Recommendation for health insurance for a Thai citizen

[ole1291]

Hello,

 

I'm looking at options to insure my thai wife (mid thirties) here in Thailand.

I'm aware that as a Thai she's entitled to free healthcare but we live in a remote rural area (Umphang) and the local hospital is really ill equipped/doctors sub par etc...

The thought of her stuck there if she ever had a serious condition is really not pleasant.

 

I have been in contact with AA brokers.

Having browsed this forum and read about the downsides of local insurance companies/regulations, I asked about foreign based ones.

Alas it turns out international insurances firms will only insure foreigners, not Thai citizens, except for a company named VUMI, based in the US.

Has anybody heard/dealt with them before?

Are US insurance regulations broadly similar to EU/UK ONES?

 

I was also given quotes for AXA and April Thailand.

I realise they being Thai based, they can in theory raise their premiums based on claims, but my agent assured me that in their case, being community rated, that is not the case.

 

She also said that in her experience, they hadn't been problematic to pay claims (I had read that this can sometimes be an issue with Thai based firms, them claiming the problem is related to a pre-existing condition on flimsy grounds).

 

Would people here confirm that?

Any advice is welcome. 

[Upnotover]

For several years my wife had AXA Thailand OPD/IPD cover (Thailand cover only).  She had several OPD claims and one IPD claim, all paid without any issue and directly with the hospital (BHP).  I do not recall that annual premiums were increased as a result of the claims.

[ole1291]

Good to hear.

Does that mean she is no longer insured? Any particular reason?

Thanks 

[Upnotover]

21 minutes ago, ole1291 said:

Does that mean she is no longer insured? Any particular reason?

Since our divorce I stopped paying, maybe she still does????

[ole1291]

OK, I'm now eyeing buying a policy from VUMI as the only foreign based insurance firm that will insure a Thai national.

Sheryl among others has been clear about avoiding local ones.

 

Problem is there isn't much info reviews about VUMI. 

On their website, they show they only had 6 million net income last year, not very impressive.

The whole point of subscribing now that we're young and have no medical conditions would be moot if in 10 years, the company goes bankrupt...

 

[lopburi3]

On 11/4/2022 at 2:44 PM, ole1291 said:

VUMI, based in the US.

From website:

https://www.vumiglobal.com/who-we-are/

Quote

 

Main Office

Office 103, Building 7
Dubai Outsource City. Dubai
United Arab Emirates

 

 

[ole1291]

In the attached image, it clearly states that legal action would be settled in new york.

 

Also says they are reinsured by another company, to pay their claims in case of bankruptcy? 

 

Seems like a lot of their business is in South America.

[howerde]

A friend uses FWD, note i am not recommending them, but she uses them .this is in addition to to Thai social security scheme, as delays can be long, is is around 50ish no current health issues and pays 80 000 baht a year, not sure exactly what policy she uses.

https://www.fwd.co.th/en/products/       she has never needed to claim, but says they are a good company

[Lorry]

On 11/4/2022 at 2:44 PM, ole1291 said:

Are US insurance regulations broadly similar to EU/UK ONES?

No, absolutely not.

Pretty much the opposite of EU regulations. 

You obviously are not very familiar with insurance regulations. 

UK regulations are much more business-friendly than EU.

The main fault line is Anglo-Saxon (business friendly, no customer protection,  so premiums can be cheap) - continental European (EU) (the nanny-state protects the consumer,  so premiums are higher).

 

On 11/4/2022 at 2:44 PM, ole1291 said:

if she ever had a serious condition

In a serious condition,  I would not want to be in Umphang. The next place with more or less decent hospitals is Phitsanuloke, but in a really serious case (let's say, car accident with broken vertebra) an European insurance would bring the patient to Bangkok (even from Phitsanuloke).

Thai standard for these trips is an ambulance. European standard is a helicopter,  but only the rich here pay 400,000 for a helicopter. You probably wouldn't even know how to order one, even if you were willing to pay.

(Thai vivat used to pay for helicopter evacuation (unique selling point), AFAIK they gave up a long time ago. BTW their owner used to be Munich Re, I think they sold them,  you can try to find it out.)

