Pacific Cross Health Insurance - Claims experience ?

[SammyJ]

2 hours ago, mfd101 said:

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

some of good options allowed by PC--20% for no claims--but, of course, this will change once you make a claim, and as you near the next age bracket 74/75 and, of course, you assume the first 40,000 baht of a claim.

[mfd101]

7 minutes ago, SammyJ said:

some of good options allowed by PC--20% for no claims--but, of course, this will change once you make a claim, and as you near the next age bracket 74/75 and, of course, you assume the first 40,000 baht of a claim.

Yes, and as always and everywhere: Stay as healthy as you can for as long as you can. You are responsible for your health both physical & mental. All alternatives are worse.

[retarius]

I daren't say.....I might be the subject of criminal defamation.

[mfd101]

30 minutes ago, SammyJ said:

some of good options allowed by PC--20% for no claims--but, of course, this will change once you make a claim, and as you near the next age bracket 74/75 and, of course, you assume the first 40,000 baht of a claim.

Note also that the 40K deductible (ie I pay the first 40K of any claim) itself reduces my premium by almost 31K.  Which, in the absence of any sickness & claims, means the 40K deductible isn't as horrid as it seems.

[SammyJ]

Just now, mfd101 said:

Note also that the 40K deductible (ie I pay the first 40K of any claim) itself reduces my premium by almost 31K.  Which, in the absence of any sickness & claims, means the 40K deductible isn't as horrid as it seems.

exactly right--some choose to self insure to keep all money in a fund that grows each year--which of the PC plans do you have?

 

[SammyJ]

25 minutes ago, mfd101 said:

Yes, and as always and everywhere: Stay as healthy as you can for as long as you can. You are responsible for your health both physical & mental. All alternatives are worse.

yes, we are responsible to a degree--but, one can never be sure when a cancer shows up, or some unexpected illness or injury, despite one's best efforts at good health and safety!

[SammyJ]

Just now, SammyJ said:

yes, we are responsible to a degree--but, one can never be sure when a cancer shows up, or some unexpected illness or injury, despite one's best efforts at good health and safety!

sorry, forgot a funny old saying a friend once told me--"Good clean living will only get you so far!"

[HampiK]

On 10/13/2023 at 6:44 AM, 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.

Yes, Cigna is not allowed to insure Thai people, only if they have a second citizenship. 
I use Cigna for myself and my wife.

[mfd101]

4 minutes ago, SammyJ said:

exactly right--some choose to self insure to keep all money in a fund that grows each year--which of the PC plans do you have?

 

If I had continued with Visa-Friendly from the previous 3 years, my premium for the next year would have been 86168. I chose to move to Premier Plus with much the same cover minus OPD (which is not worth the candle) at 74401.

[mfd101]

6 minutes ago, mfd101 said:

If I had continued with Visa-Friendly from the previous 3 years, my premium for the next year would have been 86168. I chose to move to Premier Plus with much the same cover minus OPD (which is not worth the candle) at 74401. The change was suggested to me by the PC customer manager who was extremely helpful in the whole process.

 

[scubascuba3]

29 minutes ago, retarius said:

I daren't say.....I might be the subject of criminal defamation.

Of course you can, no one knows who you are

[jaideedave]

1 hour 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.

I have the Thai version of Aetna. Recently taken over by Allianz Ayudhya Thailand. Used to be BUPA Thailand.

[jaideedave]

On 10/13/2023 at 6:44 AM, 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.

FYI my Thai wife has a policy with Aetna Thailand for the last 2 years. (Allianz Ayudhya) No claims so no issues.555

[SammyJ]

19 hours ago, jaideedave said:

FYI my Thai wife has a policy with Aetna Thailand for the last 2 years. (Allianz Ayudhya) No claims so no issues.555

I have seen that Aetna/Allianz gave a 10% rebate on a policy if no claims were made in previous plan year.

[Pumpuynarak]

1 hour ago, SammyJ said:

I have seen that Aetna/Allianz gave a 10% rebate on a policy if no claims were made in previous plan year.

So do PC......

 

[SammyJ]

3 hours ago, Pumpuynarak said:

So do PC......

