April International (France) health insurance -- some questions for those holding the policy pls

[david_je]

I am U.S. citizen, retired in Bangkok. May I ask Sheryl and others who have the April International (France) health insurance policy:

1. What are the main advantages and disadvantages of this policy compared to others you considered? 

2. Easy enough to make claims (or other dealings) with them even though they have no office in Bangkok?

3. I need a policy that I will keep for life. Can I keep this policy, or would it still suit me, if I move elsewhere long-term, or travel frequently outside my zone of coverage? I guess I’d then have to change the zone of coverage in my policy. I notice their General Conditions says, “Your Cover comes to an end: (h) If you are no longer an expatriate.” What does that mean?

4. Is $500 or $1,000 deductible better?

5. If you have Zone 3 coverage that includes Thailand, do you buy supplemental insurance when you make longer trips to U.S., U.K. and other countries outside the zone? It covers only trips of up to 90 days outside zone, and apparently only accidents, not illnesses.

6. Makes sense in Thailand not to get outpatient cover, but outpatient is not cheap if you’re on trip to countries outside zone of coverage like U.S. Japan, Hong Kong.     

7. I’m considering the Essential policy but it covers $75 max for private hospital room and cheapest single room at Bumrungrad, for example, costs $180 room only and $386 if “service and meals” included, according to their website.

Thanks for your advice.

[chakatee]

1. price quality

2. they do have office in BKK

3. when you move back to US

4. if you're not sick yes, if you're sick no

5. yes

[Sheryl]

1. Reliability/dependability and efficiency. Adherence to policy terms, which are clear. Thorough and well-informed medical underwriting when policy is issued so no surprises later as to what is covered. (But, for the same reason, the process of taking out a policy requires some time). Hospitalization only policy (Essential plan) includes day surgeries and OPD related to a hospitalization (up to 30 days before and after). Also covers outpatient cancer care and dialysis. Reasonable premiums compared to similar international policies. Comes under EU regulatory framework. You have recourse if needed to the French Insurance Ombudsman.

 

2. There is an office in Bangkok - that office is actually for April Thailand but it helps with communications and processing. Specifically, in getting pre-approvals/Guarantees of Payment, Thai hospitals can contact the Bangkok office. They have direct payment arrangements with most Thai hospitals. Also have one with at least one hospital in Cambodia.

 

3.  This question really should be directed to your Broker. If you do not have a broker - get one, absolutely. Do not purchase this or any other policy on your own. Brokers are invaluable in helping with an claims issues that may arise later.

 

To the best of my knowledge - which you should verify with broker -- it is an expatriate policy so would end if you returned permanently to your home country. The zone of coverage is quite broad,  for Zone 3 (which is what you get if living in Thailand) it includes; Albania, Andorra, Armenia, Australia, Austria, Azerbaijan, Belarus, Belgium, Bosnia and
Herzegovina, British Virgin Islands, Bulgaria, Cambodia, Costa Rica, Croatia, Cyprus, Czech
Republic, Denmark, Ecuador, Estonia, Faroe Islands, Finland, Georgia, Germany, Gibraltar,
Greece, Hungary, Iceland, Indonesia, Ireland, Israel, Italy, Latvia, Liechtenstein, Lithuania,
Luxembourg, Macedonia, Malaysia, Malta, Mexico, Moldova, Monaco, Montenegro,
Netherlands, New Zealand, Norway, Poland, San Marino, Serbia, Slovakia, Slovenia, Spain,
Svalbard and Jan Mayen, Sweden, Taiwan, Thailand, Ukraine, United Arab Emirates, Vatican
and Venezuela.

 

Were you to move to a country not on that list (but still not your country of nationality), I think you can change the plan accordingly (see section on making changes to your plan) but you should confirm this - Ask your broker.

 

4. When I ran the numbers, $500 deductible was clearly worth it as would pay for itself unless you had a claim every single year which is highly unlikely to happen. It looked to me like diminishing returns for higher deductibles but run it yourself (i.e. look at how much more it reduces your premiums and figure out how many years without a claim it would take to balance out). Note that while you can always increase your deductible later you are not guaranteed to lower it without being subject to a new medical review at which time new exclusions might be  applied to the reduced amount. (i.e. if you later reduced your deductible this might nto be applicable for any condition you have developed since the policy was issued). So consider your ability to pay deductible not just now but at later ages.

