Denied by Cigna—anyone have recommendations for alternatives?

[jerrymahoney]

16 minutes ago, KannikaP said:

I thought you were with WRLife. You are not pushing them to the OP.

MuangThai Life is a life insurance policy only for me. And I am not pushing anything to anyone. My comments on WrLife -- at least at the onset -- were because others asked if anyone actually had a claim settled with WrLife.

 

Then others followed with, as I have put it, you have bought yourself a pig-in-a-poke.

Edited September 28, 2022 by jerrymahoney

[SammyJ]

2 hours ago, nigelforbes said:

More or less, I know it as the Health Happy product. It's 5 mill. coverage which doubles in the event of major illness.

However, thinking of 5 mil coverage is a bit misleading, as the various caps/maximums on certain areas likely prevent coverage anywhere near 5 million--with the caps, on procedures and hospital treatments, it would be difficult, if not impossible, to reach too high an amount--it's nice marketing and sounds good, but...  Additionally, looking at the various coverages and max's in the example provided in the pdf, the cap for surgery and anesthesia seem a bit low--easy to exceed those if in larger, more modern hospitals in larger cities (bkk and chiang mai) that farang expats may favor.   Additionally, it does appear that there are exclusions for pre-existing conditions, and simply because they say they may accept one at older ages, doesn't mean they will--it's subject to their underwriting dept--CIGNA said they will accept new coverage up to age 70, but I know several friends that applied in their mid-60's and were denied because of pre-existing conditions--they did not simply exclude certain medical conditions, but rejected any coverage.

I think it takes common sense to understand that the CIGNA, Aetna, Pacific Cross, AXA, LUMA, are some of the leading Thai companies who provide health insurance here, and see what their rates are, and then think you can get the same thing for a fraction of their costs.  If it's too good to be true......

Edited September 28, 2022 by SammyJ

[jerrymahoney]

AS to above, doesn't seem to me that the AIA Happy premiums are that far out of line with those other providers:

 

[nigelforbes]

28 minutes ago, SammyJ said:

However, thinking of 5 mil coverage is a bit misleading, as the various caps/maximums on certain areas likely prevent coverage anywhere near 5 million--with the caps, on procedures and hospital treatments, it would be difficult, if not impossible, to reach too high an amount--it's nice marketing and sounds good, but...  Additionally, looking at the various coverages and max's in the example provided in the pdf, the cap for surgery and anesthesia seem a bit low--easy to exceed those if in larger, more modern hospitals in larger cities (bkk and chiang mai) that farang expats may favor.   Additionally, it does appear that there are exclusions for pre-existing conditions, and simply because they say they may accept one at older ages, doesn't mean they will--it's subject to their underwriting dept--CIGNA said they will accept new coverage up to age 70, but I know several friends that applied in their mid-60's and were denied because of pre-existing conditions--they did not simply exclude certain medical conditions, but rejected any coverage.

I think it takes common sense to understand that the CIGNA, Aetna, Pacific Cross, AXA, LUMA, are some of the leading Thai companies who provide health insurance here, and see what their rates are, and then think you can get the same thing for a fraction of their costs.  If it's too good to be true......

In respect of AIA happy Health:

 

The coverage in my case is 5 million per year or 5 million per medical admission, 10 million in the event of critical illness. Coverage is available up to 25 mill.

 

The payable benefits are for items as charged, except room costs which are limited by the number of days and cost per day, based on the total sum insured each year. In that respect there are no caps (except on room days).

 

There are no caps on surgery and anesthesia etc.

 

It is entirely feasible that a person could breach the 5 million figure, which is why the product is sold with different levels increasing in 5 mill. stages, up to 25 mill. A decent bout of cancer, early in the year, could easily see that 5 mill. limit reached, which is why it is doubled for critical illness.

 

I currently pay 118k for CIGNA and my deductible is 350k plus 160k co-pay, it excludes two key areas of my body including my heart and vascular system, it is a very poor deal. By switching to AIA I expect to have the same exclusions but will eliminate the deductible and the co-pay, that's a better deal for me which reduces my risk. My cost under AIA will be slightly higher than with CIGNA but my future costs are known and published, subject to increases across the board (rather than specific to only me). My AIA costs are fixed for the next three years then fixed for the following 5 years.

 

 

 

 

[nigelforbes]

6 minutes ago, jerrymahoney said:

AS to above, doesn't seem to me that the AIA Happy premiums are that far out of line with those other providers:

 

I agree, except there is no deductible or co-pay which in my case is substantial.

[SammyJ]

47 minutes ago, nigelforbes said:

In respect of AIA happy Health:

 

The coverage in my case is 5 million per year or 5 million per medical admission, 10 million in the event of critical illness. Coverage is available up to 25 mill.

 

The payable benefits are for items as charged, except room costs which are limited by the number of days and cost per day, based on the total sum insured each year. In that respect there are no caps (except on room days).

