- About
- Committee Members
- Ongoing Initiatives
- Press Release
- Annonucements
About Us
HPPSC, formerly known as the Grievance Mechanism Committee, is a multi-stakeholder platform consultative body to strengthen collaboration in medical claims management, address industry-level issues, and improve communications among healthcare partners
The Committee to HPPSC reflects its expanded and more proactive role in identifying issues, developing solutions and driving implementation through collaborative protocols and best practices.
Roles of HPPSC
HPPSC is tasked to:
- Co-developing claims protocols, resolving systemic issues, improving communications, fostering collaboration, and recommending practical best practices that enhance operational efficiency and patient experience
- Reviews issues received through medical professional bodies and industry associations with the objective of bridging knowledge gaps and providing broad guidance aligned with fair treatment of policyholders and ethical patient management
HPPSC does not:
Determine any punitive action against doctors, hospitals or the insurance industry
Adjudicate in individual medical dispute but to provide broad guidance for future reference purpose
Members of HPPSC
✓ HPPSC consists of 14 members, with an additional 2 members as observers.
✓ Co-Chairs
Dr Gunalan Palari @ Arumugam Palari, MMA
Mark O’ Dell, CEO, LIAM
✓ The members comprise:
- 4 doctors from Malaysian Medical Association (MMA)
- 2 representatives each from the Life Insurance Association of Malaysia (LIAM), General Insurance Association of Malaysian (PIAM), Malaysian Takaful Association (MTA), and Association of Private Hospitals in Malaysia (APHM).
- Representatives from the Ministry of Health (MOH) and Bank Negara Malaysia (BNM) will attend as observers.
- Representatives from Third Party Administrators
- One representative from a consumer advocacy group
Committee Members of HPPSC
Life Insurance Association of Malaysia (LIAM)
- Mr Mark O’Dell, Chairman
- Dr Kumari Sangaran Kutty - AIA Bhd
Medical Malaysian Association (MMA)
- Dr Gunalan Palari @ Arumugam Palari -Co Chair
- Dato Dr Venugopal Balchand
- Dr Vasu Pillai Letchumanan
- Dr Liew Shan Fap
Association of Private Hospitals Malaysia (APHM)
- Datuk Dr Kuljit Singh
- Anwar Anis
Malaysian Takaful Association (MTA)
- Dr Zaireen Zamri
- Prudential BSN Takaful Berhad
- Dr Prema A/P Sundralingam
- Takaful Ikhlas Family Berhad
Persatuan Insurans Am Malaysia (PIAM)
- Dr Aden Yusof Yong
- Allianz General Insurance Company (Malaysia) Berhad
Third Party Administrators
- Dr Yeogeswaran
- MiCare Sdn Bhd
- Mr Kenny Tai
- MediExpress (Malaysia) Sdn Bhd
- en Kamal Aryf Baharuddin
- PM Care Sdn Bhd
Patient Advocate
Manvir Victor
Advisors/observers:
- Ministry of Health
- Dr. Harshinderjeet Singh a/l Jeswant Singh
- Bank Negara Malaysia
- Ms Lau Chin Ching
Ongoing initiatives addressed by HPPSC
To improve communications
Establish a dedicated “doctor-to-doctor” hotline to facilitate direct clinical discussions between medical practitioners and insurers and takaful operators (ITOs) to enable swift resolution of clinical queries and reduce unnecessary delays that may disrupt patient care
Currently available. Please log in to view more. Access is restricted to members of MMA, APHM, LIAM, MTA and PIAM
To improve transparency in processes
Establish a transparent and streamlined framework for reviewing and panelling of doctors and hospitals for cashless facility of medical and health insurance/takaful (MHIT), including communication, engagement, review and appeal processes.
To improve MHIT claims management operational efficiency
Clinical protocols and policy coverage
Develop standardised processes to guide ITOs in managing claims involving treatment recommended by medical practitioners which may be not directly aligned to or covered by existing clinical practice guidelines (CPGs)
Develop framework for ITOs to assess and determine coverage for new procedures, diagnostics, treatments and medicines (including emerging medical technologies such as robotic surgery, genetic testing and new cancer therapy)
Endorse cancer drug list develop with MOH’s prescribed formulary prior to publication by MOH/PHCorp. This is to ensure private hospital doctors stay updated on MOH’s current prescribed cancer drug formulary.
The above will include:
Collaboration with MOH, hospitals, treating specialist and relevant medical associations to facilitate alignment and resolution
Implementation of a mechanism to disseminate such outcomes, protocols and solutions from such engagements to all ITOs to promote consistency in application
Simplify issurance of Guarantee Letters
- Simplify and improve Guarantee Letter issuance process to ensure timely issuance and effective communication between ITOs/TPAs, medical practitioners and hospitals.
Healthcare Partners Protocol & Solutions Committee
Central repository on medical insurance/takaful insurance claims
Please contact Malaysian Health Technology Assessment Section (MaHTAS) at [email protected] for further enquiry on the Clinical Practice Guidelines.
Note: MaHTAS is a division within Ministry of Health and hence, regarded as equivalent to Ministry of Health.