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CONSUMERS URGED TO BE CAUTIOUS WHEN SELECTING MANAGED CARE FIRMS

Kuala Lumpur, September 18 — The insurance industry advised consumers to be cautious when considering joining any medical card schemes. As a precaution, consumers are advised to thoroughly understand, verify and satisfy themselves on the benefits offered by any particular card scheme.

Consumers should be clearly informed as to the identity of the insurance company providing the insurance cover , the benefits offered as well as the terms, conditions and exclusions under the card scheme and whether they are insured as an individual or under a group insurance policy taken out by the card company offering the medical card scheme.

The advice came hot on the heels of a number of press reports which highlighted complaints from card holders of medical schemes who have faced difficulties when presenting their “cashless admission” card at hospitals.

These cases of mis-selling, misrepresentation or exaggeration of benefits by untrained distributors of direct selling companies are of great concern to the insurance industry,” said Lim Chia Fook, Persatuan Insuran Am Malaysia’s (PIAM) Executive Director.

Lim advised consumers who intend to participate in any medical card scheme to first check that the agents or distributors whom they are dealing with are also insurance agents registered with PIAM or Life Insurance Association of Malaysia (LIAM) and that they are able to provide ready and reasonable explanations to any queries that the customer may have on the medical insurance coverage.

The agent should be in the position to provide advice on the benefits as well as the terms, conditions and exclusions of the medical insurance coverage. If the agent is unable to do so, customers may wish to refer the matter to the insurance company that is providing the insurance coverage.

If the insurance company is not made known or there is reluctance to provide this information, the customer is advised to discontinue any further discussions with the agent.

“Taking the trouble to check for the agents’ credentials will help consumers to protect their interest by ensuring that they receive professional advice from qualified agents on the actual terms, conditions, exclusions and benefits of the insurance product sold under such schemes,” he said.

Lim said that the insurance industry, in consultation with Bank Negara Malaysia and the Malaysian Insurance Institute, has initiated measures to enhance the professional standards in the underwriting and sale of medical and health insurance to ensure that staff as well as agents who sell or market medical and health insurance products receive proper training and have the knowledge and understanding of the product they are selling.

Furthermore, in order to ensure transparency in the insurance products and services purchased by the consumers, PIAM and LIAM have prohibited the bundling of insurance products with other non-insurance products and services.

The “bundling” of benefits from medical and health insurance policies together with other non-insurance services such as “wellness programs”, blood tests, annual check-ups and medical history data have been a key feature of these medical card schemes.

Essentially, there are two parts to a medical card or medical insurance benefits , for which consumers should be completely satisfied with the benefits and the terms, conditions and exclusions attached to the insurance coverage before taking up the offer.

The other part comprises anciliary services such as emergency services, blood tests, annual medical check-ups, etc which are not insurance related.

This new measure to ‘unbundle’ the packaged products and services also requires that the insurance premiums be separately quoted from the cost of the other non-insurance services or products. This move will allow for greater transparency and for customers to make an informed decision on whether the price and scope of the medical and health insurance policy matches their needs.

While both PIAM and LIAM acknowledge that direct selling and distribution of insurance products have been conducted for some time now, the consumer complaints and negative feedback received on this mode of distribution have required the industry to take the necessary remedial measures. This is to ensure that consumers’ interests as well as the industry’s professional image are adequately protected and for consumers to enjoy an acceptable level of professional service.

PIAM and LIAM assure customers who are protected by insurance policies provided by licensed insurance companies under these medical card schemes that they will continue to be covered under existing terms and conditions until the expiry of their current period of insurance.

For more details on this matter, consumers are advised to seek clarification from their card scheme operators. Customers who wish to renew their insurance protection, after the term of cover has expired under their present scheme, can contact their respective insurers for advice on continuation of their insurance protection.

PIAM and LIAM are the national trade associations of all the licensed general and life insurance companies in Malaysia.

Copyright © 2001-2006,  Persatuan Insurans Am Malaysia.

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