WE refer to the comments on medical insurance by Datuk Marimuthu Nadason of Fomca in “Draw up laws to monitor schemes” (NST, Jan 15).

The General Insurance Association of Malaysia wishes to clarify that insurance companies do not interfere in or influence medical decisions on treatment and tests conducted by doctors.

The insurance industry offers many types of medical and health insurance plans to meet different needs. At the point of purchase of a medical and health plan, the policyholder is given information on the basic and salient features of the policy.

This information would include details of benefits payable, significant medical or other exclusions including pre-existing conditions and specified illnesses, survival period and waiting period, limits of benefits payable, amount of premium payable, nature and extent of insurer rights to review and revise the premiums payable and the notice to be given in the event of any revision as well as any renewal guarantees.

The medical and health insurance policy would provide cover and benefits for treatment and expenses as specified in the plan. The plan, however, does not cover or pay for everything and all treatments done or recommended by physicians or charged by hospitals.

Consumers, however, have the right to select and obtain medical treatment from any private doctor or hospital of their choice. The insured can seek reimbursement from their medical insurance policy, if eligible.

It is important for consumers to understand the reasons for the treatment and/or admission recommended by their physician and what is covered in their policy contract.

Insurance companies may provide value-added services through their payment facility arrangements with panel hospitals and doctors, and this is referred to as the cashless facility.

The insured seeking medical care at these panel hospitals and doctors would enjoy the convenience of a letter of guarantee from the insurance company for a covered disability on the benefits provided by their policy.

If the insured chooses to go to non-panel hospitals and doctors, the insured does not have the convenience of the “cashless” facility and will need to settle the medical bills first and later seek reimbursement from the insurance company.

As medical policies differ as to coverage, benefits and costs, policyholders should be aware that not all of them have the cashless facility as policy benefits are priced differently for different needs.

Consumers are advised to ensure that they provide complete information to their insurer as requested in the proposal form when purchasing a medical insurance policy, and ensure that they fully understand any exclusions or limitations imposed on benefits provided under their medical and health insurance policy before confirming their purchase.

Members of the public are advised to examine the benefits and cost of premiums and select a medical policy that best suits their needs and budget.

C.F. LIM, for General Insurance Association of Malaysia

Source: NST – January 17, 2008