KUALA LUMPUR, Feb 6 — Health Minister Dzulkefly Ahmad has revealed a feature of the Base Medical and Health Insurance/Takaful (MHIT) Plan that disrupts the market: coverage of pre-existing conditions.
The Base MHIT Plan only has an RM100,000 annual limit, compared to existing health insurance products in the market with annual limits exceeding RM1 million that are similarly priced or even cheaper than the government-designed product.
However, coverage of pre-existing conditions distinguishes the Base MHIT Plan from all other medical plans in Malaysia that do not cover pre-existing illnesses, or conditions that a person already had prior to purchasing their policy.
“It was difficult for us and we fought very hard for this – yes pre-existing medical conditions are covered under the MHIT plan,” Dzulkefly was quoted as telling StarBiz at the sidelines of the Forum Ekonomi Malaysia 2026 conference here yesterday.
StarBiz’s report did not provide further details on what coverage of pre-existing conditions means for the Base MHIT Plan.
Bank Negara Malaysia’s (BNM) White Paper explicitly states that the Base MHIT Plan is risk-rated based on an individual’s age, gender, and health status, not community rated. This suggests that unhealthy individuals may be charged higher premiums, although the White Paper states “limits” will be applied to premium-loading based on health status.
The central bank is also considering a “no look-back” provision. This means that insurers won’t investigate a policyholder’s past medical history after a certain point or “look back” to find reasons to deny claims based on pre-existing conditions.
Under the Affordable Care Act in the United States, coverage of pre-existing conditions means:
- Insurers must accept sick individuals for coverage.
- Insurers cannot charge higher premiums due to health status or pre-existing conditions (i.e. community rating).
- Policies cannot exclude benefits related to pre-existing conditions (for example, if you already have diabetes, your plan must cover diabetes treatment).
- Coverage starts from day one of the policy.
CodeBlue’s October 2025 survey among more than 850 private specialist doctors on health insurance issues found that insurance and takaful operators (ITOs) often cited pre-existing conditions, especially diabetes, as a reason to deny claims or revoke guarantee letters (GLs), even if these illnesses were unrelated to the admission diagnosis.
Malaysia has a high prevalence of non-communicable diseases (NCDs).
According to the National Health and Morbidity Survey (NHMS) 2023, more than half of Malaysian adults (54.4 per cent) are overweight or obese. About one in six adults (15.6 per cent) have diabetes, one in three (29.2 per cent) have hypertension, and about 7.6 million adults (33.3 per cent) have high cholesterol. Millions of people are unaware about having either condition.
Specialists also reported frequent GL denials or revocations for patients whose policies were less than two years old.
Policyholders in Malaysia who report conditions like high cholesterol face premium repricing; their premiums don’t go down even if the policyholder manages to get back to normal health status later on.
If the Base MHIT Plan does indeed cover pre-existing conditions – as per Dzulkefly’s remarks, notwithstanding BNM’s White Paper saying that the product is risk-rated – this would benefit many Malaysians who have chronic disease.
The Base MHIT Plan isn’t underwritten by the government that isn’t paying for claims or subsidising premiums, but is open to participation from ITOs.
