Advice- how much to put aside for self health insurance?

[cnx355]

On ‎11‎/‎6‎/‎2018 at 11:30 AM, Sheryl said:

All policies raise premiums as you age though to very different degrees and this information is readily attainable in advance.

 

Internationally issued policies (EU, UK) cannot raise policies on an individual basis due to claims or change in health status  as the insurance regulations in their country of incorporation does not allow it. Thailand does. This s exactly why I advise against a Thailand-issued policy for people planning to live out their old age here. 

Thanks a lot Sherryl. What you mention here is very important. I am with a Thai Insurance and I have 2 Canadian friends with  April in Europe. So I as I age, I am considering a change of policy to International. Anoher avantage is if I move to another country in Asia,  I am always covered.

Edited November 7, 2018 by cnx355

[GarryP]

23 hours ago, Sheryl said:

(replying to GarryP)

 

Making sure you are enrolled at the best possible hospital under SS is a priority.

 

21 hours ago, GarryP said:

Thank you for your detailed answer. I will start checking to see which is the best SS hospital. 

I am currently registered with Kluaynamthai Hospital. However, I want to change that to a government hospital as they have a better referral system and some have highly recommended doctors. I can file to change hospitals at the beginning of the year but have been told it is very difficult to get in at Chulalongkorn, the Police Hospital or Ramathibhodi as their SS patient lists are already full. In order to have any chance of getting into one of these it was recommended that I visit the local SS office within the first two weeks of January to submit my request to change. If there is a space available, I will be given it then and there.  Anyway, if I can't change it in Jan 2019, I still have 3 or 4 more Januarys to try before I retire. 

 

[Sheryl]

16 minutes ago, GarryP said:

 

I am currently registered with Kluaynamthai Hospital. However, I want to change that to a government hospital as they have a better referral system and some have highly recommended doctors. I can file to change hospitals at the beginning of the year but have been told it is very difficult to get in at Chulalongkorn, the Police Hospital or Ramathibhodi as their SS patient lists are already full. In order to have any chance of getting into one of these it was recommended that I visit the local SS office within the first two weeks of January to submit my request to change. If there is a space available, I will be given it then and there.  Anyway, if I can't change it in Jan 2019, I still have 3 or 4 more Januarys to try before I retire. 

 

Yes, do try to change. Your current hospital is shall we say less than  optimal.  Go as early as you possibly can and even if you can't change now get on wait lists (if possible for all3, otherwise whichever of the 3 has the shorter wait list - all 3 are good).

[Sheryl]

20 minutes ago, cnx355 said:

Thanks a lot Sherryl. What you mention here is very important. I am with a Thai Insurance and I have 2 Canadian friends with  April in Europe. So I as I age, I am considering a change of policy to International. Anoher avantage is if I move to another country in Asia,  I am always covered.

Change sooner rather than later as once you develop any pre-existing conditions (i.e. chronic illness that you have to take regular medication for etc) your options narrow.

[Sheryl]

30 minutes ago, melvinmelvin said:

re Siriraj,

is that a mix of private and government? or government only

 

am treating smth at Siriraj now, outpatient, they told me that they up prices by 25% for foreigners

 

anybody know if Siriraj overcharges grossly for medicine? or are they reasonable?

 

Siriraj is a government hospital that also has a private hospital attached to it, 

Siriraj Hospital Piyamaharajkarun  (SIPH).

I have heard that Sirarj government hospital is now charging foreigners more.

Normally government hospitals do not overcharge for medications but I don't know if this 25% charge also applies to drugs, it might.

 

[James26]

First of all, it is not going to hit $10,000 by the time you are 70. Depending on which policy you have, and assuming you have inpatient cover only, it will likely be in the range of $4-5,500. Your insurer should be able to give you a chart showing current rates by age group. Note that many insurers raise rates in 5 year increments with only small cost of living increases in between and then big jumps every 5 years. others do the age based increases annually. age related increases reflect the higher average pay outs to people in older age groups whereas inflationary adjustments reflect changes in cost of medical care. I suspect your policy works in 5 year brackets and you just jumped a bracket.
 
Secondly if as it sounds your health is good, there are less costly options. For example, under 3,000 with April International (My Health International NOT My Health Thailand! You do not want a policy issued out of Thailand if you plan to live out your life here.)
 
