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STARTS ON 15 JUNE 2023

Skim Perubatan MADANI

Free Treatment for Sumbangan Tunai Rahmah Recipients at Registered GP Clinics

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Welcome GP Participation in Skim Perubatan MADANI

Clinic
Registration
Clinic Briefing &
Onboarding Sessions
Open Door Q&A
Session for Clinic/GP

Skim Perubatan MADANI is a pilot initiative by the Government of Malaysia through the Ministry of Health that is implemented to accommodate the health needs of the B40 group for Acute Primary Care Services.

Sumbangan Tunai Rahmah (STR) recipients in the B40 group can seek treatment at private medical clinics (GP) registered under the Skim Perubatan MADANI.

Approximately 700,000 households will gain access to the Acute Primary Care Services when needed at GPs for free, which can reduce the burden of healthcare treatment costs whilst improving the well-being of low-income group.

Skim Perubatan MADANI focuses on partnership between the public and private sectors, especially in delivering Acute Primary Care Services.

Eligibility of Skim Perubatan MADANI

  • Sumbangan Tunai Rahmah (STR) recipients who are family households, senior citizens (without spouse) and singles.
  • Eligibility is automatic.
  • Eligible beneficiaries MUST make a declaration that they are NOT receiving any benefit equal or similar to this Scheme from any other employer/state government/medical agency scheme.

Treatment of Acute Primary Care Services inclusive:

  • Cough and Cold
  • Diarrhoea and Vomiting
  • Sprains and Strains
  • Headache
  • Mild Trauma, such as Superficial Wounds & Others

Treatments that are not included are 1) Routine Vaccination; 2) Health screening; 3) Routine NCD Follow-ups; 4) Routine Perinatal Follow-ups; 5) Family Planning; 6) Rehabilitation Request 7) Medicines without doctor’s consultation; and 8) Supplements Request 

Treatment Benefits of Skim Perubatan MADANI

Family Household
RM 250

* List of households registered with LHDN

Senior citizens
(without spouse)
RM 125

* Aged 60 years old and above

Singles
RM 75

* Singles aged between 21 - 59 years old
* Singles OKU aged between 19- 59 years old

Steps To Obtain Skim Perubatan MADANI Treatment​

Step 1, Check Eligibility : Check your eligibility on the website or via MySejahtera application.

Check Eligibility

Step 2, Clinic Visit : Proceed to any GP registered with Skim Perubatan MADANI (which can be identified by the Skim Perubatan MADANI sticker) with your identification card/document.

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Step 3, Receive Treatment: If you are eligible, you can receive Acute Primary Care Services for free.

Step 4, Balance of Benefit: The limit of your Skim Perubatan MADANI benefits will be deducted after each visit. The benefits of Skim Perubatan MADANI are subject to the Terms & Conditions by ProtectHealth Corporation Sdn. Bhd. as stated in our website.

Frequently Asked Questions​

General Information​

What is Skim Perubatan MADANI?

Skim Perubatan MADANI is a pilot initiative by the Government of Malaysia through the Ministry of Health (MOH) that is implemented to accommodate the health needs of the B40 group for Acute Primary Care Services.

What are the objectives of Skim Perubatan MADANI?

Objectives of Skim Perubatan MADANI are: 

  • To increase the low-income group’s access to acute primary care services at private sector and improve the welfare and enhance the well-being of rakyat. 
  • To increase participation of General Practitioners in acute care at primary level, through Public-Private Partnership. 
What is the benefit of Skim Perubatan MADANI?

The benefit is eligible beneficiary could receive Acute Primary Care services for FREE at empanelled General Practitioners under Skim Perubatan MADANI. List of GPs can be found here: https://kelayakan-spm.protecthealth.com.my/find-clinics  

Who are eligible for Skim Perubatan MADANI?

Rahmah Cash Contribution (STR) recipients who are family, elderly (without a spouse), and singles. Eligible beneficiaries should make a declaration that they are not receiving any benefit equal or similar to this Scheme from any other employer/state government/medical agency scheme such as Iltizam Selangor Sihat, Perak Prihatin and others.

How to check for Skim Perubatan MADANI’s eligibility?

Eligibility checking can be done via Skim Perubatan MADANI website: https://protecthealth.com.my/skimperubatanmadani, MySejahtera or Skim Perubatan MADANI mobile applications. Eligibility is AUTOMATIC during visit to the empanelled GP under this Scheme. Eligible beneficiary only has to present identification card (IC) to check for eligibility.

How much is the benefit entitlement for each of the Skim Perubatan MADANI category?

