Malaysia does not run a national health insurance scheme, as such, for expats, so you will have three options. You can access public healthcare, which you can pay for either out of pocket or through your existing international health insurance; you can use private clinics, which you can again pay for either out of pocket or through international insurance cover; or you can employ a combination of both, using your private insurance as a top-up. We will consider your choices in more detail below.
In 2011, the Malaysian government introduced the Foreign Worker Hospitalisation and Surgical Insurance Scheme (FWHS or SKHPPA). This is a compulsory scheme run by the Ministry of Health & Immigration Department to protect overseas workers if they become ill or have an accident. You will have a choice of insurance providers, as a number of them are contracted to the government scheme. However, the scheme is limited in scope and will not cover your dependants.
You may wish to check with your employer whether you are covered under a group health insurance package. This will be a private scheme, but is worth considering depending on what is covered.
Your other option is to pay out of pocket expenses. This is worthwhile if you have only minor medical issues, as costs in Malaysia are substantially lower than in other countries, such as the USA. However, costs can escalate rapidly if you have a chronic condition or need to see a specialist, or if you have to spend a night or more in hospital. Most expats resident in the country take out private cover.
Check the small print of any private health insurance policy you are interested in to see whether it covers treatments that you may want to access, such as specialist surgical treatment or more advanced dental care, such as crowns or dental implants.
Remember to check whether your potential policy covers pre-existing conditions. The definition of this will vary between insurers. Usually the term applies to any conditions that present symptoms or for which you’ve been treated in the last five years. This normally includes any conditions you were diagnosed with over five years ago, but some insurers have different time limits for when the diagnosis must have been given.
You may also want to check whether your policy has a ‘hospitalisation’ clause covering you for occasional hospital visits. You may need to discuss this directly with your insurer. You may also wish to check whether there is a medical evacuation clause. Some expats choose to seek treatment in Singapore, which is relatively close, as private medicine there is of a world-class standard.
Take a good look at any potential policy for any cover relating to healthcare that does not apply to you. Some policies have provision for maternity care, for instance, and if you are not intending to become pregnant then you may wish to reduce your policy costs by having such options removed.
You may also be able to reduce the cost of your premium through ‘cost sharing’. This is where you and your insurer share the costs of any treatment. You will pay up to an agreed limit, and your provider will cover the rest. Different insurers will have different ways of arranging cost sharing.
This is where you pay a fixed sum for your treatment and your insurer covers the rest. For instance, if the total cost of your treatment is €85, and your co-pay amount is set at €40, then you will pay €40 and your insurer will pay €45.
This is where you pay a fixed percentage of the total cost and your insurer covers the rest. For instance, if your coinsurance is set at 20%, you will pay 20% of €85 and your insurer will cover the remaining 80%.
This is where you pay the entire amount allowed for all services provided until the deductible is met. For instance, if your policy has a €1,000 annual deductible, you would pay €85 for each visit to your healthcare clinic and then, once you have had 11 such appointments (€1000/€85 = 11.8), your insurance will begin to pay out to the doctor directly.
You may also need to look at whether there is an out-of-pocket maximum that you would be expected to pay after your deductible has been met. Let’s say that your plan above, with a €1000 deductible, also has a co-insurance option of 20% and an out-of-pocket maximum of €1500. In this instance, you would pay €85 for 11 visits to the doctor under your deductible until it is met. You will then pay €17 for each visit as your 20% coinsurance, until you reach the co-insurance ceiling of €500 (€1500 minus the deductible of €1,000). At that point, you would pay nothing more for the remainder of the plan year.
It is worth doing the maths, especially if you don’t think that you’ll need to make more than a couple of visits to your GP in any one policy period. For example, if you just want dental check-ups with an occasional filling, it might be worth working out whether one or two out-of-pocket costs might be cheaper than full dental cover.
As so many variables have an effect on the cost of international private medical insurance, it is very difficult to give accurate estimates without knowing the full details of what coverage you require. However, as a very rough guide, using a standard profile of a 40-year-old British male with no deductibles, no co-insurance, a middle tier plan/product, all modules included and worldwide coverage excluding the US, a ballpark price of around £4,000/$5,000 might be expected. If you want your coverage to include the US, the premium could increase to almost double this amount.