What You Need To Know When Making A Life Insurance Claim

We all take steps such as exercise, healthy eating, and avoiding bad habits to keep healthy. It can be very gratifying to be working on avoiding bad health consequences and maximising our quality of life. However, even the healthiest are not immune to medical emergencies or the unthinkable. This is why it is important to know that should the time come when either occurs, you and your family are financially protected. But having insurance is not enough if you do not make a claim. There are two types of claims that are important to understand: medical insurance and life insurance.

What is medical insurance?

Malaysia’s medical inflation was projected at 12% in 2022. In comparison the September 2022 inflation rate was about 4 times lower at 3.3%. It is becoming increasingly important to be covered by medical insurance.
 
Medical insurance can be broken down into several types that cover either hospitalisation and surgical or provide lump sum cash for you to recover from your critical illness. To find out more about the two, check out our article here.

a) Hospitalisation and surgical insurance

• Covers hospital and surgical expenses incurred by specified diseases and injuries. 
• Suitable for anyone who wants to have less financial stress by avoiding having to pay for hospitalisation and treatment. 
• Important to consider whether the policy allows for continual coverage by the insurer even after the diagnosis of a long term illness that requires constant follow up visits to the hospital.

b) Critical illness insurance

• Provides a lump sum benefit upon diagnosis of any listed critical illness conditions specified in the policy such as cancer, heart attack, stroke, etc.
• Suitable if you or your family depend heavily on your income, people with hereditary illness, and the elderly. 

With i-Protect, you can get your critical illness coverage starting from only RM7.60 per month. It covers the three most common critical illnesses in Malaysia that include cancer, stroke, and heart attack. Get a quick quote here

What is life insurance?

Nobody is immune to unforeseen circumstances that will financially affect their loved ones. The RinggitPlus 2018 Malaysian Financial Literacy Survey found that as many as 59% of Malaysians do not have enough savings to last them for more than 3 months and that 34% admitted to spending equal to or more than their monthly salary. In September 2020, over 50% of Employee Provident Fund (EPF) contributors above 54 have savings of below RM50,000. These statistics show many Malaysians do not have enough to leave a comfortable legacy to their loved ones. 

Life insurance pays a lump sum known as a death benefit to your beneficiaries after the life assured’s death. It is suitable for people who want to provide security for their family after their passing. In this case, your beneficiaries will have to make the claim. 

Life insurance can also include total & permanent disability (TPD) and accidental death benefit which:

• Pays a lump sum insured amount in part or in whole, depending on the severity of the disability.
• Suitable if you and your family rely on you to maintain a comfortable lifestyle.

With i-Care, you can get your life insurance coverage starting from only RM9.75 per month. It has a sum assured coverage of up to RM500,000, with death and total & permanent disability benefit. Get a quick quote here.

Claiming medical insurance

Now that you know the types of insurance, let’s start with how to make a medical insurance claim. The two common ways are:

a) Cashless and hassle-free admissions

Most medical insurance plans such as Gibraltar BSN i-Med provide cashless and hassle-free admissions. It allows for admission into hospitals without the need to provide funds upfront for medical treatment. With most cashless policies, just presenting your medical card to a panel hospital will suffice for admission. Some medical cards are digital, such as Gibraltar BSN’s medical app that contains your e-Medical Card and allows you to view the claims that you have made. To ensure a smoother admission and avoid being on the hospital waiting list, you could call your insurance provider or agent beforehand and inform them of your situation to get a Letter of Guarantee for quicker admission.
 
The insurance provider will settle the hospital bills directly subject to the policy terms and conditions. The claims settlement process is fast-tracked. You can recover better without the need to worry about payment and documentation on the hospital bed. 

If your preferred hospital is not a part of the insurance company’s network, then you won’t be able to raise a Cashless Claim request. That is why it is important to be insured with a provider that has a tie-up with the top hospitals in or around your area. 

The main attraction of cashless and hassle-free admission is the convenience which makes it the most preferable way for admission into a hospital. However, the other option, a pay and claim model, is still viable. 

b) Pay and claim

With this type of claim, you can seek treatment in the hospital of your choice. You make your payment first as an out-of-pocket expense before admission. It is advisable to get in touch with your insurance provider immediately as most insurance providers require you to inform them within a specified time limit after incurring the cost.

There are key steps when making a pay and claim. Make sure you check that your policy is still in force. When you make a claim, different companies require different documents. Below are some of Gibraltar BSN’s required documents related to medical insurance.

