Insurance and Takaful Industry Joint Response to The Star - Insurance and Takaful Industry Welcomes Stakeholder Dialogue on Medical Claims Experience in Private Hospitals
Kuala Lumpur, 4 November 2025 – The Insurance and Takaful Industry is committed to the well-being and protection of Malaysians. 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.
The industry recognises the importance of timely access to critical treatments such as cancer treatments and looks forward to open and sincere engagement with regulators, medical professionals, and healthcare providers to improve processes and align expectations.
Industry data reflects a strong commitment to timely and fair claims settlement:
- 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.
- 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:
- 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. The committee is scheduled to meet next on 10 November 2025.
- 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 operates under Bank Negara Malaysia’s strict regulatory framework and members provide structured avenues for review. These include internal appeals, the Industry Grievance Mechanism Committee mentioned above, and the regulator complaint channels so disputes can be resolved quickly. BNM has also been invited to conduct a thematic inspection of the industry’s claims practices to identify improvements beneficial to all parties.
The industry also continuously reviews its claims and underwriting guidelines to ensure they are in line with evolving medical standards and treatment protocols – all while keeping premiums sustainable for everyone. Meanwhile, insurers continue to strengthen engagement with policyholders to provide better understanding of coverage, pre-authorisation processes, and available options for treatment.
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.
