KUALA LUMPUR, August 10 — The Malaysian Medical Association (MMA) has criticised the RM50 limit for general practitioner (GP) visits under AIA’s new medical plan that covers primary care besides hospitalisation.
MMA president Dr R. Arasu pointed out that after he told the Selangor state government in 2018 that Skim Peduli Sihat’s RM50 limit was inadequate for consultation and medication, the limit was subsequently increased to RM70.
In 2023, the federal government similarly raised the initial RM60 limit for consultation and medication combined under the Madani Medical Scheme to RM70.
“So in 2026, we should seriously ask why RM50 is appearing again as a benchmark for both GP consultation and medication,” Dr Arasu said in a statement yesterday.
“This is not simply about doctors’ fees. It is about what we expect RM50 to pay for.
“A proper GP consultation involves history taking, examination, clinical judgement, diagnosis, counselling, and appropriate treatment. Medication costs vary considerably depending on the patient’s condition and what is clinically required.”
He stressed that although RM50 might be sufficient for some simple consultations, the amount cannot be treated as a reasonable universal benchmark for consultation and medication across different clinical conditions.
In a comparison between AIA’s new A-Plus Health360 medical card and the government-designed MediAsas, CodeBlue reported that A-Plus Health360 offers a GP benefit, which AIA claimed to be the first in the market, capped at RM50 per visit for consultation and medication, up to three visits a year for illnesses like flu or cough.
Despite proposals by doctors’ associations for the minimum GP fee to be raised to RM50 to prevent undercutting by third-party administrators (TPAs) and corporate clients, the Madani government decided last October to retain the RM10 floor but increased the ceiling from RM35 to RM80.
It’s not clear if AIA allows panel providers to charge the maximum RM80 consultation fee, which would mean that policyholders or patients must copay the balance beyond RM50 paid by AIA (including for medications), or if the insurance company caps its payments to panel GPs.
In an interview with CodeBlue last November, before the new RM80 GP fee ceiling came into effect in April 2026, PMCare Sdn Bhd, a TPA, said it paid panel GPs nationwide an average of RM134 per visit, comprising RM100 for medication and RM34 for consultation.
MMA welcomed AIA’s coverage of primary care as a step in the right direction but stressed that primary care should be seen as an investment in health care sustainability, not simply another cost to be capped.
“MMA is not against insurers making commercially sustainable decisions. Insurers, health care providers, and doctors all have a responsibility to ensure that health care remains sustainable,” said Dr Arasu.
“But commercial sustainability cannot come at the expense of clinical appropriateness.
“Insurance products require sound actuarial design. Health care benefits require sound clinical design. One cannot substitute for the other.”
