Lifetime Limit: The amount you can claim throughout your lifetime under your medical plan.
Annual Limit: The maximum amount your insurer will pay in a year for your medical plan. Likewise, a medical plan’s Lifetime Limit is the maximum amount you can claim throughout your lifetime.
Underwriting: A process where insurers assess the amount of risk you might have in relation to the cost of the coverage.
Waiting period: This is the time period where the insurance company will not pay for certain claims. This period typically falls within 30 – 90 days from the commencement of the medical plan.
Deductible: An upfront amount that you will have to pay for healthcare services before your medical insurance begins to pay. This is applicable for most medical insurance plans with the exception of zero deductible plans, where the insurer pays 100% of medical expenses that are covered under the medical plan.
Zero deductible: The person covered will not have to pay any portion of the medical charges, as the insurer pays 100% of medical expenses covered under the medical plan.
Referral Emergency Assistance: Also known as REA, it is a programme that provides international and domestic medical assistance for emergency medical evacuation and repatriation. It may also include emergency car, home and travel assistance.
Hospital Room & Board: The benefit provided by a medical insurance plan for the hospital room and boarding of the policyholder
Pre-Existing Illness: Past or existing illnesses which a person has at the time of buying a medical insurance policy, which insurers do not provide coverage for.
Outpatient Treatment: Treatment at a hospital, clinic or medical facility that does not require admission to hospital for an overnight stay.
Cost Sharing: When both you and your insurer pay part of your medical expense, it’s called cost sharing. Deductible and Co-insurance are examples of how cost sharing may work in a typical medical plan.
Deductible: An upfront amount that you will have to pay for healthcare services before your medical insurance begins to pay. This is applicable for most medical insurance plans with the exception of those with zero deductible, where the insurer pays 100% of medical expenses that are covered under the medical plan.
Co-Insurance (also known as Co-Takaful in Takaful plans): A fixed amount that is usually a percentage of your total medical expenses. For example, if your medical bill is RM5,000, a % of the total medical expense cost will be charged to you. The remainder will be covered by your insurer based on the coverage of your policy. Similar to deductible, there are medical insurance plans with zero co-insurance as well.