One of the most heartbreaking moments I face as an insurance advisor is telling a client their medical card won’t cover a hospital bill because they are still in the “waiting period.”
There is a common misconception among Malaysians that the moment you sign the policy and pay your first premium, you are covered for everything. This is not true.
Based on my many years of experience in the insurance sector in Malaysia, I have seen claims rejected simply because the policyholder didn’t understand the timeline. Whether you are holding a policy from AIA, Prudential, Allianz, or Great Eastern, the rules on waiting periods are remarkably similar across the board.
Here is exactly what you need to know to avoid a financial nasty surprise.
TLDR: A Quick Summary
- Accidents: Covered Immediately (0 Days).
- Common Fevers/Sickness: Covered after 30 Days.
- Specific/Serious Illnesses: Covered after 120 Days.
- Pre-existing Conditions: Often strictly excluded or subject to a multi-year waiting period.
Here’s a neat table that elaborates on the different waiting periods to help you develop a better understanding on this topic more effectively.
| Waiting Period Type | Duration | Coverage Status | Common Examples | My Experienced Advice |
| Accidental Injury | Immediate (0 Days – after you’ve signed and paid for your policy) | ✅ Covered for all types of accidents. | Motor accidents, falls, broken bones, accidental cuts. | You are protected from the moment your policy is active. No waiting required. Your treatments at the hospital caused by accidental injuries are fully covered by your medical card. |
| General Illness | First 30 Days | ❌ Not Covered | Dengue, Covid-19, Influenza, Food Poisoning, Fevers. | If you get sick in Month 1, use a government hospital or bite your teeth and just pay out-of-pocket at a local GP. Do not try to force a claim; it may trigger an investigation. (Also non admission/outpatient treatments are generally excluded anyway) |
| Specified Illness | First 120 Days | ❌ Not Covered | Hypertension, Tumors/Cancers, Kidney Stones, ENT issues, Hernias. | These are “slow-developing” conditions. Unless it is life-threatening, wait until the 5th month to seek treatment or surgery. |
| Contestability | First 2 Years | ⚠️ Subject to Review | Any hospitalization (Insurer may request “Pay and Claim”). | Insurers may investigate to check for pre-existing conditions. Avoid switching policies unnecessarily, as this resets the 2-year clock. (This is also why we usually discourage people to switch insurer abruptly.) |
1. The 30-Day Waiting Period (General Illness)
This is the standard rule for almost every medical card in Malaysia.
For the first 30 days after your policy starts, you generally cannot claim for any sickness. This includes common issues like Dengue fever, food poisoning, influenza, or Covid-19.
Why does this exist? Insurers need to prevent “anti-selection.” Without this rule, people would only buy insurance after they start feeling sick. If you rush to buy a medical card today because you have had a fever for three days, and you try to claim next week, your claim will almost certainly be rejected.
My Advice: If you fall sick during this first month, you will likely need to pay out of pocket or go to a government hospital. Do not try to “force” a claim during this window; it can flag your file for investigation.
2. The 120-Day Waiting Period (Specified Illnesses)
This is the one that catches people off guard. There is a list of specific, slow-developing conditions that are not covered for the first 120 days (approx. 4 months).
These are illnesses that doctors consider to be “chronic” or slow to develop—meaning you likely had them before you bought the policy, even if you didn’t know it yet.
Common “Specified Illnesses” in Malaysian policies typically include:
- Hypertension (High Blood Pressure), Diabetes, and Cardiovascular disease.
- Growths: Tumors, Cancers, Cysts, Nodules, Polyps.
- Stones: Kidney stones, Gallstones, Urinary stones.
- Ear, Nose, and Throat (ENT) conditions (e.g., Sinusitis).
- Hernias and Hemorrhoids (Piles).
Real-world scenario: I once had a client who was diagnosed with a nasal polyp 3 months after buying his policy. Because it fell within the 120-day window, the insurer declined the Guarantee Letter (GL). He had to wait until the 5th month to seek treatment if he wanted to use the card (provided it wasn’t an emergency).
3. The “Hidden” Waiting Period: The 2-Year Contestability Period
This isn’t technically a “waiting period” printed on the brochure, but it is just as important.
For the first two years of your policy, the insurance company has the right to investigate any claim thoroughly to ensure you didn’t hide a pre-existing condition.
If you are admitted to the hospital within these first two years, the insurer may not issue a “Cashless” Guarantee Letter immediately. Instead, they might ask you to “Pay and Claim”—meaning you pay the bill first, and they reimburse you after they investigate your medical history.
Pro Tip: After 2 years, your policy becomes “incontestable” (unless there was total fraud). This is why I always tell my clients: Don’t switch medical cards unnecessarily. Every time you switch insurers, you reset this 2-year clock to zero.
4. What About Accidents?
This is the good news. Accidental injuries have NO waiting period.
If your policy is active today and you unfortunately get into a motor accident or slip and break a bone tomorrow, you are covered immediately. Accidents are unforeseen events, so insurers do not impose a waiting period on them.
Frequently Asked Questions (FAQ)
Q: Can I use my medical card immediately for Dengue fever? A: Only if your policy has been active for more than 30 days. If you are diagnosed with Dengue on Day 20 of your policy, you cannot claim.
Q: What happens if I forget to pay my premium and the policy lapses? A: If your policy lapses and you reinstate it (revive it), the waiting periods reset. You will have to wait another 30 days for general illness and 120 days for specified illnesses from the reinstatement date.
Q: Does the waiting period apply to “Pay and Claim” or just Cashless? A: It applies to both. You cannot claim reimbursement for an illness treated during the waiting period.
Q: I have a pre-existing condition. How long is the waiting period? A: Pre-existing conditions are usually permanently excluded. However, some insurers may offer to cover them after a specific waiting period (e.g., 2 to 5 years) if you pay a higher premium (loading), but this is on a case-by-case basis.
Disclaimer: The information I wrote above is based on my general understanding developed through many many years of being in the Malaysian insurance industry. However, discrepancies can regularly occur. Your specific situation can be much different than what I have described above. Please refer to your insurance policy for a more accurate understanding of the specific terms and conditions that govern your medical coverage. Bear in mind takaful medical insurance can have different general rules, terms and conditions when compared to conventional medical/health insurance plans.
Remember, every time you switch medical cards, your 2-year contestability period resets. Before you cancel your old plan or buy a new one, talk to a professional first.
I help my clients plan their coverage so they never have a gap in protection.
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