The industry’s priority is ensuring all medical claims are managed fairly, transparently, and efficiently. Insurers and takaful operators are responsible for paying all eligible claims while safeguarding the collective medical claims pool to maintain sustainable premium/contribution rates for consumers.

 

Industry data reflects a strong commitment to timely and fair claims settlement:

 

1. High Claims Approval Rate: The Insurance and Takaful Industry has maintained an average claims approval rate of over 90%. Collectively, the industry has consistently approved over one million claims annually, demonstrating a strong commitment to paying legitimate claims promptly and fairly. The main reasons for claims rejections include policy exclusions, failure to meet policy eligibility criteria, pre-existing conditions or non- disclosure and treatments not related to admission.

 

2. Improving Customer Experience: According to the Malaysia Insurance & Takaful Customer Satisfaction Survey 2024, a total of 2,796 Medical and Health Insurance and Takaful (MHIT) policyholders rated insurers and takaful operators scores ranging from 84 points to 89 points in 2024 out of 100 points, across key metrics such as responsiveness, trustworthiness, satisfaction and peace of mind.

 

As part of our ongoing commitment to excellence, the following initiatives will be prioritised:

 

a. Resuming the Industry Grievance Mechanism Committee – to strengthen communication, foster better understanding, and provide a platform for addressing grievances from all stakeholders including physicians, hospitals, insurers and takaful operators, the Ministry of Health and Bank Negara Malaysia.

 

b. Establishing Internal Working Groups – comprising insurers, takaful operators and TPAs to analyse the root causes of the issues raised and develop solutions to prevent recurrence.

 

The Insurance and Takaful Industry will continue to engage constructively with all stakeholders through an “all-of-nation” approach to strengthen Malaysia’s private healthcare ecosystem. This is evident in the industry’s active involvement in the joint ministerial committee on RESET. Our collective goal is to enhance the claims process, improve service delivery, and ensure a positive healthcare experience for all Malaysians. Ultimately, the care and protection of Malaysians is our primary concern, and the industry will continue to explore ways to support the nation’s healthcare system as well as ensure that every Malaysian has access to quality protection and care.

 

Issued by: LIAM,MTA and PIAM

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