A medical card is a healthcare financing product offered by insurance companies and takaful operators that provides coverage for hospitalization and medical expenses.
It covers hospital admission, surgical procedures, medication, and other medical treatments up to the policy limit. When cardholders seek treatment at panel hospitals, they can enjoy cashless admission without having to pay upfront for covered medical expenses.
What Does A Medical Card Cover?
A medical card typically provides coverage for various medical expenses including hospital room and board, surgical procedures, specialist consultations, and prescription medications. The coverage extends to both planned treatments and emergency care.
Most medical cards also cover pre-hospitalization diagnostic tests and post-hospitalization follow-up treatments within a specified period, usually 30-90 days before and after hospitalization.
What Are The Types Of Medical Cards?
Medical cards come in different tiers with varying coverage limits and benefits:
- Basic medical cards covering essential hospitalization and surgical expenses
- Comprehensive plans with higher coverage limits and additional benefits
- Investment-linked medical cards that combine protection with investment elements
- Group medical cards provided by employers
Each type offers different coverage limits, room eligibility, and additional benefits.
How Does The Cashless Admission Work?
When visiting panel hospitals, cardholders present their medical card at admission. The hospital verifies coverage with the insurance provider/takaful operator and processes admission without requiring upfront payment.
For non-panel hospitals or overseas treatment, cardholders typically need to pay first and claim reimbursement later, subject to policy terms and conditions.
What Are The Common Exclusions?
Medical cards usually don’t cover:
- Pre-existing conditions (within waiting period)
- Cosmetic procedures
- Fertility treatments
- Dental care (unless due to accidents)
- Congenital conditions
- Self-inflicted injuries
- Experimental treatments
It’s important to review policy exclusions carefully before purchasing.
What Are The Key Features To Consider?
When choosing a medical card, consider:
- Annual and lifetime coverage limits
- Room and board coverage
- Network of panel hospitals
- Coverage for critical illnesses
- Overseas treatment coverage
- Deductibles or co-insurance requirements
- Premium/contribution increases with age
Understanding these features helps in selecting appropriate coverage.
How Much Does It Cost?
Premium/contribution rates depend on various factors:
- Age at entry
- Health condition
- Smoking status
- Coverage amount selected
- Type of plan chosen
- Additional riders or benefits
Rates typically increase with age and are reviewed annually based on claims experience.
What About Pre-Existing Conditions?
Pre-existing conditions are usually subject to waiting periods, typically:
- 30 days for general conditions
- 120 days for specific illnesses
- 12 months for pre-existing conditions
Some conditions might be permanently excluded or covered with loading (higher premiums).
How To Make The Best Use Of Medical Cards?
To maximize medical card benefits:
- Understand policy terms and coverage limits
- Keep track of panel hospitals in your area
- Maintain a healthy lifestyle to avoid premium loading
- Consider supplementary coverage for gaps
- Keep emergency contact numbers handy
- Review coverage periodically as needs change
Regular review ensures your protection remains adequate for your needs.
