Claims FAQs

Still have questions on claims? Get answers to the frequently asked questions here.
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Frequently asked questions

Common Claims Illnesses
Am I covered for an admission for Minor Illnesses?

FAQ Minor Illness 

Which intraocular lens (IOL) can I pick if I’ve been diagnosed with cataract?

FAQ Cataract Medical Coverage 

What is FilmArray Respiratory Panel?

FAQ FilmArray Respiratory Panel 

Am I covered if I am in Cancer Remission stage?

FAQ Cancer Remission 

What is Day Surgery?

FAQ Day Surgery 

What is FilmArray Gastrointestinal Panel?

FAQ FilmArray Gastrointestinal Panel 

Serious Conditions

What is Serious Condition?

A Serious Condition shall mean any one of the following illnesses as defined below. It is applicable for policy attached with PRUValue Med Booster or PRUMillion Med Booster only. If you are hospitalised due to any serious condition below and require any post-hospitalisation support (including outpatient physiotherapy) after your discharge from the hospital, you are eligible to receive the post-hospitalisation support up to 365 days.

Important note: Eligibility of the claim would be subjected to your policy terms and conditions.

List of Serious Condition

Serious Condition


Stroke – resulting in Permanent neurological deficit with persisting clinical symptoms

Death of brain tissue due to inadequate blood supply, bleeding within the skull or embolization from an extra cranial source resulting in Permanent neurological deficit with persisting clinical symptoms. The diagnosis must be based on changes seen in a CT scan or MRI and certified by a neurologist.

For the above definition, the following are not covered:

(i)  Transient ischemic attacks

(ii) Cerebral symptoms due to migraine

(iii) Traumatic injury to brain tissue or blood vessels

(iv) Vascular disease affecting the eye or optic nerve or vestibular functions.

Paralysis of Limbs

Total, Permanent and Irreversible loss of use of both arms or both legs, or of one arm and one leg, through paralysis caused by illness or injury.

Heart Attack

Death of heart muscle, due to inadequate blood supply, that has resulted in all of the following evidence of acute myocardial infarction:

(i) A history of typical chest pain;

(ii) New characteristic electrocardiographic changes; with the development of any of the following: ST elevation or depression, T wave inversion, pathological Q waves or left bundle branch block and

(iii) Elevation of the cardiac biomarkers, inclusive of CPK-MB above the generally accepted normal laboratory levels or Troponins recorded at the following levels or higher:

  • Cardiac Troponin T or Cardiac Troponin I > / = 0.5 ng/ml

The evidence must show the occurrence of a definite acute myocardial infarction which should be confirmed by a Doctor or Physician.

Coronary Artery By-Pass Surgery

Refers to the actual undergoing of open-chest surgery to correct or treat Coronary Artery Disease (CAD) by way of coronary artery by-pass grafting.

For the above definition, the following are not covered:

(i) angioplasty;

(ii) other intra-arterial or catheter based techniques;

(iii) keyhole procedures;

(iv) laser procedures.

Serious Coronary Artery Disease

The narrowing of the lumen of Right Coronary Artery (RCA), Left Anterior Descending Artery (LAD) and Circumflex Artery (not inclusive of their branches) occurring at the same time by a minimum of sixty percent (60%) in each artery as proven by coronary arteriography (non-invasive diagnostic procedures are not covered). A narrowing of sixty percent (60%) or more of the Left Main Stem will be considered as a narrowing of the Left Anterior Descending Artery (LAD) and Circumflex Artery. This covered event is payable regardless of whether or not any form of coronary artery surgery has been performed.

Angioplasty and Other Invasive Treatments for Coronary Artery Disease

The actual undergoing of Coronary Artery Balloon Angioplasty, artherectomy, laser treatment or the insertion of a stent to correct a narrowing or blockage of one or more coronary arteries as shown by angiographic evidence. Intra-arterial investigative procedures are not covered.

Heart Valve Surgery

The actual undergoing of open-heart surgery to replace or repair cardiac valves as a consequence of heart valve defects or abnormalities.

For the above definition, the following are not covered:

(i) Repair via intra-arterial procedure

(ii) Repair via key-hole surgery or any other similar techniques.