Three (3) cumulative benefit entitlement by category for Skim Perubatan MADANI are (until December 2023.):

  1. Family Household – RM250
  2. Senior citizens (without spouse) – RM125
  3. Singles – RM75

This allocation limit will be maintained until December 31, 2023. Each household, senior citizen (without spouse), or single individual can receive complete single visit treatment, within the limits for every visit, until the beneficiary fully utilise the above cumulative amount. Please note that this allocation limit may be subject to change in future years depending on Government policies or programs. The benefits of the Skim Perubatan MADANI are subject to the Terms & Conditions provided by ProtectHealth Corporation Sdn. Bhd. as stated on our website.

Where are the current location which Skim Perubatan MADANI is available?

Skim Perubatan MADANI focuses on 10 districts namely:

  • W.P. Kuala Lumpur
  • Gombak, Selangor
  • Hulu Langat, Selangor
  • Petaling, Selangor
  • Klang, Selangor
  • Johor Bahru, Johor
  • Kinta, Perak
  • Timur Laut, Pulau Pinang
  • Kota Kinabalu, Sabah
  • Kuching, Sarawak

List of GPs can be found here: https://kelayakan-spm.protecthealth.com.my/find-clinics

Will the Skim Perubatan MADANI beneficiary will be charged for payment of any treatment and medications?

No payment will and shall be charged to beneficairy by any parties involved for any treatment, procedure, and medications under Skim Perubatan MADANI for any treatment, procedure, and medications. If any complaints to be made, kindly send us an email at: [email protected] or contact +603-8687 2525. 

Why does Skim Perubatan MADANI is available only to B40 group?

High health care cost is causing serious impact to financial status of the B40 group. Therefore, to avoid this group from continuously burdened from accessing primary acute treatment service, this Scheme is created by the Government through Ministry of Health. If any complaints to be made, kindly send us an email at: [email protected] or contact +603-8687 2525. 

How to check for the entitlement balance?

1) Message/SMS will be sent to the registered mobile phone number after treatment visit.

2) The entitlement balance can be checked through the GP during treatment visit.

3) Can make a call to +603-8687 2525.

Skim Perubatan MADANI Benefit Package

What are the treatments that are in the Exclusion list of Skim Perubatan MADANI?

Treatments that are not included are: 

  1. Routine Vaccination; 
  2. Health screening 
  3. Routine NCD Follow-ups; 
  4. Routine Perinatal Follow-ups;  
  5. Family Planning;  
  6. Rehabilitation Request; 
  7. Medicines without doctor’s consultation; and  
  8. Supplements Request 
What are the treatments covered under Skim Perubatan MADANI?

Treatment of Acute Primary Care Services inclusive: 

  1. Cough and Cold 
  2. Diarrhoea and Vomiting 
  3. Sprains and Strains 
  4. Headache 
  5. Mild Trauma, such as Superficial Wounds & Others 
Is the treatment package in Skim Perubatan Madani also include therapeutic procedure and medications?

Yes, The Skim Perubatan MADANI Benefit package includes consultation, a selection of medications, treatment procedures, and tests that can be provided at private clinics. The maximum treatment limits that the Government pays to private clinics for each visit are as follows:

  1. The combined limit of consultation and medications is RM70(including consultation fee up to RM35)
  2. The limit for tests is RM50,
  3. The limit for treatment procedures is RM50.

This means that the maximum total limit for each visit paid by the Government is RM170.

What is the action required if the treatment package charge by GPs exceeding the visit entitlement limit?

GPs is prohibited from imposing additional charges to Skim Perubatan MADANI beneficiary. 

Can Skim Perubatan MADANI recipient get treatment at any empanelled GP under the Scheme?

Can, as long as the GP is empanelled under the Scheme. Beneficiaries can check the list of empanelled clinics in our website or identify through Skim Perubatan MADANI Glass sticker. 

General Practitioner

GP Empanelment Process for Skim Perubatan MADANI
  1. Sign in/Register: Visit ProtectHealth website https://primis-provider10.protecthealth.com.my/register for empanelment & upload required documents in the PRIMIS Provider Portal. 
  2. Letter of Appointment: Once application is approved, GP will receive a notification email to download the Letter of Appointment (LOA) from PRIMIS.  
    Note: GP can access to the dashboard of PRIMIS Provider Portal- <Provider Resources> for List of Services and Fee Schedule 
  3. Upload signed LOA: GP needs to upload the signed LOA into PRIMIS for ProtectHealth’s verification. 
  4. Successful Registration: Once verified, GP will be notified of successful registration as SKIM Perubatan MADANI Panel GP.   
  5. Onboarding Assessment: GP needs to complete and pass the Online Onboarding Assessment at PRIMIS. 
    Note: 10 questions. Allow multiple attempts until 80% passing mark. 
  6. Status becomes “Active”: GP now can access PRIMIS Clinical Portal. Ready for service provision once program starts. 
If my clinic has both BMS and VCS account credentials, which one should I use to empanel for Skim Perubatan MADANI?

