Pacific Cross Health Insurance - Claims experience ?

[Pumpuynarak]

Has anyone actually got Pacific Cross Health Insurance cover that they have actually made a claim on or do you know of anyone who has ?, if so can you enlighten me as to your experience or anyone else ?

I'd like to be informed of policyholders claims experience. TIA guys.  

[SammyJ]

28 minutes ago, Pumpuynarak said:

Has anyone actually got Pacific Cross Health Insurance cover that they have actually made a claim on or do you know of anyone who has ?, if so can you enlighten me as to your experience or anyone else ?

I'd like to be informed of policyholders claims experience. TIA guys.  

Not sure if you are thinking of applying to Pacific Cross or have it already and are concerned about making a claim?  Regardless, I know several expat friends who have Pacific Cross and like it and enjoy a variety of options it allows that some other carriers do not.  However, if you have not applied, then, depending upon age (they do not offer new policies to those 65 or older--as is the case with most all carriers here) and pre-existing conditions, they may approve an application,  If you qualify with them and all claims are legitimate, I have never heard any problem with them paying claims,

[Pumpuynarak]

1 minute ago, SammyJ said:

Not sure if you are thinking of applying to Pacific Cross or have it already and are concerned about making a claim?  Regardless, I know several expat friends who have Pacific Cross and like it and enjoy a variety of options it allows that some other carriers do not.  However, if you have not applied, then, depending upon age (they do not offer new policies to those 65 or older--as is the case with most all carriers here) and pre-existing conditions, they may approve an application,  If you qualify with them and all claims are legitimate, I have never heard any problem with them paying claims,

Thanks for your post. Its for my 42yo Thai wifey not me. I'm way past being able to get health insurance due to age and pre-existing conditions. I'm thinking she's very healthy and fit at the mo so a good time to sign up. Having spent most of my working life in the UK insurance industry i have good knowledge of how things work in the UK but Thailand is a totally different ball game, i'm concerned regarding how good claim payments are cos if they are sketchy i won't bother to get her insured.

 

In the UK if you're insured and have given full disclosure when initially applying and with subsequent renewal then no problems with having claims paid, well you certainly were with the company i worked for lol  

[BKKBike09]

Only ever made Outpatient claims. Pretty straightforward so can't complain about that. However they won't pay for some medicines / treatments. If the hospital has these on an exclusion list then you pay for that at the hospital. But I've also had hospital ask me to reimburse them for something that PC said later wasn't covered. 

 

However PC underwriters are definitely not on my Christmas Card list. They will try to exclude as much as they can from coverage when you apply. They are also incredibly slow to assess / respond (in my experience). My antipathy towards them stems from them retroactively excluding coverage for something at renewal after having a policy for several years (and no claims related to the new exclusion). This was despite me making full disclosure of medical history when I applied for the policy. Took several very stressful months to argue with them and finally get them to be more reasonable. 

[mfd101]

14 minutes ago, BKKBike09 said:

However PC underwriters are definitely not on my Christmas Card list. They will try to exclude as much as they can from coverage when you apply. They are also incredibly slow to assess / respond (in my experience). My antipathy towards them stems from them retroactively excluding coverage for something at renewal after having a policy for several years (and no claims related to the new exclusion). This was despite me making full disclosure of medical history when I applied for the policy. Took several very stressful months to argue with them and finally get them to be more reasonable. 

Yes, I've had much the same experience. Like extracting blood from a stone ...

 

49 minutes ago, SammyJ said:

they do not offer new policies to those 65 or older--as is the case with most all carriers here

I joined 3 years ago at 71, just renewed at 74. But perhaps the entry rules have changed since then?

 

In any case it was very expensive at first (3M cover c104K with 40K deductible) but  - with no claims - progressively reduced to now 74K with a 40K deductible & OPD excluded.

[Etaoin Shrdlu]

51 minutes ago, BKKBike09 said:

Only ever made Outpatient claims. Pretty straightforward so can't complain about that. However they won't pay for some medicines / treatments. If the hospital has these on an exclusion list then you pay for that at the hospital. But I've also had hospital ask me to reimburse them for something that PC said later wasn't covered. 

 

However PC underwriters are definitely not on my Christmas Card list. They will try to exclude as much as they can from coverage when you apply. They are also incredibly slow to assess / respond (in my experience). My antipathy towards them stems from them retroactively excluding coverage for something at renewal after having a policy for several years (and no claims related to the new exclusion). This was despite me making full disclosure of medical history when I applied for the policy. Took several very stressful months to argue with them and finally get them to be more reasonable. 