Cancer – of specified severity and does not cover very early cancers

Any malignant tumour positively diagnosed with histological confirmation and characterized by the uncontrolled growth of malignant cells and invasion of tissue. The term malignant tumour includes leukemia, lymphoma and sarcoma.

For the above definition, the following are not covered:

(i) All cancers which are histologically classified as any of the following:

  • pre-malignant

  • non-invasive

  • carcinoma in situ

  • having borderline malignancy

  • having malignant potential

(ii) All tumours of the prostate histologically classified as T1N0M0 (TNM classification)

(iii) All tumours of the thyroid histologically classified as T1N0M0 (TNM classification)

(iv) All tumours of the urinary bladder histologically classified as T1N0M0 (TNM classification)

(v) Chronic Lymphocytic Leukemia less than RAI Stage 3

(vi) All cancers in the presence of HIV

(vii) Any skin cancer other than malignant melanoma.

Brain Surgery 

The actual undergoing of surgery to the brain under general anesthesia during which a craniotomy (surgical opening of skull) is performed.For the above definition, the following are not covered:

(i) Burr hole procedures

(ii) Transphenoidal procedures

(iii) Endoscopic assisted procedures or any other minimally invasive procedures

(iv) Brain surgery as a result of an Accident.

Encephalitis – resulting in Permanent inability to perform Activities of Daily Living

Severe inflammation of brain substance, resulting in Permanent functional impairment. The Permanent functional impairment must result in an inability to perform at least three (3) of the Activities of Daily Living. The covered event must be certified by a neurologist.

Encephalitis in the presence of HIV infection is not covered.

Parkinson’s Disease – resulting in Permanent inability to perform Activities of Daily Living

A definite diagnosis of Parkinson's Disease by a neurologist where all the following conditions are met:

(i) Cannot be controlled with medication;

(ii) Shows signs of progressive impairment; and

(iii) Confirmation of the Permanent inability of the Insured Life to perform without assistance three (3) or more of the Activities of Daily Living.

Only idiopathic Parkinson's Disease is covered. Drug-induced or toxic causes of Parkinsonism are not covered.

Alzheimer’s Disease/Severe Dementia

Deterioration or loss of intellectual capacity confirmed by clinical evaluation and imaging tests arising from Alzheimer's Disease or Severe Dementia as a result of Irreversible organic brain disorders. The covered event must result in significant reduction in mental and social functioning requiring continuous supervision of the Insured Life. The diagnosis must be clinically confirmed by a neurologist.

From the above definition, the following are not covered:

(i) Non organic brain disorders such as neurosis

(ii) Psychiatric illnesses

(iii) Drug or alcohol related brain damage

Systemic Lupus Erythematosus with Severe Kidney Complications

A definite diagnosis of Systemic Lupus Erythematosus confirmed by a rheumatologist. For this definition, the covered event is payable only if it has resulted in Type III to Type V Lupus Nephritis as established by renal biopsy. Other forms such as discoid lupus or those forms with only hematological or joint involvement are not covered.

WHO Lupus Classification:

Type III - Focal Segmental glomerulonephritis
Type IV - Diffuse glomerulonephritis
Type V - Membranous glomerulonephritis

Crohn’s Disease with Intestinal Fistula, Obstruction or Perforation

Crohn’s Disease is a chronic granulomatous inflammatory bowel disease. Crohn’s Disease must have resulted in fistula formation, or intestinal obstruction or intestinal perforation that has required surgery and continuous immunosuppressive treatment or continuous treatment with immunomodulating drugs. Crohn’s Disease must be proven on biopsy and there must be continuous treatment under the care of a gastroenterologist.

Serious Accident - including Major Head Trauma with Permanent inability to perform Activities of Daily Living

Inability to perform at least three (3) of the Activities of Daily Living resulting from serious accident.



Updated as of 24 Jun 2022

Note: The above list is not exhaustive and is subject to revision by Prudential Assurance Malaysia Berhad from time to time. If you have any enquiries, please email to Prudential at

Claim forms, documents & submission
Who can certify claims documents?
  • Prudential Branch Officers

  • Prudential Business Development Executive/Manager

Where can I obtain the claims form required for submission?

You may contact your agent or Customer Service at 03-2116 0228 or you can also write to us at

How do I submit my claim?

You may submit the completed forms and supporting documents to us via your agents or directly to any Prudential branch

What happens after I submit my claim?

