SBC 'More Than' Health Travel Insurance by Coris (Zurich).

[The Fugitive]

Anyone with experience of SBC insurance office on Koh Samui? Just got a quote for ‘More Than’ Health Travel Insurance by Coris (Zurich). Appears to be a combination of travel, health and personal accident cover suitable for; families abroad, pensioners abroad and travellers. Even includes motorcycle accidents providing you hold the appropriate licence of course. Cover of up to 365 days can be taken out whilst already living/travelling abroad. Age up to 100 years. Maximum cover amount is only 100,000 euros however.

 

They are able to provide cover, in my case, for the 9 months each year I spend in Thailand. What rang alarm bells was that I disclosed being previously diagnosed with raised blood pressure and also suffering an unexplained collapse due to low blood glucose. I would have expected premium loading and/or exclusions to be specified but there was neither. Too good to be true? 

[Puccini]

9 minutes ago, The Fugitive said:

Too good to be true? 

 

Yes. Given the absence of a link to the General Terms and Conditions, it is too good to be true.

[The Fugitive]

1 minute ago, Puccini said:

 

Yes. Given the absence of a link to the General Terms and Conditions, it is too good to be true.

The General Terms and Conditions are just that of course. Not tuned to my individual quotation. Attached to their email stating; 'yes we can offer cover' were these two .pdf files.

(EN)Zurich-Coris_61+.pdf Zurich Travel 01-TI-11_2023.pdf

[rwill]

A couple of things I noticed in the General Terms document.

1)  Under the Accident extension package, item 5.4 it says "f the Insured is admitted to hospital as an in-patient for more than 48 hours as a result of an accident while staying abroad, we will pay to the amount stated in the schedule for each day of hospitalisation (from the 3 rd day inclusive) up to a maximum of 10 days"

So you aren't covered for the first 2 days or after 10 days.

 

2) Article 8 Special exclusions, number 2.  "deterioration of Pre-existing Medical Conditions or recurring illnesses;"  

So I would expect a lot of stuff to not be covered if they determine it is pre-existing even if not specifically excluded in advance.

[The Fugitive]

2 hours ago, rwill said:

A couple of things I noticed in the General Terms document.

1)  Under the Accident extension package, item 5.4 it says "f the Insured is admitted to hospital as an in-patient for more than 48 hours as a result of an accident while staying abroad, we will pay to the amount stated in the schedule for each day of hospitalisation (from the 3 rd day inclusive) up to a maximum of 10 days"

So you aren't covered for the first 2 days or after 10 days.

 

2) Article 8 Special exclusions, number 2.  "deterioration of Pre-existing Medical Conditions or recurring illnesses;"  

So I would expect a lot of stuff to not be covered if they determine it is pre-existing even if not specifically excluded in advance.

Many thanks for casting a detailed eye on the conditions for me. The premium was only one third of that of other insurance companies which made me think! I gave detailed explanations of my two 'pre-existing' conditions. No mention of them in their email. It just simply said 'we can provide cover for you'.

[BE88]

Exclusions for sole proprietor’s liability insurance

 

 

3.##### the possession, ownership or use of vehicles,#### aircraft or watercraft and vessels (except surfboards for water surfing, hand powered
boats propelled by oars, rafts and canoes);

 

5. events connected with playing golf;

 

Fraud insurance companies exist not only in Thailand

 

 

[Etaoin Shrdlu]

It is a travel insurance policy and the coverage, limitations and exclusions are typical for this type of cover.

 

It isn't a medical insurance policy and won't provide the level of cover that a real medical insurance policy is intended to provide.

 

The limit of Euro 100,000 is also too low to contemplate a catastrophic accident or illness and/or full medivac expenses.

[The Fugitive]

35 minutes ago, Etaoin Shrdlu said:

It is a travel insurance policy and the coverage, limitations and exclusions are typical for this type of cover.

 

It isn't a medical insurance policy and won't provide the level of cover that a real medical insurance policy is intended to provide.

