Introduction
MediAsas co-payments determine how much you must pay when you are admitted to a hospital under this medical insurance scheme. Although premiums start from RM65 per month, you may still need to pay a RM500 deductible and 20% co-insurance, depending on the hospital and treatment. This guide explains the MediAsas co-payments structure, including panel and non-panel hospital charges, emergency admissions, and estimated out-of-pocket costs.
Before you enroll, you must fully understand how MediAsas co-payments work. Specifically, this system dictates exactly how much cash you must pay out of your own pocket before the insurance steps in. Consequently, this guide breaks down the math so you can prepare your emergency funds accurately.
MediAsas Co-Payments: What Are Deductibles and Co-Insurance?
To ensure the MediAsas scheme remains financially sustainable for the country, it utilizes two specific cost-sharing mechanisms for every hospital admission. Understanding these terms is crucial to avoid sudden financial shocks.
- Deductible: A fixed cash amount (RM500) that you must pay upfront when you are admitted to the hospital.
- Co-Insurance: After paying the deductible, you must pay a small percentage (20%) of the remaining hospital bill. Meanwhile, the insurance covers the other 80%.
Hospital Admissions: Panel vs Non-Panel
Under the official MediAsas framework, you are subject to the same RM500 deductible and 20% co-insurance rule. This applies whether you hold the basic Teras plan or the upgraded Fleksi plan. However, the primary difference lies in the maximum cap applied to that 20% charge, depending on the hospital you visit:
- Panel Hospitals (In-Network): You pay the RM500 deductible plus the 20% co-insurance. Fortunately, that 20% charge is strictly capped at a maximum of RM1,000.
- Non-Panel Hospitals (Out-of-Network): You pay the RM500 deductible plus the 20% co-insurance. Here, the cap is much higher, forcing you to pay up to a maximum of RM3,000.
Real-World Mathematical Examples
Let’s simulate a scenario where you undergo surgery, resulting in a total hospital bill of RM20,000.
Scenario A: Treatment at a Panel Hospital
- Deductible: RM20,000 – RM500 = Remaining balance of RM19,500.
- Calculate 20% Co-insurance: 20% of RM19,500 = RM3,900.
- Apply the Cap: Since this is a panel hospital, the RM3,900 charge is reduced to the maximum cap of RM1,000.
- Total Out-of-Pocket Cash: RM500 (Deductible) + RM1,000 (Co-insurance) = RM1,500.
- (MediAsas pays the remaining RM18,500).
Scenario B: Treatment at a Non-Panel Hospital
- Deductible: RM20,000 – RM500 = Remaining balance of RM19,500.
- Calculate 20% Co-insurance: 20% of RM19,500 = RM3,900.
- Apply the Cap: Since this is a non-panel hospital, the maximum cap is RM3,000. Therefore, you must pay RM3,000.
- Total Out-of-Pocket Cash: RM500 (Deductible) + RM3,000 (Co-insurance) = RM3,500.
- (MediAsas pays the remaining RM16,500).
What About Emergency Admissions?
A common misconception is that deductibles are waived during all medical emergencies. In reality, under the MediAsas scheme, deductibles and co-insurance charges are only waived completely if you receive emergency treatment at a Government Hospital.
Conversely, if you are rushed to the emergency room of a Private Hospital, you are still legally required to pay the standard RM500 deductible. Furthermore, the accompanying co-insurance applies regardless of whether it is a panel or non-panel facility.
Quick Comparison: MediAsas Cost-Sharing
| Cost-Sharing Feature | Private Panel Hospital | Private Non-Panel Hospital | Government Hospital (Emergency) |
| Fixed Deductible | RM500 | RM500 | Fully Waived |
| Co-Insurance Rate | 20% of the remaining bill | 20% of the remaining bill | Fully Waived |
| Co-Insurance Maximum Cap | Capped at RM1,000 | Capped at RM3,000 | No charges applied |
| Maximum Total Out-of-Pocket | RM1,500 | RM3,500 | RM0 |
Frequently Asked Questions (FAQ)
- Does the upgraded Fleksi plan have a higher deductible?
- No. Both the RM100,000 Teras plan and the RM300,000 Fleksi plan use the exact same RM500 deductible. Additionally, the 20% co-insurance structure applies equally per disability.
- Do I need to prepare emergency savings before being admitted?
- Yes, it is highly recommended. Because MediAsas co-payments rely on a cost-sharing mechanism, you must prepare an emergency cash fund. At least RM1,500 is needed (if planning to use panel hospitals) to ensure smooth admission and discharge processes.
- Where can I compare these medical plans?
- You can visit Bjak.my to easily compare quotes and benefits side by side. This helps you evaluate the true cost differences between MediAsas and standard private medical cards.
Related Bjak Guides
For more essential context, read our comprehensive guide on medical insurance basics in Malaysia. Understanding how hospital coverage works fundamentally will help you make better financial decisions. Additionally, compare the differences between medical cards and critical illness cover before browsing quotes.
How Bjak Helps You
Navigating complex insurance terms like deductibles and co-insurance should not prevent you from securing vital health protection. At Bjak, we prioritize complete transparency in every medical package we showcase to our users.
On Bjak.my, you can easily compare health insurance plans from Malaysia’s top insurers side-by-side on a single screen. Effortlessly analyze policy limits, premium prices, and deductible rates without any hidden fees. Once you find the perfect fit, complete your enrollment 100% online in just minutes!
Conclusion
In conclusion, the MediAsas co-payments system is the precise mechanism that allows its monthly premiums to remain incredibly affordable for the masses. It balances public affordability while effectively preventing the exploitation of medical claims.
However, this policy strictly requires you to be disciplined enough to maintain an emergency cash fund (RM1,500 to RM3,500) for unforeseen medical events. Take a few minutes today to evaluate your health risks and compare the best medical coverage options at Bjak.my!
Also Read:
Sistem Ko-Bayaran MediAsas: Berapa Anda Kena Bayar?
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MediAsas vs normal medical cards: Which is better?
