If you have recently started paying attention to the coverage scope of medical insurance, you may wonder: “I already have high blood pressure or diabetes — can I still buy a medical card?” In Malaysia, applying for insurance with pre-existing conditions does present some challenges, but it does not mean you will definitely be rejected. As long as you understand the insurers’ underwriting mechanisms and application techniques, you still have the opportunity to secure suitable medical protection for yourself.
Pre-existing Condition refers to any illness or health condition that the applicant already has, has been diagnosed with, or has shown obvious symptoms of before applying for a medical card. According to Bank Negara Malaysia (BNM) guidelines, insurers pay special attention to these pre-existing health risks when assessing policies.
Many people have misconceptions about pre-existing conditions, thinking they only refer to long-term chronic illnesses (such as diabetes, hypertension, or heart disease). In reality, the scope is much broader. It includes not only chronic diseases but also cysts, nodules, unhealed injuries, and even recurring symptoms in the recent past that have not yet been clearly diagnosed. The main challenge of applying with pre-existing conditions is that insurers must reassess the underwriting risk based on the applicant’s health status. If the recurrence rate of the condition is high or there is a significant likelihood of large future medical expenses, insurers will apply stricter underwriting standards.
Having pre-existing conditions does not mean you absolutely cannot buy a medical card. The insurer’s underwriting department will assess the risk based on your medical reports and provide one of the following 5 common outcomes:
Loading Fee and Exclusion are the two main risk mitigation mechanisms insurers use to balance the additional risks brought by pre-existing conditions.
Why do insurers charge a Loading Fee? Simply put, medical insurance premiums are calculated based on the probability of illness in a standard healthy population. When an applicant has pre-existing conditions, the likelihood and amount of future claims are usually higher. To maintain fairness in the insurance risk pool, insurers must charge higher-risk individuals extra fees. The premium loading is usually calculated as a percentage increase on the base premium, but the exact loading percentage depends on the severity of the individual’s condition and each insurer’s underwriting guidelines — there is no fixed universal rate.
When faced with a Loading Fee or Exclusion, many people hesitate about whether to accept it. It is recommended that you evaluate the potential future treatment costs of the condition. For illnesses that easily trigger multiple complications, paying a higher premium for comprehensive coverage is often the wiser choice. For a localised benign nodule, accepting an Exclusion and obtaining standard premium coverage for other major illnesses can be a reasonable compromise.
The Waiting Period (排病期) refers to the observation period after the policy takes effect, during which you must wait before you can claim for specific illnesses. Even if your pre-existing condition is successfully approved for coverage, this waiting period cannot be ignored.
In Malaysia, the standard waiting period is generally 30 days (except for accidental injuries, which are usually covered immediately). For certain Specified Illnesses, Bank Negara Malaysia regulations allow insurers to set an additional waiting period of up to 120 days. However, for pre-existing conditions that are not excluded, some policies or special plans may impose specific observation periods of 12 to 24 months. This means medical expenses arising from that pre-existing condition during this period will not be claimable. If frequent medical visits or claims are made during the waiting period, insurers often initiate strict background investigations to confirm whether the applicant concealed a more serious condition at the time of application.
People with common chronic conditions such as diabetes or hypertension still have the opportunity to obtain medical card coverage, provided their condition is well-controlled and they provide complete medical documentation.
The core principle for improving success in applications with pre-existing conditions is “Utmost Good Faith” — honest disclosure and provision of detailed information.
What happens if I conceal pre-existing conditions when applying for a medical card?
You must never hide your medical history when applying. According to the Financial Services Act 2013, policyholders must fulfil their duty of disclosure. If the insurer discovers undisclosed pre-existing condition records during a claims investigation, they have the right to deny the claim and may cancel the entire policy (Void Policy) for “Misrepresentation” without refunding premiums paid.
Do I definitely need a medical examination when applying for a medical card with pre-existing conditions?
Not necessarily — it depends on the insurer’s underwriting rules and the specifics of your condition. Sometimes the insurer only requires a medical report (APS) completed by your treating doctor and copies of recent follow-up visits. However, if the condition is complex or the sum insured is high, the insurer may require you to undergo specific tests (such as blood tests or ECG) at a designated clinic or hospital.
If my application is rejected by Insurer A, can I still try Insurer B?
Absolutely. Every insurer has different Underwriting Guidelines and risk appetites. Being rejected by one company does not mean you will be rejected by all companies in the market. However, when applying to Insurer B, you usually need to honestly declare on the application form that you have been rejected or loaded by other insurers.
What is an Exclusion clause in a medical card?
An Exclusion clause means the insurer explicitly lists specific illnesses or situations that are not covered under the policy. If one of your pre-existing conditions is listed as an Exclusion, future medical expenses arising from that condition and its related complications will not be claimable. However, other unrelated, unforeseen sudden illnesses or accidents can still receive normal medical card coverage.
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