Medical & Health Insurance – Non Medical Aspects of Claims

Overview

This program provides participants with a comprehensive understanding of medical   insurance   benefits   and healthcare  procedures.  By  course  end,  attendees  will proficiently navigate key areas, including benefit structures, expense  categorization,  medical  necessity  upgrades,  and cost assessments. They will also grasp specialist charges, claims  procedures,  fraud  awareness,  and  stakeholder responsibilities.  This  program  equips  participants  with essential knowledge for informed decision-making in the healthcare industry.

• At the end of the programme, participants should be able to:
• State the types medical & health insurance
• Explain the potential of medical & health insurance in Malaysia and how it is marketed
• State the principles of medical & health insurance
• Explain the common features and benefits covered under hospital &surgical insurance
• Explain the common policy exclusions in the hospital &surgical insurance
• State the roles and responsibilities the mega team:
  • Policyowner and person insured
  • Insurance companies
  • Healthcare providers
  • Third party administrators/ managed care organisation
  • Ombudsman

Recommended For

• Those who have undergone the fundamental and intermediate courses in Hospital & Surgical Insurance.
• Those with more than two years of experience in the Medical & Health Claims division.