GHS Insurance: All About Medical Insurance for Employees in Malaysia

Published December 23, 2023  

We hope this article helps you out with your medical insurance shopping for your employees!

If you want to save time and get us to match you with 3 employee medical plans that best suit your needs, click here.

GHS insurance, the short form of "Group Hospitalisation and Surgical insurance", is the core of most if not all employee benefits insurance packages in Malaysia.

It takes care of the biggest medical expenses (those hefty hospital bills!) for your employees if something really bad happens to them...

And it can be extended to take care of a few other very important things, too.

(If you came confused about GHS at all... do not worry! Read on and everything will soon make sense.)

We'll cover these below and more:

  • Price range of a GHS plan,
    They start from RM350 and can go as high as you need.
  • How many insurance companies sell them,
    In Malaysia there are at least 3 great options to choose from.
  • The best method to choose the most suitable plan for your team
    that saves you the most time while getting the best deal in town.
  • Other FAQs

Company insurance for employees in Malaysia (and its many other names!)

The number one reason insurance can be confusing is that people use different names for the same thing.

Whether you call it a "company insurance for employees", "medical benefits for employees", "corporate medical card" or one of these more formal names below:

  • Group hospitalisation & surgical insurance (GHS)
  • Group hospital & surgical plan
  • Group medical insurance
  • Employee medical insurance
  • etc...

If you're referring to getting an insurance plan to cover your employees' hospitalisation needs and/or their clinic or specialist doctor visits (by adding on an outpatient rider), you can be reassured that you're in the right place!

Looking for all-rounded coverage for your employees?

If you want coverages beyond just medical for your employees, check out our in-depth article about employee benefits insurance package.

What are the requirements for getting GHS plan?

The minimum headcount to qualify for a group medical insurance purchase is 3 people. And they all need to be working full-time at your company, and be 16 years old or older, but not over 64 years old.

Basic requirements for GHS/outpatient plan:

  • You have 3 or more employees to insure.
  • They are full-time employees.
  • They are 16 years old or older but not over 64 years old.

If you have any staff member who don't qualify for the age limits, you'll need to exclude them for these benefits unfortunately.

See our FAQ section for more details.

Price range of an employee medical insurance in Malaysia

The minimum cost of a GHS plan is around RM350 per headcount per year.

When you spend more on an employee's premium,

  • they get a higher annual claim limit 
    (meaning less chance they need to fork out their own money to pay hospital bills)
  • they get higher quota for hospital room & board
    (increasing the chance of getting a single-bedded room instead of sharing room with other patients. This means a more comfortable hospital stay!)

The highest a company can spend on an employee's medical insurance annually is around RM10,000 per employee (or even higher with a custom quote if you want!).

The variation in spending depends on the extent of coverage you may want to provide to your employees of different seniority and job level.

Here's a helpful glance at the price range of different extents of coverage you can offer an employee (and their family members).


Hospitalisation only

Hospitalisation
+ Clinic visits (GP & specialists)

Employee only

RM350 - RM1500

RM920 - RM2700

Employee & spouse

RM870 - RM3700

RM1900 - RM6000

Employee & child(ren)

RM870 - RM3700

RM2000 - RM6700

Employee & family
(spouse & children only)

RM1390 - RM6030

RM3100 - RM10000

Note: Price range quoted based on room & board quotas ranging from RM90 to RM600 per day, as well as clinic visit expenses ranging from RM700 to an unlimited amount per year.

Price ranges of different medical insurance coverages you can offer your employees

Also important to note, you can customise as many tiers of medical benefits as you need, with varying limits and quotas, for different job levels or employee categories in your company.

Below is an example of what that could look like:


Directors

Managers

Executives

Annual limit for hospitalisation

RM200,000

RM150,000

RM40,000

Room and board quota
(per day)

RM500

RM350

RM150

Clinic visits
(GP & specialists)

Annual limit for spouse & children's hospitalisation

RM200,000 per person

RM150,000 per person

Example for tiers of benefits or employee categories

Best company insurance for employees in Malaysia

The top group medical insurance plans for employees offer a comprehensive medical coverage for a fair price, and provide great support in terms of quality customer care, a user-friendly mobile app and seamless claim experiences.

We work with numerous top brands in Malaysia including these 11 insurance companies (in alphabetical order):

  1. AIA
  2. Allianz
  3. AmMetLife
  4. Etiqa
  5. Great Eastern
  6. Hong Leong Assurance
  7. MCIS Life
  8. Prudential
  9. Takaful Malaysia
  10. Tokio Marine
  11. Tune Protect

The fastest route to find your perfect match for employee medical insurance

Truth is, medical insurance for employees is a beast to navigate.