 

If you are happy with the medical care in Mae Sot or Tak (I wouldn't), any Thai insurance will do. Medical care is cheap there. 

 

If you want the standards of Bangkok Hospital Phitsanuloke or the standards of Bangkok, in many cases a road trip isn't really advisable.

Transport will be your biggest problem.  I doubt you can find any insurance to help you with this.  

So, keep half a million ready on standby and get the 24hrs phone number of a trustworthy EMS helicopter (Bangkok Hospital in Bangkok has one, private ones are rare here. The military has them, find out whether they use them in Umphang - they use them sometimes on the islands,  free)

 

[Lorry]

On 11/4/2022 at 2:44 PM, ole1291 said:

Are US insurance regulations broadly similar to EU/UK ONES?

My last post was not very clear.

I meant to say:

US regulations are NOT similar to EU regulations.  They are almost the opposite.

UK regulations are also quite different from continental EU regulations. 

You shouldn't say "EU/UK" regulations. 

The main difference is US/UK vs EU.

[ole1291]

20 hours ago, howerde said:

A friend uses FWD, note i am not recommending them, but she uses them .this is in addition to to Thai social security scheme, as delays can be long, is is around 50ish no current health issues and pays 80 000 baht a year, not sure exactly what policy she uses.

https://www.fwd.co.th/en/products/       she has never needed to claim, but says they are a good company

I wasn't aware of them, thanks.

"In addition to Thai social security" meaning she would use them for scans etc and would then seek treatment in a Thai hospital? 

[ole1291]

9 hours ago, Lorry said:

No, absolutely not.

Pretty much the opposite of EU regulations. 

You obviously are not very familiar with insurance regulations. 

UK regulations are much more business-friendly than EU.

The main fault line is Anglo-Saxon (business friendly, no customer protection,  so premiums can be cheap) - continental European (EU) (the nanny-state protects the consumer,  so premiums are higher).

 

In a serious condition,  I would not want to be in Umphang. The next place with more or less decent hospitals is Phitsanuloke, but in a really serious case (let's say, car accident with broken vertebra) an European insurance would bring the patient to Bangkok (even from Phitsanuloke).

Thai standard for these trips is an ambulance. European standard is a helicopter,  but only the rich here pay 400,000 for a helicopter. You probably wouldn't even know how to order one, even if you were willing to pay.

(Thai vivat used to pay for helicopter evacuation (unique selling point), AFAIK they gave up a long time ago. BTW their owner used to be Munich Re, I think they sold them,  you can try to find it out.)

 

If you are happy with the medical care in Mae Sot or Tak (I wouldn't), any Thai insurance will do. Medical care is cheap there. 

 

If you want the standards of Bangkok Hospital Phitsanuloke or the standards of Bangkok, in many cases a road trip isn't really advisable.

Transport will be your biggest problem.  I doubt you can find any insurance to help you with this.  

So, keep half a million ready on standby and get the 24hrs phone number of a trustworthy EMS helicopter (Bangkok Hospital in Bangkok has one, private ones are rare here. The military has them, find out whether they use them in Umphang - they use them sometimes on the islands,  free)

 

 

I agree. Actually a lot of patients die here during transport.

A typical case would be say a Motorbike accidents, injured person is brought to Umphang hospital (ill equipped and with a bad crop of newbie doctors), doctors decide they can't treat the patient and send him by ambulance to Maesot hospital  (4h drive, mostly on a windy mountain road), patient dies in ambulance before arriving (probably 5-6h after accident without any meaningful care).

 

I will definitely look into this helicopter thing.

 

Sheryl in her post lumped EU with UK regulations together (I think while talking of CIGNA), that's why I assumed they were similar. I freely admit knowing nothing about them.

 

Even bearing in mind what you said, I would still expect US regs to be safer than Thaï.

Maybe it's fair to say that with regards regulations for consumer protection: EU>US>THAI

With Thaï almost be a dice roll as whether you'll be screwed or not.

In this case I just don't have a choice, it's either US regs (but with a dubious company no ones seems to have heard about) or local with very little legal protection (again as to Sheryl s post).

 

I would like to point out though, in case other people are interested that at least AXA and April Thailand (according to AA Insure), contrary to what was said in the past on this forum, cannot raise premiums based on claims (community rated) or dump customers for no reason (or so I was told)).