Thirdly this is not something you "may never need".  The odds of never needing it are astronomically small if you are planning to stay permanently in Thailand (or anywhere else you don't have access to free care).  You will need it, sooner or later and probably more than once or twice..probably several times at least. Health problems are not a rare occurrence  -- they are a universal facet of growing old. Both life threatening problems (heart disease, cancer etc) and problems that impact severely in quality of living (cataracts, arthritis leading to constant pain unless you get a joint replacement etc).  It is true that you will probably end up having paid more in than you get paid out, but you might also end up getting back many fold what you paid in, that is how it works. And you have no way at all of knowing if you will be in that minority or not.
 
If you want to self-insure instead then you need at least USD$150,000  put aside and a way to immediately replenish it as it is spent. Which it could be in just one hospitalization. Or else a clear plan in place for returning to your home country once it is spent.
 
A more sensible approach if you want to bank on your current state of health remaining the norm for most of the rest of your life (a questionable bet IMO -- your present state of health in no way renders you immune to accidents nor the development of serious illness in future) would be to up the deductible, most policies will let you go as high as $5000. Of course, that means you have to have that amount of money set aside and be able to replenish it every time any of it is used, but likely more affordable than $150,000.
 
Be forewarned though that once you take a higher deductible, the insurance company can refuse to let you lower it later and likely would if you had developed a chronic health condition. So think carefully about how well you can afford this for the long run, keeping in mind things like currency flunctuation and rising  cost of living in Thailand.
 
We have had a number of  self insured people here deplete their savings and have to return to their home country, broke or near broke. Many of them had little choice because they were uninsurable due to pre-existing conditions from the time they first arrived in Thailand. Others were short-sighted and made decisions based on assuming they would always stay healthy or the only health costs they would ever face would be small. And by the time they found out otherwise they were no longer insurable.
 
You are very fortunate to still be healthy at your age and would be foolish IMO to give up your insurance. I suggest you look into a possible change of policy as now is the time to do that, before you have any claims. Contact a good broker, they can help you make a selection as well as help with claims later on. Suggest AA brokers. If you are in Pattaya, Hua Hin or Phuket they have offices you can go into otherwise by email www.aainsure.net
 
They can tell you  not just the current premium for different policies under different deductible scenarios  but what premiums you can expect, at current rates (i.e. without cost of living adjustment), at older ages. Actual will end up being a bit higher because most years there is some inflationary adjustment but it gives you a pretty good idea.
 
 
 
 
 

Can you please elaborate why you don't want a policy issued out of Thailand if you plan to live out your life here?

Sent from my A1601 using Thailand Forum - Thaivisa mobile app

[melvinmelvin]

7 minutes ago, Sheryl said:

Siriraj is a government hospital that also has a private hospital attached to it, 

Siriraj Hospital Piyamaharajkarun  (SIPH).

I have heard that Sirarj government hospital is now charging foreigners more.

Normally government hospitals do not overcharge for medications but I don't know if this 25% charge also applies to drugs, it might.

 

SIPH is the unit I am using, quite impressive - huge very modern building - too good air con - cold

I find the charges for consulting medical staff very very reasonable, same goes for ultrasounds x-rays cardiograms etc

drugs represents the major drain on the invoices

 

(the very first hospital I have been to in LoS which has an invoice structure suitable for me if I should decide to

 go further and claim from insurance or  my government rather than paying myself)

 

[KiChakayan]

On 11/6/2018 at 12:32 PM, Sheryl said:

(replying to GarryP)

 

Any nationality can get a UK issued expat health policy. Ditto French issued etc.

I and my first daughter are (well) covered by my UN/Cigna policy; my Thai wife 36)  and second daughter (3) have a  4 Millions, hospital only, Thai issued Allianz coverage, costing me about 100000 Bahts a year. Are you saying that I could get and expat health policy for my wife and second daughter without being myself included? 

[KittenKong]

On 11/6/2018 at 11:30 AM, Sheryl said:

All policies raise premiums as you age though to very different degrees and this information is readily attainable in advance.

 

Internationally issued policies (EU, UK) cannot raise policies on an individual basis due to claims or change in health status  as the insurance regulations in their country of incorporation does not allow it. Thailand does. This s exactly why I advise against a Thailand-issued policy for people planning to live out their old age here.

