Pacific Cross health insurance ?

[Orton Rd]

Has anyone experience of claiming from them? They seem OK but you never can tell until you have to put a claim in. I only intend to get the basic cover, but better than nothing as you can't always get on a plane and go home if you have many acute illnesses which may well prevent travel. I have lived here 12 years with no cover, but in that time Hospital costs seem to have gone up quite sharply in Bkk.

[simoh1490]

They are the most conservative of all the insurance companies, or so the broker tells us, certainly, the restrictions they imposed on my quote were truly amazing and totally unlike the other quotes we received.

[HampiK]

But you have to know after you do a claim, which is more than your yearly payment, then the next year your yearly fee will increase (actually they told me, when you do a claim or claims worth more than double of the yearly fee) and it's then still depending on the claim and other factors which only the BackOffice is aware off.

 

That I think is actually the only bad part about the insurance I can tell till now.

[Orton Rd]

1 hour ago, simoh1490 said:

They are the most conservative of all the insurance companies, or so the broker tells us, certainly, the restrictions they imposed on my quote were truly amazing and totally unlike the other quotes we received.

who did you go with then?

[simoh1490]

5 minutes ago, Orton Rd said:

who did you go with then?

I didn't, I continue to "self insure".

 

Despite having a medical exam which didn't really show anything untowards, PC quoted premiums of 18k a month and that was with a 300k deductible. Thereafter, the first 300k was co-pay plus so much of my body was excluded from coverage that it simply wasn't a viable option.

 

 

 

[Orton Rd]

12 minutes ago, simoh1490 said:

I didn't, I continue to "self insure".

 

Despite having a medical exam which didn't really show anything untowards, PC quoted premiums of 18k a month and that was with a 300k deductible. Thereafter, the first 300k was co-pay plus so much of my body was excluded from coverage that it simply wasn't a viable option.

 

 

 

18k a month! I must have misread the info I was expecting to pay about twice that a year, no that's not worth it better to save it.

[TallGuyJohninBKK]

I've had Pacific Cross, and their predecessor LMG, for quite a few years. Fortunately, never had any big claim with them.

 

In the earlier years under LMG, I had a lot of small outpatient claims that were almost always covered without any problem. In those situations, the LMG insurance was honored by the hospitals for most or all of the payment, and I either paid nothing or a very small portion extra.

 

I've discussed the claims "penalty" notion with my broker, and gotten feedback on that directly from Pacific Cross in the past. Without digging into my files to find my notes on that, my memory says the question of whether they'd raise your premium at the next renewal time, in the event of a large claim, has to do with the amount of the claim vs. your total paid premiums during the life of your coverage. In other words, what the insurance industry would call your loss ratio. And if they did decide to raise your premium, I believe there's some percentage limit on that, like 25% or so...again, doing this from memory.

 

My coverage with them is 20 million baht lifetime, and the policy pretty much covers 100% of normal, customary charges for both OPD and IPD with a daily hospital room rate capped at $8K per night. The coverage obviously excludes any pre-existing conditions noted on the policy at the time it was first issued.

 

They used to have a 5 million baht per incident limit, but I believe they did away with that in the past year or two. And I pay less than $1400 U.S. per year for my coverage, which includes a no recent claims discount and an additional 20 or 25% premium discount for accepting a 40,000 baht annual deductible on my policy.

 

Obviously, if I had insurance claim on the policy, I'd lose the smaller (10%?) no claims discount for that year. But I'd still be entitled to the deductible-based 25% discount, regardless of having a claim/claims and even if I were to end up with a premium increase. Then the deductible discount would simply be taken off the new higher premium.

 

 

[simoh1490]

33 minutes ago, Orton Rd said:

18k a month! I must have misread the info I was expecting to pay about twice that a year, no that's not worth it better to save it.

The premiums etc are based on age and medical history and we're all different, there's no reason why you couldn't try and see how much they want.

[TallGuyJohninBKK]

2 hours ago, TallGuyJohninBKK said:

My coverage with them is 20 million baht lifetime, and the policy pretty much covers 100% of normal, customary charges for both OPD and IPD with a daily hospital room rate capped at $8K per night. The coverage obviously excludes any pre-existing conditions noted on the policy at the time it was first issued.

 

 

Sorry, that should have read, maximum 8,000 baht per night hospital room charge -- not $8K.

 

BTW, I also have the impression, though can't confirm it, that they have a somewhat better rate structure for customers who kept their policies from the original LMG company vs. customers who have taken out newer policies under Pacific Cross.

 

[drtreelove]

15 hours ago, simoh1490 said:

I didn't, I continue to "self insure".

