Changing to another health insurance with pre-existing conditions?

[OneMoreFarang]

Currently I am covered by a good health insurance which is a group insurance from a company. Sooner or later, I will have to change from that health insurance contract to another individual contract.

I am still under 60 and I should be able to find a new health insurance.

But I have diabetes (taking tablets twice a day) and obviously I should mention that to the new health insurance.

I asked already my current insurance company what will happen if I am not part of the group contract anymore but when I will have an individual contract.

They told me (without looking at the details), that they will likely not cover the pre-existing condition, diabetes.

 

Now my question is: what does it mean in real life if they exclude diabetes?

If they only don't pay for my doctor visits and medication for diabetes that is acceptable.

But let's say I have in the future a heart problem. And then maybe someone has the idea that might be caused or made worse because of the pre-existing diabetes. Does that mean that the health insurance will possibly not cover i.e. a problem with the heart?

 

Are there clear rules what an exception means? Or is that open to interpretation and maybe different from insurance to insurance and case to case?

 

And are you aware of any decent health insurance which would nor exclude pre-existing conditions but maybe charge extra and then include them?

 

I guess we need an expert to answer this. Please no speculations without background knowledge. Thanks.

[ezzra]

Buying health insurance is a mind field at best of times and one has to be very, very careful what he buys and read/ask the fine prints and details, overall, not a good idea to switch providers specially with preexisting conditions, but do your HomeWorks before deciding.

[Mickeymaus]

"I guess we need an expert to answer this. Please no speculations without background knowledge. Thanks." 

 

Since every insurance company can make whatever contract they want you will need to contact them and ask for a written statement. Also let them confirm this again when you intend to accept the contract. 

[KannikaP]

I just had a call (again) from a company selling Health Insurance. The name sounded like a Beatle's album.

To get him off my back, instead of the two words I had used to previous agents, I said OK, send the details. An email arrived a few hours later with information regarding only...........WRLife. 

What do I do hmmmmmmm?

[OneMoreFarang]

9 minutes ago, Mickeymaus said:

"I guess we need an expert to answer this. Please no speculations without background knowledge. Thanks." 

 

Since every insurance company can make whatever contract they want you will need to contact them and ask for a written statement. Also let them confirm this again when you intend to accept the contract. 

Thanks, that is what I will do.

 

But maybe some people here have experience with exclusion of pre-existing conditions. I guess some pre-existing conditions are easy to define, i.e. a previously broken leg. But I think diabetes is something which might influence many other conditions. So excluding that is, I guess, not straightforward. 

[scubascuba3]

Diabetes will give them a wonderful get out for many serious things. Really they should reduce the premium for all the exclusions but they won't.

 

Focus on reversing the diabetes 

[howerde]

The issue is your cover will be severely limited not just not diabetes, but anything related/associated with diabetes, one issue is a lowered immune system that alone will just about invalidate any claim, nerve damage/foot issues, blood vessel damage so increased stroke/heart attack, nerve damage affects eyes amongst other/gum disease, kidney issues, i would stay with the insurer you are with, i was told no Thai insurer would cover you at all with diabetes,  not sure about foreign insurers but with so many exclusions a payout might not happen,  you will need everything in writing,  i had to go the self insurance route

[Sheryl]

Many insurers will not cover a diabetic  period.

 

Others will do so but with far reaching exclusions. Remember that heart disease, kidney disease and vascular disease are all complications of diabetes/ problems more common in diabetics. These would thus likely be excluded. 

 

If there is any way to stay with your current insurer this would be best. 

 

 

 

 

 

 

[AgMech Cowboy]

@OneMoreFarang That's a problem that I face, too, except mine are joints. I can't get coverage for my hips and knees since they've all been replaced (one hip and knee 15 yrs ago). No one would insure me for those joints after work died and the insuring consulting agentency moves on.  Nothing i can do. Two new joints coming up in the near future...

[skorts]

I switched on a Moratorium basis from a group policy to an individual policy with the same International insurer several years ago. This is the actual wording in my individual policy exclusions:

“No benefit is payable for any investigations and treatment related to XYZ any underlying cause and conditions arising therefrom or associated therewith”.

