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Medical or Travel Coverage

Medical or Travel Coverage 

The regulation of medical reimbursements by the Federal Government to pensioners is subject to General Orders Chapter F, 1974, which stipulates that pensioners and eligible dependents may be given free medical services at Government hospitals and clinics. However, if Government hospitals or clinics are unable to supply the medical services needed, pensioners can go to private hospitals or clinics. The expenses incurred will be reimbursed by the Government, and are subject to compliance with the conditions and regulations as set out in Service Circular Number 21, Year 2009.

Eligible Recipients:

  • Pensioners
  • Pensioner’s Spouse
  • Children*

*18 years and below; or under 21 years old who are still schooling; or disabled children due to mental or physical weakness (no age limit)

 

Application for Medicines, Medical Devices, Medical Services, & Treatment and Kidney Treatment 

Specialist Treatment Application Procedure Terms of application
Procedure Application Procedure

  1. Obtain medical treatment at Government hospitals or clinics;  and
  2. Government hospitals or clinics are unable to supply the required medical services; and
  3. Certification/Verification by Government officer / physician; and
  4. Medical Form 1/09 together with financial documents (bills, receipts, invoices, quotes, etc.)
Terms & Conditions Supply of Medicines

Approval for medication expenses reimbursement is limited to prescriptions for three (3) months' consumptions only.

Reimbursements for food supplements are strictly prohibited.
Medical Device

Reimbursement for expenses for medical device:
  1. Orthopaedic device
  2. Artificial limbs
  3. Wheelchair
  4. Hearing aids
  5. Cardiac equipment, respiratory aids, cochlear implants, colostomy bag, urine bag and intraocular lens
  6. Other devices are subject to:-
    • No alternative for the device
    • Non- usage will lead to fatality or harmful
    • No alternative for treatment
Application for expenses for repairing or replacing any equipment damaged due to negligence is not allowed.

Application for expenses for supply / replacement / repair for cosmetic purposes is not allowed.

Application for expenses for supply / replacement / repair for a purpose other than of treating the ailment is not allowed.

Application for expenses for supply of disposable equipment is not allowed.
Medical Services

Reimbursement for expenses on medical services for Computed Tomography Scan (CT scan) and Magnetic Resonance Imaging (MRI) may be considered provided that a Government officer/physician has acknowledged and confirmed that government hospitals or clinics are unable to provide the required services.
Treatment of Kidney Disease

Reimbursement for haemodialysis and CAPD treatment expenses may be considered, subject to the condition that a Government's nephrologists has recommended such treatments and verified that such treatments is not supplied/provided by Government hospitals/ health clinics.

Limited to medical expenses only, based on the actual expenditure and subject to a maximum of RM200.00 for each treatment session.

Reimbursement for Other Medical Expenses

Types of Treatment Application Procedures for Specialist Treatment Terms of Application
Specialist Treatment To receive treatment at Government hospitals or clinics; and   
 
The required Specialist Treatment is unavailable at Government hospitals or clinics; and  
 
Confirmation by Government Medical Specialist; and:-  
Medical Form 1/09 with financial documents (bills, receipts, invoices, quotes, etc.)
Cost incurred by the Government:
  • Treatment cost;
  • Food and wards expenditure according to 80% of entitlement.
Costs incurred by pensioners:
  • Excess of entitled ward charges;
  • 20% of entitlement rate on food and ward;
  • Other costs - food outside of the normal component of the ward charges, telephone, laundry, bed charges for companion and others.
Emergency Treatment Emergency treatment at the closest private hospital or clinic as there is no hospital or clinic closer to the scene of the emergency; and

Immediate treatment is crucial as delay of treatment may lead to fatality (life- threatening); and

Certification or validation of medical facility by private hospital or clinic physician; and

Medical Form 2/09 with financial documents (bills, receipts, invoices, quotes, etc.).
Immediate treatment in order to save a patient's life;

Certified by physician from private hospital / clinic that treats the patient.

