KUALA LUMPUR, August 18 – The Madani Medical Scheme provides low-income earners treatment that is fully subsidised by the government for acute cases in participating private general practitioner (GP) clinics.
The scheme run by ProtectHealth Corporation – a fully-owned company under the Ministry of Health (MOH) – is currently available in 14 districts: Johor Bahru (Johor), Wilayah Persekutuan Kuala Lumpur, Klang, Petaling, Hulu Langat & Gombak (Selangor), Kinta (Perak), Timur Laut (Pulau Pinang), Kuching (Sarawak), Kota Kinabalu (Sabah), Kota Setar, Kuala Muda (Kedah), and Kuala Terengganu, Kuala Nerus (Terengganu).
Another seven districts will commence the Madani Medical Scheme, or Skim Perubatan Madani, in the fourth week of this month: Kota Bharu, Pasir Mas (Kelantan), Kuantan (Pahang), Melaka Tengah (Melaka), Seremban (Negeri Sembilan), Seberang Perai Tengah (Pulau Pinang) and Perlis.
Those automatically eligible to access the Madani Medical Scheme are Sumbangan Tunai Rahmah (STR) recipients, with the benefit limits as follows until December 31, 2023:
- Family household registered with the Inland Revenue Board (LHDN): maximum RM250
- Senior citizens aged 60 years and above without spouse: maximum RM125
- Singles aged between 21 and 59 years old, and OKU singles aged between 19 and 59 years old: maximum RM75
Eligible beneficiaries must make a declaration that they are not receiving any benefit equal or similar to the Madani Medical Scheme from any other employer/ state government/ medical agency scheme.
The acute primary care services in panel GP clinics covered under the Madani Medical Scheme are:
- Cough and cold
- Diarrhoea and vomiting
- Sprains and strains
- Headache
- Mild trauma (for example, superficial wounds and others)
The following services are excluded from coverage:
- Routine vaccination
- Health screening
- Routine non-communicable disease (NCD) follow-ups
- Routine perinatal follow-ups
- Family planning
- Rehabilitation request
- Medicines without doctor’s consultation
- Supplements request
Steps to obtain treatment at panel GP clinics under the Madani Medical Scheme:
- Check your eligibility on ProtectHealth’s website here or via the MySejahtera mobile application. On the website, simply key in your identity card (IC) number.
- If you’re eligible, look for your nearest GP registered with the Madani Medical Scheme on ProtectHealth’s website here. Select the relevant state and district from the dropdown menu and click “Cari Klinik”. A list of participating clinics will appear. You are advised to call your desired clinic ahead for its operating hours.
- Bring your IC when you visit your desired clinic (which should have a Skim Perubatan Madani sticker). The limit of your Madani Medical Scheme benefit will be deducted after each visit. Check your balance either with the GP during your visit or by calling +603-8687 2525.
On what happens if charges by panel GPs exceed the beneficiary’s visit entitlement limit, ProtectHealth’s website simply states that GPs are “prohibited from imposing additional charges”.
It is unclear if this means that the patient will have to fork out payment out-of-pocket for the remaining charges exceeding their entitlement limit, or if the panel GP is forced to absorb the cost that is not subsidised by the government.
Guide for GPs: Only 10 Districts Eligible, Specialist Clinics Excluded
For the current pilot phase of the Madani Medical Scheme, only GPs in the 10 districts listed below can join as a panel clinic:
- Johor Bahru (Johor)
- Timur Laut (Penang)
- Kinta (Perak)
- Klang (Selangor)
- Hulu Langat (Selangor)
- Petaling (Selangor)
- Gombak (Selangor)
- Kuala Lumpur (WPKL)
- Kuching (Sarawak)
- Kota Kinabalu (Sabah)
Only general private medical clinics can be empanelled with the Madani Medical Scheme; private specialist clinics are excluded. GP clinics that wish to participate must have a telephone line, internet access, and a computer and printer.
GP clinics that wish to be empanelled with the Madani Medical Scheme can click here to sign up as a ProtectHealth Partner. This includes those that were not previously registered as panel clinics for the Peka B40 programme or the National Covid-19 Immunisation Programme (PICK), as long as the clinics operate in the 10 districts listed above.
For a GP clinic with existing BMS and VCS account credentials, ProtectHealth recommends using the VCS account to empanel for the Madani Medical Scheme.
ProtectHealth Corporation uses a web-based system called Primary Care Information System (PRIMIS) for panel GPs to make claims and receive payments.
The payment mechanism for providers in the Madani Medical Scheme is fee-for-service, in which the panel GP will be reimbursed according to the services rendered to the beneficiary. The full list of services and the respective fee in the Madani Medical Scheme List of Services & Fee Schedule can be found in the PRIMIS Provider Portal.
The conditions for panel GP registration are as follows:
Clinic registration must be made in the name of the “person in charge” as stated in the Borang B / Borang F (Certificate of Registration of Clinic). Documents that need to be uploaded are:
- Certificate of registration to operate private medical clinic (Borang B or Borang F)
- MMC full registration certificate of the person in charge
- Current annual practising certificate (APC) of the person in charge
- Proof of Bank Account (which contains Clinic/Company name as per in Borang B/F) (Personal bank account is not accepted).
- Clinics with X-Ray Service are required to upload their Licence of Tenaga Atom (within validity period).
Interested GPs can register for a virtual briefing and onboarding session with ProtectHealth on August 24 (3pm-4pm). ProtectHealth’s website did not list other future dates at the time of writing.
ProtectHealth is also organising virtual open-door Q&A sessions for GPs today (3pm-4pm), August 25 (3pm-4pm), and September 1 (3pm-4pm).