 

5. It covers not just accidents but also any medical emergency when travelling up to 90 days outside the zone of cover. If you will be more than 90 days in a country outside the zone of cover you should indeed get a supplemental policy/travel insurance.

 

6. That is correct, especially in the US. And given the tendency in the US not to hospitalize people for things that would lead to hospitalization elsewhere, you could be pretty ill and still get just outpatient care there.

 

7. The room rate limitation applies only to the room portion not to meals and nursing care. They will pay in full for a semi-private room, even if it is over $75.  In practice, hospitals may adjust their billing so that a private room is covered - either by how they present it (i.e. "standard room" rather than "private room") or by accepting the $75 limit. But this does depend on the hospital. I have twice been hospitalized at hospitals which had no semi-private rooms and neither time did I have to pay anything.  In the first instance, when I discussed the issue on admission the hospital  told me "don't worry, we don't categorize  rooms as private/semi-private but as standard and higher" and it went fine. In the second instance I was initially called by the hospital and told about the $75 limit but then the issue magically vanished, not sure how/why but it was a package price for surgery inclusive of the room so perhaps they just adjusted their internal breakdown of the package cost for the insurer.  Anyhow both times I paid only the deductible.

 

No guarantees though, so you do need to be prepared to pay the excess over $75 if in a private room. If you get the Comfort Plan rather than Essential plan it will pay in full for private room but by my calculations, not worth it - the extra premium far exceeds what you would ever be likely to pay out of pocket under the Essential plan. And other than the private room I don't see any meaningful advantage in cover under the Comfort Plan.

[david_je]

On 1/28/2022 at 1:12 PM, Sheryl said:

 

 

To the best of my knowledge - which you should verify with broker -- it is an expatriate policy so would end if you returned permanently to your home country. 

 

Thank you very much Sheryl, for your very helpful comments.

Re #3: April Int'l France confirmed that it is an expatriate policy and would need to be canceled if you returned to live in your home country. Which raises the question -- If one day we decided to return to the U.S. (or wherever one’s home country is), wouldn’t we be faced with the possibly daunting challenge of trying to find a new policy at an advanced age?

[Sheryl]

2 hours ago, david_je said:

Thank you very much Sheryl, for your very helpful comments.

Re #3: April Int'l France confirmed that it is an expatriate policy and would need to be canceled if you returned to live in your home country. Which raises the question -- If one day we decided to return to the U.S. (or wherever one’s home country is), wouldn’t we be faced with the possibly daunting challenge of trying to find a new policy at an advanced age?

If you are a US citizen and return there is old age you'll be under Medicare and able to get a Medicare Advantage or Medigap plan.

 

If you return prior to age 65 then yes, you'll need to find a new plan. There isn't a way around this as there no afforable  US insurance plans that cover you living abroad (except for some special plans limited to people with prior government employment or military service) . US health insurance is a thing unto itself and quite US specific -- indeed, often state-specific..

[david_je]

17 hours ago, Sheryl said:

If you are a US citizen and return there is old age you'll be under Medicare and able to get a Medicare Advantage or Medigap plan.

 

And Medicare and options would be sufficient, without non-Medicare supplementary policy? I guess if you returned to US and had to cancel April policy and then after living in the US later decided to return abroad (and Medicare does not cover overseas), it would be difficult for a 65+ person to get a new policy. Thanks again.

[Sheryl]

42 minutes ago, david_je said:

And Medicare and options would be sufficient, without non-Medicare supplementary policy? I guess if you returned to US and had to cancel April policy and then after living in the US later decided to return abroad (and Medicare does not cover overseas), it would be difficult for a 65+ person to get a new policy. Thanks again.

US insurers do not issue "non Medicare" supplemental policies to people with Medicare. Any private insurance policy for someone with Medicare will be some type of Medicare supplement. 

 

If later going abroad again your insurance options are fewer if over 65 but not nil. The bigger problem is that by 65 most people have one or more pre-existing conditions which would be excluded or might even preclude getting insured altogether.  

