MediAsas · Coverage and costs

How does MediAsas work? Coverage, costs & what you pay

Direct answer

MediAsas helps pay eligible medical expenses, mainly for private healthcare, but it does not mean every hospital bill is fully covered.

What you pay depends on your MediAsas plan, your deductible, whether you use a Preferred In-Network Provider, your remaining annual limit and whether the treatment is covered.

Last reviewed: August 18, 2026

2026 pilot noteThe information below reflects the MediAsas Pilot Programme FAQ dated 29 July 2026. Benefits, terms and conditions may change before the industry-wide MediAsas launch scheduled for January 2027.

The basics

How does MediAsas work?

MediAsas is a standalone medical insurance or takaful plan under Malaysia's Medical and Health Insurance/Takaful (MHIT) framework.

When you receive eligible treatment, the insurer or takaful operator pays eligible medical expenses after applicable deductibles, co-insurance or co-takaful, subject to benefit-specific limits, the overall annual limit and the terms of your policy or takaful certificate.

In simple terms

Choose a plan
Keep coverage active
Get eligible treatment
Pay your applicable share
MediAsas pays the remaining eligible costs, subject to benefit limits and plan terms

There are two plan options:

MediAsas Teras
MediAsas Fleksi

They provide the same core benefit categories, but have different annual limits and cost-sharing structures.

Coverage

What does MediAsas cover?

MediAsas covers eligible hospitalisation and selected outpatient medical expenses, subject to the plan's terms and annual limit.

Core benefits include:

Hospital room and board
Intensive care
Hospital supplies and services
Surgery and operating theatre fees
Anaesthetist fees
In-hospital doctor visits
Ambulance fees
Day surgery
Pre-hospitalisation treatment
Post-hospitalisation treatment
Post-hospitalisation physiotherapy
Post-hospitalisation home nursing care
Outpatient cancer treatment
Selected outpatient illness treatment

Selected outpatient illness treatment includes dengue fever, bronchitis, influenza A and B, and pneumonia or bronchopneumonia under the 2026 pilot.Coverage does not mean every medical expense is automatically payable. Exclusions, waiting periods, deductibles and annual limits still apply.

Your share

What do I have to pay with MediAsas?

You may need to pay four types of costs: your premium or takaful contribution, a deductible, applicable co-insurance or co-takaful, and any expenses not covered by the plan.

1
Premium or takaful contribution
This is what you pay to keep your MediAsas coverage active. Premiums or contributions can be paid monthly. They are not guaranteed and may change based on factors such as attained age, medical costs and the overall claims experience of the MediAsas portfolio.
2
Deductible
A deductible is the amount you must bear before MediAsas pays the remaining eligible expenses. The deductible differs between MediAsas Teras and MediAsas Fleksi.
3
Co-insurance or co-takaful
This means you pay a percentage of an eligible bill in situations where cost-sharing applies. Under the 2026 pilot, this mainly affects MediAsas Teras when treatment is received outside the preferred network.
4
Expenses not covered
You are responsible for costs that fall outside the plan's coverage, exceed applicable limits or are excluded under the policy or takaful certificate.

Deductibles

How much is the MediAsas deductible?

The deductible depends on whether you choose Teras or Fleksi and whether you use a Preferred In-Network Provider.

2026 pilot cost-sharing

MediAsas Teras and Fleksi deductibles and co-insurance under the 2026 pilot, by provider network.
Plan	Preferred In-Network Provider	Out-of-Network Provider
MediAsas Teras, age 0–59	RM500 deductible per disability	RM500 deductible + 20% co-insurance/co-takaful, capped at RM3,000 per disability
MediAsas Teras, age 60+	RM1,000 deductible per disability	RM1,000 deductible + 20% co-insurance/co-takaful, capped at RM3,000 per disability
MediAsas Fleksi	RM10,000 deductible per year	RM15,000 deductible per year

MediAsas Fleksi does not generally apply co-insurance or co-takaful on top of its annual deductible under the 2026 pilot.Cancer drug exception: up to 20% co-insurance or co-takaful may apply to specified cancer drugs under the MediAsas Cancer Drug List. This cost-sharing is currently waived until the Cancer Drug List is established and published.