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Required documents for a Gibraltar BSN medical claim

• Original copies of:
  a) Medical bill(s) and receipt(s)
• Certified true copies of:
   a) Itemised bills
   b) Test result(s) available
   c) Discharged note(s)
   d) Bank statements / bank book details (for auto credit verification)

Required documents for a Gibraltar BSN hospital and surgical benefit claim

• Certified true copies of:
  a) Discharge note(s)
  b) Test result(s) available
  c) Medical bill(s) and receipt(s)
  d) Bank statements/bank book details (for auto credit verification)

Required documents for a Gibraltar BSN critical illness claim

• Original copies of:
  a) Life Assured's policy document (otherwise complete Indemnity for Loss of Policy Contract)
• Certified true copies of:
  a) Blood test, ECG and/or radiology reports, Histopathological report
  b) Bank statements / bank book details (for auto credit verification)
  c) Discharged note(s)
  d) Other relevant medical evidence
• Miscellaneous:
  a) Proof of age, i.e. identity card or birth certificate (if age was not previously disclosed)

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For greater convenience and to focus on your recovery without worrying about reimbursement, ensure you get a medical plan that has cashless and hassle-free admission like Smart Health Cover. It has no lifetime limit and includes comprehensive medical coverage. Learn more here.

Claiming life insurance

Life insurance provides financial protection for your loved ones in the event of your passing. The easiest way to ensure they receive the sum assured from the insurance company is by nominating them.

Firstly, it is important that you understand what happens when you nominate someone. A nomination is made so that the policy monies can be disbursed much faster without the need to obtain the Grant of Probate or Letter of Administration or Distribution Order. You can also nominate more than one individual and indicate the portions to be paid out to each of them.

Your parents, spouse or children are your legal beneficiaries. If you nominate someone other than them, they will receive the money as an executor and must distribute it according to your will. To learn more about insurance nomination, check out our article Making A Nomination: What You Need To Know.

Secondly, for your nominee to receive the lump sum, it is important that they understand how to make a death claim. The nominee should have a copy of your policy documents so they can make a claim from the insurance provider. If there is no copy of a policy, the nominee would not know they can make a claim or with which insurance provider. There are different processes from different companies when making a death claim, but here are the key documents required from Gibraltar BSN.

Required documents for a Gibraltar BSN death claim

• Original copies of:
  a) Life Assured’s policy (otherwise complete Indemnity Loss of Policy Contract)
  b) Deed of assignment (if available)
• Certified true copies of:
  a) Death certificate
  b) Burial Permit or Police Report (for Cause of Death classified as 'Unknown' or Death certified by Police)
  c) Letter from JPN (for Oversea Death)
  d) MRTA (Mortgage Reducing Term Assurance) certificate if applicable
  e) Nominee’s NRIC
  f) Proof of relationship, i.e. marriage certificate (spouse), birth certificate (child / deceased)
  g) Bank statements/bank book details (for auto credit verification)
• Miscellaneous:
  a) Proof of age, i.e. identity card or birth certificate (if age was not previously disclosed)
  b) Letters of Administration / Grant of Probate / Form E or F under Small Estates (Distributions) Act 1955 / Court Order
• Additional document for Accidental Death Benefits:
  a) Certified true copies of:
       i) Police Report
       ii) Third-Party Police Report
       iii) Final Investigation Police Report
       iv) Post Mortem / Autopsy Report
       v) Toxicology Report
       vi) News article on the accident (if available, in any language) 

Required documents for a Gibraltar BSN total and permanent disability claim

• Original copies of:
  a) Life Assured’s policy document (otherwise complete Indemnity Loss of Policy Contract)
• Certified true copies of:
  a) Blood test, and all radiology reports
  b) Bank statements/bank book details (for auto credit verification)
• Photocopies of:
  a) Medical bill(s) and receipt(s)
• Miscellaneous:
  a) Proof of age, i.e. identity card or birth certificate (if age was not previously disclosed
• Additional document for Accidental Total and Permanent Disability Benefit
  a) Certified true copies of: 
      i) Police Report
      ii) Third-Party Police Report
      iii) Final Investigation Police Report
      iv) News article on the accident (if available, in any language) 

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Conclusion

Understanding the claims process is not only so that you may fully utilise your insurance, but also for the peace of mind that comes with that knowledge. The claims process does not need to be difficult, especially with a good insurance provider, and after being equipped with this knowledge.

Have further questions? Don’t fret! Contact any one of these channels for assistance.

1. GINA, our chatbot at gibraltarbsn.com
2. Our Customer Careline at 1 300 22 6262.
3. Your agent.