KUALA LUMPUR, July 11 — A clinical psychologist has questioned various restrictions in AIA Malaysia’s mental illness benefit that limits claims to RM1,500 annually for psychiatric consultation.
Chua Sook Ning, founder of mental health non-profit Relate Malaysia, asked why the insured could not use up all the money they saved in their “Health Wallet” under AIA Malaysia’s “A-Plus Health” medical plan on treatment for six covered mental illnesses: major depressive disorder, obsessive compulsive disorder (OCD), schizophrenia, bipolar disorder, Tourette Syndrome, and postpartum depression.
The “Health Wallet” is a piggy bank of sorts where AIA deposits between RM500 and RM2,000 for the insured at the end of every year, depending on the plan, if no claims were made for other items under the medical policy like hospitalisation and outpatient care, up to a total of 10 times.
The insured can use the money in their “Health Wallet” on things like health screening, vaccination, and mental health — but the mental health benefit is limited to RM1,500 a year on psychiatrist consultation fees for the six mental disorders. The mental health benefit is not available either under the cheapest version of AIA’s “A-Plus Health” medical plan.
“How can you restrict people on how they spend their money? If I’m accumulating up to RM20,000, why am I only allowed to spend RM1,500?” Chua told CodeBlue.
She said if people were buying AIA Malaysia’s “A-Plus Health” plan just for the mental health benefit, they would be better off just saving their own money every month. AIA’s product brochure gives a fictional example of a 30-year-old woman paying an RM300 monthly premium for the second-cheapest version of the plan.
“The mental health benefit is marginally beneficial,” Chua said. “The product is not as solid as it could be.”
Global insurance company AIA’s Malaysian chapter is the first here to cover mental illness, amid a nationwide debate on mental health triggered by the suicide of a 16-year-old girl over an Instagram poll that told her to kill herself.
AIA Bhd chief marketing officer Heng Zee Wang said the “Health Wallet” was a product benefit designed to encourage people to stay healthy by allowing them to spend on preventive care, not a monetary fund from which to withdraw for cash.
“Given the lack of data and insights on mental health conditions in Malaysia at the moment, we have started with allowing our customers to claim up to RM1,500 a year so that over time, we are able to understand the claims experience and the usability of the benefit better,” Heng told CodeBlue.
“This will help us as we continue to look into developing more comprehensive solutions for mental health coverage. Furthermore, we are providing the mental health benefit to all our new and existing A-Plus Health customers without them having to pay additional premiums or insurance charges. Therefore, putting a limit to how much they can claim in a year is necessary for the medical plan to remain sustainable for all our customers.”
Psychotherapy Is ‘First Line Treatment’
Chua questioned why AIA Malaysia only covered “psychiatric consultation”, pointing out that psychotherapy is the first line treatment for disorders like mild to moderate depression and OCD.
The insurance company doesn’t cover medicine for mental illnesses either, which she said was often more expensive than consultation fees, citing a 2007 study that found that one month’s worth of antidepressant fluoxetine (brand name Prozac) cost about RM420.
While medicine is required for severe depression and conditions like schizophrenia and bipolar disorder, psychotherapy remains a crucial treatment for these disorders, Chua argued. Psychotherapy is provided by psychologists, while most psychiatrists focus on medicine management, with only a few providing therapy.
The clinical psychologist added that based on anecdotal evidence, psychologists with a PhD charge about RM450 for a 50-minute therapy session, while those with a Master’s charge between RM250 and RM300. As for counsellors, the government caps their fees at between RM80 and RM150 for a 45-minute counselling session, depending on their qualifications.
“Anyone who provides psychotherapy who is legislated — counsellors are legislated, psychologists are recognised — should be allowed to provide mental health services that are covered,” said Chua.
AIA Malaysia said in response that it only covered psychiatrists’ consultation fees as a psychiatrist is a registered medical practitioner with the Malaysian Medical Council, whose charges are regulated under the Private Healthcare Facilities and Services Act (PHFSA).
“At present, we do not reimburse the cost of psychotherapy as there is no governed fee schedule for psychotherapy, and we do not reimburse for medications that are related to the consult,” said Heng.
Schedule 7 and Schedule 13 of the PHFSA, which regulate fees at private clinics and hospitals respectively, however do set out fees for psychotherapy provided by psychiatrists.
But Heng said: “At present, AIA only covers consultation fees. We do not reimburse for psychotherapy of any sort for these six medical health conditions.”
Chua said AIA Malaysia also shouldn’t exclude coverage of pre-existing conditions or substance-use disorders, pointing out that depression and schizophrenia usually start in one’s teenage years and in their early 20s respectively. In Singapore, it takes depressed people four years to get treated after the start of their illness.
“The peak of it is in your 20s. That’s when people are thinking of purchasing insurance. So I wonder if it rules out all these people who need immediate help.”
But AIA Malaysia said not covering those who are already suffering from a health condition before they purchase its medical policy is typical in “any insurance plan”. Like standard insurance policies, AIA Malaysia’s “A-Plus Health” medical plan also lists “alcoholism” and “drug abuse” among its exclusions.
AIA Singapore’s Mental Health Benefit Also Questionable
AIA Singapore’s “AIA Beyond Critical Care” critical illness plan provides a mental health benefit that pays “additional 20 per cent of the coverage amount”, up to SG$50,000 (RM152,313) per claim, besides covering critical illnesses. The five mental health conditions covered are major depressive disorder, schizophrenia, bipolar disorder, OCD, and Tourette Syndrome.
It’s unclear if the insured must first get diagnosed with a critical illness before they can claim the mental health benefit, as the product brochure cites an example of a man who gets 100 per cent of his coverage amount when he gets cancer, and an additional 20 per cent of the coverage amount when he gets depression after.
When asked why didn’t AIA Malaysia replicate AIA Singapore’s mental health benefit, Heng pointed out that Singapore’s product was a critical illness plan that paid out a cash lump sum upon diagnosis, whereas the Malaysian product was a newly-added benefit under a medical rider that reimbursed psychiatric consultation fees.
“In line with the objective of the Health Wallet, we hope that this benefit will help to reduce the barrier for people to take the first step to seek professional help.
“We cannot stress enough that this is just the beginning of the journey for us, and it is what we are able to offer at this point given the shortage of data. We acknowledge that there is still a lot to be done in this area, and we will always be the first to challenge ourselves to bring more and better insurance solutions to market that will benefit Malaysians in the long run,” Heng told CodeBlue.
AIA Singapore’s plan also only allows one claim per mental health condition, subject to a waiting period of three years between each claim.
“It’s super restrictive,” Chua said. “There’s comorbidity for mental disorders.”
She noted that comorbidity for schizophrenia and depression was 50 per cent, which means that half of those diagnosed with schizophrenia also get depressed at the same time.
Move Towards Mental Health Parity
Many mental health patients also self-medicate by turning to alcohol or drugs, she said, but having a substance-use disorder would disqualify one from insurance coverage in Malaysia.
“Addiction is a mental health condition,” Chua told CodeBlue.
Chua questioned why mental disorders were treated differently from physical diseases, pointing out that typical insurance plans allow people to claim for both diabetes and cancer at the same time, for example.
She cited the United States’ Mental Health Parity and Addiction Equity Act that generally prohibits health insurance that provide mental health or substance-use disorder benefits from imposing less favourable benefits for those conditions than for medical or surgical benefits.
“So ultimately, we do want to move towards mental health parity, but understanding the nation isn’t there yet, but if this is what we’ve got right now, then let us spend money on what we want — which should be medication and psychotherapy.”
