When we think about employee benefits, we often imagine a safety net—
coverage for medical emergencies, surgeries, and hospital stays. But what happens when an employee’s health condition requires a procedure often misunderstood as “cosmetic”?
Let’s talk about bariatric surgery—a medically recognized treatment for severe obesity and related conditions like hypothyroidism, diabetes, hypertension, and sleep apnea.
Recently, we at Minaris Risk Management handled a case that tested the true limits of an employee’s Group Hospitalisation and Surgical (GHS) policy. One of our clients, Mat, was advised by her doctor to undergo Laparoscopic Sleeve Gastrectomy, not for aesthetics, but to prevent life- threatening complications from hypothyroidism-induced weight gain and metabolic slowdown.
The Policy Exclusion Dilemma
Her employer’s GHS policy had a standard exclusion clause: treatment for weight reduction is not covered. The insurer initially denied the claim based on this clause.
But here’s where we made a difference.
We understood the medical context: this was not a vanity procedure. It was a medically necessary intervention backed by physician advice, aimed at avoiding heart disease and other metabolic complications.
We didn’t stop at “no.” We went all the way—preparing a justification, compiling the medical memos, and negotiating with the insurer to review the case based on medical necessity. The insurer eventually agreed to re- evaluate her reports.
So, Was the Claim Approved?
Unfortunately, the story didn’t get its ending. Before a final verdict could be reached, the employer decided to discontinue their Group Hospitalisation and Surgical policy due to budget constraints.
This highlights a bigger question for companies and HR managers alike:
Do Group Hospitalisation and Suroftical Policies Cover Bariatric Suroftery? Short answer: No, not by default.
Most GHS policies in Malaysia explicitly exclude:
- Elective surgeries
- Cosmetic procedures
- Treatments for weight loss
But here’s the nuance: If a doctor certifies the surgery as medically necessary and it’s supported by documented comorbidities (e.g., diabetes, hypothyroidism, high BMI), some insurers may consider an exception—on a case-by-case basis.
Key Takeaways for Employers & HR
Review Your Policy Wording Carefully
Standard GHS plans have limitations. Don’t assume all hospital procedures are covered.
Medically Necessary ≠ Automatically Covered
Even with doctor recommendations, the insurer may still reject based on general exclusions.
Negotiation Matters
With the right documentation and advocacy (like what we do at Minaris), there’s always room to push for a review.
Policy Discontinuation Leaves Employees Exposed
Once coverage lapses, any ongoing claims or pending reviews may be void. Be mindful of timing.
A Final Word
At Minaris, we don’t just manage insurance—we advocate for our clients. When policies fall short, we step in to bridge the gap between medical need and insurer logic. Because health isn’t always black and white—and neither should your coverage be.
If you’re a business owner or HR manager reviewing your GHS policy, ask the hard questions. And if you’re an employee unsure about your coverage—let’s talk.
Your health deserves more than exclusions. It deserves attention.
👉 Talk to an Expert at Minaris today.
Get protected with a plan that fits your business.
Jayadarshiniy Sankar is a Senior Insurance Advisory Manager with a background in law and over 5 years of experience in professional indemnity and general insurance. She specializes in regulatory compliance and client solutions, delivering tailored coverage with prompt, results-driven support while actively educating clients through industry content and guidance.