11/08/2026
According to an FAQ by Bank Negara Malaysia (BNM), MediAsas doesn't cover pre-existing conditions or mental disorders, among 35 exclusions that are mostly similar to conventional medical plans in the market.
BNM's 22-page FAQ, dated July 29, was on the "pilot" version of MediAsas, even though the medical plan didn't end up getting piloted for the public, but was instead piloted for internal testing last month.
On the "no look-back" clause, a moratorium of seven continuous years is imposed from the Risk Commencement Date, after which claims cannot be contested on the grounds of non-disclosure or misrepresentation.
However, the insurance or takaful operator (ITO) can still reject or contest a claim if the ITO establishes that non-disclosure or misrepresentation was "fraudulent, deliberate, or reckless"; or the claim relates to a Pre-Defined Medical Condition that existed before, or first manifested within 30 days from, the Risk Commencement Date.
Pre-Defined Medical Conditions include all cancers, end-stage organ failure and transplant-related conditions, major cardiovascular conditions, major neurological disorders, and systemic autoimmune and inflammatory disorders.
"Where an applicant has pre-existing conditions (PEC), depending on the information provided, additional medical evidence or assessments may be required to determine insurability," says the MediAsas FAQ.
The government isn't mandating medical check-ups for purchase of MediAsas, but tells customers at the same time to disclose their health condition accurately and completely when applying for MediAsas, a fully underwritten product.
"Failure to do so may affect your coverage and could result in claims being delayed or rejected," says the FAQ.
There are two products under MediAsas – Teras and Fleksi – that also come with takaful versions. MediAsas Teras has an annual limit of RM100,000 for policyholders aged 59 years and younger, and RM150,000 for those aged 60 years and older, whereas MediAsas Fleksi’s annual limit is RM300,000. There are no lifetime limits for either product.
MediAsas is available for individuals aged zero to 70 years, with coverage renewable up to age 85. Premiums/contributions will change based on one’s attained age.
The MediAsas FAQ doesn't list premium rates, but merely says that premiums/contributions aren't guaranteed.
"MediAsas may be subject to future medical repricing, in line with changes in medical costs, claims experience and regulatory requirements. Any repricing activity shall be communicated through a written notice of at least 30 days prior to the policy/certificate anniversary date."
MediAsas imposes a slew of copayments.
For the MediAsas Teras plan, deductibles are charged at RM500 per disability for policyholders aged 59 years and below, and RM1,000 per disability for those aged 60 years and older.
For treatment at Out-of-Network Providers, a 20% co-insurance/co-takaful, capped at RM3,000 per disability, is charged on top of deductible.
As for MediAsas Fleksi with an RM300,000 annual limit, deductibles are charged at RM10,000 per annum for treatment at Preferred In-Network Providers, and RM15,000 per annum for treatment at Out-of-Network Providers.
Copayments (deductible and co-insurance/co-takaful) don’t apply to treatment at government health care facilities, emergency treatment, and outpatient cancer treatment, but this copayment waiver is applicable only for MediAsas Teras.
MediAsas may further impose co-insurance/co-takaful of up to 20% on the cost of specified cancer drugs, according to a Cancer Drug List, for both inpatient and outpatient care.
MediAsas also slaps on additional deductibles for its outpatient illness treatment benefit, which is limited to the outpatient department of hospitals, for dengue fever, influenza A, influenza B, bronchitis, pneumonia/bronchopneumonia.
Under MediAsas Teras, this outpatient illness treatment benefit is as charged, up to RM3,000 per year, subject to an RM50 deductible per outpatient visit and annual limit. Under MediAsas Fleksi, the benefit is as charged, up to RM3,000 per year, subject to RM10,000 or RM15,000 deductible per annum and annual limit.
MediAsas’ room and board benefit is only room-sharing (four-bedded or two-bedded, depending on availability), without a daily monetary cap, to support “cost-efficient and sustainable health care delivery”.
Cashless facilities under MediAsas are only available for treatment at a Preferred In-Network hospital, whereas treatment at Out-of-Network Providers may only be reimbursed on a pay-and-claim basis.
MediAsas provides a guarantee letter (GL) facility for treatment at Preferred In-Network hospitals, but pre-authorisation requirements apply and approval is subject to the assessment and policy/certificate terms. If a GL isn’t issued, policyholders need to pay the expenses upfront and subsequently claim for reimbursement.
Besides conventional hospitalisation benefits, MediAsas offers outpatient benefits like day surgery, pre-hospitalisation treatment within 30 days prior to hospitalisation, post-hospitalisation treatment within 90 days after hospital discharge, post-hospitalisation outpatient physiotherapy treatment, post-hospitalisation home nursing care, and outpatient cancer treatment.
MediAsas doesn’t gatekeep care, allowing policyholders to self-refer to a specialist or hospital without additional copayments.
The current list of MediAsas’ Preferred In-Network Providers includes:
🔵KPJ Sentosa KL Specialist Hospital
🔵KPJ Tawakkal Specialist Hospital
🔵KPJ Rawang Specialist Hospital
🔵KPJ Kajang Specialist Hospital
🔵Pantai Hospital Klang
🔵Pantai Hospital Cheras
🔵Pantai Hospital Ampang
🔵Bukit Tinggi Medical Centre
🔵Columbia Asia Hospital Klang
🔵Subang Jaya Medical Centre
The six participating ITOs so far are:
🔵AIA Berhad
🔵Allianz Life Insurance Malaysia Bhd
🔵Etiqa Family Takaful Bhd
🔵Great Eastern Life Assurance (Malaysia) Bhd
🔵Prudential BSN Takaful Bhd
🔵Syarikat Takaful Malaysia Keluarga Bhd
According to the FAQ, MediAsas, a standalone medical insurance/takaful plan, adopts a “standardised and cost-focused design” that includes defined benefits and limits, cost-sharing features, selected preferred and cost-effective network hospitals with lower copayments, and broader risk pooling to spread claims costs across more policyholders.
MediAsas also adopts cost-control mechanisms to reduce unexpected bill variations, such as a diagnosis-related groups (DRG) payment system and prescribed covered drugs/devices based on effectiveness assessed by the Ministry of Health.
MediAsas is planned for public launch in January 2027. The "final approved" version of MediAsas may differ from the benefits, terms and conditions in the FAQ on the "pilot" version.
Read more: https://codeblue.galencentre.org/2026/08/mediasas-doesnt-cover-pre-existing-conditions-seven-years-before-no-look-back-bnm-faq/