Their premiums are similar to VUMI (around 1100$ per year for a 32 years old) but for a much smaller amount of coverage: 3.5 million dollars (VUMI) VS 3.5 million THB (AXA and April Thailand).

 

 

 

 

[Sheryl]

4 hours ago, ole1291 said:

 

I would like to point out though, in case other people are interested that at least AXA and April Thailand (according to AA Insure), contrary to what was said in the past on this forum, cannot raise premiums based on claims (community rated) or dump customers for no reason (or so I was told)).

 

They absolutely can raise premiums based on claims and this is clearly spelled out in their policy documents. It has to be  because the Thai Insurance Commission so decrees and will not approve a policy without that language.

 

It is true that, to date, April Thailand has not done so, but they can in future if at any time they desire. Not sure about AXA Thailand.

 

This is all coming from the (very weak, from consumer perspective) regulatory framework for health insurance in Thailand.

 

No Thai insurer is allowed to "dump customers for no reason".  But they can, and often do, price people out by raising rates based on claims in addition to the age related increases. And many of them do not insure for life but rather stop at a pre-defined age -- an issue if you are planning to grow old here.

 

The other thing Thai insurers often do, is decide after the fact, after a policy has been issued, that something not specified in the policy is pre-existing, often on the basis of very questionable data/logic. Some insurers are much worse than others in this regard; some appear to try to get out of virtually any claim.

 

All insurers will especially scrutinize claims (other than from accidents) occurring in the first year or two of a policy.

 

Among the Thai insurers, the least worst IMO are April Thailand and Aetna.

[Etaoin Shrdlu]

VUMI's website states that its head office is in Dubai Outsource City. Dubai Outsource City is a free zone within the UAE. Companies in free zones in the UAE do not come under the regulation of the UAE Insurance Authority, so it is not clear which insurance regulator, if any, would oversee that operation, which is probably their distribution arm and not the actual insurance company. 

 

After further search, I believe VUMI's insurance company is domiciled in the Turks and Caicos Islands. I haven't been able to find any financial information on the Turks and Caicos company and I have searched Standard and Poors and AM Best. This leads me to believe that it is a small company compared with the likes of AXA, Cigna. Turks and Caicos requires just $100,000 in capital to form an insurance company.

 

Ole1291 has posted information above that indicates QBE reinsures VUMI. QBE carries a group rating of "A" from AM Best, which is good.  But policyholders do not have direct access to reinsurers in the case of insolvency of the primary insurance company and reinsurance will not necessarily prevent an insurer from becoming insolvent.  

 

 

[ole1291]

5 hours ago, Sheryl said:

 

They absolutely can raise premiums based on claims and this is clearly spelled out in their policy documents. It has to be  because the Thai Insurance Commission so decrees and will not approve a policy without that language.

 

Then AAinsure, which is promoted by this website are misleading us:

 

Their faq pages:

https://www.aainsure.net/faq_health-insurance.html

18. Can an Insurer change my premium based on claim history?

This depends on the kind of policy you have. There are 2 types available.

1 Community rated plans:
With a community rated plan everybody from the same age and the same plan is paying the same premium regardless the claim history. The premium of an individual will never be loaded based on claims.

2 individually rated plans (also called experience rated plans):
With an individually rated insurance plan the premiums can change based on the claim history. You can also receive a No Claim Discount after a year with no claims. If you do claim however, the insurer might load your premium at the next renewal date. The maximum percentage with which the premium can be loaded depends on the Company.

 

 

 

 

 

AXA and April Thailand both offer policies that are renewable for a lifetime or up to 99 years:

 

Option 3: April Thailand

April International is a French company from origin. Over the years we have built a strong long-term relationship with April. Their claim handling is efficient and reliable and takes place from their own management center in Bangkok, which is well known amongst the Thai private hospitals, and available 24/7 in case you need assistance.