I guess this wording could be used for any medical condition and as Sheryl says the exclusions are far reaching as this wording demonstrates. 
I have recently tried to switch insurers with the help of a broker but decided to stay put as things covered under my current insurance would be excluded under a new policy. 
The thing I have learnt is to find a good insurance policy/company while you are still relatively young and healthy as switching as you get older and with pre -existing conditions becomes increasingly difficult.
 
 

 

[bradiston]

2 hours ago, KannikaP said:

I just had a call (again) from a company selling Health Insurance. The name sounded like a Beatle's album.

To get him off my back, instead of the two words I had used to previous agents, I said OK, send the details. An email arrived a few hours later with information regarding only...........WRLife. 

What do I do hmmmmmmm?

WRLife, and I don't want to get into the pros and cons on them, gave me a 6 month moratorium on my AF. So not as bad as a total exclusion. I got through it ok, but have no OP cover and no optical, so ended up shelling out well over 110k THB for various procedures. Seems to me OP cover is essential as so many procedures nowadays can be done in a matter of hours/minutes.

[Sheryl]

6 hours ago, bradiston said:

WRLife, and I don't want to get into the pros and cons on them, gave me a 6 month moratorium on my AF. So not as bad as a total exclusion. I got through it ok, but have no OP cover and no optical, so ended up shelling out well over 110k THB for various procedures. Seems to me OP cover is essential as so many procedures nowadays can be done in a matter of hours/minutes.

Outpatient cover typically doubles premium cost and is seldom worth it.

 

Most inpatient policies will cover day surgeries and outpatient cancer care and dialysis.

 

Some will also cover  diagnostic procedures like endoscopies as a "day hospitalization", but some will not.

 

Are you certain none of your costly procedures qualified as a day surgery? 

 

 

 

[bradiston]

5 hours ago, Sheryl said:

Outpatient cover typically doubles premium cost and is seldom worth it.

 

Most inpatient policies will cover day surgeries and outpatient cancer care and dialysis.

 

Some will also cover  diagnostic procedures like endoscopies as a "day hospitalization", but some will not.

 

Are you certain none of your costly procedures qualified as a day surgery? 

 

 

 

The hospital checked. Cataracts, not covered. Optical is an additional item, and done in 20 minutes, so no IP required. I fell over and cut myself and broke a rib. Not covered. OP only. It was precisely this eventuality I was scared of and took out the 10,400 THB per month medical insurance with them in case. Great. Self pay. So 2 cataracts, 104,000 THB. Falling over, about 15k all told. Had to cover the CT scan, X rays, meds, consultation fees etc etc, myself. I've been insured with them for 9 months. 93,600 THB. For absolutely sweet fa. Oh yeah, I know,shouldn't have fallen over. Shouldn't have developed cataracts. How do I know what's an IP procedure and what isn't? Rubbish!

[bkk6060]

I would say most will not cover you with Diabetes.

If they will, I bet the premium could run approx. 50,000 b a month.  That is what a friend of mine was quoted with your condition and his coverage was only going to be 2 or 3 million b I believe.

[Etaoin Shrdlu]

Different insurers may consider pre-existing conditions differently.

 

I am aware of one insurer that in some cases excludes cardiovascular issues if they are the result of diabetes. Another excludes all cardiovascular issues full stop if one has diabetes. The first one will decide upon cover based upon the facts at the time of claim using the opinion of their doctor as to whether diabetes is the cause. The second one will simply exclude it. I'm not sure whether there is a great difference in actual practice, but I suppose there may be some cardiovascular ailments that arise independently of diabetes so the first approach is at least theoretically better.

 

Kidney and eye issues are also often excluded for those declaring diabetes.

 

Work with a good insurance broker to find the best solution available. 

[CanNot]

@OneMoreFarang Did you ask your HR department (not the insurance) if they have some agreement with the insurance to keep existing conditions covered (normally with a high premium e.g +xx%) when leaving the group insurance and move to an individual plan? 

