Sheryl

Yes, there have been many complaints on this board. I believe most relate to claims in the first year or two of a policy, but not all. See https://aseannow.com/topic/1186192-pacific-cross-cover-reviews/ among other threads (can google PC Insurance + site:aseannow.com). I have also heard PC excludes some age related conditions like cataract and prostate problems absolutely, but am not sure if that applies to all or just people who enroll past a certain age. And there have been reports of them adding exclusions years after a policy was issued, based on a claim (i.e. you have condition X one year with a related claim, on your next renewal it appears as an exclusion even though you did not have it at time of initial enrollment). This may be timebound and seems to be related to a general policy exclusion of "chronic" conditions. If growing old here you absolutely do not want a policy that contains any sort of exclusion for "chronic" conditions...since the development of chronic health probolems is pretty universal as people age. And, like most Thai insurers they can and will raise your premiums based on claims history - by as much as 25% in a given year and that is on top of age related and inflationary increases. For anyone planning to grow old here, this is a major consideration. Thai based insurers do not have as good or as professional a record for claims management compared to international insurers who offer expat policies, and once past about age 60- 65 the international policies cost about the same or even less. International insurers are not allowed to raise premiums based on claims history, and any disputes go through channels in their company of registration, where insurance regulation is usually much tighter than in Thailand. On the other hand it is true that switching insurers can be problematic. If you then have a claim in the first year or so of the new policy it will certainly get more scrutiny than it otherwise would (accidents excepted). That does not mean it won't be paid, but it will be scrutinized especially if it is in the first year of the policy and a condition which by its nature might have been present before hand. And if you have anything that might be considered a pre-existing condition (anything you take medication for; anything that required medical treatment in the past say 5-10 years; any abnormal finding on lab test or check-up even if not currently requiring treatment - e.g. elevated PSA, elevated cholesterol, early cataract) these will likely be excluded or else you may have to pay a "premium load" to include it - you will know for sure once your application is reviewed, a process that is more detailed and lengthy than with a Thai insurer (but unlike the latter, as long as you withheld nothing, leads to a clear policy where you can be sure what is covered and what not). Personally if it were me, I'd make a move to an internationally issued policy now if you are committed to living here for the rest of your life. Now is the time to do so, before you get any older, or develop/learn of any health conditions. Like any policy, an international expat policy should be gotten via a broker and your current broker is unlikely to be able to help with anything but a Thai issued policy. I used AA brokers in the past but they have now restructured and there is a separate entity called AA-World handling internationally issued policies and I have so far no experience with them. Contact is [email protected]. As this is a quite recent restructuring the website is nto yet operational https://aa-world.com/ There are other brokers foir international expat policies as well, such as https://www.aoc-insurancebroker.com/ Personally I have April International from France (not ot be confused with April Thailand) but above brokers can give you a comparison chart that includes more options as well. Be sure to look not just at current premiums but how much they will increase with age, and deductible options. Also make sure hospitalization-only policy includes day surgeries, outpatient cancer care and outpatient dialysis.

Also brand names: Mometasone Sandoz Mometasone Teva Nasospray The last one is locally made so should be less expenfive. Any large Thai pharmacy will have at least one of these brands. Where in Thailand are you?

Length of stay is largely irrelevant. Room charges are the least of cost of hospital care. In the case referenced, he may have been administered a clot busting drug or other delicate neurosurgical intervention. These are expensive. With an acute heart attack, angiography and stent will run that much or more (depending in number of stents needed) but if stenting is successful, the stay will be short. Many similar examples of high cost/low stay duration hospitalizations. Conversely you could be hospitalized for several weeks and still have a modest bill, if no surgery or expensive procedures were involved.