Hmmm.

https://www.thisismoney.co.uk/money/markets/article-3595418/The-couple-charged-12-000-year-Bupa-health-insurance-ve-no-illnesses-customers-30-years.html

 

Also:

https://www.vitality.co.uk/health-insurance/renewal-rates/

 

" How Claims affect your premium

We look at the amount paid out in claims over the preceding plan year for everyone on your plan. If you only make a small claim, or no claims at all, you’ll receive a lower increase."

Edited November 7, 2018 by KittenKong

[khunPer]

On 11/5/2018 at 12:45 PM, peterb17 said:

So would it be more sensible just to put say 5 million into a savings account for any possibility?

If you have 5 million baht, are in good health and never had any insurance claims, and likely to pay $10,000, equaling some 300,000 baht a year, it might make sense.

 

Sheryl use to say that one need some 3 million baht or more for self insurance – probably when using private hospitals – and normally wisely asks, when that money is used, what are you then going to do..?

 

The alternative is to use government hospitals, but they can also be costly in some cases, and you might face waiting time.

 

Whatever you choose, in my opinion you should continue to set aside in a "rainy day account" the same amount as you would have been paying for an insurance – it might make more sense to be self-insured, if one cannot afford an unlimited insurance, but are limited with a maximum per planned operation, and per day hospitalization, and per incident, and per year, provided one has some level of "start capital" in the account; or in case one might not have a choice when coming from a country with free heath care, and realizing difficulty being accepted by any insurance provider due to age.

 

 

[Sheryl]

2 hours ago, James26 said:

Can you please elaborate why you don't want a policy issued out of Thailand if you plan to live out your life here?

Sent from my A1601 using Thailand Forum - Thaivisa mobile app
 

Because Thai insurance regulations allow health insurers to raise premiums on an individual basis due to claim history or development of a chronic health problem, and most of them do so. So even though they may guarantee lifelong coverage they can price you out.  In most western countries this is not allowed so the only increases you get will be the same as anyone else, based on age.

[Sheryl]

1 hour ago, KiChakayan said:

I and my first daughter are (well) covered by my UN/Cigna policy; my Thai wife 36)  and second daughter (3) have a  4 Millions, hospital only, Thai issued Allianz coverage, costing me about 100000 Bahts a year. Are you saying that I could get and expat health policy for my wife and second daughter without being myself included? 

I don't think so as they are not expats, they are living in their country of nationality.

 

As Thai citizens they already have access to free health care through the public health system, most people do not get private insurance for their Thai family members since it is nto necessary other than to be able to utilize private hospitals.

[murraynz]

5 hours ago, steve73 said:

I had my gall bladder removed at age 46, just before settling in T/L 12 years ago... Now according to BUPA T/L, my entire gastro intestinal system is a pre-condition and excluded.  I had a slipped disc "trimmed" (twice) in 2012, and the insurers welched after first approving the surgery (costing me around 400k for both operations), and now my entire spinal column is excluded.

Not much left now that wouldn't be a pre-condition, so I'm happy to self-insure.... I keep about 2MM equivalent in readily accessible funds (some of it for the retirement extension).

i think insurance companies will always find a 'pre- existing condition'...but they are very happy to take your 'ever increasing' premiums, in the meantime....

they think were all suckers.....

[JimmyJ]

On 11/5/2018 at 9:45 PM, melvinmelvin said:

 

so you reckon 150 k US would serve as a decent buffer? in most cases?

 

maybe I am totally wrong but I figure worst case triggers would be traffic accidents,

with such, there is no end to what could be smashed/go wrong

 

had a sojourn in a hospital this winter

step 1 very reluctantly accepting to be admitted, 2 days ICU then 1 day non ICU

step 2 left the hospital against medical advice and went home

step 3 the week after; collapsed at home, factotum had the brains to call the same hospital and request EMS

step 4 stayed a short week in ICU, a total of 5 weeks + in ward

total for my insurance company about 2.5 million

 

what was done;

a couple of stents

terrible infection in right lower leg, huge open wound in ankle - dripping dripping dripping took very long time to sort

some skin cancer stuff on arms was sorted

pneumonia - in stereo

plenty liquid in lungs

crapped down lungs 'cause excessive smoking - very lousy oxygen saturation

right leg swollen to gigantic proportions, liquid being pressed out through the skin, upper thigh pressing on prostate

     frustrating Jimmie Riddle

 

I reckon pretty straightforward stuff compared to what could be the aftermath of a severe car crash.