 

Some countries enable expat retirees to purchase cover under National Health schemes. Thailand so far does not.

[Lia C]

Hi Sheryl (and all), I'm also a US citizen considering April International (France) via AA Brokers and have been scrutinizing it against the April Thailand plan which was initially presented to me by them (despite my clear request for the true International policy). In particular I'm wondering:

 

1. Can you comment on what the "more thorough and well-informed underwriting process" is actually like?
   • Aside from the medical questionnaire, should I expect to need to grant access to my US health records? Will a social security number be required?
2. I'm eager to understand why it's generally accepted as not worth it to buy OPD coverage when living in Thailand? Is it simply because one is unlikely to spend, out-of-pocket, an amount equal to or greater than the difference in premium between IPD and IPD+OPD?
   • I'm 33, so for the Essential plan I'd pay $1162 for just IPD or $2499 for both (w/o deductible), so I can see how a 45,000 baht difference might not pay for itself, but I want to make sure I'm getting the full picture.
   • One thing I'm concerned about is labs and more importantly, medications. If an OPD consultation results in a diagnosis that requires expensive medication (but that may not be officially defined as "life-saving"), those costs in addition to whatever labs and routine tests are needed to manage a condition, that could easily overtake that kind of figure. Anyone experienced a scenario like this?
3. If considering OPD and comparing the France-based policy to the Thai-based one, is it accurate to state that April Thailand can direct-bill for OPD expenses while April International would only reimburse you after filing a claim?
4. Anyone have any experience using the free telehealth services? My broker at AA said it's available in Thailand so wondering if it's of any actual use in practice?
5. Lastly, does anyone have an especially helpful broker they can recommend to purchase April International through? My contact at AA has been very responsive and informative, but I'm somewhat turned off by the fact it took me asking literally 3 times before he acknowledged we had in fact not been discussing the International (France-based) policy I had clearly stated I was only interested in.

 

Thanks so much for all your insights. They've been a huge help in this process for me.

[Sheryl]

#1 = No and No. Though depending on your medical history, if there is indication of a pre-existing health condition then they may ask you to submit medical records or medical summary specific to it.

 

#2 - it would be extremely difficult, and rare, to incur outpatient costs that equal the increased premium. Out patient costs in Thailand are quite reasonable and most  medications can be bought at an outside pharmacy without prescription (never buy fro ma hospital pharmacy, big mark-up).  This includes things that are prescription-only in the US e.g. antibiotics, blood pressure,medications, cardiac meds etc. Assuming the hospitalization-only policy does cover outpatient cancer care and dialysis, about the only situation I can imagine where your OPD costs would equal or exceed the premium difference would be if you needed an unusually expensive and prescription-only drug on a long term basis. 

  - if you are planning in living in Thailand long term be sure to look at premium costs at later ages.

 

#3 I am not sure as I only have hospitalization cover.

 

#4 I have never used it. There are plenty of telemed options if you want them, including US based ones that are pretty inexpensive.

 

5 - AA is the best for this IMO.

[david_je]

On 4/15/2022 at 12:59 PM, Sheryl said:

 

 

5 - AA is the best for this IMO.

Dear Sheryl and all,

Would you pls advise whom to contact at AA for this and alternative policies?

Thanks.

[Lia C]

@Sheryl

Re: outpatient medication, do OPD plans cover prescribed meds purchased at independent pharmacies? Or is it only if buying directly from the hospital at which the prescription was issued? In other words if expensive meds were to become a factor and an OPD plan theoretically became a good value, are you then limited to what one hospital can/will provide? Or can you procure what you need on your own as long as it fits the Rx?

 

One new thing I'm now a bit concerned about is claims processing speed. My broker at AA mentioned that while they presently have no outstanding claims for their customers with April Thailand, apparently they have a handful that have been open and awaiting reimbursement from April International for "2-3 months".

 

I'm wondering, all things considered, whether any circumstances at all might favor April Thailand over International? I don't see myself growing old in Thailand, so renewal beyond 90 isn't a big concern for me, and while I have definitely noted several superior aspects of International's coverage vs. Thailand's, I'm hesitating a bit around my fear of additional administrative headache. The $75/day toward private room limit on April International's Essential plan isn't super comforting either.

