Pacific Cross health insurance ?

[xylophone]

57 minutes ago, wgdanson said:

They publish a table of premiums for various age ranges, down to the last Baht. The sales rep there told me that these are only inducative. So why is the one for a 71-75 year old shown as Bht 99,737 and not Bht 100,000 as they will change it if there is anything untoward in your test results.

I looked at Pacific Cross because my Aetna health insurance has just gone up to 133,000 baht for the year, so I thought I would look around, and I did and Pacific Cross was worth a try.

 

I had a medical done and also outlined all of my pre-existing conditions, which I didn't expect them to cover anyway, however I have got to say that the exclusions that came back on my offer letter were just quite amazing, mostly because I had no history of things like eye disease and my eye test was excellent, then an exclusion for anything to do with my lower back, which I have never had a problem with and so on.

 

There wasn't a lot left to cover and although I had a TURP some 11 years ago, anything whatsoever to do with that was excluded, whereas on the old BUPA policy after a few years it was included again.

 

Granted the premium was low in comparison to many others, but I'm not sure that I wanted cover on just about nothing in reality, so I will be sticking with Aetna.

 

Such a shame, as it looked so promising early on and I have to say that the representative, Stephen, was very helpful.

[thedemon]

2 hours ago, wgdanson said:

Be aware that the Medical Repatriation clause says that it is back to the insured's country of residence......no good if you live in Thailand.

Also, any implants will not be covered until a 5 year wait.

Also, the no claims bonus is 10% for the first year, 5% for the second, but that is off the already discounted premium, and 10% for year 3. So assuming a Bht 100,000 premium, year 2 you would pay Bht 90,000...year 3 85,500 and year 4 ....76,950. If you opt for the 40,000 excess on any claim, it is really 50k as you lose your NCD.

 

I have had a policy from Pacific Cross for about 25 years. I just looked at my most recent invoice and it says;

 

NET OF 25% TAL DISCOUNT; AND 20% NO CLAIM DISCOUNT

 

I have no idea what TAL discount is and a quick google search didn't help. But there is definitely a 20% no claims bonus.

[thedemon]

2 hours ago, wgdanson said:

Be aware that the Medical Repatriation clause says that it is back to the insured's country of residence......no good if you live in Thailand.

 

Do you mean Repatriation after treatment or (Evacuation) for treatment?

[wgdanson]

12 hours ago, thedemon said:

 

I have had a policy from Pacific Cross for about 25 years. I just looked at my most recent invoice and it says;

 

NET OF 25% TAL DISCOUNT; AND 20% NO CLAIM DISCOUNT

 

I have no idea what TAL discount is and a quick google search didn't help. But there is definitely a 20% no claims bonus.

Did you ever make a claim.? Your 20% NCB goes away. TAL is possibly the 25% for saying you will pay the first 40k of any claim. 

12 hours ago, thedemon said:

Do you mean Repatriation after treatment or (Evacuation) for treatment?

 

 

No idea, must ask their Rep.

Edited July 15, 2019 by wgdanson

[wgdanson]

14 hours ago, Sheryl said:

 

That is true of pretty much any insurance and it is of definite use to people living in Thailand if they travel in the region, especially to neighboring countries where quality of health care is poor.

Thanks Sheryl. So that part of the policy is as much use to me as the maternity benefit, but I still pay for it !     

[alfieconn]

21 hours ago, wgdanson said:

Be aware that the Medical Repatriation clause says that it is back to the insured's country of residence......no good if you live in Thailand.

Also, any implants will not be covered until a 5 year wait.

Also, the no claims bonus is 10% for the first year, 5% for the second, but that is off the already discounted premium, and 10% for year 3. So assuming a Bht 100,000 premium, year 2 you would pay Bht 90,000...year 3 85,500 and year 4 ....76,950. If you opt for the 40,000 excess on any claim, it is really 50k as you lose your NCD.

It is not really 50,000 ! excess and NCD are two separate things and same applies if your insure any other object be it house, car, pets. 

As for the MR clause applying only to the insured's country of residence, well if you live in Thailand that is your country of residence.

Edited July 15, 2019 by alfieconn

[wgdanson]

7 minutes ago, alfieconn said:

It is not really 50,000 ! excess and NCD are two separate things and same applies if your insure any other object be it house, car, pets. 

As for the MR clause applying only to the insured's country of residence, well if you live in Thailand that is your country of residence.