 

The limit of Euro 100,000 is also too low to contemplate a catastrophic accident or illness and/or full medivac expenses.

Thanks for the clarification. It's important therefore to consider this insurance to be annual travel insurance but with the trip duration limit (sometimes 31 days) removed plus the ability to commence cover whilst outside your home country. It is disturbing that the 100,000 Euro limit would be inadequate in a worst case scenario.

[Etaoin Shrdlu]

7 minutes ago, The Fugitive said:

Thanks for the clarification. It's important therefore to consider this insurance to be annual travel insurance but with the trip duration limit (sometimes 31 days) removed plus the ability to commence cover whilst outside your home country. It is disturbing that the 100,000 Euro limit would be inadequate in a worst case scenario.

 

Another thing to consider: If a serious accident or illness occurs, and in the insurer's opinion the policyholder is fit to travel back to their home country to obtain treatment, coverage would not continue if the policyholder decides to stay abroad. If the policyholder repatriates, coverage under the policy would also terminate and further treatment in the home country would be at the policyholder's (or their regular medical insurer's) expense. Read Article 6 2.2. 

[The Fugitive]

25 minutes ago, Etaoin Shrdlu said:

 

Another thing to consider: If a serious accident or illness occurs, and in the insurer's opinion the policyholder is fit to travel back to their home country to obtain treatment, coverage would not continue if the policyholder decides to stay abroad. If the policyholder repatriates, coverage under the policy would also terminate and further treatment in the home country would be at the policyholder's (or their regular medical insurer's) expense. Read Article 6 2.2. 

Thanks again! Thinking of the ten day in-patient hospital limit already mentioned above. This policy does seem strictly time limited. For those of us with somewhere to stay and free National Health Service treatment in our home countries this is less of an issue. Unfortunately, for those of us for whom this does not apply, this policy is less than ideal! 

[Etaoin Shrdlu]

7 minutes ago, The Fugitive said:

Thanks again! Thinking of the ten day in-patient hospital limit already mentioned above. This policy does seem strictly time limited. For those of us with somewhere to stay and free National Health Service treatment in our home countries this is less of an issue. Unfortunately, for those of us for whom this does not apply, this policy is less than ideal! 

I think this product is primarily marketed in EU countries, so these shortcomings may be less of a disadvantage. Still, the low limit would seem to preclude adequate limits for serious accidents or illnesses requiring lengthy hospital stays and/or medivac to the home country.

 

These are things a good insurance broker should be pointing out to their potential clients.

 

Thai insurance regulations also prohibit an insurance broker licensed by the Office of the Insurance Commissioner from inducing someone in Thailand to contract insurance with an offshore insurance company.

[Sheryl]

23 hours ago, The Fugitive said:

The General Terms and Conditions are just that of course. Not tuned to my individual quotation. Attached to their email stating; 'yes we can offer cover' were these two .pdf files.

(EN)Zurich-Coris_61+.pdf 1.72 MB · 8 downloads Zurich Travel 01-TI-11_2023.pdf 425.03 kB · 8 downloads

General Terms and Conditions apply to all insured persons and if nothing else is specified in your policy, these are the full extent of the limitations for you.

 

reading it, the main limitations appear to be:

 

1. Only "urgent" medical care is covered.  This is typical or travel policies. Necessary but elective surgeries etc would not be covered, neither would routine care. If you are in fact just visiting Thailand this may be fine but if actually living here, would not be equivalent to full health cover.

 

2. Exclusion for " events which are in any way connected with the insured’s conscious self-inflicted injuries or disease, reckless behaviour, abuse of alcoholor drugs or other prohibited substances, or with self-exposure to
unnecessary risk (except in case of trying to save a human life)," " claims related to consequences of excessive consumption of alcohol, drug
abuse, etc"  and " driving motor vehicles without holding appropriate official permits". These too are standard travel insurance policy clauses. (Also excludes injury from diving, downhill cycling, competitive racing and other "extreme" sports. This too is usual).