 

I suppose if I intend to live anywhere other than the US after Thailand, having history with April International would be important, and having been a customer of April Thailand I assume would be effectively useless, which is significant. I'm guessing your claims and approvals experience with April International has overall been just as smooth as one could hope with any insurance here? Can you envision any case where you would actually recommend April Thailand over April International?

 

Thanks so much, Sheryl!!

[Sheryl]

5 hours ago, david_je said:

Dear Sheryl and all,

Would you pls advise whom to contact at AA for this and alternative policies?

Thanks.

If you are wanting to do face to face contact (offices in Bkk, Pattaya, Phuket  and Hua Hin) then see here

https://www.aainsure.net/contact_hua-hin.html

 

If doing it by email, the 2 people I have dealt with on my own policy are:

 

Jeanine Hermanussen   [email protected]

Matthieu Heijligenberg [email protected]

 

Both I think based in the HUA Hin office

 

[scubascuba3]

22 minutes ago, Lia C said:

@Sheryl

Re: outpatient medication, do OPD plans cover prescribed meds purchased at independent pharmacies? Or is it only if buying directly from the hospital at which the prescription was issued? In other words if expensive meds were to become a factor and an OPD plan theoretically became a good value, are you then limited to what one hospital can/will provide? Or can you procure what you need on your own as long as it fits the Rx?

 

One new thing I'm now a bit concerned about is claims processing speed. My broker at AA mentioned that while they presently have no outstanding claims for their customers with April Thailand, apparently they have a handful that have been open and awaiting reimbursement from April International for "2-3 months".

 

I'm wondering, all things considered, whether any circumstances at all might favor April Thailand over International? I don't see myself growing old in Thailand, so renewal beyond 90 isn't a big concern for me, and while I have definitely noted several superior aspects of International's coverage vs. Thailand's, I'm hesitating a bit around my fear of additional administrative headache. The $75/day toward private room limit on April International's Essential plan isn't super comforting either.

 

I suppose if I intend to live anywhere other than the US after Thailand, having history with April International would be important, and having been a customer of April Thailand I assume would be effectively useless, which is significant. I'm guessing your claims and approvals experience with April International has overall been just as smooth as one could hope with any insurance here? Can you envision any case where you would actually recommend April Thailand over April International?

 

Thanks so much, Sheryl!!

Try and find out how many claims denied or % denied, not sure if they'd be forthcoming but worth a try. A delay in claim processing is better than a quick claim denied

[Sheryl]

7 minutes ago, Lia C said:

@Sheryl

Re: outpatient medication, do OPD plans cover prescribed meds purchased at independent pharmacies? Or is it only if buying directly from the hospital at which the prescription was issued? In other words if expensive meds were to become a factor and an OPD plan theoretically became a good value, are you then limited to what one hospital can/will provide? Or can you procure what you need on your own as long as it fits the Rx?

 

One new thing I'm now a bit concerned about is claims processing speed. My broker at AA mentioned that while they presently have no outstanding claims for their customers with April Thailand, apparently they have a handful that have been open and awaiting reimbursement from April International for "2-3 months".

 

I'm wondering, all things considered, whether any circumstances at all might favor April Thailand over International? I don't see myself growing old in Thailand, so renewal beyond 90 isn't a big concern for me, and while I have definitely noted several superior aspects of International's coverage vs. Thailand's, I'm hesitating a bit around my fear of additional administrative headache. The $75/day toward private room limit on April International's Essential plan isn't super comforting either.

 

I suppose if I intend to live anywhere other than the US after Thailand, having history with April International would be important, and having been a customer of April Thailand I assume would be effectively useless, which is significant. I'm guessing your claims and approvals experience with April International has overall been just as smooth as one could hope with any insurance here? Can you envision any case where you would actually recommend April Thailand over April International?

 

Thanks so much, Sheryl!!

 

"Can you envision any case where you would actually recommend April Thailand over April International?"

NO.

 

Except for one low cost day procedure for which I did nto seek advance approval (not required in costs <USD2,000) My hospital costs have been paid by April direct to the hospitals, no delay at all - processed on day of discharge. Getting the initial Gurantee of Payment took about 4 hours (on a Sunday) for an emergency hospitalization and about a week for an elective surgery.