This "pricing out" based on claims is unique to Thai companies. Western country insurance regulations do not allow it, premium is not affected by your claims history. To me, a policy which can raise your rates based on claims history (on top of the ordinary inflationary and age increase) defeats the whole point of insurance. But Thailand's insurance regs allow it, so most of them do it. And indeed, people do get priced out and then unable to get another policy. This alone is an overwhelming reason to stick with internationally issued policies. Premiums will go up with age (though to a much lesser extent than the Thai policies in the older age brackets - I have seen some where the premium at say age 80 actually equalled the maximum coverage, which is absurd). But this is predictable, and there will be no add on charge because you had a claim or developed a chronic health condition. Some Thai insurers also cancel policies at a certain age. And I have heard of some introducing exclusions after the fact, i.e. year 1 you develop a certain condition and have a claim related to it, year 2 that condition becomes an exclusion. Western insurance regs would not allow that either.

The cost difference would largely be explained by the OPD cover which I do not have. Male sex and pre-existing hypercholsterolemia might add a bit more but the OPD is the main factor. Note that April hospitalization-only cover includes day surgeries as well as outpatient cancer care (chemo etc) and dialysis. It also covers outpatient care related to a subsequent hospitalization (I think up to 30 days before admission) and outpatient care related to a hospitalization up to 30 day after discharge. With the most costly OPD covered and given that including elective OPD cover more of less doubles the premium it goes not make sense to me to have it.

At the higher ages (say 70 on up) this compares unfavorably to the best internationally issued expat policies...which also provide more cover. But make no mistake, with any policy premiums will rise with age. So will the likelihood of needing to use the insurance.

That is not quite it. The insurer has calculated what they are likely to have to pay out for claims across the whole pool of insured people by age group (understanding that there willl be people with no claims, small claims and some with very large claims in that mix) and base that along with their administrative costs and profit to set premiums. The only assumption about individual policy holders is that they are at average risk for their age at time of initial enrollment (hence the importance of knowing of any prior or pre-existing conditions). The insurer fully expects to take a "loss" on some policies and that is fine as long as the overall payouts for all policies is not higher than projected for a sustained period of time. Getting this calculation correct is complex and there are insurers out there new to the game who badly underestimate (or intentionally underprice at first to lure in new customers). . These end up either going bankrupt or having to drastically raise rates dcross the board. The longer the insurer has been in business and the larger their pool of insured persons, the less risk there is of this. When one decides to get insurance of any type it is with the understanding that odds favor paying more on premiums over the life of the policy than receiving in benefits but that there is a possibility of the opposite happening and that which group you will be in, is impossible to predict.

You can. But you have to start while younger and still healthy. The problem is that retirees, by definition, tend to already be older when they move to Thailand and often already have health conditions.

I am the same age and have the same policy but my latest premium is much less than half what you report. (With a $500 deductible). You must have some extras tacked on, or have been assigned a premium liad at enrollment due to gome pre-existing condition. . Just hospitalization would not cost anywhere near this amount.

If your are unable to get insurance then certainly you should self insure. The problem is that few can afford to self insure adequately.

Depending on what the conditions are for which you take medication you may be right. Especially if one of them is diabetes. The best insurer for people with stable well controlled conditions seems to be Cigna Global.

This. I would add you not only need to be able to immediately put aside several million baht but also have a way to replenish it as used. In my experience most of the expats who say they are "self insured" are not really. They are uninsured or under-insured. At 61 years and still healthy you can get a good policy without difficulty. That will change as you near 65 (or develop a health problem -- as you eventually will, good health does not last hmforever) ) so I would advise acting sooner rather than later.

Around 2.500 baht bincluding hospital add on charges (but not including medications should he prescribe any)

As a Thai she is covered under the universal health care scheme (AKA "30 baht scheme")- but would have to start at hhe hospital which serves the district where she is listed in a tabien ban (house registration) and be referred from there. As already stated the best spinal specialst is at BNH and also at Chula. There is also a good unit at Bangkok Hospital. The MRI report does not indicate a need for surgery but seems inconsistent with the clinical picture so the film should be read by a good spine speciaist. Consultation at BNH will be few thousannd baht. At Chula just 50 baht but limited interaction with the senior doctor. If Prof. Wicharn thinks surgery is indicated get a written recommendation and take it to her registered hospital and try to get a referral letter from them to Chulalongkorn.