Some of the highlights:

• Direct payment to private hospitals in case of a hospitalization
• Annual limit of 3,275,000 Baht or 16,375,000 Baht (higher coverages are available)
• Choice between 3 different cover zones
• Standard private room is covered in full
• Community rated plan: no individual loadings
• Cancer treatment is always covered (also Outpatient treatment when you have the Inpatient plan)
• Free Hospital Choice
• Outpatient add-on available (against extra costs)
• Lifetime renewable
• Deductibles possible to lower the premium (discount up to 65%; please see discount schedule below)

 

Option 1: AXA SwitchCare plan

 

AXA Thailand General Insurance was founded in 1998. The AXA group is a global leader in insurance and wealth management, serving more than 105 million customers in 54 countries. Their SwitchCare plan is designed to meet the insurance needs of both Thai and foreign nationals who want the security of a trusted global health insurer and are looking for insurance with a more extensive zone of cover.

 

Some of the highlights:

 

• Direct payment to private hospitals in case of a hospitalization
• Annual limit ranging from 3.500.000-30.000.000 THB
• Choice between 3 different cover zones
• Community rated plan: no individual loadings
• Wide network of contract hospitals
• Outpatient add-on available (extra costs)
• Renewable up to 99 years of age
• Deductibles possible to lower the premium (discount up to 40%; please see discount schedule below)

[ole1291]

4 hours ago, Etaoin Shrdlu said:

VUMI's website states that its head office is in Dubai Outsource City. Dubai Outsource City is a free zone within the UAE. Companies in free zones in the UAE do not come under the regulation of the UAE Insurance Authority, so it is not clear which insurance regulator, if any, would oversee that operation, which is probably their distribution arm and not the actual insurance company. 

 

After further search, I believe VUMI's insurance company is domiciled in the Turks and Caicos Islands. I haven't been able to find any financial information on the Turks and Caicos company and I have searched Standard and Poors and AM Best. This leads me to believe that it is a small company compared with the likes of AXA, Cigna. Turks and Caicos requires just $100,000 in capital to form an insurance company.

 

Ole1291 has posted information above that indicates QBE reinsures VUMI. QBE carries a group rating of "A" from AM Best, which is good.  But policyholders do not have direct access to reinsurers in the case of insolvency of the primary insurance company and reinsurance will not necessarily prevent an insurer from becoming insolvent.  

 

 

Thanks for looking into it. 

Basically, we seem to reach the same conclusion that VUMI is small, somewhat shady, player with mixed reviews:

https://www.reviewcentre.com/health_insurance/vumi_group_-_wwwvumigroupcom-reviews_2512473

Getting insured with them seems a gamble as no one knows if they'll still be around in the medium to long-term future. 

 

[Etaoin Shrdlu]

10 minutes ago, ole1291 said:

Thanks for looking into it. 

Basically, we seem to reach the same conclusion that VUMI is small, somewhat shady, player with mixed reviews:

https://www.reviewcentre.com/health_insurance/vumi_group_-_wwwvumigroupcom-reviews_2512473

Getting insured with them seems a gamble as no one knows if they'll still be around in the medium to long-term future. 

 

I think the business model is to set up a company in one jurisdiction, perhaps the US or UK where capital is safe, get it licensed as an insurer in a lightly-regulated jurisdiction, as many of the Caribbean countries are, and then set up a distribution hub in yet another jurisdiction, possibly lightly regulated or unregulated.

 

UAE free zone distribution hub, Caribbean insurance license, no info on financials of the risk-bearing entity, reference to reinsurance. I'm not implying anything wrong or illegal, but I don't consider the Dubai Outsource Zone or the Turks and Caicos to be hubs of financial probity. Lack of financial information on the insurer concerns me as well.

 

In looking for a non-Thai insurer, my preference would be to go with a major insurer that has acceptable S&P or AM Best ratings, is domiciled in a developed and well-regulated jurisdiction and has verifiable claims-paying history.

 

But to each his own.

 

 

 

[ole1291]

11 minutes ago, Etaoin Shrdlu said:

 

 

In looking for a non-Thai insurer, my preference would be to go with a major insurer that has acceptable S&P or AM Best ratings, is domiciled in a developed and well-regulated jurisdiction and has verifiable claims-paying history.

 

But to each his own.

 

 

 

Me too.

But major international expat insurers will not insure a Thai national residing in Thailand, that is because  "In general, international insurance plans are designed for expats living part of the year outside of their home country. If you are a Thai national, you are not."