Outpatient cost-sharing

Do the same deductibles apply to outpatient illness treatment?

No. Selected outpatient illness treatment has a different cost-sharing structure.

Under the 2026 pilot, selected outpatient illness treatment covers dengue fever, bronchitis, influenza A and B, and pneumonia or bronchopneumonia.

For MediAsas Teras:

RM50 deductible per outpatient visit
Benefit limit of up to RM3,000 per year

For MediAsas Fleksi:

The applicable RM10,000 in-network or RM15,000 out-of-network annual deductible continues to apply
Benefit limit of up to RM3,000 per year

This is separate from the standard RM500 or RM1,000 Teras deductible per disability used for other eligible treatment.

Definition

What does "deductible per disability" mean?

For MediAsas Teras, the deductible applies to a period of treatment arising from the same medical cause and related complications.

A new deductible may apply for a separate disability. A disability is treated as separate if the person has fully recovered and has remained free from further treatment for that disability for at least 90 days after the latest discharge.

Definition

What does "deductible per year" mean?

For MediAsas Fleksi, the deductible applies across claims within the same policy or certificate year, regardless of how many different medical conditions are involved.

Once the applicable annual deductible has been met, the insurer or takaful operator bears the remaining eligible costs for that year, subject to the annual limit and other policy terms. The deductible resets when the policy or certificate renews.

What gets paid

Does MediAsas pay the full hospital bill?

Not always.

The amount MediAsas pays can depend on:

Your plan
Your deductible
Any applicable co-insurance or co-takaful
Whether the hospital is in-network
Whether the treatment is covered
Your remaining annual limit
Exclusions and waiting periods
Charges above covered benefits

Simple example

For a RM6,000 eligible hospital bill under MediAsas Teras for a person below age 60:

At a Preferred In-Network Provider

You pay: RM500
Insurer/takaful operator pays: RM5,500

At an Out-of-Network Provider

Deductible: RM500
20% co-insurance/co-takaful: RM1,200
You pay: RM1,700
Insurer/takaful operator pays: RM4,300

This example assumes the full RM6,000 is otherwise eligible for coverage and reflects the MediAsas 2026 Pilot FAQ.

Provider network

Does the hospital I choose affect how much I pay?

Yes. Using a Preferred In-Network Provider can reduce your out-of-pocket cost and make the claims process simpler.

Preferred In-Network Providers are hospitals and healthcare providers included in the MediAsas preferred network.

At these providers:

Cashless facilities are generally available
Your out-of-pocket cost can be lower
A larger share of eligible hospital expenses may be paid by the insurer or takaful operator

At an Out-of-Network Provider, you may face a higher deductible, additional cost-sharing or a pay-first-and-claim-later process. The preferred provider list can change over time, so check the latest list before planned treatment.

Claims journey

How does a MediAsas cashless hospital admission work?

At a Preferred In-Network Provider, eligible medical expenses can generally be settled through a cashless facility.

For planned treatment:

1Check that the hospital is in the MediAsas preferred network.
2Confirm that the planned treatment is covered.
3Present your MediAsas e-medical card during registration.
4A pre-authorisation request is submitted through the hospital.
5If approved, an Initial Guarantee Letter is issued.
6Proceed with admission and treatment.
7Review the final hospital bill and Final Guarantee Letter before discharge.
8Pay any deductible, co-payment or other amount not covered by the plan.

A Guarantee Letter is subject to pre-authorisation, assessment and the terms of your policy or takaful certificate.

Guarantee Letter

What if I do not get a Guarantee Letter?

You may still receive treatment and submit a reimbursement claim, subject to your policy or takaful certificate terms.

If a Guarantee Letter is not issued, you may need to pay the hospital bill upfront and claim eligible expenses from your insurer or takaful operator afterwards.

Out-of-network

What happens at an Out-of-Network Provider?

You may need to pay the hospital first and submit a claim for reimbursement.