But at the end of the day, you pay 40k excess plus an extra 10k premium because you do not get NCD, which 40 + 10 = 50.

[alfieconn]

9 minutes ago, wgdanson said:

But at the end of the day, you pay 40k excess plus an extra 10k premium because you do not get NCD, which 40 + 10 = 50.

If you make a claim in the year you take out the insurance you pay 40,000 baht excess, you do not pay an extra 10,000. If you take an insurance the following year, your premium would probably be higher due to not receiving a NCD, like i have already said 2 completely separate things, basicly no different to how any insurance company works and certainly not unique to Pacific Cross. You really must stop giving out false information and you haven't corrected the comment " be aware that the Medical Repatriation clause says that it is back to the insured's country of residence......no good if you live in Thailand".

[wgdanson]

16 hours ago, alfieconn said:

If you make a claim in the year you take out the insurance you pay 40,000 baht excess, you do not pay an extra 10,000. If you take an insurance the following year, your premium would probably be higher due to not receiving a NCD, like i have already said 2 completely separate things, basicly no different to how any insurance company works and certainly not unique to Pacific Cross. You really must stop giving out false information and you haven't corrected the comment " be aware that the Medical Repatriation clause says that it is back to the insured's country of residence......no good if you live in Thailand".

False information? Please read again what I said. If I claimed in the first year I pay 40k excess and do not get a 10% NCD the following year. So what has it cost me...50k. Or is my logic flawed? 

I correct my comment....no good if you are still in Thailand.

[alfieconn]

On 7/14/2019 at 4:45 PM, wgdanson said:

Be aware that the Medical Repatriation clause says that it is back to the insured's country of residence......no good if you live in Thailand.

Also, any implants will not be covered until a 5 year wait.

Also, the no claims bonus is 10% for the first year, 5% for the second, but that is off the already discounted premium, and 10% for year 3. So assuming a Bht 100,000 premium, year 2 you would pay Bht 90,000...year 3 85,500 and year 4 ....76,950. If you opt for the 40,000 excess on any claim, it is really 50k as you lose your NCD.

Incorrect, more misleading info you have put on here, the discount works as follow : 10% year 1, 15% year 2, 20% year 3.

Edited July 16, 2019 by alfieconn

[wgdanson]

17 minutes ago, alfieconn said:

Incorrect, more misleading info you have put on here, the discount works as follow : 10% year 1, 15% year 2, 20% year 3.

Sorry Mr Alfie, a typo or mis-reading of the brochure. I apologise to anyone who took my misleading info as Gospel.

[alfieconn]

1 hour ago, wgdanson said:

False information? Please read again what I said. If I claimed in the first year I pay 40k excess and do not get a 10% NCD the following year. So what has it cost me...50k. Or is my logic flawed? 

I correct my comment....no good if you are still in Thailand.

Please elaborate.

[wgdanson]

19 minutes ago, alfieconn said:

Please elaborate.

I am paying for Medical Repatriation to my country of residence....which is Thailand, in my case. So unless I get sick outside Thailand the repatriation part will not apply.

 

Nice to see you are a Blue!

Edited July 16, 2019 by wgdanson

[alfieconn]

9 minutes ago, wgdanson said:

I am paying for Medical Repatriation to my country of residence....which is Thailand, in my case. So unless I get sick outside Thailand?

 

Nice to see you are a Blue!

Sorry you have lost me ????

 

I am a blue, don't know what you are talking about.

[Sheryl]

He means that the repatriation part will nto apply unless he gets ill while out of the country.

 

Which is of course true. That is standard for any repatriation clause.

 

he is nto paying anything extra for this, it is a standard part of the insurance package and adds very very little to costs.

[BobBKK]

On 7/14/2019 at 5:44 PM, xylophone said:

I looked at Pacific Cross because my Aetna health insurance has just gone up to 133,000 baht for the year, so I thought I would look around, and I did and Pacific Cross was worth a try.

 

I had a medical done and also outlined all of my pre-existing conditions, which I didn't expect them to cover anyway, however I have got to say that the exclusions that came back on my offer letter were just quite amazing, mostly because I had no history of things like eye disease and my eye test was excellent, then an exclusion for anything to do with my lower back, which I have never had a problem with and so on.

 

There wasn't a lot left to cover and although I had a TURP some 11 years ago, anything whatsoever to do with that was excluded, whereas on the old BUPA policy after a few years it was included again.