 

I find the wording about chronic diseases (which would include your pre-existing hypertension) confusing as in  Article 6 it states "Urgent Medical Treatment, transportation, medication and any other
costs in relation to acute deteriorations of Chronic Illnesses are
covered up to the specific limit stated in the insurance cover chart." but in Article 8, Special Exclusions, it lists "deterioration of Pre-existing Medical Conditions" as an exclusion. I suggest you email them specifically equesting clarification on this point, it is important. A stroke or heart failure could be considered a deterioriation of your chronic  hypertension.

 

Regarding accidents, in Article 6 it states "Costs of Urgent Medical Care and doctor’s visit due to an injury or illness of the Insured are covered" but makes no specific mention of hospitalization.  In Section 5 it states "if the Insured is admitted to hospital as an in-patient for more than 48 hours as a result of an accident while staying abroad, we will pay to the amount stated in the schedule for each day of hospitalisation (from the 3rd day inclusive) up to a maximum of 10 days" only if you take out the additional Accident Extension cioverage. I think, but am not 100% certain, that this is referring to a daily payment separate from actual hospital charges (hence kicking in only from day 3 onward; it would be intended to compensate for other incidental costs incurred due to prolonged hospitalization).  @Etaoin Shrdlu do you read it same way?

 

 

[The Fugitive]

32 minutes ago, Sheryl said:

General Terms and Conditions apply to all insured persons and if nothing else is specified in your policy, these are the full extent of the limitations for you.

 

reading it, the main limitations appear to be:

 

1. Only "urgent" medical care is covered.  This is typical or travel policies. Necessary but elective surgeries etc would not be covered, neither would routine care. If you are in fact just visiting Thailand this may be fine but if actually living here, would not be equivalent to full health cover.

 

2. Exclusion for " events which are in any way connected with the insured’s conscious self-inflicted injuries or disease, reckless behaviour, abuse of alcoholor drugs or other prohibited substances, or with self-exposure to
unnecessary risk (except in case of trying to save a human life)," " claims related to consequences of excessive consumption of alcohol, drug
abuse, etc"  and " driving motor vehicles without holding appropriate official permits". These too are standard travel insurance policy clauses. (Also excludes injury from diving, downhill cycling, competitive racing and other "extreme" sports. This too is usual).

 

I find the wording about chronic diseases (which would include your pre-existing hypertension) confusing as in  Article 6 it states "Urgent Medical Treatment, transportation, medication and any other
costs in relation to acute deteriorations of Chronic Illnesses are
covered up to the specific limit stated in the insurance cover chart." but in Article 8, Special Exclusions, it lists "deterioration of Pre-existing Medical Conditions" as an exclusion. I suggest you email them specifically equesting clarification on this point, it is important. A stroke or heart failure could be considered a deterioriation of your chronic  hypertension.

 

Regarding accidents, in Article 6 it states "Costs of Urgent Medical Care and doctor’s visit due to an injury or illness of the Insured are covered" but makes no specific mention of hospitalization.  In Section 5 it states "if the Insured is admitted to hospital as an in-patient for more than 48 hours as a result of an accident while staying abroad, we will pay to the amount stated in the schedule for each day of hospitalisation (from the 3rd day inclusive) up to a maximum of 10 days" only if you take out the additional Accident Extension cioverage. I think, but am not 100% certain, that this is referring to a daily payment separate from actual hospital charges (hence kicking in only from day 3 onward; it would be intended to compensate for other incidental costs incurred due to prolonged hospitalization).  @Etaoin Shrdlu do you read it same way?

Very well spotted and thanks for pointing this out Sheryl! I have sent an email asking whether my previously raised BP has been regarded as falling under Article 6 or 8? You may be interested to know that my BP was around 165mm/110mm at age 29 in 1986. My GP prescribed Frusimide for three months only on a gradually reducing dose. Since then my BP has remained normal without any treatment/medication. However, Doctors to whom I've told this tale insist that's nonsense.

[Etaoin Shrdlu]

48 minutes ago, Sheryl said:

General Terms and Conditions apply to all insured persons and if nothing else is specified in your policy, these are the full extent of the limitations for you.