The usual process is:

1Receive treatment.
2Review your hospital bill.
3Pay the hospital charges upfront.
4Submit the claim to your insurer or takaful operator.
5Include required documents such as itemised bills and medical reports.
6The insurer or takaful operator assesses the eligible amount.
7Applicable deductibles, co-payments and exclusions are deducted.

Out-of-network treatment can therefore mean higher upfront and out-of-pocket costs.

Annual limits

What are the MediAsas annual limits?

The annual limit is the maximum amount available for eligible medical expenses within a policy or certificate year. It is not a cash payout.

2026 pilot annual limits

MediAsas overall annual limits by plan under the 2026 pilot.
Plan	Overall annual limit
MediAsas Teras, age 0–59	RM100,000
MediAsas Teras, age 60+	RM150,000
MediAsas Fleksi	RM300,000

MediAsas does not impose an overall lifetime limit under the 2026 pilot. If your available annual limit is exhausted, further expenses above that limit are not payable under MediAsas for that policy or certificate year.

Waivers

Are there situations where I do not have to pay the Teras deductible?

Yes. Under the 2026 pilot, the MediAsas Teras deductible and co-insurance/co-takaful are waived in several situations.

The waiver applies when:

Treatment is received at a Government Healthcare Facility
Emergency Treatment applies
Outpatient Cancer Treatment applies

This waiver does not apply to MediAsas Fleksi under the current pilot.

Exclusions

What may not be covered by MediAsas?

MediAsas has exclusions and waiting periods, so not every illness or treatment is immediately covered.

Important examples under the 2026 pilot include:

Pre-existing conditions
A general 30-day waiting period for applicable disabilities, except accidental injury
A 120-day waiting period for specified illnesses
Cosmetic or plastic surgery
Most routine dental treatment
Refractive eye procedures such as LASIK
Certain other exclusions listed in the policy or takaful certificate

Always refer to the latest Product Disclosure Sheet and policy or takaful certificate before relying on coverage.

Existing coverage

Can MediAsas work together with my company medical coverage?

Yes. MediAsas can complement employer medical benefits or an existing medical card.

For example, someone with employer medical coverage may use that coverage toward medical expenses and use MediAsas for additional eligible expenses, subject to the terms and claims rules of both plans.

MediAsas Fleksi may be relevant to consumers who already have medical coverage because it uses a higher annual deductible.

FAQ

Frequently asked questions

No. Your deductible, applicable co-insurance or co-takaful, annual limit, exclusions and uncovered expenses can affect how much MediAsas pays.

A MediAsas deductible is the amount you must bear before the insurer or takaful operator pays the remaining eligible expenses. Teras uses a deductible per disability, while Fleksi uses an annual deductible under the 2026 pilot.

You can seek treatment outside the preferred network, but the claims process and your out-of-pocket costs may differ. Preferred In-Network Providers generally offer cashless facilities and lower cost-sharing.

MediAsas can generally be used on a cashless basis at Preferred In-Network Providers, subject to pre-authorisation and approval. Out-of-network treatment may require you to pay first and claim reimbursement later.

Yes. A Guarantee Letter facility is available at Preferred In-Network Providers, subject to pre-authorisation, assessment and policy or certificate terms.

During the 2026 pilot, MediAsas Teras has an annual limit of RM100,000 for ages 0–59 and RM150,000 from age 60. MediAsas Fleksi has a RM300,000 annual limit.

No overall lifetime limit is imposed under the 2026 MediAsas pilot.

Any eligible amount above your remaining annual limit is not payable under MediAsas for that policy or certificate year and would need to be covered by another source or paid by you.

No. Under the 2026 pilot, MediAsas benefits apply only to treatment received in Malaysia.

Before you rely on your coverage

Check three things before planned treatment.

1Is the treatment covered?
2Is the hospital a current Preferred In-Network Provider?
3How much deductible or other cost-sharing applies to your plan?

MediAsas terms may change as the pilot progresses, so use the latest information from your insurer, takaful operator and Bank Negara Malaysia.

Related guides

Primary source: Bank Negara Malaysia

This page summarises publicly available information published by Bank Negara Malaysia. Refer to the official pages for the full details.