Only a periodontist upon examination of your gum can answer this. Suggest you consult periodontist at one of thee places: http://www.dentalhospitalbangkok.com/services.php https://bangkokdentalcenter.com/

The best spinal specialist in Thailand is Prof. Wicharn Yingsakmongkol who can be seen privately at the BNH Spine Center. https://www.bnhhospital.com/search-doctor/entry/4093/ He is also at Chulalongkorn Hospital ( Bhor Por Ror Building, 5th Floor, Mn-Fri 8:30 - 4 PM), but going through the public channel there may not have much direct contact with him as he is in a teaching/supervisory capacity. Given the seeming discrepancy between the MRI report and the severity of the clinical signs it may be worth paying for a private consultation initially. Before going, make sure you have the MRI on DVD, not just the report as Prof. Wicharn will need to directly review it.

You can get psyllium at Villa markets and also online easily.

What Thai insurers will consider a pre existing condition and what you do are quite differrnt. I have for example seen claims for heart attacks denied based on an isolated outpatient visit related to gastric reflux a decade back, or an isolated borderline high BP reading recorded once at a doctor visit years ago despute multipke other normal readings . Internationsl insurers are not going to do that sort of thing. But even they are not going to view your health status the way you do. An ICU admission with lung damage 7 years ago would likely lead to some exclusions on a new policy. That you are healthy now does not mean you will always remain so and your healthy habits are no guarantee. I was in perfect health at your age too. Did not stop a motorcycle from slamming into me at high speed a few years later (2 weeks in hospital, 2 surgeries, cost a little under 1 million baht all told). Didn't stop age related changes to my spine from eventually compressing nerves requiring spinal surgery a decade later. And while right now I seem perfectly healthy and have great habits I could have a heart attack or stroke or develop any number of cancers at any time. Indeed the older I get, the more likely it is that one of those things will happen sooner or later.

Was the increase 50% or 33%? title of your thread says 33%. Having turned 56 you likely moved into a new 5 year age bracket. As mentioned your current policy is also local not international. Only reason I suggest keeping it is that there is an advantage to holding same policy for many years. Increases the odds of smooth claims approval. Insurers look very closely at claims occurring in first few years of a new policy. Thai insurers in particular will dig deeply to find any possible indication of a predisposing factor (and draw some pretty far-ferched conclusions at times i that regard). Wheras if you have held the policy for many years this is less likely. If you do change policies then I stronhly advise you do so for an internationslly issued one. Some insurers to look at would be: April International (what you have now is April Thailand). Cigna Global (not Cigna Thailand) Thwmey offer both deductible and copay options ACS (they have a plan specific to SEA) However none are likely to be less than the 31k baht you can get on your current policy with deductible. That is already a quite low cost for health insurance at your age. I would be very, very suspicious of any policy costing under 30-40k baht a year at your age. Beware of policies that use a "bait and switch" approach i.e. an artificially low initial premium that immediately shoots up at renewal . And of policies that actually cover very little. Looking at the AXA Thailand policy you have in mind it will cover only up to 8k per day ICU room cost (too low) and only up to 150k general hospital costs (unclear if per hosputalization or per year but way too low in either case). Also limited to 1 doctor visit per day while in hospital (common to have more e .g. visits from different specialists). The cancer care benefit is only 100k -- way way too low. Cancer care can snd will easily run into the millions. While the maximum benefit per disability is listed at 4 million there is almost no way you would actually get reimbursed to anything near that given these sub category limits.

