KUALA LUMPUR, Jan 30 — The government’s Base Medical and Health Insurance/Takaful (MHIT) Plan with an RM100,000 limit likely can’t cover major operations like coronary artery bypass graft surgery (CABG).
Association of Private Hospitals Malaysia (APHM) president Dr Kuljit Singh told Business Times that the Base MHIT’s Standard Plan could be sufficient for “relatively straightforward” cases like appendicitis, but likely not for complex and advanced procedures like CABG, an open-heart surgery for coronary artery disease.
“The extent of coverage would be assessed on a case by case basis, taking into account the type of illness, how advanced the condition is and whether the patient has other underlying conditions,” Dr Kuljit was quoted as saying in a report last Monday.
Dr Kuljit previously told CodeBlue in 2024 that the total hospital bill for CABG (without complications) in Malaysian private hospitals averages between RM70,000 and RM80,000. Minimal invasive surgery can go up to RM100,000.
National Heart Institute (IJN) CEO Prof Dr Mohamed Ezani Md Taib told reporters in 2024 that CABG typically costs RM100,000 to RM120,000 in private hospitals.
A reference price range for common procedures in private hospitals on the Life Insurance Association of Malaysia’s website – which was launched by Health Minister Dzulkefly Ahmad and Finance Minister II Amir Hamzah Azizan last week as part of the government’s Reset strategy – omits CABG.
According to the price list, a typical bill amount for laparoscopic appendicectomy to remove the appendix is RM20,700.
According to the Department of Statistics Malaysia’s (DOSM) 2025 report released last month, ischaemic heart disease remained as Malaysia’s top cause of death in 2024.
Ministry of Health (MOH) data shows that more than a third (about 35 per cent) of heart attack fatalities in Malaysia occur in people aged below 60. Dzulkefly told reporters last August about the youngest recorded case of heart attack at IJN involving a 19-year-old.
Dr Kuljit also told Business Times that the Base MHIT Plan would likely cover a four- to six-bedded room; patients who prefer two-bedded or single rooms can choose to pay the difference in room charges.
Bank Negara Malaysia’s (BNM) White Paper claimed that the Base MHIT Plan’s RM100,000 annual limit would be adequate to cover 99 per cent of treatment episodes across a range of “common medical conditions”, even after allowing for some possibility of multiple admissions.
This Standard Plan proposes RM80 to RM120 monthly premiums for those aged 31 to 35, with RM500 deductible per disability (or illness episode). Deductibles are the initial amount a policyholder must pay upfront before coverage begins.
For senior citizens aged 61 to 65, their annual limit is increased to RM150,000, with monthly premiums proposed at RM280 to RM350, along with RM1,000 deductible per disability.
While the Base MHIT’s Standard-Plus option has a higher annual limit of RM300,000, this plan comes with hefty deductibles of RM10,000 to RM15,000.
The Base MHIT Plan charges a 20 per cent copayment, capped at RM3,000 per disability, if treatment is sought outside “in-network” hospitals. In-network hospitals were described by the central bank as hospitals that “demonstrate an appropriate use of resources aligned to best-practice, cost-efficient care models, and are committed to minimum standards of cost transparency and service levels”.
CodeBlue’s curation of existing medical plans in the market found at least five products for young adults aged 31 to 35 and three for senior citizens aged 61 to 65 that are comparably priced or even cheaper than the Base MHIT, but with minimum RM1 million annual limits and RM500 or optional deductibles.