Apparently it's that simple...

 

[Etaoin Shrdlu]

4 minutes ago, ole1291 said:

Me too.

But major international expat insurers will not insure a Thai national residing in Thailand, that is because  "In general, international insurance plans are designed for expats living part of the year outside of their home country. If you are a Thai national, you are not."

Apparently it's that simple...

 

Yes, finding offshore medical insurance for a Thai national can be difficult. The reason is that only insurers licensed by the OIC can legally offer insurance to the Thai public. Technically, the "Thai public" is anyone physically in Thailand. The reality is that the OIC has not enforced this rule. The fact that almost the only persons seeking offshore health insurance are foreigners probably has something to do with it. It would probably be a different matter if offshore insurers actively sought to sell insurance to Thai nationals. Offshore insurers are aware of this regulation and will not wish to overtly go against.

[howerde]

9 hours ago, ole1291 said:

I wasn't aware of them, thanks.

"In addition to Thai social security" meaning she would use them for scans etc and would then seek treatment in a Thai hospital? 

As i understand she has selected the option to use any doctor she wants, she would use the social security as the first option, if there were delays or if she was not happy with the hospital doctor, then she would use FWD, not sure but i think that if tests etc were done at the hospital using the social security then the private doctor should use those tests, but these things never seem to be clear in Thailand

[ole1291]

21 minutes ago, Etaoin Shrdlu said:

Yes, finding offshore medical insurance for a Thai national can be difficult. The reason is that only insurers licensed by the OIC can legally offer insurance to the Thai public. Technically, the "Thai public" is anyone physically in Thailand. The reality is that the OIC has not enforced this rule. The fact that almost the only persons seeking offshore health insurance are foreigners probably has something to do with it. It would probably be a different matter if offshore insurers actively sought to sell insurance to Thai nationals. Offshore insurers are aware of this regulation and will not wish to overtly go against.

Finally, an explanation on that subject that makes sense.

So it all comes down to Thai protectionism in the end.

I wouldn't mind, if their own regulations were better.

[ole1291]

18 minutes ago, howerde said:

As i understand she has selected the option to use any doctor she wants, she would use the social security as the first option, if there were delays or if she was not happy with the hospital doctor, then she would use FWD, not sure but i think that if tests etc were done at the hospital using the social security then the private doctor should use those tests, but these things never seem to be clear in Thailand

I actually was wondering about the feasibility of the reverse:

Doing scans, diagnostic etc privately (cause that's where the delays are) and then seeking treatment under universal coverage in the public sector.

But would public hospitals accept implementing a treatment based on the recommendations of a private  hospital?  

[Etaoin Shrdlu]

11 minutes ago, ole1291 said:

Finally, an explanation on that subject that makes sense.

So it all comes down to Thai protectionism in the end.

I wouldn't mind, if their own regulations were better.

Actually, the restriction on cross-border insurance transactions is not something unique to Thailand. Almost all countries have such regulations. In fact, the US has roughly similar regulations in each of the 50 states! I think the EU is a bit easier when it comes to insurance between member states, but I don't think it is completely free. Haven't kept up with EU regulations, however.

 

So, yes, it is a bit protectionist, but no more so than almost all other countries. It is normal for regulators in the financial sector to protect the public from foreign entities over which they have no jurisdiction and control. 

[lopburi3]

56 minutes ago, ole1291 said:

 

But would public hospitals accept implementing a treatment based on the recommendations of a private  hospital?  

I was accepted for major surgery by leading Thai government hospital based on medical tests done at a major private hospital.  I was referred by a former student however so that may have been a factor.  In the end it did not work out (no ICU vacancy so no operation).  But in any case public hospitals are always open to Thai on payment basis (which normally much cheaper than any private facility).

[Sheryl]

1 hour ago, ole1291 said:

I actually was wondering about the feasibility of the reverse:

Doing scans, diagnostic etc privately (cause that's where the delays are) and then seeking treatment under universal coverage in the public sector.

But would public hospitals accept implementing a treatment based on the recommendations of a private  hospital?  

Doctor at public hospital will certainly accepts scans and test results done elsewhere, happens all the time. BUT they will not automatically implement someone else's treatment plan. They will use their own judgement in that regard. Which might or might nto coincide with what private hospital recommeneded. (And if it does not, no guarantee the private hospital's recommendation is the better of the two, could just as easily be the opposite case).