Unfortunately there isn't much in Thailand by way of regulation that prevents insurers from changing terms and conditions or introducing new exclusions at renewal.  Thai insurers only issue policies for a one-year term and, with the exception of some regulations regarding how much they can increase premiums, there is no guarantee that cover will remain the same from year to year. This is one reason why it may be better to take health insurance from insurers domiciled in more consumer-friendly markets.

[howerde]

I had a policy tied to my visa had it 3 years no claims, then due to an accident i tried to claim on the out patient part of the insurance, they turned it down as i had not informed them within 24 hours, the doctor i saw actually phoned them and they relented my total claim was for about 15000 baht, at renewal my premium jumped from around 30000 to 88000 baht, then the hospital contacted me and said the insurer wanted to see all my medical records, i had had the policy 3 years i gave full disclosure at the time, so 3 years after i had taken out the policy i had one of those full checkups at the hospital they did not find anything of significance,  i then had a letter from the insurance adding a whole lot of exclusions for things i do not have,  if it is for your Thai wife have a look at FWD.

[scubascuba3]

A friend successfully claimed for a detached retina operation, the op caused a cataracts, claim denied. Thai logic

[Pumpuynarak]

21 hours ago, Etaoin Shrdlu said:

This is one reason why it may be better to take health insurance from insurers domiciled in more consumer-friendly markets.

I tried Cigna, they would'nt insure my Thai wifey. So i then tried AXA 4 weeks ago and i'm still waiting for a reply.

[Pumpuynarak]

20 hours ago, howerde said:

if it is for your Thai wife have a look at FWD.

Thankyou, thats what i will be doing pronto. i've spent some time going through ALL the PC T&C and i have to say i've never seen such onerous T&C in my life and i spent most of my working life employed in the UK insurance industry.

 

Edited October 12, 2023 by Pumpuynarak

[Etaoin Shrdlu]

9 hours ago, Pumpuynarak said:

I tried Cigna, they would'nt insure my Thai wifey. So i then tried AXA 4 weeks ago and i'm still waiting for a reply.

Some offshore insurers won't insure Thai nationals but will insure foreigners. I'm not sure of the reasons behind this. Could be concerns for regulatory issues, could be concern for something else.

[SammyJ]

On 10/12/2023 at 8:39 AM, mfd101 said:

Yes, I've had much the same experience. Like extracting blood from a stone ...

 

I joined 3 years ago at 71, just renewed at 74. But perhaps the entry rules have changed since then?

 

In any case it was very expensive at first (3M cover c104K with 40K deductible) but  - with no claims - progressively reduced to now 74K with a 40K deductible & OPD excluded.

That's pretty unusual--joining at 71--they have told some of my expat friends no new coverage 65 and older??  But, you may not have had any pre-existing conditions that concerned them, but, again, pretty unusual, any of us in later years almost always have something in our medical history that will cause concern.  Yes, here--most only take in patient coverage as the outpatient coverage is relatively inexpensive--and PC allows you to adjust the deductible to lower the annual coverage--which PC plan do you have?  Of course, that also will determine the annual premiums.

And, while some here shared slow payment or coverage, again, that's not what i have seen--if they question claims or are slow to pay sometimes it has to do with reviewing if it is covered under the plan or was not doing to the claim involving a pre-existing condition.

[SammyJ]

On 10/12/2023 at 8:02 AM, Pumpuynarak said:

Thanks for your post. Its for my 42yo Thai wifey not me. I'm way past being able to get health insurance due to age and pre-existing conditions. I'm thinking she's very healthy and fit at the mo so a good time to sign up. Having spent most of my working life in the UK insurance industry i have good knowledge of how things work in the UK but Thailand is a totally different ball game, i'm concerned regarding how good claim payments are cos if they are sketchy i won't bother to get her insured.

 

In the UK if you're insured and have given full disclosure when initially applying and with subsequent renewal then no problems with having claims paid, well you certainly were with the company i worked for lol  

Many Thai use Aetna for private insurance--of course, your wife, as does my Thai family, qualify to use Govt medical care (in some instances, it can be very good)--Aetna purchased BUPA, which was a quick and simple private medical carrier for many years.  I was involved in health insurance in the US for quite a few years before coming to Thailand--I really don't see that much different, overall, in what is a for profit industry--all my Thai family has Aetna--and over many years, never had any issue with legitimate claims being paid directly to the hospital,  Additionally, i have never seen anything done here that was really out of the ordinary for health insurance companies--it is a surprise that they will avoid paying a claim if they think they can--some are used to having a national health service or Medicare, etc, where pre-existing conditions may not matter,

Again, my Thai family with Aetna has been served as well as insurance carrier I have seen.