 

2.5 million - no giveaway.

 

 

 

 

What hospital was this?

[melvinmelvin]

2 hours ago, JimmyJ said:

What hospital was this?

World Medical Centre on ChaengWattana, BKK

 

[JAS21]

Both my wife, who is Thai and myself were in a company scheme (AXA PPP) until we retired here, from the UK in 2007. At that time our ages were 62 and 53.

AXA PPP offered us their International Policy ..exc  Canada and USA. It did include travel Insurance and covered Pre Existing Conditions. This was not their top cover ... covered for in patient likes of MRI, CT and latest cancer drugs.

Payments were in £

2007   …  2700 (part year)

2008   …  3668

2009   …  4063

2010   …  4300

2011   …  5336

2012   …  6042

2013   ...  6776

2014   …  7486

 

In 2015 it would have been a big jump, and I have a figure of £9600 in my mind.

 

After some consideration we opted to cease cover. We are fortunate in that we could fund most things … and we keep a substantial amount here in THB, have own house etc and my pension is okay.

 

We viewed that at some time the premiums would be un-affordable. To date I think we have spent less than  100,000thb since Jan 2015. We tend to use Princess Chulabhorn or government hospitals.  

 

The odds say that we could very well get some big bills in the near future ….

 

It is a difficult choice...I feel that we should look into some accident insurance

Edited November 7, 2018 by JAS21

[melvinmelvin]

11 minutes ago, melvinmelvin said:

World Medical Centre on ChaengWattana, BKK

 

Nonthaburi, not BKK

 

[micmichd]

On 11/5/2018 at 10:33 PM, BestB said:

My policy is world wide, excluding USA, the reason for price in euro because its a French Insurance company, but i got the policy in Thailand and they have office in BKK.

 

Price increases generally year on year due to medical inflation as they like to call it. but also big jumps with age brackets.

 

Just like yourself, i can no longer access free medical care back home.

 

Problem with self insuring in my opinion is that how much is enough? and the answer is no one knows.

 

You mentioned 5 million. Sounds enough, but that means having to put aside 5 million up front, where as insurance policy may take you 5-10 years before you rich 5 million(hope it makes sense)

 

Then if anything happens, they fix you up, with current insurance policy you are covered for anything going wrong again, without one, once 5 million is gone, you will need another 5.

 

In the end of the day, its a personal choice, to me, if i can afford an insurance policy, i would rather have one. ????

 

What about conditions?

Would they be covered by private health insurances?

[micmichd]

18 hours ago, JAS21 said:

Both my wife, who is Thai and myself were in a company scheme (AXA PPP) until we retired here, from the UK in 2007. At that time our ages were 62 and 53.

AXA PPP offered us their International Policy ..exc  Canada and USA. It did include travel Insurance and covered Pre Existing Conditions. This was not their top cover ... covered for in patient likes of MRI, CT and latest cancer drugs.

Payments were in £

2007   …  2700 (part year)

2008   …  3668

2009   …  4063

2010   …  4300

2011   …  5336

2012   …  6042

2013   ...  6776

2014   …  7486

 

In 2015 it would have been a big jump, and I have a figure of £9600 in my mind.

 

After some consideration we opted to cease cover. We are fortunate in that we could fund most things … and we keep a substantial amount here in THB, have own house etc and my pension is okay.

 

We viewed that at some time the premiums would be un-affordable. To date I think we have spent less than  100,000thb since Jan 2015. We tend to use Princess Chulabhorn or government hospitals.  

 

The odds say that we could very well get some big bills in the near future ….

 

It is a difficult choice...I feel that we should look into some accident insurance

Accident insurances are much cheaper than private health insurances. 

Since I only needed medical treatment from accidents all my life long, accident insurances are certainly a good option. 

[Sheryl]

1 hour ago, micmichd said:

What about conditions?

Would they be covered by private health insurances?

What conditions do you refer to?

 

If pre-existing then usually not unless they have fully resolved by the time of application.

[thequietman]

On 11/5/2018 at 7:57 PM, BestB said:

Spot on premiums go up i believe every 5 year intervals and the older you get the higher the rise. Then add on medical inflation and premiums are crazy high. I am 42 and i am paying 1600 euro.