There are more details than we could cover without boring our readers to death 😂 (We've answered some deeper questions in detail in our FAQ at the bottom so you're welcome to geek out with us but even that doesn't cover everything.)

Being a team of experts who eat, sleep and breathe group insurance plans of all well-known insurers in Malaysia (11 insurance companies and counting!)...

We don't mean to boast... But! We believe we are your best resource to uncover your ideal employee medical insurance.


Use our help ✨

Whether you are a thousands-strong MNC or a 10-person elite team, or somewhere in between, let us know your requirements for us to start getting to work on comparing quotations for you.


Frequently Asked Questions

What is covered under a GHS plan?

When an employee needs to be hospitalised, a GHS insurance plan will cover his/her hospital bills for anything that is medically necessary to treat a sickness or injury.

What is not covered under a GHS plan?

Hospitalisation expenses that are not medically necessary will not be covered by a GHS plan. Below are the common examples. Exact exclusions will vary slightly depending on which insurer you choose.

  • Plastic/Cosmetic surgery or treatment
  • Circumcision (unless medically necessary)
  • Improving vision with either glasses or contact lenses for refractive errors
  • Use or acquisition of all appliances such as wheelchair, crutches, artificial limbs, pacemakers, hearing aids, aero chambers, etc.
  • Dental treatment unrelated to accidental injuries
  • Private nursing care
  • Treating congenital abnormalities or deformities, including hereditary and developmental conditions
  • Pregnancy related conditions
  • Conditions related to sexually transmitted diseases, AIDS, or related complications
  • Experimental procedures
  • Hospitalisation mainly for investigations or preventive treatments
  • Treating injuries from committing a crime, felony or under the influence of substances, including self-inflicted while sane or insane
  • Any forms of war, riots, insurrection, war weapon explosions, terrorism, armed forces duty, and direct participation in strikes
  • Effects from radiation or contamination by radioactivity
  • Expenses incurred for donation of any organ or costs of acquisition of any organ
  • Sleep and snoring disorders, hormone therapy, weight-related surgeries, hyperhidrosis, etc
  • Sexual dysfunction or infertility
  • Non-medical nature expenses such as television, telephones, extra meals, etc.
  • Illnesses or injuries during air travel, except as a fare-paying passenger on licensed commercial airlines over established routes
  • Sickness or injury from racing, hazardous sports, and illegal activities
  • Private flying
  • Expenses incurred for sex changes
  • Psychotic, mental or nervous disorders
  • Any preventive supplements/supplies

What is covered under an Outpatient GP and Specialist plan?

"Outpatient" describes getting treatment at a medical facility without staying there overnight.

GP (general practitioner) and specialist care are always bundled together. You cannot get only GP or only specialist care for your employees.

These are what your outpatient GP and specialist plan will cover:

Outpatient general practitioner care

Consultation

Cashless.
Covered only at panel clinics.

Medication

Injection

Diagnostic services

Outpatient surgical procedure

Mandatory child immunisation

Pap smear examination

Emergency non-panel GP clinic visit

On reimbursement basis

Overseas coverage

Outpatient specialist care

Consultation

Cashless.
Covered only at panel clinics.

Medication

Injection

Diagnostic services

Outpatient surgical procedure

Physiotherapy

Overseas coverage

On reimbursement basis

What is not covered under an Outpatient GP and Specialist plan?

Exact GP and specialist plan exclusions will vary slightly depending on which insurer you choose.

Below are the common exclusions:

  • Physical examination, health check-ups or tests, unless medically necessary
  • Blood and topical allergy testing
  • Outpatient rehabilitation therapy, chemotherapy, radiation therapy, kidney dialysis and chronic illnesses
  • Preventive vaccinations except those stated under mandatory child immunisation
  • Diseases or disabilities of a newborn child contracted prior to or during birth or within the first 14 days thereafter
  • House calls or home visits by doctors
  • Any treatment or medication which are not consistent with the diagnosis
  • Any treatment received purely for investigatory purposes or preventive treatments except for benefit payable under Diagnostic Services
  • Dispense of current medication for more than 1 month
  • Vitamins, supplements, herbal cures, anti-obesity agents, etc.
  • Soaps, shampoos, vitamin creams
  • Plastic/Cosmetic surgery or treatment
  • Improving vision with either glasses or contact lenses for refractive errors
  • Dental treatment unrelated to accidental injuries
  • Treating congenital abnormalities or deformities, including hereditary and developmental conditions
  • Pregnancy related conditions
  • Conditions related to sexually transmitted diseases, AIDS, or related complications
  • Treating injuries from committing a crime, felony or under the influence of substances, including self-inflicted while sane or insane
  • Experimental procedures
  • Effects from radiation or contamination by radioactivity
  • Psychotic, mental or nervous disorders

Are there waiting periods involved in a GHS plan? What are they for?

