For many Malaysians with a history of illness, applying for medical insurance often begins with a difficult question: Will my medical condition prevent me from getting covered?

In the past, having a medical condition could make it difficult for some individuals to obtain medical protection, leaving some individuals with limited to no options despite having recovered, completed treatment, or successfully managed their condition.

MediAsas seeks to change that by introducing a more inclusive approach to underwriting. Instead of treating every pre-existing condition as an automatic barrier, eligibility is assessed based on factors such as the condition's nature, severity, and the individual's current health status.

This allows for a more considered assessment of each applicant’s circumstances and creates greater opportunities for Malaysians with existing or past medical conditions to access medical protection.

Expanding protection beyond traditional exclusions

This means some applicants with certain and stable medical histories may still be considered for coverage following individual underwriting assessment. For example, individuals who have completed treatment and are in remission from selected early-stage cancers, or those with certain well-managed forms of coronary artery disease, may now have an opportunity to obtain protection that may previously have been unavailable to them.

Coverage considerations will also be extended to selected mental health and neurodevelopmental conditions, including mild-to-moderate autism and stable stress disorders, subject to individual underwriting assessment and potential premium loadings.

Under MediAsas, treatment related to these existing medical conditions may remain excluded, depending on the individual's medical profile. However, policyholders can still receive protection for new and unrelated medical conditions that arise in the future.

This helps expand access to medical protection while ensuring that insurance and takaful coverage remain affordable and sustainable for all policyholders.

Providing greater certainty

Expanding access is only part of the solution. Consumers also need confidence that their coverage will be there when they need it most.

To address this, MediAsas introduces the No-Look-Back feature, a safeguard designed to provide greater certainty for long-term policyholders.

Under current market practice, claims may be reviewed against a policyholder's medical history many years after a policy is purchased. While such reviews are important for detecting fraud and deliberate non-disclosure, they can also create uncertainty for consumers who believed they had disclosed all relevant information when applying for coverage.

Greater certainty for long-term policyholders

MediAsas introduces a seven-year moratorium, or “no-look-back” period. This means that once a person has been continuously covered for seven years, claims can no longer be contested, except in specified circumstances such as fraud, deliberate or reckless non-disclosure, and certain pre-defined medical conditions. This gives policyholders greater peace of mind over their coverage while allowing insurers time to verify the information provided.

Insurers and takaful operators also retain the ability to investigate claims, including certain serious pre-defined medical conditions.

The seven-year period reflects a careful balance between strengthening consumer protection and preserving a fair and sustainable insurance and takaful system. It provides insurers and takaful operators sufficient time to assess risks responsibly, while ensuring long-standing policyholders are not exposed to uncertainty indefinitely.

According to Dr. Zaharuddin A. Rahman, Chief Executive Officer of Elzar Shariah Solution, the proposed “No Look-Back” model in MediAsas could represent a meaningful step towards fairer and more accessible medical protection if implemented carefully. He noted that this feature has the potential to benefit policyholders, particularly those facing premium affordability pressures and uncertainty over long-term coverage.

Dr. Zaharuddin A. Rahman, Chief Executive Officer of Elzar Shariah Solution


Some may argue that the feature does not go far enough because certain exceptions remain. That is a fair observation. However, the No-Look-Back feature represents a significant step forward by introducing, for the first time, a clear boundary that enhances consumer certainty while maintaining safeguards against fraud and abuse.

While it may not eliminate every dispute, it provides greater predictability and peace of mind, reinforcing confidence that coverage will remain there when it is needed most.

The product is currently being piloted ahead of its planned nationwide rollout in January 2027, allowing Bank Negara Malaysia and the insurance and takaful industry to address implementation issues and refine the product.

Supporting Long-Term Affordability

Ultimately, expanding access to medical protection must be accompanied by measures that keep healthcare costs manageable over the long term. Otherwise, broader coverage may simply lead to higher premiums and reduced affordability in the future.

MediAsas introduces coordinated measures across the healthcare ecosystem to help contain costs and protect policyholders from sharp premium increases over time. This comprehensive approach is what distinguishes MediAsas from current medical plans in the market.

Zaharuddin explained that the mechanism also includes the phased implementation of Diagnosis-Related Groups (DRG), which establishes predetermined payment rates for essential hospital treatments based on diagnosis and severity. This encourages greater clinical efficiency, reduces unnecessary procedures and variation in treatment costs, and maintains appropriate standards of care and patient outcomes.

The framework also includes measures to manage unnecessary healthcare utilisation through tiered co-payments, which can help address costly and less efficient treatments while encouraging more appropriate use of healthcare services.

Tiered co-payments refer to a payment structure in which ITOs set different payment thresholds for policyholders depending on the category of medicines or treatments, such as commonly available or specialised medicines and treatments.

These provider-level reforms are reinforced by ecosystem-wide safeguards. Centralised claims monitoring, managed through ProtectHealth's Care Outcome and Fraud, Waste and Abuse (COFWA) unit, strengthens oversight of healthcare utilisation and claims patterns. 

In parallel, interoperable Electronic Medical Records (EMRs) across participating private hospitals can help reduce duplicate diagnostic tests, improve care coordination, and support more effective utilisation management.

Overseeing these initiatives will be an independent governance board, established to provide strategic oversight and ensure transparency, accountability, and evidence-based decision-making. Together, these measures are designed to support a more sustainable healthcare financing system, helping keep coverage affordable and relevant to Malaysians' evolving healthcare needs while safeguarding the long-term viability of MediAsas.

Together, these features are designed to support a more sustainable healthcare financing system while helping keep medical protection within reach for more Malaysians over the long term.

MediAsas is not about eliminating every coverage limitation. Rather, it seeks to strike a practical balance between expanding access, strengthening consumer protection and maintaining affordability.