If a pre-existing condition was diagnosed before 1 January 2019, you can still claim for income replacement during hospitalisation or for Critical Illness Benefit, subject to the following terms:
(i) For hospitalisation income replacement benefit, claims are allowed if you were hospitalised on/after 1 January 2019.
(ii) For Critical Illness Benefit, claims are allowed if the pre-existing illness has not progressed to the severity level specified in the definition of the Critical Illness prior to 1 January 2019. Please refer to for definitions of the 36 Critical Illnesses.
The following examples illustrate possible scenarios under 7(ii):
Example 1
Mr A had a heart attack in 2017. He cannot make a claim for this because it happened before 1 January 2019.
In February 2019, Mr A suffered another heart attack. As the second attack occurred after 1 January 2019, he is eligible to claim RM8,000 under Critical Illness Benefit.
Example 2
Mr B was diagnosed with diabetes in 2010 and his condition worsened over time. In March 2019, Mr B was diagnosed with kidney failure (chronic irreversible failure of both kidneys), a condition that requires regular dialysis. In this case, he is eligible to claim RM8,000 under Critical Illness Benefit.
Example 3
Mr C was diagnosed with kidney failure in 2018 and currently undergoes regular dialysis. He is not eligible for Critical Illness Benefit as the irreversible condition of his kidneys occurred prior to 1 January 2019.
However, if he suffers a heart attack (listed under the 36 Critical Illnesses) on January 2 2019, he can claim RM8,000 under Critical Illness Benefit.
Example 4
Mr D was diagnosed with early stage Parkinson?s Disease in 2005 but was still able to perform his daily activities. His condition gradually worsened resulting in progressive impairment. In March 2019, Mr D received a confirmed diagnosis from his neurologist of his permanent inability to perform basic tasks such as eating, bathing and moving without assistance, and that his condition cannot be controlled with medication. In this case, he is eligible to claim RM8,000 under Critical Illness Benefit.
Example 5
Miss E was diagnosed with Carcinoma-in-situ of the breast in 2018. She cannot make a claim for this because Carcinoma-in-situ is not covered in the list of 36 Critical Illnesses.
In March 2019, a doctor confirmed that Miss E's condition had progressed to Stage 1 Breast Cancer. In this case, Miss E is eligible to claim RM8,000 under Critical Illness Benefit, as cancer diagnosed on/after 1 January 2019 is covered in the list of 36 Critical Illnesses.
Example 6
Mr F was diagnosed with Stage 1 Lung Cancer in 2017. He responded well to treatment and by 2018, was declared cancer-free. In February 2019, a doctor?s diagnosis confirmed that his lung cancer had relapsed. As the relapse occurred after 1 January 2019, he is eligible to claim RM8,000 under Critical Illness Benefit.