Once a claim has been submitted to us, we will assess it based on the terms and conditions of the policy. When a decision has been made or if we require further clarification or details so that we can assess your entitlement to the claim, we will notify you in writing.

How do I check the progress of my claims submission? 

Once a claim has been submitted to us, you may contact your agent, Customer Service at 03-2116 0228 or write to us at for more information on your claims progress.

If my employer/other insurer does not cover my medical expenses in full, can I claim the balance under my Prudential policy? 

Yes. You may submit your claims documentation to us and we will assess it in accordance with your policy terms and conditions. Please refer to the amount that was not covered by your employer/other insurers for the document requirements. 

What are the types of documents that I need to submit to prove registration of an allied health professional or traditional and complementary medicine practitioner? 

As long as the evidence of registration is recognised under the law or by the authorities, we will accept that document as proof of registration.

I want to submit a claim for total and permanent loss of use of a body part due to an accident. Even though my policy has a table of benefits that specifies benefit percentage based on loss of use of a particular body part, I could not find this body part from the table. Can I still submit the claim?

Yes, and we will assess the claim based on the terms and conditions of your policy. If you are entitled to the claim, we will assess then based on a percentage that is not inconsistent with existing table in your policy.

Claims reassessment & claims payout
Can I appeal for a reassessment?

You may write in your appeal, together with relevant supporting documents for us to reassess your claims again.

How long will I have to wait for my claims payout?

The time taken depends on the complete-ness of the documentation received.

Whose name will the claims payout be issued under?

For death claims, the claims payout will be issued to the beneficiary or the assignee of the policy. For life claims, the claims payout will be issued to the assured/policy owner or the assignee of the policy.

Co-insurance & HAS waiting period
What is co-insurance?

Co-insurance is a cost-sharing arrangement between you and the insurer whereby you will need to pay a specified percentage of the cost of your eligible benefit. 

What is HAS?

HAS waiting period is applied within the first 90 days from policy cover date in which no Guarantee Letter facility is available except for accident cases. However, claims can still be submitted under reimbursement basis subject to terms and conditions.

Pre-hospitalisation & post-hospitalisation
What is Pre-hospitalisation?

Pre-hospitalisation refers to the expenses incurred at the clinic/hospital prior to your admission to the hospital.

E.g. you consulted your nearby clinic for fever and your doctor referred you to be admitted to the hospital for dengue fever. In this scenario, you may claim for the clinic consultation payment under pre-hospitalisation.

Important note: Eligibility of the claim would be subjected to your policy terms and conditions.

What is Post-hospitalisation?

Post-hospitalisation refers to the expenses incurred at the specialist clinic/hospital after your admission and subsequent discharge from the hospital.

E.g. After your discharge from the hospital, you go for a follow-up with your doctor. In this scenario, the payment for the follow-up will be part of the post-hospitalisation expenses.

Important note: Eligibility of the claim would be subjected to your policy terms and conditions.

Tip: if your follow-up is with a different doctor, please ask the doctor to indicate on the receipt the diagnosis and the type of treatment endorsed by the doctor.

Emergency & Accidental Treatment (EAT)
What is Emergency & Accidental Treatment (EAT)?

EAT refers to consultation and medical expenses incurred upon an accident. For example, you suffer injuries due to an accidental fall and seek treatment for the injuries sustained.

Important note: Only applicable if medical treatment is sought within 48 hours from the accident and for expenses incurred within 30 days from the date of the accident.

Tip: if your medical bills are below RM500.00, please ask the doctor to indicate the date of the accident, nature of the accident, and the type of treatment on the receipt

Non-claimable items
What are the claim items that are not covered and considered not as customary under Prudential medical benefits?

