If you have recently started paying attention to the coverage of medical insurance, the “MHIT Waiting Period” regulations are definitely one of the key points you must understand first. The medical card waiting period refers to a specific period after the policy officially takes effect. During this period, any illness diagnosed will temporarily not be eligible for claims.
The main purpose of establishing this mechanism is to prevent “insuring after diagnosis.” According to the definition and regulations of Bank Negara Malaysia (BNM), setting a waiting period in insurance policies ensures the fairness and long-term sustainability of the insurance fund for all policyholders. Without this mechanism, people could simply wait until they fall ill before buying a medical card to claim, which would significantly drive up overall premiums and would be very unfair to those who purchase coverage early while healthy.
Simply put, how long after buying a medical card you can claim depends on whether the reason for your hospitalisation is an accident or an illness. The general medical card waiting period is mainly divided into the following two situations:
In addition to the 30-day rule above, most medical cards set a 120-day waiting period for “Specified Illnesses.” These illnesses usually take a longer time to develop or have a certain incubation period.
The claim situation for hospitalisation shortly after buying a medical card depends entirely on the reason for admission and how long the policy has been in effect. The most important thing is to clarify whether it is due to accidental injury, sudden illness, or if it is still within the waiting period.
If hospitalised due to accidental injury, the claims process is usually relatively smooth. You can generally apply directly through the hospital for a Guarantee Letter (GL) to enjoy cashless admission.
However, if it is a sudden illness and you are hospitalised shortly after passing the 30-day waiting period (for example, on the 35th or 40th day), the insurance company will usually adopt a more cautious review process. In such cases, the insurer is very likely to temporarily refuse to issue a GL and require the policyholder to pay first (Pay and Claim). Afterwards, the insurance company will conduct a medical records investigation to rule out the possibility that the illness is a pre-existing condition. If the investigation proves that the cause of the illness indeed occurred after the 30-day waiting period, the insurer will eventually reimburse the medical expenses.
If hospitalised before the waiting period is completed (for example, on the 15th day of the policy for a common illness), all related medical expenses must be borne by the policyholder themselves.
Yes. Whether you cancel your existing medical card and switch to a new insurer or upgrade the coverage with the same company, the waiting period will be reset to varying degrees. For readers who want to switch plans, the following points are worth clarifying first:
What should I do if I fall ill and am hospitalised during the 30-day waiting period of the medical card?
During this period, all medical expenses must be paid by yourself. More importantly, the illness may be classified by the insurance company as a pre-existing condition, resulting in future medical expenses arising from that illness also not being covered. Therefore, it is strongly recommended to purchase coverage as early as possible while you are healthy to avoid missing out on protection.
Do I need to wait 30 days if hospitalised for a fracture caused by an accident?
No. The vast majority of medical cards in Malaysia provide coverage for accidental injuries with no waiting period. As long as your policy has officially taken effect and the premium has been paid, medical expenses caused by sudden accidents (such as car accidents or falls resulting in fractures) can be claimed.
Is the cooling-off period the same as the waiting period for a medical card?
They are completely different. The cooling-off period (Free-look period) refers to the first 15 days after the policy takes effect. This period allows you to review the policy terms; if you are not satisfied, you can cancel unconditionally and get a full refund of the premium. The waiting period, on the other hand, refers to the period after the policy takes effect during which specific illnesses are temporarily not covered.
Which diseases are included in the 120-day waiting period?
It mainly includes chronic and specified illnesses that require a long time to develop or have an incubation period. Common examples include hypertension, diabetes, cardiovascular diseases, all cancers or tumours, various stones (such as kidney stones), cysts, and endometriosis, etc.
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