B40 Can Still Get RM50 mySalam Benefit Despite Pre-Existing Conditions

Those diagnosed with a critical illness before January 1 2019 are not eligible for an RM8,000 lump sum benefit.

KUALA LUMPUR, April 18 — Although the poor with pre-existing conditions are excluded from receiving RM8,000 cash under mySalam, they are still eligible for the RM50 daily hospitalisation benefit.

mySalam chairman Johan Mahmood Merican reiterated that the bottom 40 percent of society (B40) would only receive the RM8,000 lump sum benefit under the government’s health insurance scheme if they were diagnosed with one of 36 critical illnesses after January 1 this year.

“It’s covered in the sense that if you already have a pre-existing condition and you need to go for hospitalisation, you’re still eligible for RM50 a day,” Johan told Astro Awani presenter Melisa Idris on the “Let’s Talk with Sharaad Kuttan” show last Tuesday.

“However, given that this scheme was announced in the 2019 Budget and basically the coverage period starts on the 1st of January 2019 for five years, what it means is that you’re only eligible for RM8,000 if you’re diagnosed with a critical illness after 1 January 2019,” he added.

Besides the RM8,000 one-time payout, the mySalam scheme operated by Great Eastern Takaful Berhad also pays B40 beneficiaries aged 18 to 55 daily hospitalisation income replacement of RM50, up to RM700 per annum for treatment at any Ministry of Health (MOH) hospital. University hospitals are excluded.

Johan added that the Finance Ministry was currently discussing with other foreign insurance companies the possibility of joining mySalam, a five-year scheme, from the third year onward.

“The first two years, almost exclusively, mySalam will be administered by Great Eastern,” he said, adding that the government chose to start with Great Eastern because it was the biggest insurance company.

Johan also said about 1,000 claims have been made after mySalam opened for applications since March 1, but only about 100 claims were paid out so far as their standard operating procedure (SOP) is to process claims within two weeks.

“But we expect these numbers to rise quickly,” he said.

The mySalam chairman, however, did not specify how many of the 100 claims received the RM8,000 one-off payment.

Deputy Finance Minister Amiruddin Hamzah reportedly told Dewan Rakyat earlier this month that only two out of the 97 approved claims received the RM8,000 cash, while the other 95 received the hospitalisation benefit. The Finance Ministry had received 1,094 mySalam claims as of April 4.

Johan also admitted that the list of 36 critical illnesses covered under mySalam — including cancer, heart attack, and kidney failure — was based on industry standards.

“That list of 36 is based on industry standard. It’s already quite an established protocol in terms of determining on which point you are eligible,” he said.

Critics have charged that the strict critical illness definitions under the mySalam scheme followed traditional commercial health insurance, questioning if Great Eastern would end up denying coverage to many Malaysians, besides those already disqualified for pre-existing conditions.

Johan said that even though the list of critical illnesses covered was based on industry standards, the terms of mySalam were much better than typical private insurance because no health screening is required.

“We’ve tried to simplify the process,” said Johan.

“Very minimal documentation is required. This is not a private insurance programme. There’s no profit element in this instrument. What was contributed in RM2 billion from Great Eastern will end up in the rakyat’s hands.”

Great Eastern’s RM2 billion contribution to the government in lieu of local divestment is paid back to the insurance company in the form of premiums at RM112 per annum for 3.8 million B40 people over five years.

Johan said Great Eastern would not profit from mySalam because the Singapore-based insurance company would have to put any surplus back into the fund if the payouts were lower than the premiums it received. But Great Eastern would still have to cover payouts if those exceeded premiums.

“So it’s a one-sided bet,” he said.

Johan said that under terms negotiated between Great Eastern and the PH government, the insurance company was not allowed to benefit from mySalam data.

“While they administer the mySalam scheme, data is kept separately,” he said, without elaborating where exactly beneficiaries’ data is stored or who has access to it.

“They cannot use data for cross-selling to market any of their products. No possibility that automatically those on mySalam would then graduate to some form of private insurance programme.”

Johan stressed that people were better off with the mySalam scheme than without it.

“Certainly that’s why there’s urgency placed to ensure it got rolled out so that you can immediately help, particularly the lower income who have the unfortunate situation of being diagnosed with critical illness or being hospitalised.”

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