List of Non-Claimable Items

Prudential covers all costs directly related to the treatment of the covered conditions. However there are certain things that Prudential does not cover as per below:

1. Stationery or services provided by a hospital that is not directly related to treat the medical condition or illness

  • Admission & registration fees/Medical report & medical record fees
  • Telephone/Fax/Mail/Computer/Electric/Billing processing related charges

2. Home care or take home external appliances that can be purchased from retail store or pharmacy without prescription

  • Crutches/Shoulder crutch/Folding walker/Walking frame/Walking stick/Wheelchair/Ice pack and ice bag cover/Wrist aid support/Lumbosacral support/Lumbar corset (any back and spine patient)/Knee brace/Knee immobilizer/Arm-sling/Cervical support/Jewett brace/Neck collar/Ankle support/Embolism stocking/TED stocking/Stockinette

  • Stoma bag/Colostomy bag/Accu-check test strips and needles/Aerochamber

  • Diapers/Lining/Towels or similar items

  • Any kind of facial cleanser/Body and hair shampoo and scar gel or any form of moisturizer

3. Vitamins or supplements to promote health or enhance bodily functions

  • Including but not limited to Neuroaid/Ginko/Sangobion/ Tanakan/Neurobion/Ostinol/Calcium/Revicon/Hexbio/ Legalon/Cefasily/Livolin forte/Fibre sachet/Omega fish oil/ Bio-Quinone/Essential Forte & Piascledine/Folic acid/Iberet folic/Arcalion/Adaxil /Probiotics/Any supplement containing active ingredient of Glucosamine or similar

  • Any kind of infant's or adult's nutrition formula

4. Investigation (Lab, Imaging or of any other kind) that is not covered under the medical benefit and/or done for Screening purpose

  • May including and not limited to Sexually transmitted disease test/Pregnancy test/Infertility test/Genome test/Somatic DNA targeted Sequencing Panel/Hepatocyte growth-promoting factors/Circular RNA and Polymerase Chain Reaction (CR & PCR test)/RNA fusion analysis/Peptide Receptor Radionuclide test (PRR test)/Paradigm Cancer Diagnostic (PCDx)/Genome test/Molecular profiling/Cancer marker

  • Skin Allergy test/Skin Prick test/Mantoux test

5. Treatment that is elective, cosmetic and experimental in nature, including but not limited to:

  • Transconjunctival eye bag removal and similar nature of surgery

  • Vaginal rejuvenating laser or energy treatment

  • Laser coagulation for treatment of stress Incontinence

  • Circumcision/Preputioplasty/Hyperhidrosis/Staphylococcal Enterotoxin C Injection/Any kind of skin resurfacing using yag or carbon dioxide laser

  • Blood & adipose products injection (Stem cell/Blood products Injection)

  • Adoptive Immunotherapy and Cellular Therapy (Stem cell)

  • Lutetium 177 radioIsotope treatment

  • Pulsed Radiofrequency for chronic pain syndrome

  • Nerve block ie: Genicular nerve block and similar

  • Robotic Surgery for cardiac/gastrointestinal/urology/gynecological etc. (except Prostate cancer, based on pre-authorization assessment consideration)

Note: The above list is not exhaustive and is subject to revision by Prudential Assurance Malaysia Berhad from time to time. If you have any enquiries, please email to Prudential at

Advanced Treatment claimable items
What are the Advanced Treatment claim items that are covered under Prudential medical benefits?


List of Advanced Treatments Coverable Under Medical Benefits

Advanced Treatment

Coverable Conditions


Primary therapy alternative to surgery for individuals with localized disease or as a salvage therapy for recurrent cancer following failure of radiation therapy.

  • Prostate cancer

  • Lung cancer with endobronchial obstruction

  • Renal Cell Cancer

  • Cardiac arrhythmia - Drug resistant or drug intolerant Atrial fibrillation, with evidence of a localised site(s) of origin

  • Skin cancer (Malignant melanoma, Basal Cell Carcinoma or Squamous Cell Carcinoma - where surgery or radiation is contraindicated or impractical)

  • Soft tissue sarcoma


Immunotherapy is used to stimulate the body's immune system against cancer. Some forms of immunotherapy:
1. Immune checkpoint inhibitors, which are drugs that block immune checkpoints. These checkpoints are a normal part of the immune system and by blocking them, these drugs allow immune cells to respond more strongly to cancer.

2. T-cell transfer therapy, which is a treatment that boosts the natural ability of T cells to fight cancer.

3. Monoclonal antibodies, which are immune system proteins created in the lab that are designed to bind to specific targets on cancer cells. Some monoclonal antibodies mark cancer cells so that they will be better seen and destroyed by the immune system.

4. Treatment vaccines, which work against cancer by boosting your immune system’s response to cancer cells. Treatment vaccines are different from the ones that help prevent disease.

