Outpatient medical benefit, although is not specified in the Employment Act of Malaysia that it is a must to be provided by the employer, most employers in Malaysia are providing this benefit to their employees, or some even to the employees’ family members, with different annual limit.
There are two common ways of outpatient medical plan administration, which is, either managed by the employer itself, or outsource. There are two common types of outsourcing, which the first one, is to insure the employees under outpatient medical benefit with an insurance company, and an annual premium is paid. The other one is to engage an external company (some insurance company also provide this service) to manage all administration work of outpatient medical benefits, whereby the employers will pay all outpatient medical expenses incurred to its employees, and on top of that, pay a percentage of administration fees to the external company.
As a HR person, if your outpatient medical benefit is managed by your own, perhaps you may include the following exclusion and limitation into your outpatient medical plan policy, as a way of controlling your cost, besides having the annual limit.
- Acne treatment or cosmetic treatment;
- Care and treatment that is experimental, investigative and not according to accepted professional standard and care that is not medically indicated;
- Treatments or injuries sustained while committing a crime or felony, or while under the influence of alcohol, narcotics, or mind altering substance or injuries which are self inflicted while sane or insane;
- House calls by doctors for any reasons;
- Any expenses in respect of pregnancy, confinement, miscarriage, contraceptive medications and devices, sterilization procedures, or treatment for complications;
- Conditions related to sexually transmitted diseases, AIDS and AIDS Related Complex or its sequelae;
- Alternative therapies such as Acupuncture, Chiropractic, Osterpathy, Reflexology, etc;
- Vitamins, food supplements, herbal cures and anti obesity / weight reducing agents including any off the counter medications;
- Soaps, shampoos, vitamin creams and vitamin ointment;
- Psychotic, mental or nervous disorders and behavioral conditions including any neurosis and their physiological or psychosomatic manifestations;
- Treatment or therapy for congenital or hereditary diseases, deformities and disabilities and any medical or surgical complication arising therefrom e.g. childhood hernias, clubfoot, Thalassemia, etc;
- Diseases or disabilities of a newborn child contracted prior to or during birth;
- Blood and topical allergy testing;
- Routine physical examination, health check-ups or tests;
- Spectacles, lenses, any process solely for determination of eye refraction and the correction of the same by radial keratotomy, orthoptic or visual training or by other means, optician’s fees;
- Any dental treatment or surgery;
- Use or acquisition of all external appliances (e.g. artificial limbs, hearing aids, etc.) and the rental charges of such devices;
- Outpatient physical therapy or physiotherapy;
- Preventive vaccinations;
- Any expenses incurred in respect of illness, injury or disablement arising from any proven faults, carelessness, participation in any hazardous sport, pursuit or pastime.