 

There are no caps on surgery and anesthesia etc.

 

It is entirely feasible that a person could breach the 5 million figure, which is why the product is sold with different levels increasing in 5 mill. stages, up to 25 mill. A decent bout of cancer, early in the year, could easily see that 5 mill. limit reached, which is why it is doubled for critical illness.

 

I currently pay 118k for CIGNA and my deductible is 350k plus 160k co-pay, it excludes two key areas of my body including my heart and vascular system, it is a very poor deal. By switching to AIA I expect to have the same exclusions but will eliminate the deductible and the co-pay, that's a better deal for me which reduces my risk. My cost under AIA will be slightly higher than with CIGNA but my future costs are known and published, subject to increases across the board (rather than specific to only me). My AIA costs are fixed for the next three years then fixed for the following 5 years.

 

 

 

 

I may be looking at the wrong thing--but are you referring to the link that shows a pdf of the  AIA new standard plan?  Or is there another version??  In looking at that pdf there does seem to be caps on coverages--and the sample case given is not really a practical example.  Is there a different link to the plan you mention?  

 

The Elite health in another pdf does seem to offer some more flexibility in payments--but, see the caveat that reads:  (it appears to give them quite a bit of flexibility in changing things.

 

Policy Renewal on Anniversary Date
This rider may be renewed on the policy’s anniversary date without having to provide evidence, but the Company reserves the right to adjust the premium as specified in Section 14 Re: Premium Adjustment, as approved by the regulator, except in any of the following events, the Company shall reserve the right not to renew the rider. If the insured decides not to renew the rider, Company must inform the insured in writing at least 30 days before the end of the effective period.
1) In case there is the evidence that the insured omits the disclose any fact in the insurance application form or reinstatement form, health declaration form and other declarations related to the formation of health insurance rider which is material so that the Company may be induced to charge higher premium, or refuse to enter into the insurance contract, or provide the coverage with conditions.
2) The insured makes a claim from the fact that he/she has requested for the treatment for injury or illness without medical necessity.
3) The insured makes total claims from all companies for compensation from hospitalization higher than the actual income.

Premium Adjustment
The Company may adjust the premium on policy anniversary date due to many factors such as:
1) Age, career class of each individual;
2) Higher medical expenses or overall claim experience of the portfolio of this rider or claim experience of each insured whereby the Company shall notify the insured in writing via a registered mail or other means accepted by the insured at least 30 days in advance.

For premium adjustment due to the claim experience of each insured, if this general provision is removed from the contract, the Company shall issue endorsement or insurance contract that does not contain such clause for every insured.

[jerrymahoney]

14 minutes ago, SammyJ said:

I may be looking at the wrong thing--but are you referring to the link that shows a pdf of the  AIA new standard plan? 

Try this:

 

https://imo.aia.co.th/imosmart-lbc/contents/1003939/fileupload/1021812/AIA Health Happy Brochure EN V2.pdf

[jerrymahoney]

16 minutes ago, SammyJ said:

(it appears to give them quite a bit of flexibility in changing things.

It seems that they can adjust the premium by 

 

16 minutes ago, SammyJ said:

1) Age, career class of each individual;
2) Higher medical expenses or overall claim experience of the portfolio of this rider or claim experience of each insured

So they are referencing a portfolio in 2) -- not a policy holder's individual claim experience I infer.

[Liverpool Lou]

On 9/21/2022 at 8:55 AM, PadPrikKhing said:

So, my hopes rest with Jenny and April International at the moment...

Make sure that you answer the " have you ever been refused insurance" (or words to that effect) honestly, if it's asked.  

[SammyJ]

10 minutes ago, jerrymahoney said:

It seems that they can adjust the premium by 

 

So they are referencing a portfolio in 2) -- not a policy holder's individual claim experience I infer.

i think it is the individual's claim experience--they are having the caveat, so they could make adjustments

[Liverpool Lou]

On 9/26/2022 at 6:26 AM, PadPrikKhing said:

Regarding this, I did disclose the prior cancer in a detailed email, so she's well aware of that and the other history.

She's not the insurer, it's the insurance company that needs that disclosure from you.     

[jerrymahoney]

8 minutes ago, SammyJ said:

i think it is the individual's claim experience--they are having the caveat, so they could make adjustments

OK so these are 2 similar policies one from AIA and one from Muang Thai.