5. Immune system modulators, which enhance the body’s immune response against cancer.

  • Blood cancers (Classical Hodgkin lymphoma)

  • Gastrointestinal cancers (Upper gastrointestinal tract tumors, Metastatic squamous cell anal carcinoma, Colorectal cancer, small bowel adenocarcinoma, appendicle carcinoma)

  • Genitourinary cancers (Bladder cancer, Primary carcinoma of the urethra, Urothelial carcinoma of the prostate)

  • Hepatocellular carcinoma

  • Kidney cancer

  • Skin cancer (Melanoma)

  • Lung cancer (Malignant pleural mesothelioma, Non-small cell lung cancer, Small cell lung cancer)

  • Head and neck cancer

  • Advanced gynaecology malignancy (Ovarian, uterine, and cervix)

Proton Beam Radiotherapy (PBRT)

Proton beam radiation therapy (PBRT) is a type of external beam radiation therapy (EBRT) that utilizes protons (positively charged subatomic particles) that are precisely targeted to a specific tissue mass.

  • Brain tumor

  • Breast cancer

  • Bone cancer including Chrondroma or Chondrosarcoma especially in children

  • Gastrointestinal tumor

  • Prostate cancer

  • Eye cancer including Uveal melanoma

Neutron Beam Radiation Therapy (NBRT)

Neutron Beam Radiation Therapy (NBRT) is a form of external beam radiation therapy (ERBT) used in inoperable tumours or tumours that are resistant to conventional radiation therapy. It involves a sophisticated stereotactic method in which high energy neutrons (neutral charge subatomic particles) are exerted to accurately target the diseased tissue mass localised using computed tomography (CT).

  • Salivary gland cancer

  • Soft tissue sarcoma

  • Prostate cancer

Stem Cells for Hematopoietic Cell Transplant

Hematopoietic stem cell transplantation (HSCT) refers to intravenous infusion of healthy hematopoietic progenitor cells, either autologous (stem cells from the same person going for transplant), or allogeneic (stem cells from compatible donor other that the patient), harvested from bone marrow or peripheral blood to replace aberrant or dysfunctional cells in a patient.

  • Leukaemia - Chronic Myeloid Leukaemia, Acute Myeloid Leukaemia

  • Lymphoma - Hodgkin and non-Hodgkin Lymphoma

  • Multiple myeloma

Implantable Neural Stimulator for Epilepsy and Parkinson Disease

Implantable neural stimulators represent an advanced treatment adjunct to medication for pharmacoresistant epilepsy and alternative for patients that are not good candidates for resective surgery. The technology involves the surgical implantation of an electrode to deliver intermittent stimulation to the vagus nerve or part of brain.

Types of Implantable neural stimulator are :
• Vagus nerve stimulation (VNS)- An implantable vagus nerve stimulator that triggers the vagus nerve with electrical impulses. VNS is used to treat complex type epilepsy that is resistant to conventional and standard medication for epilepsy.

• Deep brain stimulation (DBS) involves implanting electrodes within certain areas of the brain. These electrodes produce electrical impulses that regulate abnormal impulses. DBS is commonly used for treatment of intractable tremors as a consequence of Parkinson's disease with appropriate assessment of the independence in his/her daily life to meet the medical necessity.

  • Epilepsy

  • Parkinson Disease




Brachytherapy is a type of internal radiation therapy, also known as interstitial radiation, intracavitary radiation, or internal radiation therapy. It is a radiotherapy technique where radioactive devices are inserted near tumors to safely deliver high doses of radiation to eliminate and shrink tumors. Brachytherapy is commonly used in conjunction with surgical management.

  • Breast cancer

  • Eye tumors

  • Genitourinary cancers (including penile cancer, bladder cancer, prostate cancer, urethral cancer)

  • Gynecologic cancers (including cervical, endometrial, vaginal or vulvar cancer)

  • Head and neck cancers (including buccal mucosa cancer, lip cancer, mouth cancer, nasopharyngeal cancer, salivary gland cancer, soft palate cancer, tonsillar fossa/pillar cancer)

  • Respiratory (including lung cancer, pleural mesotheliomas)

  • Gastrointestinal tract cancers (including colorectal cancer, pancreatic cancer, oesophageal cancer)

  • Skin cancer

  • Soft tissue sarcomas.

