Medical Rate Revision
Malaysians have witnessed medical and health insurance premium increase in recent years, driven by rising healthcare costs and higher claims utilisation. The surge in medical expenses, advancements in medical technology, and growing hospitalisation rates resulted in medical inflation and have led insurance companies to implement medical repricing across various health and medical insurance plans.
As policyholders navigate these changes, understanding the key factors behind the medical insurance premium rise is crucial for making informed decisions about their coverage. The information below provides a comprehensive overview of the medical rate revision. Additionally, you can review the Medical Cost Inflation and Claims Utilisation Trend 2024 for further insights into the evolving healthcare landscape.
Medical Cost Inflation and Claims Utilisation Trend 2024
Product Level Healthcare Metrics
| Medical Plan/Rider Abbreviation | Plan/Rider Name | Utilisation Rate | Average Claim Amount | Medical Cost Inflation 2024 | Medical Cost Inflation 2023 | Medical Cost Inflation 2022 | 3-year Average Medical Cost Inflation (per annum) |
|---|---|---|---|---|---|---|---|
| GMC | Great MediCare | 251 out of 1,000 policy owners made a claim compared to 170 out of 1,000 policy owners 2* year(s) ago. |
Increased from RM8,413 to RM9,065 | 8% | 0% | 4% | 4% |
| GMC2 | Great MediCare 2 | 200 out of 1,000 policy owners made a claim compared to 128 out of 1,000 policy owners 2* year(s) ago. |
Increased from RM9,752 to RM10,408 | 10% | -3% | 10% | 6% |
| GMS2 | Great Medic Shield 2 |
86 out of 1,000 policy owners made a claim compared to 57 out of 1,000 policy owners 1* year(s) ago. |
Increased from RM6,648 to RM6,875 | 4% | N/A | N/A | 4% |
| GMX | Great Medic Xtra |
157 out of 1,000 policy owners made a claim compared to 84 out of 1,000 policy owners 5* year(s) ago.
|
Increased from RM5,298 to RM9,358 | 15% | -3% | 10% | 7% |
| HP + HPI-OAC |
Health Protector | 221 out of 1,000 policy owners made a claim compared to 151 out of 1,000 policy owners 5* year(s) ago. |
Increased from RM8,227 to RM9,852 | 15% | -5% | 18% | 9% |
| IL-HP |
IL Health Protector |
126 out of 1,000 policy owners made a claim compared to 94 out of 1,000 policy owners 2* year(s) ago. |
Increased from RM9,135 to RM9,698 | 7% | -1% | 4% | 4% |
| SE/SE99 |
Smart Extender/ Smart Extender 99 |
7 out of 1,000 policy owners made a claim compared to 2 out of 1,000 policy owners 5* year(s) ago. |
Increased from RM13,701 to RM19,447 |
9% | 17% | 1% | 9% |
| SM/SM99 |
SmartMedic/ SmartMedic 99 |
147 out of 1,000 policy owners made a claim compared to 130 out of 1,000 policy owners 1* year(s) ago. |
Increased from RM8,971 to RM9,572 |
7% | -1% | 7% | 4% |
| SME |
SmartMedic Enhancer |
19 out of 1,000 policy owners made a claim compared to 8 out of 1,000 policy owners 5* year(s) ago. |
Reduced from RM397 to RM345 |
-26% | -10% | -24% | -20% |
| SMM | SmartMedic Million |
127 out of 1,000 policy owners made a claim compared to 21 out of 1,000 policy owners 3* year(s) ago. |
Increased from RM5,175 to RM7,864 | 18% | 8% | 20% | 15% |
| SMS | Smart Medic Shield |
89 out of 1,000 policy owners made a claim compared to 66 out of 1,000 policy owners 1* year(s) ago. |
Increased from RM5,894 to RM6,267 | 6% | -22% | N/A | -8% |
| SMX/SMX99 | SmartMedic Xtra/SmartMedic Xtra 99 |
138 out of 1,000 policy owners made a claim compared to 122 out of 1,000 policy owners 1* year(s) ago. |
Increased from RM7,915 to RM8,667 | 10% | -1% | 8% | 6% |
Notes:
1. Reference time-frame used for computing the Year on Year and 3-year average medical inflation rate:
2024 - 1 July 2023 to 30 June 2024
2023 - 1 July 2022 to 30 June 2023
2022 - 1 July 2021 to 30 June 2022
3-year average - 1 July 2021 to 30 June 2024
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 2024 | Medical Cost Inflation 2023 | Medical Cost Inflation 2022 | 3-year Average Medical Cost Inflation (per annum) |
|---|---|---|---|---|---|---|
All Medical Products with at least 3 years exposure **Refer to Comprehensive Medical Product List |
