usually not covered, or is paid at Malaysian cost levels. Check before you go.
Are TCM, acupuncture, physiotherapy or psychotherapy covered?
Most medical cards don’t cover TCM or acupuncture. Physiotherapy referred by your doctor after a hospital stay can sometimes be claimed within the post-hospital period. Psychological treatment varies, and many plans exclude or limit it.
Can I use my company medical card and my own together?
Yes. Usually you claim from the company plan first, then claim the excess or uncovered part from your own medical card (coordination of benefits). Total payouts won’t exceed the actual bill. If you have company cover, a deductible on your own plan can save premium.
I changed jobs and lost my company medical card. Should I buy my own right away?
As soon as possible. Without company cover you have no hospital protection, and a new personal plan has waiting periods. Ideally arrange it before you leave, so the new policy is already in force.
What is the difference between a medical rider on a life policy and a standalone medical card?
A medical rider attached to a life or investment-linked policy is paid from that same policy and is tied to it, so if the main policy lapses, the medical cover goes too. A standalone medical card can be managed and cancelled on its own. Cover can be similar, so compare total cost and flexibility.
The account value of my ILP medical plan keeps dropping. Is it about to lapse?
That is a real risk. Investment-linked plans deduct insurance charges from the account value every month, and the charges rise with age. If premiums are too low or funds perform poorly, the value falls, and at zero the policy may lapse. Check your annual statement and consider topping up or adjusting cover. Lulu can work it out with you.
The insurer rejected my claim saying admission was “not necessary”. What can I do?
Ask the insurer for the reason in writing, then get your doctor to write a report explaining why admission was medically necessary, and appeal. If you are still not satisfied, complain to the insurer’s complaints unit, then the Ombudsman for Financial Services (OFS). Lulu helps her clients prepare the documents.
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Questions about your medical card?
Price increases, switching plans or rejected claims: ask Lulu first and decide with the full picture.