Introduction
Medical inflation in Malaysia has spiked drastically, with healthcare costs rising by 15% in 2024. This surge has left many middle-income earners unable to afford conventional health insurance. In response, the government and Bank Negara Malaysia (BNM) are introducing the MediAsas RM65 medical insurance scheme, which will officially roll out nationwide in 2027.
While a basic monthly premium starting from RM65 sounds incredibly appealing, it is crucial to understand the fine print. This transparent guide breaks down exactly how the coverage works, the strict co-payment rules, and the major policy exclusions you must know before signing up.
What Is MediAsas RM65 Medical Insurance?
MediAsas is a standalone, voluntary medical insurance and takaful plan designed to provide an affordable healthcare safety net. Unlike conventional investment-linked policies, it strips away extra bundled benefits to ensure premiums are used solely for medical protection.
Eligible Malaysians can seamlessly enroll at any time before turning 70 years old, and the coverage extends up to age 85. Ultimately, it is meant to complement the government healthcare system rather than completely replace comprehensive private medical cards.
MediAsas Teras vs Fleksi
The scheme offers two distinct tiers: the Teras (Basic) plan and the Fleksi (Plus) plan. The Teras plan provides an annual limit of RM100,000, which automatically increases to RM150,000 once policyholders reach age 60. This basic tier requires an upfront deductible of RM500 per disability for those aged 59 and below.
Conversely, the Fleksi plan offers a much higher RM300,000 annual limit but comes with a massive financial catch. It requires a staggering RM10,000 to RM15,000 annual deductible that you must pay entirely out of pocket before the insurance covers anything. On the positive side, neither plan imposes a lifetime limit.
How Much Do You Pay Out of Pocket?
The way you pay out-of-pocket depends heavily on which specific hospital you visit. For the Teras plan at a panel (in-network) facility, you only pay the flat RM500 deductible per disability with no extra co-payment.
However, visiting an out-of-network provider requires that same deductible plus a 20% co-insurance charge on the remaining bill. For example, on an RM10,000 bill at a non-panel hospital, you pay the RM500 deductible first. Then, you pay 20% of the remaining RM9,500 (RM1,900), bringing your total out-of-pocket cost to RM2,400. Fortunately, this co-insurance is strictly capped at RM3,000 per disability.
MediAsas Coverage Exclusions
To keep the RM65 premium sustainable, BNM has outlined 35 major exclusions where the policy will not pay out. Most importantly, all pre-existing conditions diagnosed before your enrollment are strictly excluded from coverage.
Additionally, the plan completely excludes treatments for mental or nervous disorders, routine maternity care, pregnancy complications, and dental treatments. It also does not cover alternative medicine (like acupuncture), cosmetic surgery, sexually transmitted infections, or weight management treatments.
Waiting Periods and the No-Look-Back Clause
Like standard commercial insurance, MediAsas imposes a 30-day waiting period for general medical conditions (except accidents). Furthermore, there is a strict 120-day wait for specified severe illnesses before claims can be made.
The scheme does advertise a unique “no look-back” clause that protects consumers if they need to switch insurers. However, policyholders must be fully aware that this specific safeguard only takes effect after seven continuous years of holding the policy.
Quick Comparison: MediAsas Teras vs Fleksi
| Feature | MediAsas Teras (Basic) | MediAsas Fleksi (Plus) |
| Annual Limit | RM100,000 (RM150k after age 60) | RM300,000 |
| Upfront Deductible | RM500 to RM1,000 (per disability) | RM10,000 to RM15,000 (per annum) |
| Emergency Copay Waiver | Yes, deductibles are waived | No, you must still pay the deductible |
| Outpatient Copayment | RM50 deductible per visit | RM50 deductible per visit |
Frequently Asked Questions (FAQ)
- Can I pay the monthly premium using my EPF?
- Yes, you can. To make the scheme highly accessible, participation is voluntary and premiums may be paid directly using your monthly income or through your EPF Account Sejahtera.
- Does MediAsas cover emergency room visits for free?
- This depends entirely on your plan. Under the Teras plan, copayments are waived for emergency treatments and government health care facilities. However, if you hold the Fleksi plan, you must still pay the massive RM10,000 to RM15,000 deductible even during a medical emergency.
- Is this a complete replacement for my current medical card?
- No, it is not. Due to its 35 major exclusions and strict out-of-pocket deductibles, MediAsas acts as a basic safety net. If you require comprehensive coverage without massive upfront fees, a conventional private medical card remains superior.
Related Bjak Guides
For more essential context, read our comprehensive guide on medical insurance basics to fully understand how health policies work. You can also explore exactly Ways to get lower medical insurance premiums and discover the crucial differences between medical cards and critical illness cover.
How Bjak Helps
Bjak believes in complete transparency when it comes to your financial health and medical protection. On Bjak.my, you can easily compare various health insurance quotes from Malaysia’s top insurers side-by-side on a single screen.
Consequently, you can clearly see the differences in deductibles, policy exclusions, and annual limits before making a serious commitment. Whether you need a basic safety net like MediAsas or a fully comprehensive private medical card, Bjak empowers you to review and purchase your policies 100% online.
Conclusion
In conclusion, the MediAsas scheme is a genuinely helpful initiative for middle-income Malaysians struggling with medical inflation. The RM65 starting premium provides an essential, affordable entry point into private healthcare access. Before you decide, compare the MediAsas RM65 medical insurance scheme with existing private medical cards.
However, consumers must remain highly realistic about the strict deductibles, out-of-pocket co-payments, and 35 major exclusions. Always weigh these financial limitations carefully, and take the time to compare your healthcare options on Bjak.my before the official 2027 rollout!
Also Read:
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Comparing Quotes from 10+ Insurers: How Bjak Works
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