 

Yes, I knew that already and was discussed--I was just sharing for those with Aetna that it does something similar.

[TallGuyJohninBKK]

On 10/14/2023 at 9:10 AM, 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.

AFAIK, with Pacific Cross, the discount for no claims experience grows progressively, so much off for 1 year, a bit more off the 2nd year, and a bit more off for 3 years and beyond. I believe their no claims discount overall tops out at a 20% max premium reduction.

 

And then beyond that, the policy holder each year has options to select what their annual deductible will be (or none at all if so desired), Those also carry substantial premium discounts apart from the no claims one, depending on if you choose annual deductibles of 40K, 100K, etc.

 

Put the two categories of discounts together, and you easily can reduce your policy premium off their regular rates by close to 50%...  But of course, the no claims part only continues as long as you have no claims!

 

 

[TallGuyJohninBKK]

There was another thread here a while back discussing Pacific Cross, and there were some claims there that PC would retroactively add policy exclusions for existing policy holders...

 

I got a hold of Pacific Cross's main customer service manager in Bangkok, she reviewed the posted comments, and then I shared her written response in that thread.

 

She said the only circumstance that PC would retroactively add exclusions to existing policy holders is if they (PC) later find that the policy holder had some pre-existing condition that wasn't disclosed at the time of applying for the PC policy... Which I believe would be a pretty standard thing even in the Thai insurance industry.

 

People can make all kinds of claims here on the forum, but it's obviously a one-sided telling of the story... And it wouldn't surprise me too much to find that such stories may have more going on in the background than what's admitted.

 

FWIW, in my case, I had one clearly disclosed policy exclusion that was attached to my PC policy when it was originally written, and that was no surprise, considering I had some considerable prior claims experience on that issue...

 

Fast forward some years, and I no longer was having any issues with that medical situation. No treatment, no doctor's visit, no medications, etc etc... So, with my agent's consultation, I applied this past year to have that exclusion removed from my policy, and within about two weeks, got the answer back from Pacific Cross that they had removed that exclusion from my policy.

 

 

Edited October 15, 2023 by TallGuyJohninBKK

[TallGuyJohninBKK]

FWIW, I'll also add, I think this is one of those kinds of situations where you may benefit from working with/thru an experienced, knowledgeable Thai insurance broker who has a good working relationship with Pacific Cross or whatever insurer you're using...

 

My sense is, it can be very helpful to have a knowledgeable advocate on your side if you run into some issues or disputes with the insurer, including someone who's fluent in Thai which most of us aren't... and not just someone who only takes a cut of your policy premium each year.

 

[NanLaew]

On 10/12/2023 at 1:05 PM, scubascuba3 said:

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

A detached retina operation (vitrectomy) which by nature is invasive eye surgery, usually results in cataracts developing, mostly within 12 months of the operation.

 

I had a detached retina and the ophthalmic surgeon recommended that I get an intra-ocular lens implant at the same time as the vitrectomy to prevent coming back within a year for cataract surgery.

 

PC covered the cost of the vitrectomy but refused to cover the cataract-related IOL as they didn't recognize is as preventative surgery.

 

FWIW, I haven't found any insurance carrier that covers cataracts.

 

My PC insurance is up for renewal and for the third year running, there's an increase, this time due to 'age banding' so despite a 10% no-claims bonus discount, it has increased 16%. I will add a deductible and remove OPD to make the premium more wallet-friendly.

 

However, they are also requesting signed statements relating to my eye and prostate so that they can decide on either extending the existing wait list or possibly adding an exclusion.

Edited October 15, 2023 by NanLaew

[NanLaew]

30 minutes ago, TallGuyJohninBKK said:

There was another thread here a while back discussing Pacific Cross, and there were some claims there that PC would retroactively add policy exclusions for existing policy holders...

 

I got a hold of Pacific Cross's main customer service manager in Bangkok, she reviewed the posted comments, and then I shared her written response in that thread.