 

Granted the premium was low in comparison to many others, but I'm not sure that I wanted cover on just about nothing in reality, so I will be sticking with Aetna.

 

Such a shame, as it looked so promising early on and I have to say that the representative, Stephen, was very helpful.

Oh and I thought my increase from 55,000 to 79,000 was horrific but 133,000?

[undercover]

The problem I found with Pacific Cross is <snip>what they say they will pay out , they may show cover of 100,000 on something but at the back of their policy look for Exclusions / Additional Condition(s) Theres a 30% co payment for all insured healthcare expenses . So keep in mind if their offering to pay 100,000 for a procedure they will actually only be paying 70,000

[alfieconn]

19 minutes ago, undercover said:

The problem I found with Pacific Cross is <snip>what they say they will pay out , they may show cover of 100,000 on something but at the back of their policy look for Exclusions / Additional Condition(s) Theres a 30% co payment for all insured healthcare expenses . So keep in mind if their offering to pay 100,000 for a procedure they will actually only be paying 70,000

What page number is that please, as there is nothing in my policy which ses the above, as far as i'm aware Pacific Cross doesn't have a 30% co payment, although they do have different excess amounts which obviously reduce the Premium and is quoted up front.

Edited August 16, 2019 by alfieconn

[Sheryl]

The copay might be an option. Many insurers offer excess (deductible) and copay options which reduce premiums but of course mean you pay something at point of service.

 

With copays there is usually an out of pocket maximum beyond which they pay all. For example I used to have a Cigna Global policy with $750 deductible and 20% copay to a maximum of $5000 out of pocket per year.

 

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

 

 

 

 

[alfieconn]

6 minutes ago, Sheryl said:

The copay might be an option. Many insurers offer 3xcess (deductible) and copay options which r3duce premiums butof course mean you pay something at point of service.

With copays thereis usually an out of pocket maximum beyond which they pay all. For example I used to have a Cigna Global policy with $750 deductible and 20% copay to a maximum of $5000 out of pocket per year.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app
 

I think the poster undercover has got it all wrong, Pacific Cross don't have a copay option as far as i know and it's certainly not under Exclusions / additional conditions well certainly not on my policy, perhaps the post needs to be deleted if his information is deemed to be incorrect !

[CharlieH]

4 minutes ago, alfieconn said:

I think the poster undercover has got it all wrong, Pacific Cross don't have a copay option as far as i know and it's certainly not under Exclusions / additional conditions well certainly not on my policy, perhaps the post needs to be deleted if his information is deemed to be incorrect !

If he says he has it we have to give the benefit of the doubt.

Insurances are very much an individual case by case basis and details may not be the same for everyone and dependent on a variety of issues.

 People should read/check their own policy documents for details of cover.

[alfieconn]

I'll ask the director i deal with from Pacific Cross to come on here to clarify if the information is correct or not, i doubt he will be very amused if it isn't !

[Thaivisa Health Protect]

Hi Everyone,

 

Here is my reply to Alfie

 

"Sorry for delayed reply, hope this finds you well.

 

As you know we fully underwrite each policy, so each offer is specific to the applicant and their declared medical history.  

 

We do have policies where the member may have no copay applied for anything, we have some American policy holders that have a copay for treatment in the USA, but not elsewhere.  We have policy members that applied in their later years that we apply a copay for particular conditions i.e. 30% for joint diseases capped at a certain amount. 

 

We do have some age rated exclusions/wait periods, for people over 55 we always have a wait period for cataracts and prostate cancer, though these can be removed immediately on receipt of the required exams.

 

What we don't do is have a very easy application stage and then reject claims on moratorium basis at the point of claim.  We try to be as transparent as possible before any decision is reached by the policy holder.  I think that is more credible even if the offer letter isn't as attractive as a policy that doesn't fully underwrite. 

 

In my opinion people should have cover in place before that develop conditions or reach a certain age, you'd be shocked at how many people over 65 don't have any cover in place at all then feel a certain way when their policy has conditions excluded or a wait period applied for something.

 

Hope that clears all?

 

[alfieconn]

8 hours ago, Thaivisa Health Protect said:

Hi Everyone,

 

Here is my reply to Alfie

 

"Sorry for delayed reply, hope this finds you well.

 

As you know we fully underwrite each policy, so each offer is specific to the applicant and their declared medical history.  

