Insurance with deductible

[Felt 35]

Probably a stupid question for those who know more about health insurance, but anyway, how does a health insurance with a deductible of, for example, THB 100,000 work if the hospital visit, for example, only costs THB 30,000? I've never had any "major" cases in terms of health, but 2-3 less serious, like last year suddenly for unknown reasons an infection in the skin which was inflamed, and a small operation had to be done plus going in and out of the hospital cleaning wounds for several weeks etc. In total, this cost no more than about THB 28,000 so my question is with a 100K deductible who paying then, the insured or the Insurance company? Btw, I have insurance but did not use it for the above occasion.

Thanks

Felt

[Fat is a type of crazy]

Sounds like you pay in full as it is in total less than 100,000. I do note that my policy does have a proviso that a deductible, of $750 in my case, applies to first visit to a hospital and not to others in that calendar year. I would suggest that is not the norm and others may know better. 

Further point is the operation and subsequent visits may possibly be treated differently depending on the cover i.e. the operation covered under hospital cover and cleaning of wounds not as a part of hospital cover even though done at a hospital. You might have to pay for the later regardless. Worth a call. 

Edited January 9 by Fat is a type of crazy

[scubascuba3]

For a claim under 100k you pay, if over 100k they take off the 100k first to work out what they pay. How did you think it worked?

[Etaoin Shrdlu]

Read your policy to see how the insurer applies the deductible.There are different ways that deductibles may be applied.

 

Some policies have an annual aggregate deductible and all covered treatment incurred during a policy year contributes towards satisfying the aggregate deductible amount. You would not receive any claims payment for the small claims until the aggregate deductible is satisfied. After the aggregate deductible is satisfied, covered claims would be paid according to policy terms and conditions.

 

If you have an annual deductible, you should be submitting all treatment charges as soon as they are incurred so that the insurance company has a record of them and so you don't run afoul of any time bars that may prevent them from being accepted and contributing towards the aggregate deductible.

 

But first, read you policy so that you understand how the deductible applies. If you don't understand the policy, ask your broker to help you

[Felt 35]

Thanks for the replies. Will contact the insurance company and check what their policy are regarding deductible.

Felt

[J Branche]

The deductible is thought of as a way to Save a little money for people who rarely need Medical Treatment or for who medical treatment

would be less than or equal to the Savings from the deductible,   Example Only. Deductible is 20,000 baht Original Premium 50,000 Annually

Deducible Discount 8000 baht Premium 42000 baht Deductible 20,000  You may spend up to 8000 baht and Break even.

 

But wait there is more. Some Health Insurance Offers a discount Example 5% for No Claims in 1 year. (I believe if you are paying within only the deductible that is considered No claims) Check with your Insurance Broker.  

1 yr No Claims Policy Renews within same Age Bracket Next Years Premium 42,000 X .95 (or 5% disc) 39,900 Baht a 2100 savings.

 

As you can See NO ONE on this Internet knows.  You know your health needs and costs bests.  Time for a little Maths to figure your needs.

 

 

[newbee2022]

15 hours ago, Felt 35 said:

Probably a stupid question for those who know more about health insurance, but anyway, how does a health insurance with a deductible of, for example, THB 100,000 work if the hospital visit, for example, only costs THB 30,000? I've never had any "major" cases in terms of health, but 2-3 less serious, like last year suddenly for unknown reasons an infection in the skin which was inflamed, and a small operation had to be done plus going in and out of the hospital cleaning wounds for several weeks etc. In total, this cost no more than about THB 28,000 so my question is with a 100K deductible who paying then, the insured or the Insurance company? Btw, I have insurance but did not use it for the above occasion.

Thanks

Felt

You will pay. If you got health issues, which will exceed 100.000 in hospital, insurance will pay the remaining exceeding part.

[sometimewoodworker]

As has been said you need to understand your insurance. The examples under are from mine. As you can see you must notify the insurer of all incidents 

 

Margaret has Option B cover with an excess of £100. Her policy runs from 1 March each year. In July, she is referred to a specialist and her claim is approved by us. The specialist charges her £80. This is her first treatment in this year. As she has an excess of £100, she will need to pay this invoice herself, and send the invoice to us so that we can take this into account when paying any further claims this year. She has two further consultations in August and September, and the specialist charges £80 each time. We will pay £140 towards the cost of these charges. We will then write to Margaret to advise her that she needs to pay the remaining £20, because of the outstanding amount on her excess. In October, Margaret is referred to a specialist for a different medical condition, and sends us an invoice for a further £80. As the excess is applied to each person on the policy each year, and not to each medical condition, we will pay this invoice in full.

 

Mary has Option C cover with an excess of £250. Her renewal date is 1 June. In January, she injures her ankle and is referred to a physiotherapist. She has ten sessions of physiotherapy at a cost of £45 per session, and sends the invoices to us. Initially, we apply the benefit limits of her plan, which allows up to £190 per year for complementary treatment. This means that £190 of the £450 treatment costs is eligible for benefits. However, as Mary also has an excess of £250 on her policy, we will then deduct the £190 from the excess, so we will not be liable for any of the costs. Mary will need to pay £450 herself and she will have £60 remaining on her excess. The following shows what would have been payable had no excess been chosen, together with the amount payable with the excess.    

No Excess     £250 Excess     £     £ Total of Invoices     450.00     450.00 Benefit available     190.00     190.00 Excess deductible     0.00     190.00 Amount payable by us     190.00     0.00 Amount payable by Mary     260.00     450.00

Any further invoices are still subject to the remaining excess amount of £60 being deducted from the amounts claimable for the year. She has also used all of her complementary treatment benefit until her next renewal date.

 

 

[Felt 35]

5 hours ago, J Branche said:

The deductible is thought of as a way to Save a little money for people who rarely need Medical Treatment or for who medical treatment

would be less than or equal to the Savings from the deductible,   Example Only. Deductible is 20,000 baht Original Premium 50,000 Annually

Deducible Discount 8000 baht Premium 42000 baht Deductible 20,000  You may spend up to 8000 baht and Break even.

 

But wait there is more. Some Health Insurance Offers a discount Example 5% for No Claims in 1 year. (I believe if you are paying within only the deductible that is considered No claims) Check with your Insurance Broker.  

1 yr No Claims Policy Renews within same Age Bracket Next Years Premium 42,000 X .95 (or 5% disc) 39,900 Baht a 2100 savings.

 

As you can See NO ONE on this Internet knows.  You know your health needs and costs bests.  Time for a little Maths to figure your needs.

 

 

Thanks for that one. I have, knock on wood rarely needed medical treatment but getting older so that can change quickly but maybe I should go for their top plan covering 50million and premium 130K annually, but with a 300K deductible ending up with 50k premium

I have got discount every year because I never have had any claim but last year that all turned when insurance company sent me a letter explaining that due to general increased cost for insurances, they upped the price with 10%. 

Felt