 

For a day surgery where I did nto get pre-approval (cost <2,000 USD) reimbursement taooik a few weeks.

 

Reiumbursment of outpatient costs (related to hospitalization) took around a month. I think in one case (during COVID shut-downs) may have been a little longer.

 

I doubt April Thailand would have any quicker. Especially since, like most (in fact, essentially all) Thailand based companies they do extensive digging into past medical records to decide whether they think the claim is related to a pre-exisitng condition -- even if you have no pre-exisitng conditions listed as exclusions on your policy. . April International dioes not normally do this,  they do a through review at intake to decide, based on a detailed medical history obtained through a clear and comprehensive question, what exclusions if any apply. (Application process can be a little lengthy for this reason, as they may come back to you wanting more details). The Thai health insurance industry "norm" is to have garbled intake forms that make little sense and then wait for a claim to arise then look for "evidence" that it is related to a pre-existing condition.

 

Zero "adminstrative headaches" for me. The hospitals handled everything for the inpatient claims, my broker handled everything for the outpatient and the post-claim for day surgery.

 

Insurance will not cover drugs purchased at an outside pharmacy, only those issued as part of an outpatient visit. It is very rare for a large private hospital to not have something any of their doctors would prescribe.

 

 

[scubascuba3]

2 minutes ago, Sheryl said:

"The Thai health insurance industry "norm" is to have garbled intake forms that make little sense and then wait for a claim to arise then look for "evidence" that it is related to a pre-existing condition.

 

100% true this i know of an exact example of this currently in court, the forms were ambiguous and poorly worded

[Sheryl]

1 minute ago, scubascuba3 said:

100% true this i know of an exact example of this currently in court, the forms were ambiguous and poorly worded

They will often have things like: "have you ever had a sore throat?" or "have you ever had a cough?". If you answer use they will then announce you have a chronic respiratory disease (COPD etc) or history of pneumonia and that htey will nto insure you (or will level exclusions) as a result. If you answer no,m then of course you have lied, as everyone in the world has an occasion sore throat or cough at some point in their lives.

 

And so forth.

 

The staff who review these things have no medical training and work off bizarre charts they do not really understand. i recall one instance where Someone who acknowldged that they had ever in their life experienced some heartburn (who hasn't?)  was later told this proved he (1) had a hiatal herniai(he did not) and (2) had heart disease  (apparently the chart listed heart disease as in some way related to H.H.) which he also did not. That whole dialogue occurring only after he tried to make a claim, and making no medical sense whatsoever.

[Lia C]

1 hour ago, Sheryl said:

They will often have things like: "have you ever had a sore throat?" or "have you ever had a cough?". If you answer use they will then announce you have a chronic respiratory disease (COPD etc) or history of pneumonia and that htey will nto insure you (or will level exclusions) as a result.

Wow, that's insane. This seals it for me! Thank you again Sheryl and scubascuba

[C3PO]

Also regarding the April International Policy (issued in France), I have two questions to those having studied the contract:

 

1. Is it really lifetime renewable?

 

The contract says in section 3. WHO IS COVERED UNDER THE PLAN?  

To be covered by the insurance, You must:

On the Effective date of the plan, be:

> between the age of 16 and 64 for medical expenses, repatriation assistance and personal liability (private capacity) cover, if covered in zone 0, Thailand and Mexico,

 

Then under 4.4 f) when You no longer meet the conditions of insurance (see paragraph 3). Cancellation will take effect at the end of the current period and at the latest within 30 days of receipt of notification, subject to receipt of a supporting document;

 

The question is, what means "effective date"? The policy states: "EFFECTIVE DATE: date on which the plan starts. It is specified on the Membership certificate". What date is specified in the membership certificate: Is it the first date that I take out the insurance, or is it the annual renewal date? Because if it is the latter, April can terminate the contract after age 64. 

 

 

2. The contract says they exclude "in the event of Hospitalisation or excessive unreasonable or unusual costs considering the country in which they were incurred". What is the insurance definition of "unreasonable or unusual cost"? For example, if I were to get treatment in a private hospital such as Bangkok Hospital, the cost would be higher than in a government hospital. Would the insurance deem this as unreasonable?