The problem with locally issued policies as people have tried to tactfully allude to is that they have a poor track record for actually paying out on claims and the regulatory environment is weak. Very common to decide only at the point of claim that a condition is excluded on one pretext or another. Having no prior isurance claim or hospitalization does not prevent this. In addition Thai insurers can and often will raise rates based on changes in "risk profile" (e.g. having developed a chronic health condition) and your claims history. They are allowed to up premiums by as much as 25% in a single year on top of any inflationary and age related increases. Inno time at all you can find yourself priced out at ab age/state of health where you cannot get a different policy. If you are planning on growing old here this point is critical. Additional concerns are: - level of cover (what you attach gives too little info to assess..a cap of 4 million baht does not mean they'd cover a given claim up to 4 mill, need to look at limits for the various billing sub-categories) - whether hospitalization policy includes day surgeries, outpatient cancer care and outpatient dialysis. - whether they guarantee lifetime renewal (many Thai insurers cancel policies at a certain age) - what premiums will look like at later ages (Thai insurers, if they will insure past age 65 at all, tend to raise premiuns in older ages much more steeply than international companies). Again, especially important if you plan on growing old here.). Have you checked what your premium would be with maximum (300k+) deductible in your urrent policy?

totally agree but in fact what he currently has is a local policy. It is April Thailand, underwritten by LMG. I think he has some idea that there could be a plan for expatriates that covers them only in Thailand, and nowhere else, and would cost less. There is not AFAIK. And if there were, no reason for it to cost any less. Most ex-pat policies offer different zones of cover (with worldwide including US being the most expensive). A few offer with zones limited to a few countries in SE Asia. I haven't seen any that limit to Thailand only, and there would be little reason for/advantage to it.

This is the website for April Thailand. https://www.april-international.com/en/long-term-international-health-insurance/myhealth-thailand And it is what you already have. There is absolutely no advantage -- and several disadvantages - to getting a policy from April Thailand vs April international. You come under Thai rather than EU insurance regulations. And it does not cost less.

He has April Thailand not April international. Their policies are underwritten by LMG. It is actually one of the best -- perhaps even the best -- of the Thai-issued policies. That and Aetna, IMO. (Though "least worse" may be a better term than "best" when discussing Thai-issued insurance). No insurer can guarantee no premium increase unless you have a claim. All insurers increase premiums in response to inflation/rising health care costs and any with a viable business plan will also increase based on age. Such increases are predictable and can be estimated in advance. The older you get, the greater the increases as you move into new age brackets. this is normal. Some insurers' age related increases occur annually, others in 5 year age brackets. If OP has just experienced a 33% increase then he likely has a policy which uses 5 year age brackets and has just jumped into a new 5 year bracket - in which cases any increases in the next 4 years will be quite small and limited to inflation. Then in year 5 he will again see a large increase and so on. The whole point to insurance is risk sharing. A policy which will raise your rates based on your claims history (which many Thai issued policies do -- but usually in addition to, not instead of, age-related increases) is highly undesirable to put it mildly. These policies often give a "no claims bonus" each year but again, it is short-sighted to seek such a policy since it does not offer the protection that a policy should...you can and often will be priced out as soon as your health worsens/you have large claims and this undercuts the whole purpose of health insurance. That you have had no claims so far does not mean you won't have a huge claim in the near future and it would be very, very unwise to base your insurance decisions on the fact that you have had no claims so far and are n good health so far. The purpose in being insured is to transfer the risk of health care costs to an insurer. It is not expected (and certainly not to be hoped) that you will receive insurance payouts equal to what you pay in premiums. Most people will not. A minority will receive that much or many times more -- and the former group essentially subsidizes the latter. There is no way to predict in advance which group you will fall into, which is why it makes sense to be insured. OP you can get as much as a little over 300,000 baht deductible with April Thailand. Even though you may have elected to take that initially, you can do so now...and it will lower your premiums. Contact your broker or the insurer directly. Just be sure you can afford the deductible not only now but indefinitely as you age, because while you can add or increase a deductible at any time there is no guarantee you can later reduce it. If nonetheless you want to change policies I strongly suggest you get an internationally issued expatriate policy not a Thai-issued policy. These will also increase rates as you age, and irregardless of whether you have had a claim - which as explained is a good, not bad, sign as it means your premiums will nto be affected by claims or worsening health status/risk profile.

Flaming and bickering posts have been removed.

Tricyclic antidepressenats like amitryptiline and nortriptyline are not controlled drugs in Thailand. Can be sold over the counter. However as seldom used, they can be hard to find. Medisafe as already suggested may be best option.