 

reading it, the main limitations appear to be:

 

1. Only "urgent" medical care is covered.  This is typical or travel policies. Necessary but elective surgeries etc would not be covered, neither would routine care. If you are in fact just visiting Thailand this may be fine but if actually living here, would not be equivalent to full health cover.

 

2. Exclusion for " events which are in any way connected with the insured’s conscious self-inflicted injuries or disease, reckless behaviour, abuse of alcoholor drugs or other prohibited substances, or with self-exposure to
unnecessary risk (except in case of trying to save a human life)," " claims related to consequences of excessive consumption of alcohol, drug
abuse, etc"  and " driving motor vehicles without holding appropriate official permits". These too are standard travel insurance policy clauses. (Also excludes injury from diving, downhill cycling, competitive racing and other "extreme" sports. This too is usual).

 

I find the wording about chronic diseases (which would include your pre-existing hypertension) confusing as in  Article 6 it states "Urgent Medical Treatment, transportation, medication and any other
costs in relation to acute deteriorations of Chronic Illnesses are
covered up to the specific limit stated in the insurance cover chart." but in Article 8, Special Exclusions, it lists "deterioration of Pre-existing Medical Conditions" as an exclusion. I suggest you email them specifically equesting clarification on this point, it is important. A stroke or heart failure could be considered a deterioriation of your chronic  hypertension.

 

Regarding accidents, in Article 6 it states "Costs of Urgent Medical Care and doctor’s visit due to an injury or illness of the Insured are covered" but makes no specific mention of hospitalization.  In Section 5 it states "if the Insured is admitted to hospital as an in-patient for more than 48 hours as a result of an accident while staying abroad, we will pay to the amount stated in the schedule for each day of hospitalisation (from the 3rd day inclusive) up to a maximum of 10 days" only if you take out the additional Accident Extension cioverage. I think, but am not 100% certain, that this is referring to a daily payment separate from actual hospital charges (hence kicking in only from day 3 onward; it would be intended to compensate for other incidental costs incurred due to prolonged hospitalization).  @Etaoin Shrdlu do you read it same way?

 

 

 

51 minutes ago, Sheryl said:

General Terms and Conditions apply to all insured persons and if nothing else is specified in your policy, these are the full extent of the limitations for you.

 

reading it, the main limitations appear to be:

 

1. Only "urgent" medical care is covered.  This is typical or travel policies. Necessary but elective surgeries etc would not be covered, neither would routine care. If you are in fact just visiting Thailand this may be fine but if actually living here, would not be equivalent to full health cover.

 

2. Exclusion for " events which are in any way connected with the insured’s conscious self-inflicted injuries or disease, reckless behaviour, abuse of alcoholor drugs or other prohibited substances, or with self-exposure to
unnecessary risk (except in case of trying to save a human life)," " claims related to consequences of excessive consumption of alcohol, drug
abuse, etc"  and " driving motor vehicles without holding appropriate official permits". These too are standard travel insurance policy clauses. (Also excludes injury from diving, downhill cycling, competitive racing and other "extreme" sports. This too is usual).

 

I find the wording about chronic diseases (which would include your pre-existing hypertension) confusing as in  Article 6 it states "Urgent Medical Treatment, transportation, medication and any other
costs in relation to acute deteriorations of Chronic Illnesses are
covered up to the specific limit stated in the insurance cover chart." but in Article 8, Special Exclusions, it lists "deterioration of Pre-existing Medical Conditions" as an exclusion. I suggest you email them specifically equesting clarification on this point, it is important. A stroke or heart failure could be considered a deterioriation of your chronic  hypertension.