[Lorry]

3 hours ago, Etaoin Shrdlu said:

I think the EU is a bit easier when it comes to insurance between member states

Correct.

This has led to quite a bit of abuse.  Arbitrage between cheaper, less developed EU countries and rich countries.  Arbitrage between less regulated ones (it used to be the UK) and others. 

 

OP is unusual: a "poor" Thai looking for "expensive" Western insurance. 

 

The opposite is more common: people from rich countries trying to save money buying crappy insurance from a poor country which is recognized in their rich home country. Think of 

Austrians buying Slovak insurance. Saving on premiums, but not considering claims will be handled differently. 

A friend of mine has Turkish insurance and really believes it will help him if he needs surgery in Germany ????

[ole1291]

12 hours ago, Sheryl said:

 (And if it does not, no guarantee the private hospital's recommendation is the better of the two, could just as easily be the opposite case).

Maybe that's true for bkk area, but with regards to Umphang, I'd put a lot more faith in what an English speaking (and therefore I assume western trained) doctor says than one of the local ones.

That's based on multiple interactions with them.

 

You haven't commented on the snippets I provided from the AAINSURE website.

I'm not bringing it for arguments' sake but because I am genuinely not sure about who's right:

they state community rated premiums cannot be increased based on claim but you say the opposite...

 

Is it that the Thai regulations allow them to raise them but that they offer the customers of their community rated plan "a promise" ,not bound by law, that they will not do it?

[ole1291]

11 hours ago, Lorry said:

Correct.

This has led to quite a bit of abuse.  Arbitrage between cheaper, less developed EU countries and rich countries.  Arbitrage between less regulated ones (it used to be the UK) and others. 

 

OP is unusual: a "poor" Thai looking for "expensive" Western insurance. 

 

The opposite is more common: people from rich countries trying to save money buying crappy insurance from a poor country which is recognized in their rich home country. Think of 

Austrians buying Slovak insurance. Saving on premiums, but not considering claims will be handled differently. 

A friend of mine has Turkish insurance and really believes it will help him if he needs surgery in Germany ????

Except with Thaï insurance you get the worst of both worlds because they cost nearly as much as that of big name international insurers, while offering smaller amount for coverage, and are not bound by very by good (from the customer point of view) regulations.

 

Which got me to think, me and my wife sometimes spend extended amounts of time in Europe, in fact stayed the last year in a half in a EU country for which she holds a 5 year residence permit.

Couldn't we, based on that, get her insured by a big international insurer as an expat in said EU country and then also use the policy in Thailand claiming we were just on a trip there?

How would the insurer know the difference? And if they did, would it be sufficient ground to deny a claim?

[lopburi3]

9 minutes ago, ole1291 said:

Maybe that's true for bkk area, but with regards to Umphang, I'd put a lot more faith in what an English speaking (and therefore I assume western trained) doctor says than one of the local ones.

You are aware that any doctor will speak English to some extent?  Speaking some English in not an indication of foreign training.  Those working at the average upcountry private hospital are often not of the same quality as those working at adjacent government hospital (for the simple reason the government doctor is fulfilling a commitment - the private doctor is unable to obtain employment elsewhere.  (yes I know that is simplistic and often not true - but believe it is a factor to consider).

[ole1291]

1 hour ago, lopburi3 said:

You are aware that any doctor will speak English to some extent?  Speaking some English in not an indication of foreign training.  Those working at the average upcountry private hospital are often not of the same quality as those working at adjacent government hospital (for the simple reason the government doctor is fulfilling a commitment - the private doctor is unable to obtain employment elsewhere.  (yes I know that is simplistic and often not true - but believe it is a factor to consider).

It's obvious when a Thai has spent time abroad or not. Maybe I wasn't precise enough.

And yes I have met doctors that could hardly speak English...

I thought most of the doctors in the private hospitals also worked in the public sector... anyway, I am well aware that the up country private sector is not so good.

When talking private, I mean the best hospital's in bkk or cm, they're not perfect too (no where is) but my experience there were much better than Umphang/Maesot.