Most people who qualify for Skim Perubatan MADANI have never used it, and a fair number have never heard of it. It is a Ministry of Health scheme that lets eligible Sumbangan Tunai Rahmah (STR) recipients walk into a participating private GP clinic with acute symptoms and walk out having paid nothing. No form to fill in beforehand. No application. Your IC is the application.
It is also narrower than people assume, and the narrowness is where the frustration comes from. So here is the whole thing, plainly.
Who is eligible
Eligibility is automatic. There is no registration step.
You qualify if you are a Sumbangan Tunai Rahmah recipient in one of three categories, as set out by ProtectHealth, which administers the scheme for the Ministry of Health:
- Family households — the household registered with LHDN
- Senior citizens without a spouse — aged 60 and above
- Singles — aged 21 to 59, or aged 19 to 59 for OKU cardholders
One condition matters. Beneficiaries must declare that they are not receiving an equal or similar benefit from an employer, a state government scheme or another medical agency scheme. State schemes such as Iltizam Selangor Sihat and Perak Prihatin are named examples. You cannot double-claim.
What it actually covers
This is the part that trips people up. Skim Perubatan MADANI is for acute primary care — things that came on recently and need treating now.
Covered treatments include:
- Cough and cold
- Diarrhoea and vomiting
- Sprains and strains
- Headache
- Mild trauma, such as superficial wounds
The benefit package covers consultation, a selection of medications, treatment procedures and tests that a private clinic can perform.
What it does not cover
Eight exclusions, and they are firm:
- Routine vaccination
- Health screening
- Routine NCD follow-ups — so not your regular diabetes or hypertension review
- Routine perinatal follow-ups
- Family planning
- Rehabilitation requests
- Medicines without a doctor's consultation
- Supplements
The pattern is consistent: this scheme treats episodes, not conditions. Chronic disease management and screening sit with other programmes.
How much you get
The benefit is a cumulative annual allocation, drawn down visit by visit. ProtectHealth lists the amounts as:
| Category | Allocation |
|---|---|
| Family household | RM250 |
| Senior citizen without spouse | RM125 |
| Single | RM75 |
Separately, there is a cap on what the government pays the clinic per visit:
- Consultation and medication combined: up to RM70 (of which consultation is up to RM35)
- Tests: up to RM50
- Treatment procedures: up to RM50
Maximum of RM170 per visit.
Note that ProtectHealth's own documentation flags these allocation limits as subject to change depending on government policy year to year, so treat the figures as current-as-published rather than permanent.
The important protection: participating GPs are prohibited from charging beneficiaries additional amounts under the scheme. If a clinic asks you to top up the difference, that is not how it is supposed to work.
Using it, step by step
Step 1 — Check eligibility. Use the eligibility portal, the MySejahtera app, or the Skim Perubatan MADANI app. You can also skip this and let the clinic check.
Step 2 — Find a participating clinic. Not every GP is on the panel. Use the clinic finder, also reachable through the MyGovernment digital services listing. On the ground, participating clinics display a Skim Perubatan MADANI glass sticker at the door.
Step 3 — Bring your IC. That is the whole document requirement. Eligibility is verified at the counter.
Step 4 — Get treated. If you are eligible and the complaint falls within acute primary care, there is nothing to pay.
Step 5 — Track your balance. An SMS goes to your registered mobile number after each visit. You can also ask the clinic at the next visit, or call ProtectHealth at 03-8687 2525.
That last step matters more than it sounds. The allocation is cumulative — three visits at RM70 each will use most of a single person's RM75 in one go. Knowing your remaining balance stops an awkward conversation at the counter.
Where it currently runs
The scheme operates in 10 districts:
- 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
If you are outside those districts, the scheme is not available to you yet regardless of STR status. That is a coverage limitation, not an eligibility failure.
How it differs from PeKa B40 and MediAsas
Three schemes, three jobs, and people mix them up constantly.
- Skim Perubatan MADANI — acute episodes at private GPs, free, for STR recipients. What this article covers.
- PeKa B40 — free health screening plus health aid, cancer treatment incentives and transport incentives. The opposite end of the pipeline. Our guide to using PeKa B40 for a free health screening sets out that process.
- MediAsas — a separate insurance-style product with its own exclusions, covered in our piece on what the RM65 MediAsas plan actually leaves out.
And if the complaint is not acute, or you have used up your allocation, the government clinic route still exists — booking a Klinik Kesihatan appointment through MySejahtera is usually faster than walking in cold.
Small things that save a trip
- Call the clinic first and confirm they are still on the panel. Panels change.
- Go for the thing that is actually wrong. A cough gets treated; a request for supplements does not.
- Keep the SMS. It is your balance record.
- If you moved districts, check the finder again before assuming your old clinic still applies.
FAQ
Do I need to register for Skim Perubatan MADANI?
No. Eligibility is automatic for qualifying STR recipients and is verified at the clinic using your identification card. There is no manual application.
How do I know if a clinic accepts Skim Perubatan MADANI?
Check the official clinic finder at kelayakan-spm.protecthealth.com.my/find-clinics, or look for the Skim Perubatan MADANI glass sticker displayed at participating clinics.
Can a clinic charge me extra under the scheme?
No. Participating GPs are prohibited from imposing additional charges on beneficiaries for treatment, procedures or medications provided under the scheme.
Does it cover my diabetes or blood pressure follow-up?
No. Routine non-communicable disease follow-ups are explicitly excluded, as are health screenings, routine vaccinations, family planning and supplements. The scheme is limited to acute primary care.
How do I check my remaining balance?
An SMS is sent to your registered mobile number after each visit. You can also ask the clinic during a visit or call ProtectHealth on 03-8687 2525.
Is it available in my state?
Only in 10 districts at present: W.P. Kuala Lumpur; Gombak, Hulu Langat, Petaling and Klang in Selangor; Johor Bahru; Kinta; Timur Laut; Kota Kinabalu; and Kuching.
