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HRD Training Prog No 10001388313
Date & Time 29 – 30 April 2026, 9.00 a.m. – 5.00 p.m.
Registration Deadline 20 April 2026 
Learning Format Virtual

Overview

Medical Aspects of Hospital Surgical Insurance is an intermediate level course that covers the content associated with hospitalized surgical insurance. This course deals with medical aspects of hospital surgical insurance. It is designed to make you understand the terms like congenital conditions, pre-existing and long-standing conditions, waiting period, medically necessary expenses, customary and reasonable charges and discusses how to maximize these benefits for the insured.

Recommended For

Underwriters, Claims Assessors, Sales Intermediaries, Customer Service Officers, Trainers, Product Designers and those involved in pricing, Healthcare Professionals, Software Programmers, Employee Benefit Professionals and Third Party Administrators and those who are managing medical insurance claims.

Learning Outcome

A. Explain the key terminology/definition and calculate the various elements of the Hospital & Surgical Insurance benefit structure.

B. Match the various expense items to their respective benefit category and calculate the amount of admissible and non-admissible claims.

C. Explain the upgrading of rooms for medically necessary situations.

D. Deepen understanding of the specialist, customary and reasonable charges.

E. Explain M&H claims procedures and assessment.

F. Identify various red flags relating to possible fraud.

G. Identify and state the responsibilities of the various parties involved in using, delivering and financing healthcare.

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Medical & Health Insurance – Medical Aspects of Hospital & Surgical Insurance

For Inquiries

Sales

+603 2712 8882

Programme Structure

No. Content
1
  • Hospital & Surgical Claim assessment
  • Structure of Hospital & Surgical Insurance Benefits
  • Determine claims quantum based on:
    » Benefit provisions and limitations
    » Per one Disability
    » First Dollar Cover
    » Co-payment
    » Extended/Major Medical Benefit, Annual limit, Family and Life time limit
    » Reasonable & Customary Charges
    » Daycare versus overnight confinement
    » Profit refund
2
  • Tabulation and documentation of Hospital & Surgical Claims
  • Managing Policy Excesses and Non-payble  items
  • Hospital & Surgical Insurance Fraud
  • Obligations of the Policy-owner, Insurance Company and Healthcare providers
  • Q&A

 

Dates

29/04/2026

2 Days (Virtual)

Fees

Normal Fee: Individual

Aii Member: 
RM 1,200/USD 275

Non-Member:
RM 1,400/USD 320

Normal Fee: Group of 3 pax

Aii Member: 
RM 1,100/USD 250

Non-Member:
RM 1,300/USD 295

Meet The Expert

Tan Eng Bee
SRN, ANZIIF (Senior Associate), PCS, ARA, AIRC, ASRI, FLMI, FAHM, FLHC, MBA, CFP

A state registered nurse who ventured into the world of insurance, Eng Bee has since held various senior management positions in leading multinational and national insurance companies. Besides marketing of corporate life insurance, she was actively leading and managing the life insurance operations: new business, underwriting and claims team.

 

A fervent believer in staff development and the betterment of the life insurance industry, Eng Bee is a lecturer/ trainer in life, health and disability insurance and has assisted in insurance textbook reviews.

 

Eng Bee was also a technical advisor to a leading assistance company in Malaysia for 15 years and is now the special representative of a global life insurance association.