 

She said the only circumstance that PC would retroactively add exclusions to existing policy holders is if they (PC) later find that the policy holder had some pre-existing condition that wasn't disclosed at the time of applying for the PC policy... Which I believe would be a pretty standard thing even in the Thai insurance industry.

 

People can make all kinds of claims here on the forum, but it's obviously a one-sided telling of the story... And it wouldn't surprise me too much to find that such stories may have more going on in the background than what's admitted.

 

FWIW, in my case, I had one clearly disclosed policy exclusion that was attached to my PC policy when it was originally written, and that was no surprise, considering I had some considerable prior claims experience on that issue...

 

Fast forward some years, and I no longer was having any issues with that medical situation. No treatment, no doctor's visit, no medications, etc etc... So, with my agent's consultation, I applied this past year to have that exclusion removed from my policy, and within about two weeks, got the answer back from Pacific Cross that they had removed that exclusion from my policy.

 

 

That's very reassuring and if not exactly encouraging pursuit of a healthier lifestyle, maybe incentivizes the policy holder to look after themselves better.

 

For example, if one has Type 1 hypertension, it's relatively easy to get that back in check. However, the key to getting an exclusion lifted would be how many years of 'clean living' and no claims would they consider before lifting it?

[TallGuyJohninBKK]

2 minutes ago, NanLaew said:

However, the key to getting an exclusion lifted would be how many years of 'clean living' and no claims would they consider before lifting it?

I don't know how they'd deal with hypertension issues....which are a bit sticky...

 

In my case, it was a standard medical condition. From memory, the questionnaire I had to fill out and complete for them asked various questions, some about things in the past year, and others about things going back three years, I believe.

 

As far as premiums are concerned, I've been a PC policy holder for many years... And in all that time, I think I've only seen two years where they had general rate increases for everyone... Whereas for most Thai medical insurers, annual cost-of-living premium hikes are a common thing.

 

The only other rate increases I've had from PC are the standard 5 year age band increases, which are disclosed well in advance as they have standard charts showing how their premiums change as you progress into each different age band.

 

[NanLaew]

1 hour ago, TallGuyJohninBKK said:

I don't know how they'd deal with hypertension issues....which are a bit sticky...

 

In my case, it was a standard medical condition. From memory, the questionnaire I had to fill out and complete for them asked various questions, some about things in the past year, and others about things going back three years, I believe.

 

As far as premiums are concerned, I've been a PC policy holder for many years... And in all that time, I think I've only seen two years where they had general rate increases for everyone... Whereas for most Thai medical insurers, annual cost-of-living premium hikes are a common thing.

 

The only other rate increases I've had from PC are the standard 5 year age band increases, which are disclosed well in advance as they have standard charts showing how their premiums change as you progress into each different age band.

 

Yes, hypertension is the low-hanging fruit. Since I had no doctor or medical history in Thailand (or anywhere else for that matter), when I made a claim three years ago, they asked for any medical references. I had several offshore medicals at two hospitals in Bangkok over the past 8 to 10 years so I signed the waiver for them to contact and obtain any medical records that they may have on file. They received these and found one instance of Hypertension 1 level blood pressure from a medical in 2016: none before or since. Since their scope is (I believe) 7 years of medical history, they hit me with a 10,000 baht weighting on my premium. I didn't argue at the time.

 

Banding increases I can handle as forewarned is forearmed. Just disappointed to see the banding increase wiped out the NCB. Year-on-year increases haven't been less than 10,000 baht and the last (only) claim (not hypertension related) was a couple of years back.

[CanadaSam]

I applied, submitting a very recent medical report saying that my cholesterol was fully under control, (it was the same as a normal healthy person) with taking only 10mg of Atorva daily.

 

They promptly excluded all issues related to cholesterol, which of-course includes heart attack, making the policy worthless IMO.

 

Idiots.

[mfinasi]

 

On 10/14/2023 at 12:02 PM, HampiK said:

Yes, Cigna is not allowed to insure Thai people, only if they have a second citizenship. 
I use Cigna for myself and my wife.

 

Any idea why that is? 

[HampiK]

20 hours ago, mfinasi said:

Any idea why that is? 

 

I only can guess, that this have something to do with Thai market regulations.