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Medical Rate Revision

Medical Cost Inflation and Claims Utilisation Trend 2023
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Medical Cost Inflation and Claims Utilisation Trend 2023

Product Level Healthcare Metrics

Medical Plan/Rider Abbreviation Plan/Rider Name Utilisation Rate Average Claim Amount Medical Cost Inflation 2023 Medical Cost Inflation 2022 Medical Cost Inflation 2021 3-year Average Medical Cost Inflation
GMC Great MediCare 215 out of 1,000 policy owners made a claim compared to 170 out of 1,000 policy owners 1* year ago. Reduced from RM8,413 to RM8,407 0% 4% 13% 6%
GMC2 Great MediCare 2 175 out of 1,000 policy owners made a claim compared to 128 out of 1,000 policy owners 1* year ago. Reduced from RM9,752 to RM9,474 -3% 10% 12% 6%
GMX Great Medic Xtra 129 out of 1,000 policy owners made a claim compared to 83 out of 1,000 policy owners 5* years ago. Increased from RM5,727 to RM8,168 -3% 10% 25% 9%
HP + HPI-OAC  Health Protector 203 out of 1,000 policy owners made a claim compared to 150 out of 1,000 policy owners 4* years ago. Increased from RM8,286 to RM9,039 -5% 18% 10% 3%
IL-HP IL Health Protector 118 out of 1,000 policy owners made a claim compared to 94 out of 1,000 policy owners 1* year ago. Reduced from RM9,135 to RM9,057 -1% 4% 11% 5%
SE/SE99 Smart Extender/ Smart Extender 99 5 out of 1,000 policy owners made a claim compared to 2 out of 1,000 policy owners 5* years ago. Increased from RM14,816 to RM17,895 17% 1% 0% 3%
SM/SM99 SmartMedic/ SmartMedic 99 130 out of 1,000 policy owners made a claim compared to 90 out of 1,000 policy owners 3* years ago Increased from RM7,137 to RM8,971 -1% 7% 19% 8%
SMM SmartMedic Million 97 out of 1,000 policy owners made a claim compared to 26 out of 1,000 policy owners 3* years ago. Increased from RM4,828 to RM6,690 8% 20% N/A 18%
SMX/SMX99 SmartMedic Xtra/SmartMedic Xtra 99 122 out of 1,000 policy owners made a claim compared to 81 out of 1,000 policy owners 3* years ago. Increased from RM6,073 to RM7,915 -1% 8% 21% 10%
 * Refer to the number of years since the plan was first introduced, number of years since the previous re-pricing exercise or 5 years, whichever is lowest.

Notes:

1.      Reference time-frame used for computing the Year on Year and 3-year average medical inflation rate:

  • 2023 - 1 July 2022 to 30 June 2023
  • 2022 - 1 July 2021 to 30 June 2022
  • 2021 - 1 July 2020 to 30 June 2021
  • 3-year average - 1 July 2020 to 30 June 2023

2.     This table is intended to provide policyholders with reliable healthcare metrics at the product level, offering a clear understanding of the performance of individual products.

3.     Policyholders should review these metrics cautiously and consider them alongside company-level healthcare metrics for a more comprehensive assessment of their healthcare coverage.

Company Level Healthcare Metrics

Medical Plan/Rider Abbreviation & Name Utilisation Rate Average Claims Amount Medical Cost Inflation 2023 Medical Cost Inflation 2022 Medical Cost Inflation 2021 3-year Average Medical Cost Inflation

All Medical Products with at least 3 years exposure

**Refer to Comprehensive Medical Product List

 77 out of 1,000 policy owners made a claim compared to 59 out of 1,000 policy owners 3* years ago. Increased from RM6,880 to RM8,267 -3% 5% 18% 7%
 * Refer to the number of years since the plan was first introduced, number of years since the previous re-pricing exercise or 5 years, whichever is lowest.


Notes: 

1.      This table represents healthcare metrics at company level.  Metrics are computed based on collective 3-year experience of all medical products, providing an overall picture of the company healthcare costs.

Product Level Healthcare Metrics (Limited Claim Experience)

Medical Plan/Rider Abbreviation Plan/Rider Name Utilisation Rate Average Claims Amount Medical Cost Inflation 2023 Medical Cost Inflation 2022 Medical Cost Inflation 2021 3-year Average Medical Cost Inflation
GHC Great HealthCare Plan 196 out of 1,000 policy owners made a claim compared to 154 out of 1,000 policy owners 1* year ago. RM9,557 0% 3% 14% 6%
GE Great Extender 4 out of 1,000 policy owners made a claim compared to 23 out of 1,000 policy owners 5*  years ago. Increased from RM3,925 to RM19,383 -17% 81% -18% 15%
GHD Great Health Direct 0 out of 1,000 policy owners made a claim compared to 0 out of 1,000 policy owners 3* years ago. RM0 N/A N/A N/A N/A
GMS Great Medic Shield 69 out of 1,000 policy owners made a claim compared to 69 out of 1,000 policy owners 0* year ago.