 

We do have policies where the member may have no copay applied for anything, we have some American policy holders that have a copay for treatment in the USA, but not elsewhere.  We have policy members that applied in their later years that we apply a copay for particular conditions i.e. 30% for joint diseases capped at a certain amount. 

 

We do have some age rated exclusions/wait periods, for people over 55 we always have a wait period for cataracts and prostate cancer, though these can be removed immediately on receipt of the required exams.

 

What we don't do is have a very easy application stage and then reject claims on moratorium basis at the point of claim.  We try to be as transparent as possible before any decision is reached by the policy holder.  I think that is more credible even if the offer letter isn't as attractive as a policy that doesn't fully underwrite. 

 

In my opinion people should have cover in place before that develop conditions or reach a certain age, you'd be shocked at how many people over 65 don't have any cover in place at all then feel a certain way when their policy has conditions excluded or a wait period applied for something.

 

Hope that clears all?

 

So do some policy holders have a copay in their policy without being informed of this (except in the small print) when the policy is taken out, ? as this seems to be the case in post #77.

Edited August 20, 2019 by alfieconn

[alfieconn]

On 8/16/2019 at 10:21 PM, alfieconn said:

I think the poster undercover has got it all wrong, Pacific Cross don't have a copay option as far as i know and it's certainly not under Exclusions / additional conditions well certainly not on my policy, perhaps the post needs to be deleted if his information is deemed to be incorrect !

Seems like i have got the whole Copay thing wrong and apologize to anyone i have upset.

[Thaivisa Health Protect]

14 hours ago, alfieconn said:

So do some policy holders have a copay in their policy without being informed of this (except in the small print) when the policy is taken out, ? as this seems to be the case in post #77.

Hi Alfie,

 

As we fully underwrite each policy, the specifics of the coverage are made on a formal offer letter prior to the decision to purchase the policy by the applicant.  Any copays that are applied, or premium loadings to accommodate pre existing conditions are in black and white on the offer letter.  

 

 

[Elik]

I signed up with LMG Pacific in 2013, and then a few months later got a hospital bill of 420k THB, (Angiogram) of which they paid 385k, so hats off to them. They do pay out.

 

BUT in 2018, after they became Pacific Cross, they changed my Policy from Executive+Expander to Standard Extra.

 

"We would like to inform you that with effect from your above policy's renewal date
your health insurance plan will be upgraded to our Lifestyle Series [Standard Extra Plan]."
 

Same premium, so I think nothing of it and sign.

Then a month ago, I had a health checkup and the hospital would like to have a look see from the inside, so potentially the same procedure as in 2013. Not too keen on that, keep in mind they do like to sell their stuff, but lets see what insurance say.

The price estimate is 280k, of which I would have to pay 114k. over 3 time that of last time.

 

As it turns out, the upgrade raised the limits for room/hospital expense/surgical fee etc, but Major Medical was set to 0.

I can upgrade my plan, but the cover for this thing will never go up.

 

So make sure you read the fine print.

 

 

[undercover]

On 8/24/2019 at 11:52 AM, Elik said:

I signed up with LMG Pacific in 2013, and then a few months later got a hospital bill of 420k THB, (Angiogram) of which they paid 385k, so hats off to them. They do pay out.

 

BUT in 2018, after they became Pacific Cross, they changed my Policy from Executive+Expander to Standard Extra.

 

"We would like to inform you that with effect from your above policy's renewal date
your health insurance plan will be upgraded to our Lifestyle Series [Standard Extra Plan]."
 

Same premium, so I think nothing of it and sign.

Then a month ago, I had a health checkup and the hospital would like to have a look see from the inside, so potentially the same procedure as in 2013. Not too keen on that, keep in mind they do like to sell their stuff, but lets see what insurance say.

The price estimate is 280k, of which I would have to pay 114k. over 3 time that of last time.

 

As it turns out, the upgrade raised the limits for room/hospital expense/surgical fee etc, but Major Medical was set to 0.

I can upgrade my plan, but the cover for this thing will never go up.

 

So make sure you read the fine print.

 

 

Yes I also started with LMG They were an excellent company with no co payment of 30% You got the cover they said you were covered for no deductions no problem ,

But Pacific Cross is just riding on the good name of LMG , sure they do pay out but this Exclusions/Additional Conditions in small print at the end of page 7 last but one page of the policy in my opinion is worthy of the name scam.

[essox essox]

i have heard P C is actually <deleted>

[undercover]

6 hours ago, essox essox said:

i have heard P C is actually <deleted>

Deleted  ?