For the reimbursement of your health expenses, you first receive a Social Security reimbursement, the amount of which is calculated in relation to a rate of a reimbursement base set by Social Security. Then, if you have subscribed a Malaysia-plans health, you receive a second refund, complementary, calculated on the basis of the guarantees subscribed to the contract.
The guarantee level of your contract is the most important criterion for choosing a good mutual health insurance. The level of coverage of your Malaysia-plans must be selected according to the needs of your family members insured under the contract.
How do health reimbursements work?
There are several levels of reimbursements when it comes to health costs. The first level is reimbursement by Social Security. It provides for a refund in the form of a rate applied on a fixed rate basis. For example, for a dental crown, the reimbursement base is RM 512.42. The applied rate is 70%. Your refund will be 358.69 RM.
You can find all the medical acts reimbursed by the Social Security, as well as the rates applied on the site of the health insurance.
The second level is the reimbursement by your mutual health. Depending on the level of guarantees of your mutual health, you will receive a refund more or less important. Your mutual can express its guarantee levels in several ways: in Ringgit, or as a percentage. To choose your level of coverage you must already understand its needs and how you will be reimbursed:
The reimbursement in Ringgit: it is a lump sum which you have annually or biennial for the assumption of your expenses of health on certain positions of guarantees (often optics and sometimes dental). When your health expenses exceed the package that is allocated to you by your health Malaysia-plans, the additional costs are your responsibility. The advantage of this formula is that it is very clear to understand its repayments.
The percentage reimbursement of the Social Security base: it is more common. Your mutual health offers a refund that can go from 100% up to 800%. This means that your mutual will support for example 200% of the Social Security reimbursement base, for our dental crown example 107.50 x 2 = 1024.83 RM.
Be careful to read the conditions of your contract because some mutual offer a refund of 200% for example, but less the reimbursement of Social Security. This means that the amount provided by your mutual, you must deduct the refund to collect the Social Security. In our example for a crown, the mutual reimburses 200% of RM 800, less the reimbursement received by the Social Security of RM 700. You will therefore receive from the Mutual 139, 75 RM only.
The points of the mutual health contract to watch.
Your Malaysia-plans health insurance can provide for a waiting period, ie a period during which you cannot use some of your guarantees. This is often the case for important levels of safeguards such as hospitalization, optics and / or dentistry.
Mutual health insurance contracts can also impose guarantee limits, either in cash when it is a limit of benefits per year to obtain reimbursement, or in cash when the health mutual imposes guarantee ceilings.
For example, a cash guarantee limit indicates a reimbursement of RM 50 for osteopath consultations, within the limit of 2 consultations per year and per insured person.
In cash, the mutual specifies that it reimburses dental prostheses up to 400% of the Social Security base, with an annual reimbursement ceiling of RM 1,000. That is to say that your mutual will refund up to RM 1,000 per year for dentures, under the conditions agreed in the contract. Beyond this annual amount, the costs will remain your responsibility.