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Overview of the Skim Kemasukan Hospital & Pembedahan Pekerja Asing (SKHPPA)
The SKHPPA is a standardized insurance plan providing hospitalization and surgical insurance cover for all foreign workmen employed by a company. The Ministry of Health (MOH) has made it mandatory that effective 1 Jan 2011 all legal foreign workmen must purchase cover prior to being issued a work permit.
Coverage and Benefits
Duration of cover is for one year and the policy indemnifies the insured as follows:
| ITEM |
BENEFITS |
AMOUNT (RM) |
| 1 (a) |
Daily Hospital Room & Board (Maximum up to 30 days) |
As charged in accordance to charges consistent with Third (3rd) Class Room and Board to a maximum of RM60.00 per day in a Non-Corporatised Malaysian Government Hospital in conformance to the charges specified under Fees Act 1951, Fees (Medical) Order 1982. |
| 1 (b) |
Intensive Care Unit (ICU) (Maximum up to 15 days) |
| 2 |
Hospital Supplies and Services |
| 3 |
Operating Theatre |
| 4 |
Surgical Fees (Exclude Organ Transplantation) |
| 5 |
Anaesthetist Fees |
| 6 |
In-Hospital Physician Visits (Maximum up to 30 days) |
| 7 |
In-Hospital Specialist Consultation Visits (Maximum up to 30 days) |
| 8 |
Ambulance Fees/Medical Report Fees |
| Maximum Overall Annual Limit (Items 1 to 8) |
RM10,000.00 |
Premium Payable
Premium per foreign workmen is set by the MOH and is as follows:
Annual Premium: RM120.00 plus 6% service tax
Key Points to note
- The SKHPPA scheme and the Foreign workmen compensation (FWCS) scheme are two separate schemes and are both compulsory.
- Covers only legal foreign workers between the ages of 18 to 59.
- Premium for maids and workman in the plantation sector is payable by the employer.
- For all other sectors the premium can either be paid by employer or paid by employer first and then deducted from the workmen salary. (This is important as the 6% service tax is only chargeable in the event premium is paid by employer)
- Period of cover is for 1 year and is for both new and existing workmen.
- However, for existing workers with a valid work permit, the MOH has directed that period of cover is to coincide with work permit expiry date and premium is to be charged pro rata.
- In the event a worker fails the FOMEMA medical tests, premium is to be refunded pro-rata and is to be calculated from date OCA is notified by insured/agent of this fact.
- Our underwriting strategy for this class of business.
Our focus is on plantation, factory, maids and similar ‘safe’ classes of businesses. We are shying away from the construction industry unless it is for small construction projects, mega projects or projects involving multi story buildings will be declined.
In The event of a claim:
- There is no medical card issued. In the event of admission all the insured worker needs to do is provide the hospital with his passport number.
- The hospital will check with the MCO and admission is confirmed if there is cover.
Cashless admission is only applicable for government hospitals. Admission to a private hospital is not allowed unless it is for an accident and for the purpose of saving a life in this case however this is on a reimbursable basis and is based on the limits and scales of coverage.
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