Edited September 28, 2022 by jerrymahoney

[SammyJ]

24 minutes ago, jerrymahoney said:

Try this:

 

https://imo.aia.co.th/imosmart-lbc/contents/1003939/fileupload/1021812/AIA Health Happy Brochure EN V2.pdf

Yes, this seems to be the correct pdf--there certainly do appear to be some nice benefits, as there are with other carriers--but, with exclusions for pre-existing conditions, the costs are still pretty high for plans when you are older--plus, they also include the following caveat:

 

* Renewal premium
AGE
(Years)
A rider is a one - year and renewable insurance contract.
The Company reserves the right to adjust the premium rate in a policy year due to various
factors such as age, occupational class, historical claim payments of the Company, etc.
For the rider attached to a healthcare insurance policy, other factors such as the medical
inflation rate and medical expenses, etc., may also be taken into consideration.
Such adjustment of premium rate is subject to approval of the Registrar.

 

[jerrymahoney]

So both AIA and MuangThai seem to have language to be able to factor in individual claim experience in adjusting rate.

 

For some these life insurance rider type health policies may be all that is available.

[SammyJ]

19 minutes ago, jerrymahoney said:

OK so these are 2 similar policies one from AIA and one from Muang Thai.

yes, both, as expected, allow the companies to make "adjustments on one's premium each year based on a variety of factors.

[nigelforbes]

58 minutes ago, SammyJ said:

I may be looking at the wrong thing--but are you referring to the link that shows a pdf of the  AIA new standard plan?  Or is there another version??  In looking at that pdf there does seem to be caps on coverages--and the sample case given is not really a practical example.  Is there a different link to the plan you mention?  

 

The Elite health in another pdf does seem to offer some more flexibility in payments--but, see the caveat that reads:  (it appears to give them quite a bit of flexibility in changing things.

 

Policy Renewal on Anniversary Date
This rider may be renewed on the policy’s anniversary date without having to provide evidence, but the Company reserves the right to adjust the premium as specified in Section 14 Re: Premium Adjustment, as approved by the regulator, except in any of the following events, the Company shall reserve the right not to renew the rider. If the insured decides not to renew the rider, Company must inform the insured in writing at least 30 days before the end of the effective period.
1) In case there is the evidence that the insured omits the disclose any fact in the insurance application form or reinstatement form, health declaration form and other declarations related to the formation of health insurance rider which is material so that the Company may be induced to charge higher premium, or refuse to enter into the insurance contract, or provide the coverage with conditions.
2) The insured makes a claim from the fact that he/she has requested for the treatment for injury or illness without medical necessity.
3) The insured makes total claims from all companies for compensation from hospitalization higher than the actual income.

Premium Adjustment
The Company may adjust the premium on policy anniversary date due to many factors such as:
1) Age, career class of each individual;
2) Higher medical expenses or overall claim experience of the portfolio of this rider or claim experience of each insured whereby the Company shall notify the insured in writing via a registered mail or other means accepted by the insured at least 30 days in advance.

For premium adjustment due to the claim experience of each insured, if this general provision is removed from the contract, the Company shall issue endorsement or insurance contract that does not contain such clause for every insured.

I'm looking at an English language version of Health Happy which was supplied to me by AIA, I can't see that it appears on any of their websites (the lack of English language translations is a problem with AIA).

[jerrymahoney]

1 minute ago, SammyJ said:

yes, both, as expected, allow the companies to make "adjustments on one's premium each year based on a variety of factors.

Well that's what Thai-based companies are allowed to do as Ms. Sheryl often notes on these pages.

[nigelforbes]

16 minutes ago, jerrymahoney said:

Well that's what Thai-based companies are allowed to do as Ms. Sheryl often notes on these pages.

I'm not convinced that is true. It certainly is true of health insurance but life insurance, even if the health policy is a rider it is still a  life insurance policy and not a health insurance policy....unsure.

[jerrymahoney]

9 minutes ago, nigelforbes said:

I'm not convinced that is true. It certainly is true of health insurance but life insurance, even if the health policy is a rider it is still a  life insurance policy and not a health insurance policy....unsure.

 

 

When I had a BUPA Pre-Aetna policy years back and had knee surgery, they increased my rate for a few years and then (as I remember) it came back to the published premium level so I don't know that such a claim is necessarily so ominous.

 

Edited September 28, 2022 by jerrymahoney

[nigelforbes]

1 minute ago, jerrymahoney said:

Well on page 10 the AIA Health Happy brochure linked above:

For the rider attached to a healthcare insurance policy, other factors such as the medical
inflation rate and medical expenses, etc., may also be taken into consideration.

 

However, when I had a BUPA Pre-Aetna policy years back and had knee surgery, they increased my rate for a few years and then (as I remember) it came back to the published premium level so I don't know that such a claim is necessarily so ominous.

 

I am clear that the table rates will be increased based on those factors but not individual customer rates, based on usage. Once again...unsure.

[jerrymahoney]

1 minute ago, nigelforbes said:

I am clear that the table rates will be increased based on those factors but not individual customer rates, based on usage. Once again...unsure.

The language in MuangThai health rider is more direct:

Premium Adjustment

2) Higher medical expenses or overall claim experience of the portfolio of this rider or claim experience of each insured whereby the Company shall notify the insured in writing via a registered mail or other means accepted by the insured at least 30 days in advance.