[rwill]

3 hours ago, OneMoreFarang said:

Now my question is: what does it mean in real life if they exclude diabetes?

If they only don't pay for my doctor visits and medication for diabetes that is acceptable.

But let's say I have in the future a heart problem. And then maybe someone has the idea that might be caused or made worse because of the pre-existing diabetes. Does that mean that the health insurance will possibly not cover i.e. a problem with the heart?

That is the most likely outcome.  They won't cover anything to do with diabetes directly and also not cover anything they say was caused from you being diabetic.

 

I've never used wrlife so I can't really say how good they are.  But on their upper tier plans they state they will either consider covering preexisting conditions or cover them after 2 years with no claims on them.

[scubascuba3]

29 minutes ago, rwill said:

That is the most likely outcome.  They won't cover anything to do with diabetes directly and also not cover anything they say was caused from you being diabetic.

 

I've never used wrlife so I can't really say how good they are.  But on their upper tier plans they state they will either consider covering preexisting conditions or cover them after 2 years with no claims on them.

They'd be crazy to cover diabetes 2 years no claims or not, too good to be true?

[digger70]

4 hours ago, KannikaP said:

I just had a call (again) from a company selling Health Insurance. The name sounded like a Beatle's album.

To get him off my back, instead of the two words I had used to previous agents, I said OK, send the details. An email arrived a few hours later with information regarding only...........WRLife. 

What do I do hmmmmmmm?

Easy , send Email : Not interested . Don't Reply.

[OneMoreFarang]

2 hours ago, Sheryl said:

Many insurers will not cover a diabetic  period.

 

Others will do so but with far reaching exclusions. Remember that heart disease, kidney disease and vascular disease are all complications of diabetes/ problems more common in diabetics. These would thus likely be excluded. 

 

If there is any way to stay with your current insurer this would be best. 

Thanks Sheryl

maybe I will be able to stay with the current insurance contract a little longer, maybe even 10 years longer.

But because that is a group contract for one company it is likely that at some stage that company and group contract won't exist anymore. So at some stage I have to change to a new insurance (contract) or be not insured at all.

Now, with age below 60, it might be difficult to change to a new company/contract and with exclusions. I guess in 10 years it will likely be impossible. So, I have to choose between bad and worse. 

[OneMoreFarang]

1 hour ago, CanNot said:

@OneMoreFarang Did you ask your HR department (not the insurance) if they have some agreement with the insurance to keep existing conditions covered (normally with a high premium e.g +xx%) when leaving the group insurance and move to an individual plan? 

I asked the insurance but not the HR yet. That is a good idea. I will ask them. Thanks!

[jaideedave]

3 hours ago, howerde said:

The issue is your cover will be severely limited not just not diabetes, but anything related/associated with diabetes, one issue is a lowered immune system that alone will just about invalidate any claim, nerve damage/foot issues, blood vessel damage so increased stroke/heart attack, nerve damage affects eyes amongst other/gum disease, kidney issues, i would stay with the insurer you are with, i was told no Thai insurer would cover you at all with diabetes,  not sure about foreign insurers but with so many exclusions a payout might not happen,  you will need everything in writing,  i had to go the self insurance route

I was with the UK version of Bupa Blue cross from work.I then moved to Thailand and had heart bypass surgery.The Thai version placed a ton of exclusions on my policy.I tell everyone I'm covered from my chin up and my navel down.They will have a field day with the diabetes issue.Also they would only allow me to have the lowest coverage policy.I'm glad I kept it because lucky me I got bowel cancer and they covered that.Oh well. Now I don't buy green bananas.

[flbkk]

I do have a background about health insurance. I worked in a hospital office dealing with insurance for many years in United States. If you were buying individual health insurance, not in a group, particularly from Thailand. Any insurance they will give you is likely to be useless. They won’t cover your pre-existing conditions, and, as was mentioned, diabetes does micro vascular damage that can affect your heart, so they probably wouldn’t cover a heart attack or stroke that you might have. If you can get insurance at all, the amount you will likely receive with a serious illness with hospitalization will only be a little more than your annual premium, and then they will probably cancel you, exclude more pre-existing conditions, or raise the rates.  I comment about this extensively in other groups, although not on Aseannow because it’s so difficult to see the tracking. Good luck, anyway. 

