On MediAsas Teras, the hospital you choose changes your bill. Go to an in-network hospital and your out-of-pocket cost is the deductible alone. Go out-of-network and you add 20% of the bill on top of the deductible, capped at RM 3,000 per disability. Same illness, same treatment, same insurer — up to RM 3,000 difference, decided by whether the hospital is on the panel.
MediAsas Fleksi works differently: it has no percentage co-insurance at all. Network status instead changes the size of the annual deductible — RM 10,000 in-network, RM 15,000 out-of-network.
What Decides Whether a Hospital Is In-Network?
Network status is panel membership — whether the hospital has contracted with the scheme — not a ranking of clinical quality.
An out-of-network hospital is not a worse hospital. It may have excellent specialists and equipment. It simply sits outside the arrangement, so MediAsas asks you to carry a defined share of the bill rather than spreading that cost across every policyholder’s premium.
The participating insurers and takaful operators for MediAsas are AIA, Allianz Life, Great Eastern, Prudential BSN Takaful, Etiqa Family Takaful, and Syarikat Takaful Malaysia Keluarga. The panel hospital list is confirmed by the scheme ahead of the nationwide rollout in January 2027, following the Klang Valley pilot that ran from 29 July to October 2026. Hospitals can join or leave a panel, so check the current list rather than relying on last year’s.
How Is the Teras Co-Insurance Calculated?
The order of operations matters, and it is where most people miscalculate.
- Your deductible comes off the bill first — RM 500 per disability if you are under 60, RM 1,000 from age 60.
- The 20% co-insurance applies only to what remains, and only out-of-network.
- It stops at RM 3,000 per disability, however large the bill grows.
Worked on a RM 40,000 admission for someone aged 45 (RM 500 deductible):
- In-network: you pay the RM 500 deductible. The plan covers RM 39,500. Your cost: RM 500.
- Out-of-network: RM 500 deductible, plus 20% of RM 39,500 — RM 7,900, capped at RM 3,000. Your cost: RM 3,500.
Above roughly RM 15,000 of post-deductible billing the co-insurance has already maxed out and stops growing. That makes out-of-network disproportionately expensive for mid-sized bills and comparatively less punishing for catastrophic ones.
Where Does the Network Choice Cost You Most?
| Total bill | In-network cost | Out-of-network cost | Difference |
|---|---|---|---|
| RM 3,000 | RM 500 | RM 1,000 | RM 500 |
| RM 8,000 | RM 500 | RM 2,000 | RM 1,500 |
| RM 15,500 | RM 500 | RM 3,500 | RM 3,000 (cap reached) |
| RM 40,000 | RM 500 | RM 3,500 | RM 3,000 |
| RM 150,000 | RM 500 | RM 3,500 | RM 3,000 |
MediAsas Teras, age under 60, RM 500 deductible per disability.
The penalty climbs steeply to around RM 15,500 of billing and then flattens permanently. So network choice matters most for the admissions Malaysians have most often — a two-night stay, a scope, a straightforward surgery — and least for the rare catastrophic event.
The cap is per disability, not per policy year. Two unrelated conditions in the same year can each carry their own RM 3,000 co-insurance.
Is the Co-Payment Ever Waived?
Yes, and this is one of the more important details in the product.
On MediAsas Teras, the co-payment is waived for:
- Treatment at government facilities
- Emergency care
- Outpatient cancer treatment
That emergency waiver matters more than anything else on the list. An ambulance takes you to the nearest appropriate hospital, not the nearest in-network one — and the waiver means a genuine emergency does not punish you for a decision you never got to make.
MediAsas Fleksi carries no such waiver. Fleksi is a high-deductible product marketed as supplementary coverage: you absorb the first RM 10,000 in-network or RM 15,000 out-of-network each year, and the plan pays above that. If an emergency admission costs less than the deductible, Fleksi pays nothing.
What Should You Do About This Now?
- Identify the three hospitals you would realistically use — nearest to home, nearest to work, and where your regular specialist admits.
- Check each against the panel list for the insurer you are considering. Because six ITOs offer MediAsas, panels may differ between them — the same hospital can be in-network with one and out-of-network with another. That is a live reason to choose one provider over another.
- Ask your specialist which hospitals they hold admitting rights at. Many hold rights at several. If your consultant can admit you in-network for the same procedure, the network decision costs you nothing clinically.
- Budget RM 3,000 per condition on top of your deductible if your realistic default hospital is out-of-network. Treat it as part of your reserve, not an unlikely edge case.
- Compare against what you already hold. MediAsas is a floor, not an upgrade — comprehensive plans on the market today carry annual limits far above the RM 100,000 Teras ceiling. A policy review will show what your current cover does with the same admission.
Our co-payment page explains how cost-sharing works generally, and the deductible page covers thresholds.
Frequently Asked Questions
Does an out-of-network hospital mean lower quality care?
No. Network status reflects whether a hospital has contracted with the scheme, not its clinical standard. An out-of-network hospital may be excellent. The co-insurance exists to share the cost difference rather than spread it across every policyholder’s premium.
Is the RM 3,000 cap per year or per illness?
Per disability. Each separate condition carries its own cap, so two unrelated conditions in the same policy year can each trigger up to RM 3,000 in co-insurance. It is not an annual ceiling on your total out-of-pocket cost.
Do I pay 20% of the whole bill out-of-network?
No. The deductible is subtracted first and the 20% applies only to the remainder, then caps at RM 3,000. On a RM 40,000 bill with a RM 500 deductible, you pay RM 3,500 in total rather than RM 8,500.
What happens if I am rushed to an out-of-network hospital in an emergency?
On MediAsas Teras the co-payment is waived for emergency care, so you would pay the deductible without the 20% co-insurance. MediAsas Fleksi has no emergency waiver — its annual deductible applies regardless.
Does this apply to my current medical card?
No. This structure belongs to MediAsas, which rolls out nationwide in January 2027 following the Klang Valley pilot. Your existing plan keeps its own panel rules and cost-sharing terms. MediAsas is voluntary and does not replace what you already hold.
Have a question that wasn’t covered here? Our advisors at FINNO. — an authorised agent of Allianz Malaysia — offer free, no-obligation consultations — no hard sell, just honest answers about what’s right for your situation.