 

So they are a life insurance company just as is AIA.

[Sheryl]

46 minutes ago, jerrymahoney said:

 

 

When I had a BUPA Pre-Aetna policy years back and had knee surgery, they increased my rate for a few years and then (as I remember) it came back to the published premium level so I don't know that such a claim is necessarily so ominous.

 

It depends on the size of the claim, type of problem and the insurer. They are allowed under thai regs to increase by as much as 25% each year based on claims history. And they are nto required to drop the premium back down.

 

The big problem comes as one gets older, claims start to get more frequent and these 25% rises on top of what are already increased premiums due to age can rapidly add up. I have seen a lot of people totally priced out this way, at an age and state of health where they have no chance to change companies, and where it is also hard to relocate back to farangland (though some have simply had to).

 

This is why I do not recommend Thai companies for people planning to live out the rest if their lives here. For someone younger and here temporarily, can be OK.

[Sheryl]

44 minutes ago, nigelforbes said:

I am clear that the table rates will be increased based on those factors but not individual customer rates, based on usage. Once again...unsure.

I would be very, very surprised if the policy does not contain language allowing the company to raise rates based on claims history. That language is standard in Thai health insurance policies.

 

Raising premiums after someone had a claim enables the insurer to recoup at least part of their payout, maximizing their profits.  Since Thailand (unlike most western countries) allows this practice, hard to imagine why a Thai insurer would not do this.

[jerrymahoney]

Still, for some people, these life insurance rider health policies may be all that is available to them.

[nigelforbes]

36 minutes ago, jerrymahoney said:

Still, for some people, these life insurance rider health policies may be all that is available to them.

Indeed that is my case, either that or the existing CIGNA policy which is expensive and very limited.

[Sheryl]

6 hours ago, nigelforbes said:

I agree, except there is no deductible or co-pay which in my case is substantial.

Was your olicy with Cigna Global or Cigna Thailand? Sounds like the latter.

[nigelforbes]

27 minutes ago, Sheryl said:

Was your olicy with Cigna Global or Cigna Thailand? Sounds like the latter.

It is CIGNA Global. I have a cardiac stent since 2007 so that ruled out my entire cardio/vascular system. Plus a prolapsed disk ruled out my spine. Fortunately, ingrown toenails are still covered. ????

Edited September 28, 2022 by nigelforbes

[jerrymahoney]

13 hours ago, Sheryl said:

It depends on the size of the claim, type of problem and the insurer. They are allowed under thai regs to increase by as much as 25% each year based on claims history. And they are nto required to drop the premium back down.

 

The big problem comes as one gets older, claims start to get more frequent and these 25% rises on top of what are already increased premiums due to age can rapidly add up. I have seen a lot of people totally priced out this way, at an age and state of health where they have no chance to change companies, and where it is also hard to relocate back to farangland (though some have simply had to).

 

This is why I do not recommend Thai companies for people planning to live out the rest if their lives here. For someone younger and here temporarily, can be OK.

So my question given this discussion: Did any of the above 'totally priced out' rate adjustment stories involve a health insurance policy as rider to a life insurance policy?

Edited September 28, 2022 by jerrymahoney

[4MyEgo]

On 9/20/2022 at 3:29 AM, PadPrikKhing said:

I guess it was a previous bout with a form of cancer that did it, even though that was five years ago and was dealt with back then very successfully with no subsequent problems. It was so easy to deal with, in fact, that it was outpatient surgery and I was out the same day, no chemo or anything like that. It appeared they were about to say yes, and then the sales rep said that the underwriters had requested a couple of additional medical records and then when they got those, they denied me.

Now that you have been labelled as having a pre-existing condition, you can bet on it that no one will touch you, regardless, however is you do find someone to cover you, they will make sure, that part will be excluded or your policy will cost the earth. 

 

My advice from someone who has a pre-existing condition from 15 years ago with no problems since, time to self insure, if you can, otherwise, just hope for the best.

[nigelforbes]

3 minutes ago, 4MyEgo said:

Now that you have been labelled as having a pre-existing condition, you can bet on it that no one will touch you, regardless, however is you do find someone to cover you, they will make sure, that part will be excluded or your policy will cost the earth. 

 

My advice from someone who has a pre-existing condition from 15 years ago with no problems since, time to self insure, if you can, otherwise, just hope for the best.

Speaking as someone who has pre-existing conditions, my objectives now are to try to insure as much of my body as possible, at the cheapest price. If that means using a Thai company who will increase my premium after I claim, that's the price I will have to pay. I will just need to make sure that I only claim when the risk reward balance is in my favor because after I claim I may well have to cancel the policy because the premiums are so high.  Using the insurance to pay for the big ticket items and self insuring for the lesser items, is the only way left open.