If you would like to move from an existing insurer to a new one, there are no waiting periods (because they will be waived).

If you are looking to get insurance for your employees without an existing plan, a few standard waiting periods will apply, such as:

  • 3o days of waiting period for everyone
  • 120 days of waiting period for specified illnesses**
  • 120 days of waiting period for any pre-existing illness
  • there is no waiting period for accidental injury

**Specified illnesses include hypertension, diabetes, heart diseases, tumors, cancers, cysts, stones, ear, nose, throat conditions, female reproductive system diseases, etc.

How does a waiting period affect coverage & claims?

Within a waiting period, if your employee gets hospitalised, no claims can be made.

However, once a waiting period has passed, even if an employee has a pre-existing illness (e.g. hypertension, diabetes, etc), hospitalisation claims will still be paid.👍

What are the documents required to apply?

Different sets of documents will be required depending on the type of your business registration (e.g., Sdn Bhd, sole proprietor or public listed company).

Find a checklist here for the required documents if you don't have an existing policy; go here for your checklist if you are looking to switch from an existing insurer's policy.

What are the premium payment options?

Premium payments are to be made annually. There is no monthly mode of payment.

Are the premium rates and renewal of policy guaranteed?

The premium rate for GHS and Outpatient plans is determined based on how much your company has claimed in the past year, the overall cost of medical treatment, advancement in medical technology, etc.

Generally speaking, premium rates and renewal of policy are not guaranteed.

Which is why it is a good idea to engage professionals like us who are constantly kept up-to-date with changes in all well-known insurers and are skilled at comparing and negotiating the best deal for you.

A side note — very recently, one of the 11 insurers has provided a "no increase in premium rates" guarantee for 3 years.

While it is not the norm yet, we expect more insurance companies to soon follow suit. Get in touch with us to learn about the latest insights.

What happens when an employee resigns or when there are new employees?

When a new person joins or when someone leaves, our clients will simply notify us about the change, and we will take care of the rest.

Timeline-wise, a 30-day prior notice for new hires will suffice.

Premium-wise, a pro-rated premium shall be refunded for employee resignation; similarly, a pro-rated premium shall be charged when a new employee joins.

What happens when an employee is promoted or demoted?

When an employee is promoted or demoted, our clients will simply notify us about the change, and we will take care of the rest.

A 30-day prior notice will suffice for the change to take place.

A pro-rated premium will be charged or refunded.

Can I change or upgrade my GHS and Outpatient plan?

Yes, you can change or upgrade upon the policy anniversary/renewal, and it will be subject to your insurer's acceptance.

Any changes will apply across the same employee category.

Do GHS and Outpatient plans provide overseas coverage?

Yes, your employees will be covered worldwide for 24 hours a day.

The important thing to note about GHS overseas coverage is that the payable claims will be based on the costs for an equivalent treatment in Malaysia.

Meaning, for example, if the same medical treatment done in the United States for USD30,000 costs only RM80,000 in Malaysia, the payable claims can only be RM80,000 instead of RM135,000 (an estimate after USD/MYR conversion).

The same concern usually does not apply to Outpatient expenses. Because typically the maximum reimbursement for overseas clinical visits is not notably high (from RM4o to RM300 only).

What is a "takeover" of previous policy? 

A "take-over" case is one where a new insurer swoops in to take over the coverages that you had with your previous insurer... without having to go through any waiting period again.

This way, your employees' coverage will resume seamlessly as you move from a previous insurer to a new one.

With the move, you can also maintain the same coverages or you can choose to upgrade or downgrade (subject to the new insurer's acceptance).

Will my senior employees lose their coverage at age 66?

Not at all.

As long as their coverage started being in effect at age 64 or younger, they can stay covered until they turn 69 years old (provided your company continues the GHS plan, of course).

One insurer in the market even insures employees until they turn 75 years old.

This is great for older employees and founders alike who prefer to continue working in the company past the conventional retirement age.

How many children will be included if I choose to cover an employee's family?

When you insure an employee and his/her children, the plan covers all their kids regardless of how many children they have. However, there are certain limitations, such as:

  • If there's a newborn in the picture, there's a waiting period of at least 45 days before coverage will start
  • The coverage for a child stops once they are over 23 years old or once they start working full-time, whichever takes place earlier

These specifics, like the exact age limit and waiting period, can vary based on the insurance company you choose.


You may also like

{"email":"Email address invalid","url":"Website address invalid","required":"Required field missing"}

Leveling up your personal finance knowledge is going to make you the most money in 2024. Period!


Sign up to get made-for-Malaysians resources in your inbox.

>