Announced yesterday by health minister Dzulkefly Ahmad, the scheme provides an annual coverage limit of RM100,000, adjusting upwards to RM150,000 for those above 60.
Indicative monthly premiums range from RM80 to RM120 for those aged 31 to 35, RM280 to RM350 for aged 61 to 65, and RM500 to RM780 for those above 75.
Galen CEO Azrul Khalib said affordability could not come at the expense of meaningful coverage, and that while the RM100,000 annual limit might cover many routine admissions, it would not reliably protect families from complex or prolonged conditions.
“Cancer, major cardiovascular events, kidney failure, complicated infections or multi-disciplinary rehabilitation can rapidly exceed basic limits, particularly if care is required across multiple episodes or months,” he said in a statement today.
Azrul said repeated health episodes could be “financially catastrophic” for those under the plan, given the lack of a yearly cap for deductibles and co-payments.
He said a quick review of existing plans on the market showed comparable health insurance products that cost less and had similar or better coverage than what was being proposed under the base MHIT plan.
“Imposing deductibles between RM10,000 and RM15,000 for the standard-plus plan while providing an annual policy limit of RM300,000 is not competitive.
“The risk is that Malaysians purchase the plan believing they are protected, only to discover that they are underinsured when illness strikes, forcing them back into out-of-pocket payments or public hospital queues,” he said.
Azrul also argued that while the plan’s capped coverage, deductibles and co-payments might reduce insurers’ exposure, they risked shifting costs back to patients without addressing the root drivers of medical inflation, including weak or absent regulation of pricing, limited fees disclosure and variation in clinical practice.
“Without stronger consumer protection bodies such as a private healthcare commission to oversee health insurance premiums and private healthcare charges, the plan may unintentionally normalise higher out-of-pocket spending as a new standard, undermining the goal of affordability.
“Those enrolled in the base MHIT product will eventually end up in the public healthcare system,” he said.
Azrul proposed a range of solutions, including the establishment of a dedicated body to implement clearer consumer safeguards and protections on exclusions, claim adjudication, premium repricing practices, portability rights and hospital charges.
He said the proposed premiums in the base MHIT plan should also be made more affordable for those over 60 and the unemployed, with cash subsidies offered to those seeking aid under the Social Security Organisation’s employment insurance system to co-pay for their premiums.
Azrul said with the current design of the base MHIT being heavily dependent on the participation of private health insurance and takaful operators (ITOs), only the larger multinational insurance companies might be able to participate given their larger resources and margins.
“Smaller ITOs will likely opt out of participating in the plan. There needs to be incentives for them to participate,” he said, adding that such incentives could include government subsidised payouts for those above 60 years old.