[KannikaP]

On 10/12/2023 at 8:39 AM, mfd101 said:

Yes, I've had much the same experience. Like extracting blood from a stone ...

 

I joined 3 years ago at 71, just renewed at 74. But perhaps the entry rules have changed since then?

 

In any case it was very expensive at first (3M cover c104K with 40K deductible) but  - with no claims - progressively reduced to now 74K with a 40K deductible & OPD excluded.

This is the first time I ever heard of health insurance premium going DOWN by Bht 30k when the policyholder is 3 years older. 

[SammyJ]

On 10/12/2023 at 8:02 AM, Pumpuynarak said:

Thanks for your post. Its for my 42yo Thai wifey not me. I'm way past being able to get health insurance due to age and pre-existing conditions. I'm thinking she's very healthy and fit at the mo so a good time to sign up. Having spent most of my working life in the UK insurance industry i have good knowledge of how things work in the UK but Thailand is a totally different ball game, i'm concerned regarding how good claim payments are cos if they are sketchy i won't bother to get her insured.

 

In the UK if you're insured and have given full disclosure when initially applying and with subsequent renewal then no problems with having claims paid, well you certainly were with the company i worked for lol  

See my reply further down this thread--i have not seen any issue with having claims paid by the larger carriers with which I am familiar--some list issues, but "the devil is in the details" and without knowing the precise details of any case, one can't really say, I agree or not.

Someone mentioned here in a comment, which is a key issue--read the fine print, and ask questions of any broker used--as someone shared, carriers' t&c will reserve the right for them to revise certain aspects at renewal--much of that is based on utilization during the previous plan year--and, so the problem often is not whether the carrier will pay claims, the problem is with increasing premium amounts often beyond the affordability of those expats here on a fixed retirement income.

[mfd101]

14 minutes ago, KannikaP said:

This is the first time I ever heard of health insurance premium going DOWN by Bht 30k when the policyholder is 3 years older. 

'No claims' helps.

[SammyJ]

13 minutes ago, KannikaP said:

This is the first time I ever heard of health insurance premium going DOWN by Bht 30k when the policyholder is 3 years older. 

exactly, seems curious--but, will accept it at face value--very rare, even without any claims, that a carrier would reduce premiums but i do think that PC has it that premiums can be reduced 10% if there have been no claims in the previous plan year--like I said, i found PC to offer some options not seen in many carriers.

[mfd101]

2 minutes ago, SammyJ said:

exactly, seems curious--but, will accept it at face value--very rare, even without any claims, that a carrier would reduce premiums but i do think that PC has it that premiums can be reduced 10% if there have been no claims in the previous plan year--like I said, i found PC to offer some options not seen in many carriers.

Here's what it shows on my latest renewal notice:

Annual premium                      154385

Less OPD 20%                           (30877)

Less deductible 25%                 (30877)

Less No claim discount 20%    (18527)

                                                   74104

stamp duty o.4%                         297

Total Premium                          74401

[Pumpuynarak]

1 hour ago, SammyJ said:

as someone shared, carriers' t&c will reserve the right for them to revise certain aspects at renewal--

Yes indeed but surely the provider will notify you at renewal of any changes to T&C's ?

[Pumpuynarak]

1 hour ago, SammyJ said:

Many Thai use Aetna for private insurance--of course, your wife, as does my Thai family, qualify to use Govt medical care (in some instances, it can be very good)--Aetna purchased BUPA, which was a quick and simple private medical carrier for many years.  I was involved in health insurance in the US for quite a few years before coming to Thailand--I really don't see that much different, overall, in what is a for profit industry--all my Thai family has Aetna--and over many years, never had any issue with legitimate claims being paid directly to the hospital,  Additionally, i have never seen anything done here that was really out of the ordinary for health insurance companies--it is a surprise that they will avoid paying a claim if they think they can--some are used to having a national health service or Medicare, etc, where pre-existing conditions may not matter,

Again, my Thai family with Aetna has been served as well as insurance carrier I have seen.

Thanks for your post. I will get a quote from Aetna as i have experience of them in the UK where my family and i were covered BUPA TOTR by my then employer, my experience of them was very very good but it was a company arranged group policy and pre-existing conditions were not an issue. 