 

Despite having a medical exam which didn't really show anything untowards, PC quoted premiums of 18k a month and that was with a 300k deductible. Thereafter, the first 300k was co-pay plus so much of my body was excluded from coverage that it simply wasn't a viable option.

 

 

 

I'm in same boat, but Thai wife and adult daughter are insured with Pacific Cross. Wife is invincible so no claims. 40K deductible, self pay for OutPatient keeps the annual premium down.. Daughter has had a couple of claims and all good, they come through, but then exclude similar condition for two years. 

 

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[TallGuyJohninBKK]

43 minutes ago, drtreelove said:

Daughter has had a couple of claims and all good, they come through, but then exclude similar condition for two years. 

 

 

That's a new one on me.... AFAIK, once your policy is issued, the pre-existing conditions are the ones that are listed on the policy at the time, and they can't add new exclusions for things that occur in the future.

 

Just as an example, assuming someone had OPD coverage. You go to the doctor for stomach flu now and are treated and covered by Pacific Cross for the visit. Are you suggesting that their insurance then would exclude any coverage for stomach flu for the next two years. I've never heard of that kind of thing with Pacific Cross, nor have I seen any thing like that in the written policy document.

 

 

[Sheryl]

I too have never heard of an insurer doing that - unless you try to increase the coverage level in which case the new level of cover might exclude the prior claim leaving that condition covered at the old level.

 

To exclude a condition that newly developed after the policy was initially issued upon the next renewal would seem to negate the whole value of insurance. Insurers would not  be allowed to do this in most western countries.

 

 

[TallGuyJohninBKK]

Just to be clear, I know the prior poster was NOT talking about the idea that they'd add an illness/condition to the list of permanently excluded pre-existing conditions. Rather, he mentioned a two year exclusion period.

 

I have a vague feeling there may be something in the policy that limits their coverage for what's considered chronic conditions, though I'd need to go back and re-read on that, not sure. But I'm pretty sure I've never heard of or read of a two-year exclusion period with Pacific Cross once you've been treated for something. Of course, that doesn't necessarily mean it's not something hidden in the fine print somewhere.

 

[Sheryl]

Perhaps it does come under a "chronic condition" clause. but such clauses are to be avoided...especially by people planning to grow old in Thaialnd. You want a policy with no exclusion for (new) chronic conditions.

[drtreelove]

6 hours ago, Sheryl said:

I too have never heard of an insurer doing that - unless you try to increase the coverage level in which case the new level of cover might exclude the prior claim leaving that condition covered at the old level.

That may have been the case. I may have interpreted the issue wrong, due to my pet peeve about exclusions. Daughter handles her own policy renewals now. 

[offset]

I have been with PC. for 8 years now biggest claim was 55000B for my son but many smaller claims including injections for rabies (5 injections) last month all were covered with no problem the only rejection I had was for my son to have an allergy test taken which was in the small print stating it did not cover them

 

My premium is 120000 per year and I am 73 years old

[TallGuyJohninBKK]

1 hour ago, offset said:

My premium is 120000 per year and I am 73 years old

 

One of the good things about PC, relative to other Thai health insurers, is that if you take out a policy with them before a certain age, they'll continue to cover you even as you get older, provided you pay the premiums. A lot of other Thai insurers cut coverage for existing policy holders at a certain age.

 

Offset's post is interesting because PC has a premiums chart with their rates for each age band and type of policy. But it tops out at age 65. So as far as I know, there's no public document that tells anyone what their premiums will be for policy holders once they get past age 65. I've always wondered how much they'll escalate my premiums once I get past the age 65 point.

 

They also have two main different types of medical policies, Maxima and the higher coverage level Maxima Plus plans, and then lots of options within those -- having or not having OPD, many options for annual deductibles, no claim discounts, optional dental and eye coverage. So each person's premium situation is going to depend on their age and then also how their configure their policy details.

 

 

[TallGuyJohninBKK]

1 hour ago, offset said:

My premium is 120000 per year and I am 73 years old

 

Is that premium amount just coverage for you alone, or also for wife and some number of children?  Because you mentioned about claims for your son.

 

[offset]

1 hour ago, TallGuyJohninBKK said:

 

Is that premium amount just coverage for you alone, or also for wife and some number of children?  Because you mentioned about claims for your son.

 

it My premium only

[HampiK]

4 hours ago, TallGuyJohninBKK said:

They also have two main different types of medical policies, Maxima and the higher coverage level Maxima Plus plans, and then lots of options within those -- having or not having OPD, many options for annual deductibles, no claim discounts, optional dental and eye coverage. So each person's premium situation is going to depend on their age and then also how their configure their policy details.

Maxima is not the Premium yet. There is even a better one called Ultima and Ultima plus.

