KUALA LUMPUR, Feb 6 — The Base Medical and Health Insurance/Takaful (MHIT) Plan can curb policyholders from using their medical card like a “credit card” in conventional cashless health insurance.
Speaking at the Forum Ekonomi Malaysia (FEM) 2026 yesterday, Dr Kuljit said the Base MHIT product designed by the government would instil greater patient responsibility and reduce unnecessary hospital admissions and claims that inflate insurance payouts.
“I’m a provider and can tell you, when you have a medical card, it becomes a credit card and they would want to claim for almost everything, even though some things may not be claimable and some of these conditions, you should be paying out of pocket – see a patient in a general practice clinic – because it is not a serious condition that requires admission,” Dr Kuljit said during a panel discussion on health care reform at the conference.
Kuljit said the Base MHIT Plan, as a foundational insurance product, would limit overuse because it only covers essential treatment at the outset, while still allowing consumers to upgrade coverage if they can afford higher premiums.
“The MHIT is a base product. Number one, it gives responsibility to the patient. Because that is a basic product, if they want to abuse it, they are not going to get that liberty to abuse it because it’s a basic product – it covers what it needs to be covered to start off,” he said.
“And the patient can always top up if he has got the means or affordability to get a higher [coverage] card. Or within MHIT, they can go for a higher card, but that gives them the power of making that decision, because today, the medical cards are used like a credit card.”
The Base MHIT Plan has an RM100,000 annual limit, much lower than existing medical plans in the market that are similarly priced or even cheaper, but with annual limits exceeding RM1 million. The Base MHIT also has standard hospital and surgical benefits, albeit with limited additional benefits.
Dr Kuljit later clarified to CodeBlue that many policyholders assume that once they possess a medical card, they can “just tap and go into any hospital” for any treatment, only to discover limitations when seeking care.
He said patients often misunderstand how cashless arrangements work, noting that not every hospital accepts every insurance card on a cashless basis and not all doctors within a hospital are authorised for cashless claims, leaving some patients to pay upfront despite holding insurance.
He added that confusion over policy exclusions frequently leads to dissatisfaction, as some patients believe “everything is covered” without fully understanding the terms of their plans.
“There are exclusions in their policy which the patient sometimes maybe knows or didn’t understand or don’t know,” Dr Kuljit said, describing situations where insurers or hospitals reject certain claims, prompting policyholders to question the value of their coverage.
He also pointed to congenital conditions as another source of misunderstanding, where complications or infections linked to underlying congenital issues may be excluded even if the immediate illness appears unrelated to patients.
“So that is where the patient gets the wrong concept,” he said, stressing that a medical card is “not like a credit card”.
Dr Kuljit added that consumer education would be critical to ensure appropriate utilisation of insurance benefits, particularly for minor ailments that can be treated at primary care level without hospital admission.
Last March, Dr Kuljit dismissed claims of “buffet table syndrome” – the tendency for insured patients or providers to request or utilise more services than necessary – as a myth, instead attributing rising health insurance claims to an increase in more severe illnesses such as pneumonia and fatal dengue.
He maintained that stance to CodeBlue, saying the practice does not occur because insurers would not allow it.
Explaining the concept, Dr Kuljit described the “buffet table syndrome” as a situation where a patient who has already obtained a hospital guarantee letter (GL) attempts to add unrelated tests or treatments to the insurance bill.
“Say for example, you go in for dengue and then he will ask the doctor to do cholesterol tests and ask the doctor to give some other medicine not relevant to dengue and just put it into the insurance. So that is buffet syndrome,” Dr Kuljit said.
“But it doesn’t happen. Because insurance companies, not only now, but for years, they won’t allow it. If it’s not related to that condition, they are not going to pay for it.”
He noted that the situation differs for self-paying patients, who are free to request additional tests or treatments as long as they bear the cost themselves.
“But for insurance patients, the buffet syndrome, it’s a thing that they say happens, but it cannot happen – insurance will never pay,” he said.
Dr Kuljit’s remarks at FEM 2026 were made before Health Minister Dzulkefly Ahmad told StarBiz at the sidelines of the conference that the Base MHIT covers pre-existing conditions, a feature that distinguishes the government-designed product from all other health insurance products in the market that don’t cover pre-existing illnesses.
If the Malaysian government were to adopt the United States’ protection of people with pre-existing conditions, what this means is that insurance and takaful operators (ITOs) who offer the Base MHIT must accept sick individuals for coverage, avoid charging higher premiums due to health status, and cover treatment for pre-existing conditions.
Hence, contrary to initial belief that the Base MHIT will curb claims or usage of medical cards like a “credit card”, coverage of pre-existing conditions means that claims will likely spike if many people with non-communicable diseases (NCDs) purchase the plan.
Medical Inflation ‘Skewed’ By Utilisation
Dr Kuljit also challenged commonly cited medical inflation figures of 15 per cent in Malaysia, saying such numbers often conflate actual price increases with higher utilisation rates driven by insurance claims.
“Most of the time, medical inflation when it is calculated, it gives you a very scary figure of 15 per cent for Malaysia. But we’ve done our own studies and we found that the 15 per cent sometimes is not the real inflation figure that we need to worry about because the 15 per cent encompasses utilisation rate,” he told the FEM 2026 conference.
Dr Kuljit noted that medical inflation figures are largely derived from insurance industry data, which may not fully capture out-of-pocket spending or broader health system costs.
“It is not calculated besides the insurance claim, so it is, I would say, a little bit skewed. It is not an accurate figure. Because the medical claims number has become so high, and that’s where products like MHIT will actually help.”