 

OP is actually lucky in a sense that his insurance company has not cut him off, might be wise to check small print if there is a cut off age as well.

I would suggest that you take up a teaching position for 1 year. After 6 months into your contract, you are in the social security system and you get health care for no more than 750 a month. Quit after the year but continue to pay ( around 450 baht) and that's you covered till you die.

[Sheryl]

1 hour ago, micmichd said:

Accident insurances are much cheaper than private health insurances. 

Since I only needed medical treatment from accidents all my life long, accident insurances are certainly a good option. 

Unofrtunately accident insurance policies in Thailand are geared more towards death/dismemberment payouts than medical costs (since Thais already have free health care) and the medical benefits are low, especially for older people.

 

Best that I know of are:

 

Under age 65 - Siam City insurance has I think a policy that covers up to 800K medical

 

65 and over - Bangkok Insurance Company  Happy 45 Plus plan 3 covers 200K a year in medical but only up to either age 80 or 85, forget which

 

Websites of both in Thai only, best to buy through a broker. Premiums are indeed affordable and the cover includes both in and outpatient and it is easy to use.

[BestB]

2 hours ago, thequietman said:

I would suggest that you take up a teaching position for 1 year. After 6 months into your contract, you are in the social security system and you get health care for no more than 750 a month. Quit after the year but continue to pay ( around 450 baht) and that's you covered till you die.

Oh thank you so much for your useless advice . I would pass on being treated in public hospital but all the best for you 

[BestB]

4 hours ago, micmichd said:

What about conditions?

Would they be covered by private health insurances?

Do you mean pre existing? If you got insurance prior to illnesses , then covered for life but any pre conditions when taking out new policy would be excluded.

[thequietman]

2 hours ago, BestB said:

Oh thank you so much for your useless advice . I would pass on being treated in public hospital but all the best for you 

So, 6350 baht a year for health care is not attractive to you, eh?

 

So, when you get sick, you would neeeevvvveeer think about going to a public hospital, eh?

 

Oh, by the way, you can register at some of the best hospitals in your province under the social care but hey, you don't want that, eh?

[GarryP]

1 hour ago, thequietman said:

So, 6350 baht a year for health care is not attractive to you, eh?

 

So, when you get sick, you would neeeevvvveeer think about going to a public hospital, eh?

 

Oh, by the way, you can register at some of the best hospitals in your province under the social care but hey, you don't want that, eh?

And in many of the government hospitals there are highly respected specialists who also work in private hospitals. I wonder where it would be more cost effective to see them. 

 

The waiting can be a drag but well worth it.  

[BestB]

4 hours ago, thequietman said:

So, 6350 baht a year for health care is not attractive to you, eh?

 

So, when you get sick, you would neeeevvvveeer think about going to a public hospital, eh?

 

Oh, by the way, you can register at some of the best hospitals in your province under the social care but hey, you don't want that, eh?

It’s not the matter of quantity but quality . No amount is attractive to me to be treated in Thai public hospital.

 

i had tried public 3 times, never again. And mind you in public I had to pay and once again never ever again 

 

For some it may well be sufficient enough, not for me.

Edited November 8, 2018 by BestB

[KittenKong]

On 11/7/2018 at 6:35 PM, JAS21 said:

Payments were in £

2007   …  2700 (part year)

2008   …  3668

2009   …  4063

2010   …  4300

2011   …  5336

2012   …  6042

2013   ...  6776

2014   …  7486

 

In 2015 it would have been a big jump, and I have a figure of £9600 in my mind.

Your total premiums were just over £40,000. I wonder how much did you actually claim on that insurance over the 8 years you had it?

[JimmyJ]

4 hours ago, BestB said:

It’s not the matter of quantity but quality . No amount is attractive to me to be treated in Thai public hospital.

 

i had tried public 3 times, never again. And mind you in public I had to pay and once again never ever again 

 

For some it may well be sufficient enough, not for me.

 

Can you elaborate.

What occurred to have you decide "...never again"?

[BestB]

4 hours ago, JimmyJ said:

 

Can you elaborate.

What occurred to have you decide "...never again"?

Here is one example for you.

 

was bitten by a dog on my face , both eyes cut open, bleeding profusely. Not going to comment on reception procedure. Waiting in ER, the only person there. About 8 nurses, 2 doctors , all playing on their phones. 3 hours I laid there bleeding and no one did a thing.