Gamma Knife Radiosurgery

Gamma Knife radiosurgery is a non-invasive radiation therapy for brain tumours that allow most of the patient’s healthy brain tissue to be preserved. It is a specific form of radiation therapy that focuses intense beams of gamma rays with pinpoint precision to treat brain lesions. Usually, only sedation or local anaesthesia is needed for this treatment. Patients do not have to go under the knife and its outcome is similar to that of a surgical procedure.

  • Brain tumor

  • Arteriovenous malformation (AVM)

  • Acoustic neuroma

  • Pituitary tumors

Robotic Prostatectomy

Also known as robotic-assisted laparoscopic radical prostatectomy. This laparoscopic surgery is performed using a robotic approach which can only be controlled by experienced surgeons to remove the prostate and nearby diseased tissues with more precision through small abdominal incisions. It is less invasive than conventional prostatectomy.

Prostate cancer

Targeted Therapy For Cancer

Targeted therapy is a type of cancer treatment that uses drugs or other substances to precisely identify and attack certain types of cancer cells. This treatment targets proteins that help cancer cells grow and spread throughout the body.

  • Lung cancer

  • Breast cancer

  • Colorectal cancer

  • Lymphoma

  • Leukaemia

Cartilage Scaffold Treatment

Biological scaffold is designed to repair traumatic or arthrosis chondropathy. It aims to regenerate cartilage, reduce pain and delay joint replacement.

Knee, anke, and hip joint cartilage disorders.

Fistula Tract Laser Closure (FiLaC)

FiLaC is a less invasive surgery for treatment of complicated perianal fistula which are located within closed proximity of sphincter muscle. The FiLaC procedure is performed using a specialised thin fiber probe that generate laser heat energy. The laser fiber is introduced into the fistula tract via the external orifice which then delivered laser energy, causing shrinkage of the fistula tract around the fiber.

Complex and recurrent perianal fistula with high protential of sphincter incontinence.

Disclaimer note:

  1. Pease take note that the treatments or drugs above are not exhaustive and subject to revision by Prudential Assurance Malaysia Berhad, from time to time.

  2. Our medical plans cover treatments or drugs that have been approved by Ministry of Health, Malaysia and Food and Drug Administration (FDA) for indicated conditions only. Any treatments or drugs which are still under research or experimental will not be covered. In the event the above advanced treatment is sought for any conditions other than above, as advised by your Attending Doctor, please seek confirmation on the coverage.

  3. The coverage of this Advanced Treatments is still subjected to terms & conditions as specified in the policy contract.

For more enquiries, please email:

Overseas treatment claims
If I am admitted overseas, will I still be able to claim back the expenses incurred?

For overseas medical expenses, please submit your claim and we will assess it according to the terms and conditions stated in your annexure.

Oversea Treatment Claim (“OTC”)
  1. We will assess the reimbursement claim documents submitted to us according to the terms and conditions stated in your policy.

  2. If the Life Assured has been residing outside of Malaysia for more than ninety (90) days on each trip, any OTC claim is not accepted.

  3. Any OTC payment is subject to what is understood as Medically Necessary, and based on the Reasonable and Customary Charges (“RCC”) for equivalent local treatment in Malaysia. (Please refer to the OVERSEAS TREATMENT clause in your policy.)

  4. Processing of OTC may take longer compared to other claims as we need to make an accurate assessment of RCC of equivalent local treatment in Malaysia.

Important notes before claims submission
  1. Ensure completion of claim forms and completeness of all documents to avoid unnecessary delay.

  2. Ensure your signature on the claim form tallies with the one in the records.

  3. Doctor's Statement is to be completed at the claimant's own expense.

  4. The checklist provides a reference of the point-of-submission requirements only. The company reserves the right to request for other relevant documents and information.

  5. The company may request to view the original of copied documents submitted whenever necessary.

You may submit the completed form(s) and supporting documents to us via your agent or at the nearest Prudential branch.

Claims status enquiries

You may check the status of your submitted claim via the following options:

  1. Through your agent

  2. Contact our Customer Service line at 03-21160228

  3. Send us an email at

Note: The above information serves as a guide. In the event that you have any queries on the above, kindly contact your agent or our Customer Service at 03-21160228 or write to us at