83 out of 1,000 policy owners made a claim compared to 50 out of 1,000 policy owners 3 year(s) ago. |
Increased from RM8,089 to RM8,760 | 6% | -3% | 5% | 3% |
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 2024 | Medical Cost Inflation 2023 | Medical Cost Inflation 2022 | 3-year Average Medical Cost Inflation (per annum) |
|---|---|---|---|---|---|---|---|
| GHC | Great HealthCare Plan | 203 out of 1,000 policy owners made a claim compared to 154 out of 1,000 policy owners 2* year(s) ago. |
Increased from RM9,557 to RM10,582 |
11% | 0% | 3% | 5% |
| GE | Great Extender | 10 out of 1,000 policy owners made a claim compared to 10 out of 1,000 policy owners 5* year(s) ago. |
Increased from RM2,284 to RM21,560 |
11% | -17% | 81% | 25% |
| GHD | Great Health Direct | 86 out of 1,000 policy owners made a claim compared to 0 out of 1,000 policy owners 4* year(s) ago. |
Increased from RM0 to RM8,921 |
N/A | N/A | N/A | N/A |
| GMS | Great Medic Shield | 114 out of 1,000 policy owners made a claim compared to 69 out of 1,000 policy owners 1* year(s) ago. |
Increased from RM6,601 to RM8,896 |
35% | -17% | N/A | 9% |
| GMME | Great Medic Million Extender | 10 out of 1,000 policy owners made a claim compared to 2 out of 1,000 policy owners 1* year(s) ago. | Increased from RM159 to RM375 | 137% | N/A | N/A | 137% |
| GMME2 | Great Medic Million Extender 2 | 2 out of 1,000 policy owners made a claim compared to 0 out of 1,000 policy owners 1* year(s) ago. | Increased from RM0 to RM744 | N/A | N/A | N/A | N/A |
| IL HCB | IL HealthCare Benefit | 80 out of 1,000 policy owners made a claim compared to 69 out of 1,000 policy owners 1* year(s) ago. | Increased from RM9,322 to RM10,247 | 10% | 11% | 9% | 10% |
| SPH/SPH99 | Smart Premier Health/Smart Premier Health 99 | 145 out of 1,000 policy owners made a claim compared to 89 out of 1,000 policy owners 5* year(s) ago. | Increased from RM6,546 to RM9,145 | -6% | 16% | -12% | -1% |
| SEM/SEM99 | Smart Extender Max/Smart Extender Max 99 | 13 out of 1,000 policy owners made a claim compared to 0 out of 1,000 policy owners 5* year(s) ago. |
Increased from RM0 to RM18,160 | 5% | 210% | N/A | 108% |
| SBS | Smart Baby Shield | 179 out of 1,000 policy owners made a claim compared to 185 out of 1,000 policy owners 4* year(s) ago. |
Increased from RM3,064 to RM6,744 | 63% | -7% | -5% | 17% |
| SMME | SmartMedic Million Extender | 1 out of 1,000 policy owners made a claim compared to 0 out of 1,000 policy owners 2* year(s) ago. | Increased from RM0 to RM980 | -85% | N/A | N/A | -85% |
| SMMP | SmartMedic Million Plus | 9 out of 1,000 policy owners made a claim compared to 2 out of 1,000 policy owners 2* year(s) ago. | Increased from RM429 to RM540 | 38% | -9% | N/A | 15% |
| SMSP | SmartMedic Shield Plus | 7 out of 1,000 policy owners made a claim compared to 4 out of 1,000 policy owners 1* year(s) ago. | Increased from RM331 to RM589 | 78% | N/A | N/A | 78% |
| SMSES | SmartMedic Shield Extender Special | 0 out of 1,000 policy owners made a claim compared to 0 out of 1,000 policy owners 1* year ago. | RM0 | N/A | N/A | N/A | N/A |
| SMSE | SmartMedic Shield Extender | 0 out of 1,000 policy owners made a claim compared to 1 out of 1,000 policy owners 1* year(s) ago. | Reduced from RM89 to RM0 | N/A | N/A | N/A | N/A |
| SBSP | Smart Baby Shield Plus | 155 out of 1,000 policy owners made a claim compared to 155 out of 1,000 policy owners 0* year(s) ago. | RM2,049 | N/A | N/A | N/A | N/A |
| SMSDAL |
Smart Medic Shield Double Annual Limit |
0 out of 1,000 policy owners made a claim compared to 0 out of 1,000 policy owners 0* year(s) ago. | RM0 | N/A | N/A | N/A | N/A |
| MPM | MaxPremier Medic | 56 out of 1,000 policy owners made a claim compared to 58 out of 1,000 policy owners 5* year(s) ago. | Increased from RM5,353 to RM8,584 | -12% | N/A | N/A | -12% |
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 and Health Protector Insurance (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 Double Annual Limit (SMSDAL)
- 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)