 

They have many different policies… the cheapes start arround coverage of 100'000 baht per year and goes up I think till about 50 Million baht per year. For most farangs there are only 4 main polices (Standart, Premier, Maxima and Ultima) interesting as the others are too cheap. The cheaper ones are mostly made for companies (KMU)

[thedemon]

I have been covered by Pacific Cross for about 25 years. I think when I first got the policy they were called Blue Cross, then later Pacific International or something like that. But I have never taken much notice so there may have been other name changes during that time.

 

My policy is issued from and administered by their Hong Kong office and the premiums are in USD so I am a bit surprised by this thread. I hadn't realized they sold policies directly from Thailand. I'm sure they didn't when I started out with them. I wonder if I would be better of switching to a policy issued in Thailand?

 

Anyway to answer the op, I have only ever made 2 claims. The first was a night in Bumrungrad after a snake bite. It wasn't a big amount and they reimbursed that claim in full. The second was a couple of nights and a battery of tests, MRI's etc after a weird fainting incident. I think that came in at around 150K and apart from a couple of very small (strange to me) deductions, they reimbursed that too.

 

As far as I know the premium didn't increase the following year after claiming. It seems to me that the premium increases a little bit every year anyway so hard to say for sure. I did lose the 15% no claims discount the year after the 150k claim but it has been reinstated in subsequent years. 

[TallGuyJohninBKK]

2 hours ago, HampiK said:

Maxima is not the Premium yet. There is even a better one called Ultima and Ultima plus.

 

 

Yes, I remember the Ultima policy in the past, at least during LMG's time.

 

But today, when I pulled out the premiums chart I had from PC for 2017, the chart I had only listed Maxima and Maxima Plus.

 

Maybe that's all they gave me, because I happen to have the Maxima policy -- 8,000 baht maximum per night for hospital room and 20M baht lifetime maximum.

 

[TallGuyJohninBKK]

38 minutes ago, thedemon said:

I have been covered by Pacific Cross for about 25 years. I think when I first got the policy they were called Blue Cross, then later Pacific International or something like that. But I have never taken much notice so there may have been other name changes during that time.

 

My policy is issued from and administered by their Hong Kong office and the premiums are in USD so I am a bit surprised by this thread. I hadn't realized they sold policies directly from Thailand. I'm sure they didn't when I started out with them. I wonder if I would be better of switching to a policy issued in Thailand?

 

 

I've had their coverage for many years as Thailand-issued policies. When I first signed up, they were known as LMG (Liberty Mutual Group).  Then a couple years ago, LMG exited and they became Pacific Cross.

 

Previously, I had only known Pacific Cross in Thailand for issuing travel insurance policies out of Hong Kong. But then suddenly, they became my Thailand based health insurance provider.

 

[HampiK]

18 minutes ago, TallGuyJohninBKK said:

 

Yes, I remember the Ultima policy in the past, at least during LMG's time.

 

But today, when I pulled out the premiums chart I had from PC for 2017, the chart I had only listed Maxima and Maxima Plus.

 

Maybe that's all they gave me, because I happen to have the Maxima policy -- 8,000 baht maximum per night for hospital room and 20M baht lifetime maximum.

 

I have a 10'000 per night, and when you check the website there are all 4 listed.

The Maxima is already good enough in my opinion, I think I use the Maxima plus.

But maybe will change next year to Cigna or AXA as they are not thai based companies and therefore not raise their premiums after an incident.. but not sure yet….

[The manic]

BUPA or in Patyaya the PCEC do a real with AIS? some Thai insurance companies 25k a year.. Depends on your age and pre existing conditions. 

[Orton Rd]

After a mountain of form filling they quoted 30k baht a year for basic 270k cover, no idea if that is good value for 66 year old

[The manic]

I have found cover for outpatient treatment to be really useful.

[Sheryl]

9 hours ago, Orton Rd said:

After a mountain of form filling they quoted 30k baht a year for basic 270k cover, no idea if that is good value for 66 year old

270K cover is WAY too low. You need minimum 1 million if you will use only government hospitals, 3-5 million if you want the option of using private hospitals. And depending on company and whether you take a deductible, at your age this will cost around 100k baht  a year.

[Badrabbit]

I have Pacific cross and recently claimed after experiencing a TIA stroke, they paid out without any issues.

I'm 62 and my premium is 60k per yr for 1.2million cover.

 

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[HLover]

On 4/6/2018 at 7:44 AM, Sheryl said:

270K cover is WAY too low. You need minimum 1 million if you will use only government hospitals, 3-5 million if you want the option of using private hospitals. And depending on company and whether you take a deductible, at your age this will cost around 100k baht  a year.

Do you recommend using an insurance broker or signing up with PC directly?  Other members with experience please feel free to answer as well, cheers.