Policy Exclusions - Your Experiences

[The Man Who Sold the World]

Exclusions –

 

Recent regulatory requirement for mandatory Thai insurance gets the wheels turning. 

 

Many moon ago on recognizance concerning my move here I was elbow-bending with a yank in Patts. Medical insurance being on my laundry list did come up. His input concerned one of the most well know Thai medical insurance providers that he applied to through an expat club. His report (bar stool chatter) was disconcerting to say the least.

 

He said that being, I think he was 68 years old at the time, an American he had two preventative medicine colonoscopies. He reported that the insurance company excluded his entire digestive track as a “pre-existing” condition due to his having had multiple colonoscopies. He also said that he had been diagnosed as having a “heart mummer”. A relatively common problem. He stated that the insurance company excluded his coronary system as a result of this diagnosis. 

 

Now, first and foremost, this is barstool chitchat, unconfirmable and of no consequence at the time. Was his report true, I do believe him as there was no reason to lie or even stretch the truth. He did report that he got expat insurance from an international company. His view was that the popular Thai insurance provider wasn’t insuring much at all due to the exclusions they added to the quote. He did say he was entirely truthful in completing the medical questionnaires.

 

So, my question to all – what is/are your experiences with procuring medical insurance for your time here in Thailand? 

 

I’ll go first. 

 

For myself, I carry Expat Medical Insurance with a well-known International Provider. In Patient only USD $1M per event policy, covering both myself and my wife anywhere in the world, no pre-existing conditions or exclusions, aged 65 & 60 premiums of USD $6k/annum with a $5k deductible.

 

The math if either gets sick: $1M/$11k = 90X factor. I feel that this is a very good cost effective policy that’s provides me with adequate protection. 

 

1) Do you have insurance with a Thai Company or with an International Company?

2) Did you complete the medical history questionnaire truthfully?     

3) Do you have any “pre-existing” conditions? 

4) Did you receive any exclusions?

5) How much coverage do you maintain OP and IP? 

6) How old are you?

7) How much does it cost?

 

 

Thank you in advance for your input - it is appreciated. 

Edited November 8, 2019 by The Man Who Sold the World
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[fittobethaied]

3 years ago I had high blood pressure and high cholesterol, but was on meds which kept both in normal readings. I applied for health insurance via my agent with two different providers and was denied coverage because of my prior hospital report of high BP and cholesterol. At the time of my applications I had lost 39 pounds and BP and cholesterol were both naturally normal, my weight and BMI was now in the normal range and I was completely weaned off my medications. These Thai insurance underwriters just don't have the ability to "think outside the box". The truth is they really don't want to insure us older expats and they will look for any reason to deny us coverage. Under this new mandatory insurance scheme they have jacked the premiums up so high that they might wind up making a profit on us, and they know they can get away with this "highway robbery" because it has been sanctioned by Thai Immigration.  

[rwill]

Just applied for April International, in patient only except for outpatient cancer care, pays up to 1 million US per year.  A little over 200K baht per year for both of us, 69 and 62 years old.   For my wife I told them she was taking 1,500mg of metformin, 20mg atorvastatin, and between 50-100mcg thyroxine/day.   They wanted additional information on her thyroid.  They did not ask anything about diabetes, which is what I thought they would be concerned with.  They sent back a letter for an exclusion but it didn't say which of us it was for that just said, “Exclusion of thyroid pathologies, their consequences and consequences”  that is the exact wording.

I sent them back a reply that it did not state who the exclusion was for since both of us would be on the policy and that I did not understand what the exclusion included.  But have not heard back from them in a few days now.

[wwest5829]

When I first retired to Thailand in 2011, I took out a healthcare policy. Having had 5 by-passes in 2005 the company excluded anything to do with the heart or blood circulation. The following year I was informed I was in a new age bracket so the premium would be higher. On balance? Cost/benefit was out of wack so ... cancelled the policy. Non-critical I can return to US for Medicare (I am still paying a monthly premium and there will be co-pays and deductibles). Critical care? 2015 heart attack, TIA in Chiang Mai). Found out that my my college system has a retiree policy that will pay up to 5000 USD annually for overseas care). They paid 5K, I paid the balance of 6K. Orginal post says he pays 6K annually for insurance. I am retired on about 36K annually. Bit of a non starter there....

Edited November 9, 2019 by wwest5829

[dddave]

A friend was applying at BUPA.  He was 62 at the time and in good health.  Though his cholesterol was within healthy limits. it was on the higher side of healthy and his Dr. had prescribed a low dose of Lipitor just to be on the safe side.  As soon as he mentioned Lipitor, the BUPA agent immediately stated that he would be excluded from any cardiac coverage...period.  Not the least interested that his cholesterol was within acceptable limits...just the fact that Lipitor had been prescribed was evidence enough to BUPA for denial.

[gamesgplayemail]

What if you tell them that you do not smoke when you apply ? Will they find it later ?!

 

 

[Sheryl]

On 11/9/2019 at 10:37 AM, rwill said:

Just applied for April International, in patient only except for outpatient cancer care, pays up to 1 million US per year.  A little over 200K baht per year for both of us, 69 and 62 years old.   For my wife I told them she was taking 1,500mg of metformin, 20mg atorvastatin, and between 50-100mcg thyroxine/day.   They wanted additional information on her thyroid.  They did not ask anything about diabetes, which is what I thought they would be concerned with.  They sent back a letter for an exclusion but it didn't say which of us it was for that just said, “Exclusion of thyroid pathologies, their consequences and consequences”  that is the exact wording.

I sent them back a reply that it did not state who the exclusion was for since both of us would be on the policy and that I did not understand what the exclusion included.  But have not heard back from them in a few days now.

 

I am also on levothyroxine and have policy with April. I was given the option of a slightly higher premium or exclusion of thyroid conditions, I took the latter. I could probably have avoided the exclusion if I had undergone a thorough workup to exclude Hashimoto's as the cause (which is what they are concerned about as it puts one at above average risk of thyroid lymphoma( but the cost of doing that was just not worth it, given that it is an inpatient only policy. I have Medicare cover in the US and in the unlikely event I require hospitalization related to my thyroid that would usually be something I'd be fit to travel back for.

 

Age 66,  $1 million in cover with a $500 deductible and premium this year was US$2,836.60.

 

Before this I had a policy with Cigna Global. They applied no exclusions despite the fact that I was at that time taking an antihypertensive (I don't remember if I was also taking the levithyroxine at that timeor not). They asked for my most recent BP, which was quite normal as it was well controlled, and that was fine with them.

 

In my experience companies vary greatly in how they treat pre-exisitng conditions. Which means it is worth shopping around a bit if you have one, especially one that is stable and well controlled.

[Sheryl]

23 minutes ago, gamesgplayemail said:

What if you tell them that you do not smoke when you apply ? Will they find it later ?!

 

 

 

They may. And any lie on your application invalidates the entire policy.

[gamesgplayemail]

22 hours ago, Sheryl said:

 

They may. And any lie on your application invalidates the entire policy.

 

Yes but how do they know if i started to smoke after application ?