If our existing provider has both BMS and VCS account credentials, either one of the account can be used to empanel for the program. However, we encourage the use of your VCS account to empanel for Skim Perubatan MADANI. 

Can a GP that is not registered under PeKa B40 or PICK be empanelled to join Skim Perubatan MADANI?

Can. 

How are GPs paid for Skim Perubatan MADANI?

The payment mechanism used in this scheme is Fee-for-service. Panel GP will be reimbursed according to the services rendered to the beneficiary. Please find the full list of services and the respective fee in the Skim Perubatan MADANI List of Services & Fee Schedule in PRIMIS Provider Portal. 

What will GP use as a system for claims and payments?

It will be a FREE web-based digital system called PRIMIS (Primary Care Information System) that will be monitored and managed by ProtectHealth Corporation Sdn. Bhd.

List of Criteria for GPs
  • Clinics must be registered as ‘General Private Medical Clinic.’
  • Clinics registered as ‘Specialist Private Clinic’ are not included in this pilot project.
  • Clinics must be equipped with a telephone line, Internet access, computer and printer.
  • For any additional services (e.g.: Xray services), clinics are required to declare and upload relevant document during registration in the system.
Conditions for GPs Registration
  • Clinic registration must be made in the name of the “Person in charge” as stated in the Borang B / Borang F (Certificate of Registration of Clinic). Documents that need to be uploaded are:
    • Certificate of registration to operate private medical clinic (Borang B or Borang F)
    • MMC full registration certificate of Person in Charge
    • Current annual practising certificate (APC) of Person in charge
    • Proof of Bank Account (which contains Clinic/Company name as per in Borang B/F)
      • Personal Bank account is NOT ACCEPTED.
    • Clinics with X-Ray Service are required to upload:
      • License of Tenaga Atom (within validity period)

Disclaimer:

Should there be any information or declaration provided herein found to be false or inaccurate, ProtectHealth reserves the right to terminate your appointment.

Benefit 1 : Free Health Screening

  • Recipients must undergo Health Screening (Benefit 1) in order to be eligible for Health Aid (Benefit 2), Completing Cancer Treatment Incentive (Benefit 3), and Transport Incentive (Benefit 4).
  • Health screening may be performed by doctors at any MOH clinic and private clinic registered with PeKa B40.
  • Health screening includes:
    • medical history taking, noting of individual and family ailments, including risk factors
    • mental health screening
    • physical examination
    • clinical breast examination for female recipients, and clinical prostate examination for male recipients who are at risk
    • blood and urine tests
  • Blood and urine specimens will be obtained and sent to the laboratory for the following tests – blood cell test, blood sugar control test, cholesterol test, kidney function test, and urine test.
  • Benefit recipients do not need to fast to undergo those tests.
  • Benefit recipients will not be charged for undergoing physical examinations and laboratory tests under this PeKa B40 package.
  • Should recipients require treatment, they may be referred to a Klinik Kesihatan (government clinic), or, if they agree to be treated at a Private Clinic, recipients must bear the cost of said treatment themselves. For now, the PeKa B40 scheme does not
    include any treatment or medication cost.

Benefit 2: Health Aid

  • This benefit covers medical equipment that is required in procedures/ treatments and is not subsidised in MOH hospitals.
  • A maximum of RM20,000 is given to the recipients in the form of purchased medical equipment.
  • Benefit 2 includes medical equipment in the following categories:
    • Stents for the heart
    • Artificial joint equipment
    • Hearing aid devices
    • Heart pacemakers
    • Prostheses and implants for the spine
    • Prostheses and orthoses for the limb bones
    • Intraocular lenses
    • Breathing therapy equipment and oxygen concentrator
    • Nutritional support assistance
    • Wheelchairs
  • Health Screening (Benefit 1) must be performed first before recipients of PeKa B40 may avail themselves of this benefit.
  • This benefit only applies when recipients of PeKa B40 are treated in MOH hospitals, whereby the application must be made by MOH medical specialists on behalf of the patients who are recipients of PeKa B40.
  • The approval depends on the price range for each medical equipment’s category.

Benefit 3 : Completing Cancer Treatment Incentive

  • Benefit 3 is intended to encourage cancer patients, especially those in the early stages of treatment and disease, to complete their treatment plan as laid out by MOH cancer specialists.
  • RM1,000 is paid to cancer patients who complete their treatment at MOH hospitals.
  • Health Screening (Benefit 1) must be performed first before recipients of PeKa B40 may avail themselves of this benefit.
  • Payment of incentive is divided into two (2) parts
    • RM300 will be paid once the beneficiary started his/her cancer treatment.
    • RM700 will be paid after cancer treatment has been completed.
  • Payment of incentive is made directly to all eligible recipients of PeKa B40 via their registered bank accounts.
  • Application and proof of eligibility for Benefit 3 must be made by a doctor or MOH specialist on behalf of patients who are recipients of PeKa B40.

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