 RM6,601 -17% N/A N/A -17%
GMME Great Medic Million Extender 2 out of 1,000 policy owners made a claim compared to 2 out of 1,000 policy owners 0* year ago. RM159 N/A N/A N/A N/A
GMS2 Great Medic Shield 2 57 out of 1,000 policy owners made a claim compared to 57 out of 1,000 policy owners 0* year ago. RM6,648 N/A N/A N/A N/A
GMME2 Great Medic Million Extender 2 0 out of 1,000 policy owners made a claim compared to 0 out of 1,000 policy owners 0* year ago. RM0 N/A N/A N/A N/A
IL HCB IL HealthCare Benefit 69 out of 1,000 policy owners made a claim compared to 51 out of 1,000 policy owners 5* year ago. Increased from RM6,209 to RM9,322 11% 9% 6% 9%
SME/SME99 SmartMedic Enhancer/ SmartMedic Enhancer 99 13 out of 1,000 policy owners made a claim compared to 7 out of 1,000 policy owners 5* year ago. Increased from RM371 to RM463 -10% 24% 81% 16%
SPH/SPH99 Smart Premier Health/Smart Premier Health 99 102 out of 1,000 policy owners made a claim compared to 87 out of 1,000 policy owners 5* year ago. Increased from RM6,717 to RM9,765 16% -12% 40% 11%
SEM/SEM99 Smart Extender Max/Smart Extender Max 99 12 out of 1,000 policy owners made a claim compared to 0 out of 1,000 policy owners 5* year ago. Increased from RM0 to RM17,273 210% N/A N/A 210%
SBS Smart Baby Shield 60 out of 1,000 policy owners made a claim compared to 185 out of 1,000 policy owners 3* year ago.

 Increased from RM3,064 to RM4,151 -7% -5% 53% 14%
SMME SmartMedic Million Extender 1 out of 1,000 policy owners made a claim compared to 0 out of 1,000 policy owners 1* year ago. Increased from RM0 to RM6,423 N/A N/A N/A N/A
SMMP SmartMedic Million Plus 6 out of 1,000 policy owners made a claim compared to 2 out of 1,000 policy owners 1* year ago. Reduced from RM429 to RM391 -9% N/A N/A -9%
SMS SmartMedic Shield 66 out of 1,000 policy owners made a claim compared to 66 out of 1,000 policy owners 1* year ago.

 RM5,894 -22% N/A N/A -22%
SMSP SmartMedic Shield Plus 4 out of 1,000 policy owners made a claim compared to 4 out of 1,000 policy owners 0* year ago. RM331 N/A N/A N/A N/A
SMSES SmartMedic Shield Extender Special 0 out of 1,000 policy owners made a claim compared to 0 out of 1,000 policy owners 0* year ago. RM0 N/A N/A N/A N/A
SMSE SmartMedic Shield Extender 1 out of 1,000 policy owners made a claim compared to 1 out of 1,000 policy owners 0* year ago.
 RM89 N/A N/A N/A N/A
SBSP Smart Baby Shield Plus 0 out of 1,000 policy owners made a claim compared to 0 out of 1,000 policy owners 0* year ago. RM0 N/A N/A N/A N/A
MPM MaxPremier Medic 54 out of 1,000 policy owners made a claim compared to 19 out of 1,000 policy owners 5* year ago. Reduced from RM10,679 to RM9,742 N/A N/A -35% -35%
 * Refer to the number of years since the plan was first introduced, number of years since the previous re-pricing exercise or 5 years, whichever is lowest.


Notes: 

1.      This table highlights products with limited claim experience, indicating potential data volatility and reliability.  Metrics for these medical insurance plans have lesser claim experience data so it may not accurately represent the actual healthcare utilization and costs.

2.     Policyholders should review these metrics cautiously and refer to the company-level healthcare metrics to better understand the medical inflation and utilization trends in order to make an informed decision.

3.     Utilisation Rate = 0 represents that there is no claim or less than 1 per 1,000 claim incidence.

4.     Average Claim Amount = 0 represents the product has less than 1 year of exposure or was repriced less than 1 year in latest experience study time-frame.

5.     "N/A" refers to products with no exposure.

**Comprehensive Medical Product List

Medical Plan

  • Great Extender (GE)                                                             
  • Great HealthCare Plan (GHC)                                                         
  • Great Health Direct (GHD)                                                               
  • Great MediCare (GMC)                                                                       
  • Great MediCare 2 (GMC2)                                                                 
  • Great Medic Million Extender (GMME)                                       
  • Great Medic Million Extender 2 (GMME2)                 
  • Great Medic Shield 2 (GMS2)
  • Great Medic Shield (GMS)                                                                
  • Great Medic Xtra (GMX)                                                                    
  • Health Protector (HP/HPI-OAC)

Medical Rider

  • IL HealthCare Benefit (IL HCB)
  • IL Health Protector (IL-HP)                                                               
  • MaxPremier Medic (MPM)                                                                
  • Smart Extender (SE) and Smart Extender 99 (SE99)                         
  • Smart Extender Max (SEM) and Smart Extender Max 99 (SEM99)
  • SmartMedic (SM) and SmartMedic 99 (SM99)
  • SmartMedic Enhancer (SME) and SmartMedic Enhancer 99 (SME99)
  • SmartMedic Million (SMM)                                                
  • SmartMedic Million Extender (SMME)                        
  • SmartMedic Million Plus (SMMP)
  • SmartMedic Shield (SMS)                                                 
  • SmartMedic Shield Extender (SMSE)                          
  • SmartMedic Shield Extender Special (SMSES)      
  • SmartMedic Shield Plus (SMSP)
  • SmartMedic Xtra (SMX) and SmartMedic Xtra 99 (SMX99)                                                        
  • Smart Premier Health (SPH) and Smart Premier Health 99 (SPH99)

Others

  • Smart Baby Shield (SBS)       
  • Smart Baby Shield Plus (SBSP)

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