Home Web Specials MySalam: RM400m premium for a RM3m payout?

MySalam: RM400m premium for a RM3m payout?

A long queue waiting at the crowded Penang General Hospital - ANIL NETTO/FILE PHOTO

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Jeyakumar Devaraj has written an open letter to Prime Minister Dr Mahathir Mohamad expressing his concerns over the much-touted health insurance scheme.

Three weeks ago, a 48-year-old lorry driver with stage four colon cancer came to see me as he was in financial distress.

He had been the sole breadwinner and family finances were deeply in the red ever since his diagnosis about two months ago.

As he was a BR1M recipient in 2018, I downloaded the application forms for MySalam and filled them for him (as I had made the clinical diagnosis of Ca Colon with obstruction before referring him to the Ipoh General Hospital. Applying to the GH to fill up the forms would have taken another six to eight weeks).

The reply from MySalam was WhatsApped to him after a week: “… dukacita dimaklumkan bahawa tuntutan penyakit kritikal anda telah ditolak disebabkan: Kemasukan hospital bukan kerajaan. Salah satu syarat tuntutan adalah penyakit mestilah didiagnos di hospital kerajaan….”

This, Tun, is the DNA of insurance companies – deny liability first and try and turn people off. This could be one of the reasons that, as of 22 July 2019, just over RM1m had been paid out under the MySalam scheme – comprising 108 approved claims for critical illnesses (RM864,000) and 941 approved claims for hospitalisation (RM50 per day for a maximum of 14 days). These figures are from the Ministry of Finance.

Tun, we paid Great Eastern RM400m to cover the bottom 40% of the population for a year. Looks like Great Eastern will pay out less than RM3m for this year!

Clearly the rakyat are not getting our money’s worth.

This is precisely why the Socialist Party of Malaysia wrote to Lim Guan Eng in November 2018, and again in January 2019 urging him to consult other parties, do a proper actuarial study and consider other alternatives such as using Great Eastern’s payment of RM2bn to defray the co-payments required of patients going to government hospitals.

However, Lim, in his wisdom, didn’t engage us – didn’t even get one of his staff to meet up with us to get our views.

That was when we sent a memorandum endorsed by 40 organisations to you (on 20 March 2019), reiterating the same points.

Well, Tun, the performance of MySalam over the past six months shows that the largest beneficiary is Great Eastern itself, which received a payment of RM400m for insurance cover for the bottom 40% of the population for 2019, but will likely only pay out RM3m or so to the Malaysian public for 2019.

We would like to urge you to set up an independent committee to look into the MySalam scheme and, if necessary, call it off and channel the RM2bn to the Ministry of Health to help patients with their co-payments required of them in government hospitals.

Getting the opinions of the Malaysian Medical Association, the ministry and citizen groups working on health-related issues would be a good idea too.

2 August 2018

On 6 August, the Ministry of Finance responded in a statement that all government-paid premiums, if not used as claims by beneficiaries, would be reimbursed to the mySalam Trust Fund.

“It should be reiterated that there is no element of profit for Great Eastern Holdings nor Great Eastern Takaful Berhad (GETB) through the mySalam scheme.

“Therefore, there is no incentive for GETB to be a mySalam takaful manager, to not be able to issue any payments for eligible claims.”

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