[Pumpuynarak]

10 minutes ago, Pumpuynarak said:

Thanks for your post. I will get a quote from Aetna as i have experience of them in the UK where my family and i were covered BUPA TOTR by my then employer, my experience of them was very very good but it was a company arranged group policy and pre-existing conditions were not an issue. 

Well i've just tried to get an online quote from Aetna and it would appear they don't insure Thai nationals independently, but i could be wrong lol

[Sheryl]

9 minutes ago, Pumpuynarak said:

Thanks for your post. I will get a quote from Aetna as i have experience of them in the UK where my family and i were covered BUPA TOTR by my then employer, my experience of them was very very good but it was a company arranged group policy and pre-existing conditions were not an issue. 

AETNA Thailand is a  separate Thai company nit the same as AETNA overses 

 

That ssid it is one of the least worst local companies.

 

However unless required for incountry extension based on O-A visa, I much advoise against getting a Thai issued polucy. Ger an internatiobally issued expat  policy. Much better regulated and more reliable.

[Pumpuynarak]

4 minutes ago, Sheryl said:

AETNA Thailand is a  separate Thai company nit the same as AETNA overses 

 

That ssid it is one of the least worst local companies.

 

However unless required for incountry extension based on O-A visa, I much advoise against getting a Thai issued polucy. Ger an internatiobally issued expat  policy. Much better regulated and more reliable.

Problem as i see it is actually getting what you say, its for my Thai wifey not me, can you recco ? TIA Sheryl

Edited October 14, 2023 by Pumpuynarak

[Sheryl]

2 minutes ago, Pumpuynarak said:

Problem as i see it is actually getting what you say, its for my Thai wifey not me, can you recco ? TIA Sheryl

I assume you know that your Thao wife already has free health care through the government universal system? Which is why so few Thais get private health insurance...and why private health insurance here is comparatively expensive (snall pool of insured persons). 

 

If nonetheless you still want to get private jnsurance for her and her alone (as opposed to a family plan including both of you) contact AA brokers.  AETNA Thailand definitely does enroll Thais. 

[couchpotato]

6 minutes ago, Sheryl said:

AETNA Thailand is a  separate Thai company nit the same as AETNA overses 

 

That ssid it is one of the least worst local companies.

 

However unless required for incountry extension based on O-A visa, I much advoise against getting a Thai issued polucy. Ger an internatiobally issued expat  policy. Much better regulated and more reliable.

Mute point, but Aetna is not a Thai Insurance Company anymore. It has been taken over this year by Allianz Ayudhya. Policies are and benefits are similar.

[Sheryl]

6 minutes ago, couchpotato said:

Mute point, but Aetna is not a Thai Insurance Company anymore. It has been taken over this year by Allianz Ayudhya. Policies are and benefits are similar.

Allianz Ayudhya is also a Thai company. 

[SammyJ]

19 minutes ago, Pumpuynarak said:

Well i've just tried to get an online quote from Aetna and it would appear they don't insure Thai nationals independently, but i could be wrong lol

that seems wrong--they have an office, i was told here in Chiang Mai--try contacting them directly.

[Pumpuynarak]

8 minutes ago, Sheryl said:

AETNA Thailand definitely does enroll Thais. 

I hope that is the case but i've just spent good time on their website and its about as much use as a chocolate teapot in respect of Thai nationals seeking cover lol

 

But i could be wrong......

[Sheryl]

1 minute ago, Pumpuynarak said:

I hope that is the case but i've just spent good time on their website and its about as much use as a chocolate teapot in respect of Thai nationals seeking cover lol

 

But i could be wrong......

It is a Thai comoany and definitely insures Thais, they alll do...you should go through a broker in any case. 

[SammyJ]

21 minutes ago, Sheryl said:

AETNA Thailand is a  separate Thai company nit the same as AETNA overses 

 

That ssid it is one of the least worst local companies.

 

However unless required for incountry extension based on O-A visa, I much advoise against getting a Thai issued polucy. Ger an internatiobally issued expat  policy. Much better regulated and more reliable.

Yes, of course Aetna Thailand is not directly the same as Aetna overseas as there is a CIGNA international and CIGNA Thailand--and everyone's experiences  may vary---but for quite a few years, my family's experiences with Aetna Thailand have been very good.  I think the OP was looking for private coverage for his Thai wife--and for that Aetna Thailand would be a good fit--he says she is 42 and in good health.