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Skim Perubatan MADANI

Welcome GP Participation in Skim Perubatan MADANI

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Briefing & Onboarding Sessions

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.

For the pilot phase, Skim Perubatan MADANI will be available in the districts of Johor Bahru (Johor), Wilayah Persekutuan Kuala Lumpur, Klang, Petaling, Hulu Langat & Gombak (Selangor), Kinta (Perak), Timur Laut (Pulau Pinang), Kuching (Sarawak) and Kota Kinabalu (Sabah).

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

Location of Skim Perubatan MADANI

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

(Until 31 December 2023)

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

General Practitioners

  1. Sign in/Register: Visit ProtectHealth website https://primis-provider.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 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. 

No. For pilot phase, only GPs in the 10 districts listed below can participate in Skim Perubatan MADANI:

  1. Johor Bharu (Johor)
  2. Timur Laut (Penang)
  3. Kinta (Perak)
  4. Klang, Hulu Langat, Petaling, Gombak (Selangor)
  5. Kuala Lumpur (WPKL)
  6. Kuching (Sarawak)
  7. Kota Kinabalu (Sabah)

Can. GP that wishes to empanel with Skim Perubatan MADANI must be in the selected districts for the pilot phase. 

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. 

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.

  • Only GPs in the 10 districts will be eligible for Skim Perubatan MADANI:
  1. Johor Bharu (Johor)
  2. Timur Laut (Penang)
  3. Kinta (Perak)
  4. Klang, Hulu Langat, Petaling, Gombak only (Selangor)
  5. Kuala Lumpur (WPKL)
  6. Kuching (Sarawak)
  7. Kota Kinabalu (Sabah)
  • 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.

  • 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.

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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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