What To Consider Before Choosing A Medical Insurance Plan In Malaysia?

Over the years, taking care of their well-being has become an essential practice for many Malaysians as they strive to live healthier and better lives.

However, medical emergencies are incidents that cannot be anticipated and could occur at any moment. With the rising cost of healthcare in Malaysia, families and individuals all across the country need to invest in medical insurance to avoid the effects and the severe strain that a hefty medical bill could leave on their savings when an illness strikes.

By investing in medical insurance plans, individuals could get the healthcare they need while protecting their savings from unexpected medical costs, ultimately providing them with some peace of mind amidst the circumstances of their medical situation.

What is medical insurance?

Medical insurance covers the partial or entire cost of medical expenses, like healthcare services and hospitalisation when one gets sick or injured.

What is a medical insurance card?

A medical insurance card is an insurance plan that allows individuals to gain cashless admission into hospitals and receive medical benefits.

There is a wide range of medical cards, ranging from basic coverage for medical treatments and hospitalisation costs to comprehensive ones that are customisable and cater to individual needs while providing long-term coverage.

Why is a medical insurance policy important?

A medical insurance policy is important because:

  • It helps individuals cover the cost of medical bills if they develop certain illnesses or suffer from an injury.

  • Individuals will not have their salaries affected should they become unable to work since the income protection would compensate them.

  • If an individual cannot work, the insurance supports the individual and their family by providing financial support.

  • It protects individuals from having to pay sudden, unexpected, and high medical costs, exemplified by the rising rate of medical inflation.

How does medical insurance work?

Many people believe that possessing a medical card means that they are exempt from paying the total and complete coverage of their medical costs, but this is true to only a certain extent. Some medical insurance is subjected to a feature known as co-insurance and deductibles.

Co-insurance is when the cost of the medical service that an individual receives is split between them and their insurance company. Take, for example, an individual that has diabetes and visits their doctor regularly. This means that the individual would have likely paid an RM1,500 deductible, which is the amount that individuals must pay for their healthcare services before their medical insurance covers it.

Once individuals have paid the deductible, they will be able to receive the benefits of full coverage from their insurer. The co-insurance ratio paid by an individual and what is covered by their medical insurance entirely depends on their medical plan.

Things to consider before buying a medical insurance policy

The following are some factors that individuals should consider before they buy a medical insurance policy.

Type of plan

There are various medical insurance plans, so individuals should determine which plan suits their needs. For example, one needs to identify whether getting a basic plan is sufficient for them or if they would rather opt for a more comprehensive one.

Choosing an insurance company with a diverse range of plans can be beneficial to explore options for the best policy suiting their needs.

Provider network

With an in-network clinic or hospital, services and medicines are covered under an insurance plan. However, out-of-network services and medicines may not cover the costs or require individuals to pay additional costs from their own pockets.

Thus, checking if one's preferred primary care or specialist providers nearby are included in the plan's network is helpful.

Medical insurance premiums

Medical insurance premiums are the amount that individuals pay insurance companies for medical coverage, regardless of whether or not they are actively utilising medical and pharmacy services.

Premiums tend to be paid monthly, and failing to make the payments means the risk of losing insurance coverage and paying for deductibles and cost-sharing. Comparing each plan's premiums across insurers would allow individuals to find the insurer that charges a lower amount for premiums. However, it must be noted that lower premium plans may not be as comprehensive.


As mentioned above, deductibles are the amount that individuals must pay out of pocket before their insurance coverage begins. For example, if an individual has a deductible of RM1,000, their health insurance will not cover the cost of medical services until the individual spends RM1,000 on it out of their pocket. Typically, plans with higher deductibles will have lower monthly premiums and vice versa.

Co-payment clauses

Even if an individual reaches their deductible, they may have to pay for certain expenses out of pocket. This includes a co-payment, which is a flat fee for prescriptions or certain covered services.

Coverage of medicines

Prescription medications that are indicated and approved to treat your medical condition(s) should be covered under your insurance plan.

Additional perks

While medical insurance plans are critical for emergency medical situations, some plans and providers also offer incentives to keep patients fit and healthy.

This includes wellness programs, body check-ups, gym memberships, transportation for doctor appointments, free counselling sessions, video conferences with doctors, legal consultations, and much more. Knowing the additional perks covered by the insurance plan would mean that individuals would get their money’s worth out of paying for it.

Provider’s claim settlement ratio

A provider's claim settlement ratio refers to the percentage of claims that the company has managed to settle within one financial year. Providers with higher ratios indicate that the company is steadfast in settling claims.

Claim-based loading

Certain companies increase the cost of renewal for premiums if claims have been made in previous years, meaning there would be higher premium expenses to be covered. Therefore, it would be better for individuals to refrain from engaging with companies that abide by this practice.

Ease of claim process

Insurers have various claims process methods that make it simpler for customers to access. This is done through AI-enabled claim processing, WhatsApp intimation, digital documentation, quicker approvals, and app-based claim intimation and tracking. These aspects all make the claim process quicker and hassle-free.

How much medical insurance do I need?

The amount of medical insurance an individual would need depends on age, affordability, family history, and lifestyle. It is best to speak to an insurance agent to determine the amount that is best suited.

Can you get medical insurance for senior citizens in Malaysia?

Yes, senior citizens can get medical insurance in Malaysia. For example, Prudential’s PRUSenior Med is a health protection plan that protects senior citizens up to 80.

How to claim medical insurance?

Putting in a medical insurance claim for the first time can be confusing if you’re unsure of the process. However, most insurers make it easy by providing all the necessary assistance.

Contact your insurance provider

Before receiving any non-emergency treatments, an individual should contact their insurance provider to understand what the policy covers and clarify any misunderstandings.

Prepare required documents

The required documents tend to vary based on the insurance policy and company, so it is important to confirm the necessary documents beforehand. Generally, the documents needed include the following:

  • A photocopy of an individual’s NRIC/passport.

  • Original hospital receipts and invoices.

  • Itemised hospital bills or detailed bills.

  • Diagnostic reports, like blood tests, coronary angiograms, and X-rays.

  • Copies of passport, boarding pass, flight ticket details, and an original itemised bill (This is only needed by individuals wanting to claim their insurance for medical treatment overseas).

Complete claim forms

Obtain the claim forms from the insurance company or download a copy from the insurer’s website. If the policy requires a Medical Examiner’s Statement, an individual must seek a doctor to fill up that section.

Check documents and make copies

Determine and ensure that all the documents are filled and in order. Making copies before submitting the claim can be handy for reference if there are complications or delays.

Submit your claim

An individual can submit a claim via an insurance agent, insurance branch, or online. They can check the status of a claim by contacting the agent, contacting the insurance customer service line, or emailing the insurer.

Medical insurance price

Medical insurance prices also depend on an individual's age, affordability, family history, and lifestyle. So, again, it is best to speak to an insurance agent to determine the amount that is best suited.

Where to buy medical insurance in Malaysia?

With the diverse range of medical insurance plans, choosing the best option may seem challenging, but at Prudential, we are here to help! We have trained, skilled, and experienced professionals who can cater to your needs and requests. Discover the range of medical insurance plans we offer to find the one most suited for you.


Having a medical insurance plan is vital for a myriad of reasons. Opting for the best plan that can cater to your needs would result in long-term benefits and ease of pocket expenses during a medical emergency.