 

Many thanks for anyone who can provide clarity, it's much appreciated. 

[scubascuba3]

1 hour ago, C3PO said:

Also regarding the April International Policy (issued in France), I have two questions to those having studied the contract:

 

1. Is it really lifetime renewable?

 

The contract says in section 3. WHO IS COVERED UNDER THE PLAN?  

To be covered by the insurance, You must:

On the Effective date of the plan, be:

> between the age of 16 and 64 for medical expenses, repatriation assistance and personal liability (private capacity) cover, if covered in zone 0, Thailand and Mexico,

 

Then under 4.4 f) when You no longer meet the conditions of insurance (see paragraph 3). Cancellation will take effect at the end of the current period and at the latest within 30 days of receipt of notification, subject to receipt of a supporting document;

 

The question is, what means "effective date"? The policy states: "EFFECTIVE DATE: date on which the plan starts. It is specified on the Membership certificate". What date is specified in the membership certificate: Is it the first date that I take out the insurance, or is it the annual renewal date? Because if it is the latter, April can terminate the contract after age 64. 

 

 

2. The contract says they exclude "in the event of Hospitalisation or excessive unreasonable or unusual costs considering the country in which they were incurred". What is the insurance definition of "unreasonable or unusual cost"? For example, if I were to get treatment in a private hospital such as Bangkok Hospital, the cost would be higher than in a government hospital. Would the insurance deem this as unreasonable?

 

Many thanks for anyone who can provide clarity, it's much appreciated. 

Good questions, i would get April to confirm not broker or people here so you have something to rely on in black and white. We can pretty much guess the answers 

[topt]

On 5/23/2023 at 11:03 AM, C3PO said:

What date is specified in the membership certificate: Is it the first date that I take out the insurance, or is it the annual renewal date?

The first date you start the plan. I received an electronic copy of my Certificate when I started the plan in 2021 and on renewal in 2022 there was no new certificate issued.

I also queried this initially with AA.

On 5/23/2023 at 11:03 AM, C3PO said:

1. Is it really lifetime renewable?

Yes - to me that is fairly clear in the Ts and Cs

 

On 5/23/2023 at 11:03 AM, C3PO said:

What is the insurance definition of "unreasonable or unusual cost"?

They give this definition but yes open to interpretation

Quote

REASONABLE AND CUSTOMARY COSTS: medical expenses are considered to be reasonable and customary if they do not
exceed the rates normally charged for an identical service or treatment in the location in which they are incurred.
Medical costs vary greatly depending on the country, and even between practitioners and facilities in the same area:
some charge higher prices than others, but with the same quality of service. To avoid this type of abuse, and using our in-
depth knowledge of the local health systems, we have been compiling pricing databases for over 30 years. These
databases are continually added to and are updated every year. If we consider a claim to be inappropriate, we reserve
the right to reduce the amount we will pay or refuse the claim.

My concern is as mentioned by another member an arbitrary increase applied, larger than expected, for over a certain age - from memory 65 but I will check........

[C3PO]

Thanks for the answers so far. I did as scubascuba3 suggested and wrote to the insurer. Will share the answers here if I get any. 

 

Quote

My concern is as mentioned by another member an arbitrary increase applied, larger than expected, for over a certain age - from memory 65 but I will check........

Good point. Please share if you find any information regarding that. European regulators might also place a limit on price hikes based on age, but I am not sure about that. 

 

Another question I sent to the insurer is what they define as "mental or nervous" disorder, which their plans exclude or restrict. I am not sure if those are strictly psychological issues or if diseases such as Alzheimer, MS etc. would also fall under that definition. Will share an answer here if I get one.

 

  

[dave88]

One question I have is this:

 

If I plan to stay in Thailand with the retirement visa then I have to show proof of health insurance 100.000usd or more from only a thai health insurance company. I currently have the April thailand Myhealth policy 16M plan and can easily get certificate proof of insurance for the immigration because underwritten by LMG health insurance company which is a thai company.

I would like to get the April International policy instead but then how to get the certificate proof of insurance? Would I have to buy the cheapest option from a thai company, on top of having the April International plan? If so that could be expensive.

Any suggestions would be appreciated, thanks:)