Cost incurred by the Government:
  • The cost of emergency treatment for the period of up to when stable patients and can be transferred to a Government hospital / clinic;
  • 80% of entitlement rate for food and ward.
Cost incurred by pensioners:
  • Ward charges exceeding entitlement;
  • 20% of payment for food and wards according to the entitlement;
  • Other costs - food that exceeds the normal ward charges, telephone, laundry, extra bed for companion and etcetera.
The application must be accompanied by a detailed clinical report from the private hospital / clinic physician that treats the patients.
Treatment at the National Heart Institute Sdn. Bhd (Institut Jantung Negara) Obtain treatment from Government or private hospital or clinic; and

Referred by General Physician/ Cardiologist at Government or private hospital / clinic to the National Heart Institute (IJN); and

Medical Form 1/09 together with financial documents (bills, receipts, invoices, quotes, etc.)
Patients have received treatment at the Government or private hospital / clinic; and

Referred by General Physician / Cardiologist at Government or private hospital / clinic to the National Heart Institute (IJN).
Infertility Treatment Obtain treatment from Government hospitals / clinics or Klinik Lembaga Penduduk & Pembangunan Keluarga Negara (LPPKN); and

Medical facilities cannot be supplied or provided by Government hospital or clinic or LPPKN; and

Certification or validation of the needs for the medical facilities by a doctor or medical officer from the Government / LPPKN; and

Medical Form 1/09 with financial documents (bills, receipts, invoices, quotes and etc.)
To overcome the primary infertility only – first pregnancy and having difficulty in conceiving.

Not allowed:

Unnatural Process of Pregnancy
  • In Vitro Fertilisation (IVF)
  • Gamete Intra-Fallopian Transfer (GIFT)
  • Intra Cytoplasmic Sperm Injection (ICSI)
  • Secondary infertility.
Supplementary treatment may be considered, subject to the condition that the treatment is approved by the Ministry of Health and the facilities are unavailable at a Government hospital or clinics:
  • Hysterosalpingogram (HSG)
  • X-ray or surgery carried out in private hospital / clinic on referral by the officer / hospital physician / Government clinic/ LPPKN
Treatment Abroad Obtain treatment from Government hospital; and

Special treatment needed by patient is not available within the country; and

Approval by  Medical Board; and

Acknowledgement by the Director General of Health Malaysia that the treatment required is not being provided by any Government hospitals or clinic; and

Form 3/09 needs to be submitted to the Remuneration Division of JPA with financial documents (bills, receipts, invoices, quotes, etc.); and

Application is being approved by the Cabinet Officer (Jemaah Pegawai) for Abroad Treatment Abroad
Reimbursement for expenses on companion can be considered subject to the recommendation of Medical Board.

Costs incurred by the Government:

The cost of treatment:
  • Cost of living (food and hotel rental / lodging) for a period of not more than five (5) days after arriving in the country and five (5) days before returning to Malaysia for the patient and companion.
  • Economy class air ticket for patient and companion.
Costs incurred by the patient (pensioners):
  • Ward charges equivalent to the rates charged to retirees if hospitalised in Government result;
Other costs - food outside of the normal ward charges, telephone, and laundry, and bed charges for partner / visitor, etc.

Financing Services for Medication and Medical Equipment Supplies to the Federal Public Pension and Eligible Dependent

The Government has appointed Oratis Services Sdn Bhd through an open tender to process the reimbursement for medicines and medical devices supplied to Federal Government Pensioners via the Electronic Medical Supply Automation System (e-MASS).

 

With e-MASS, Federal Government Pensioners can obtain medicines and medical devices that are not supplied by Government hospitals / clinics at registered pharmacies without any payment.

 

e-MASS Execution Method

With the implementation of e-MASS, Federal Government Pensioners can obtain medicine supplies and medical devices from any hospital / clinic / pharmacy / private agency registered with Oratis Services Sdn Bhd without making any payment (subject to terms & conditions).

Federal Government Pensioners must submit Medical Form 1/09 (complete with verification from a Government medical officer or physician) and a valid prescription from a Government hospital / clinic to obtain medicine supplies or medical devices through the following methods:

  1. Obtain directly from a hospital / clinic / pharmacy / private agency registered with Oratis Services Sdn Bhd. (The list of hospitals / clinics / pharmacies / private agencies registered with Oratis Services is available on its website at www.oratis.com.my.); or
  2. Contact the e-MASS Call Centre toll-free at 1-800-88-6627 and delivery will be made directly by Oratis Services Sdn. Bhd. to Federal Government Pensioners or hospital; or
  3. Place your order online via the e-MASS Portal at www.emass.com.my and delivery will be arranged by Oratis Services Sdn. Bhd.

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