[Etaoin Shrdlu]

Quite often one of the requirements of employer-provided group medical insurance is that all insured persons have to be employees of the company and the company is obligated to pay the premium. Once one leaves or retires, this is no longer the case, so many insurers will not cover former employees or retirees. But it never hurts to ask. If you have to go under a separate policy, even with the same insurer, you'll probably face all of the pre-existing exclusion issues.

 

If your employer is covering you under the Thai social security scheme, I'd advise you to consider continuing the medical coverage portion by voluntarily paying the monthly premium after you leave the company. It is only a few hundred baht per month and is definitely worth it. You have a short window to make this election after you leave the company, so look into it sooner rather than later.

[OneMoreFarang]

11 minutes ago, Etaoin Shrdlu said:

If your employer is covering you under the Thai social security scheme, I'd advise you to consider continuing the medical coverage portion by voluntarily paying the monthly premium after you leave the company. It is only a few hundred baht per month and is definitely worth it. You have a short window to make this election after you leave the company, so look into it sooner rather than later.

Thanks. That is exactly what I will do - independent of any (additional) "good" health insurance.

Having the Thai social security is definitely a lot better than having nothing. 

 

Do you, or anybody else here, have information how to continue with that Thai social security cover? I "know" about that principle since years, but I never looked into the details because I never needed to. Now it's time to look at the details... 

[Sheryl]

5 hours ago, bradiston said:

The hospital checked. Cataracts, not covered. Optical is an additional item, and done in 20 minutes, so no IP required. I fell over and cut myself and broke a rib. Not covered. OP only. It was precisely this eventuality I was scared of and took out the 10,400 THB per month medical insurance with them in case. Great. Self pay. So 2 cataracts, 104,000 THB. Falling over, about 15k all told. Had to cover the CT scan, X rays, meds, consultation fees etc etc, myself. I've been insured with them for 9 months. 93,600 THB. For absolutely sweet fa. Oh yeah, I know,shouldn't have fallen over. Shouldn't have developed cataracts. How do I know what's an IP procedure and what isn't? Rubbish!

Most policies woukd cover cataract surgery. It's a classic example of a day surgery. 

 

Sounds like you have  locally issued policy? What does the policy say specifically re day surgeries? 

[ballpoint]

This topic raises a very good point.  I have been on work provided medical insurance policies since I began working as an expat at 20, and could very well have faced the same problem when I retired, since I chose not to return to my "own" country - where I haven't lived, and have rarely visited, for 37 of my 57 years.  However, I was fortunate in that I was able to continue with my company provided global health care policy, as a private individual, with no exclusions - even though they were aware of a medical issue I have when I made the changeover.  It is quite expensive, and I am locked into it, as I don't believe any other company would not exclude this issue - and all the related ones they could bring up from that, but as I'm under 60 I believe it is still worth it.  For now.  If I had my time all over again though, I would have started my own insurance policy, with a reputable company, separate to my work provided one when I was younger (and healthier).

[bradiston]

2 hours ago, Sheryl said:

Most policies woukd cover cataract surgery. It's a classic example of a day surgery. 

 

Sounds like you have  locally issued policy? What does the policy say specifically re day surgeries? 

It's an out patient procedure, therefore not covered. No mention of day surgeries. But I will do as you suggest and check with them myself.

Edited May 5, 2023 by bradiston

[Sheryl]

20 minutes ago, bradiston said:

It's an out patient procedure, therefore not covered. No mention of day surgeries. But I will do as you suggest and check with them myself.

Cataract op is surgery. As said most inpatient policies cover day surgeries like that. For the simple reason that it is less expensive than having the patient admitted overnight which people would otherwise be apt to do.

 

However some Thai based insurers exclude  cataract surgery, at least  in people they initially insure at an older age. 

[BangkokReady]

11 hours ago, ezzra said:

Buying health insurance is a mind field