For many Malaysians, getting medical insurance approved and more importantly, claims accepted can sometimes feel uncertain.
But that may soon change.
Bank Negara Malaysia (BNM) is currently considering a new clause that could offer stronger protection for policyholders, especially when it comes to pre-existing conditions.
A new clause that could change how claims work
BNM Governor Abdul Rasheed Ghaffour revealed that the central bank is working on introducing a “no look-back” mechanism under a proposed Basic Medical and Health Insurance and Takaful (MHIT) plan.
Under this clause, once a policyholder has maintained continuous coverage for a specified period, insurers and takaful operators will no longer be allowed to reject claims based on pre-existing illnesses, reported Berita Harian.
This also means claims cannot be denied due to past medical conditions that were not disclosed earlier.
“For policyholders, this provides long-term certainty and confidence that their protection will be there when they need it,” he said in a recent interview.
A shift away from technical claim rejections
According to Abdul Rasheed, the direction of this new plan is clear, it will not function like some existing private medical insurance products that may reject claims on technical grounds.
Instead, the Basic MHIT plan is designed to offer more inclusive, fair, and continuous protection for Malaysians across different backgrounds.
Why pre-existing conditions are usually excluded
Currently, insurance and takaful providers operate on a risk pooling model.
This means premiums collected from many policyholders are combined into a shared fund to cover unpredictable medical costs.
To keep premiums affordable, providers often exclude or limit coverage for pre-existing conditions. This helps prevent situations where individuals only purchase insurance after falling ill.
If this is not controlled, it would lead to higher claims and push premiums to unaffordable levels, ultimately burdening healthy policyholders,” Abdul Rasheed explained.
Opening doors for more Malaysians
The upcoming Basic MHIT plan aims to expand access to medical protection including for individuals with pre-existing conditions that are stable and well-managed.
BNM is currently finalising the mechanism with input from medical experts and industry players.
This includes determining waiting periods, underwriting rules, and ensuring a balance between broader access and affordable premiums.
Pilot rollout expected in 2026
The plan is expected to be piloted in the second half of 2026, before a full rollout in 2027.
During the pilot phase, BNM will assess how ready the ecosystem is, including insurance providers, takaful operators, and private hospitals.
The trial will also help identify technical issues, test operational readiness, and gather feedback from users.
“If adjustments are needed whether in product structure, benefits, or timelines, we will refine the model to ensure a smooth full rollout,” Abdul Rasheed added.
If implemented successfully, the move could mark a major shift in how medical insurance works in Malaysia offering more certainty and peace of mind to those who need it most.
