Medical and health takaful gives you cover for the cost of private medical treatment, like hospitalisation, surgery and treatment, if you are diagnosed with certain illnesses or are involved in an accident. The cover acts as a stand-alone policy or can be added to a basic family takaful plan, providing better coverage and benefits from both policies.
 
Related Information

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Dealing with takaful intermediaries

Medical & health insurance

Personal accident takaful

Personal accident insurance

Making a complaint
 
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The takaful concept is to help each other in their respective times of need. The same idea is applied to medical and health takaful.
As a participant in this plan, you make a participative contribution (tabarru’) which will be used to aid the participants who need financial help in managing the cost of private medical care, such as hospitalisation or being diagnosed with an illness.
 
 
 
 
 
     
The payment of benefits depends on the type of plan that you have. You must check the takaful certificate for details of the benefits, such as what exactly is and is not covered, when benefits will be payable and how they will be paid.  
     
  Some of the benefits covered under medical and health takaful plan are:  
     
 
 
Hospitalisation
Intensive care unit
Outpatient treatment
 
Pre-hospitalisation visits
Outpatient treatment
Visit by doctors
 
 
     
  The critical illness plan covers 36 common critical illnesses as follows;  
     
 
 
Heart attack
Coronary artery bypass surgery
Kidney failure
Major organ transplant
Multiple sclerosis
Blindness
Deafness
Loss of speech
Major burns
Terminal illness
Parkinson’s disease
Occupationally acquired HIV infection
Aplastic anaemia
Benign brain tumor
Chronic liver disease
Acute bacterial meningitis
Apallic syndrome
Brain surgery
Stroke
Cancer
 
Fulminant hepatitis
Paralysis (paraplegia, tetraplegia)
Primary pulmonary arterial hypertension
Heart valve surgery
Aorta surgery
Alzheimer’s disease
Coma
Motor neurone disease
HIV infection from blood transfusion

Accidental head injury resulting in major
head trauma
Muscular dystrophy
Viral encephalitis
Poliomyelitis
Other serious coronary artery disease
Full blown AIDS
Chronic lung disease
 
 
  The list may differ from one takaful operator to another.  
     
  The critical illness benefit is payable provided you survive for at least 30 days following the diagnosis of the critical illness.  
     
  Exclusions  
  Medical and health takaful will usually not cover the following:  
     
 
  Pre-existing illness at the time of application

  Claims for illness or injury caused through illegal or unlawful acts

  Pregnancy or childbirth

  Venereal disease, infection or parasites

  Murder or physical assault.

  Cosmetic or plastic surgery.
 
     
 
     
  Some of the more important terms used in medical and health takaful are:  
     
 
Pre-existing conditions
 
These are disabilities that existed before the effective date of the plan, for which you are receiving treatment or have shown symptoms. If you had consulted a medical doctor for any pain or discomfort, this would be regarded as a symptom of a disability.
 
Qualifying period
 
This refers to the eligibility of benefits under the takaful plan. Generally, it will start 30 days after the effective date of the certificate.
 
 
Still confused?
 
If you have any doubts about the meanings of these terms, you should ask your agent or the takaful operator. As the certificate is a legal contract, the meanings used in the certificate will apply when a claim is made.
   
Overseas treatment
 
This term explains whether you will be covered when receiving treatment overseas. It is possible that you may be covered for treatment obtained overseas, subject to exclusions, limitations and conditions specified in the certificate.
 
 
Misstatement of age
 
Your age is an important rating factor in your medical and health takaful. If you have misstated your age and lead to a lower contribution, any claim under the certificate will be prorated, based on the ratio of actual contribution paid to the contribution that should have been charged.
 
 
     
 
     
  When applying for a takaful plan :  
     
 
Do disclose all material facts on the risks to be covered.
Do read the ‘Important Notice’ on the Proposal Form.
Do answer all questions fully and accurately.
Do complete and sign the Proposal Form yourself.
 
     
 
Don't leave any question in the Proposal Form unanswered.
Don't use ticks and dashes to answer the questions requiring full answers.

Don't sign any blank form.
 
     
  To ensure your takaful plan remains valid :  
     
 
Do comply with all the terms, conditions and endorsements of the certificate.
Don't forget to pay the contribution within the terms allowed by the takaful operator.
 
 
     
  If you plan to claim from your medical and health takaful, you are advised to do the following. This will make it easier for your claims to be processed and validated.  
     
  What you can do  
     
 
   
 
     
 
     
  Provide the following documents with your written notice:  
 
All original bills and receipts
Full doctor’s report stipulating the diagnosis of the condition treated
Doctor’s opinion on the date the disability commenced
Doctor’s summary of the cost of treatment including medical and services rendered.
 
     
 
     
  Note:  
  It is important that you act on proper medical advice, as the takaful
operator will not be liable if a treatment or service becomes necessary due
to failure on your part to do so.