 

Regarding accidents, in Article 6 it states "Costs of Urgent Medical Care and doctor’s visit due to an injury or illness of the Insured are covered" but makes no specific mention of hospitalization.  In Section 5 it states "if the Insured is admitted to hospital as an in-patient for more than 48 hours as a result of an accident while staying abroad, we will pay to the amount stated in the schedule for each day of hospitalisation (from the 3rd day inclusive) up to a maximum of 10 days" only if you take out the additional Accident Extension cioverage. I think, but am not 100% certain, that this is referring to a daily payment separate from actual hospital charges (hence kicking in only from day 3 onward; it would be intended to compensate for other incidental costs incurred due to prolonged hospitalization).  @Etaoin Shrdlu do you read it same way?

 

 

 

With respect to your final paragraph, my reading is that this limitation applies only to the optional "Accident Extension Package Benefits" that provides a cash benefit of Euros 50 per day subject to a two-day deductible. I don't read it as applying to necessary urgent hospitalization expenses arising from a covered accident or illness. This is a typical cover under a personal accident policy and a previous employer of mine referred to it as "hospital cash". In my opinion, it isn't a meaningful benefit.

 

With respect to your penultimate paragraph, I suspect that the underwriter is trying to differentiate between non-urgent manifestations of a pre-existing condition and acute exacerbations of a pre-existing condition requiring urgent care. The former would be excluded, but the latter possibly covered. As you stated,  it is worth asking for clarification from the underwriter to make sure.

[Sheryl]

10 minutes ago, Etaoin Shrdlu said:

 

 

With respect to your final paragraph, my reading is that this limitation applies only to the optional "Accident Extension Package Benefits" that provides a cash benefit of Euros 50 per day subject to a two-day deductible. I don't read it as applying to necessary urgent hospitalization expenses arising from a covered accident or illness. This is a typical cover under a personal accident policy and a previous employer of mine referred to it as "hospital cash". In my opinion, it isn't a meaningful benefit.

 

Thank you, that is my reading also, but wanted to be sure.

 

So medical expenses arising form accidents are covered unless due to intoxication, driving without a license, etc.

[Sheryl]

8 hours ago, rwill said:

A couple of things I noticed in the General Terms document.

1)  Under the Accident extension package, item 5.4 it says "f the Insured is admitted to hospital as an in-patient for more than 48 hours as a result of an accident while staying abroad, we will pay to the amount stated in the schedule for each day of hospitalisation (from the 3 rd day inclusive) up to a maximum of 10 days"

So you aren't covered for the first 2 days or after 10 days.

 

 

As per last few posts, this is only in reference to a cash benefit under an optional coverage extension  that pays cash while in the hospital. It does not refer to medical expenses.

[Etaoin Shrdlu]

12 minutes ago, Sheryl said:

 

 

So medical expenses arising form accidents are covered unless due to intoxication, driving without a license, etc.

 

Yes, medical expenses arising out of an accident, unless an exclusion applies and subject to the policy limits (and sub-limits if applicable), are covered.

 

The main insuring agreement in the terms and conditions actually refers to "injury or illness". I think the term "injury" is actually broader than "accident" since an injury could be the result of a foreseen or intentional event, while "accident" requires a lack of intent and/or being unforeseen. Being assaulted in the course of being robbed isn't an accident, but injuries sustained should be covered. Some coverages, such as the optional Accident Extension Benefit would only apply in the case of an accident and not illness. Sorry to digress.

[Liverpool Lou]

7 hours ago, The Fugitive said:

I gave detailed explanations of my two 'pre-existing' conditions. No mention of them in their email. It just simply said 'we can provide cover for you'.

"we can provide cover for you".

They would say that because they are brokers, they are not insurers and I'd guess that you completed an initial SBC questionnaire not a Zurich application form.   Zurich, the insurer, will be the ones to decide on exclusions and/or loadings and that information will be included in your policy documents when/if issued.

Edited February 14 by Liverpool Lou

[The Fugitive]

24 minutes ago, Liverpool Lou said:

"we can provide cover for you".

They would say that because they are brokers, they are not insurers and I'd guess that you completed an initial SBC questionnaire not a Zurich application form.   Zurich, the insurer, will be the ones to decide on exclusions and/or loadings and that information will be included in your policy documents when/if issued.

Thanks for your information. I supplied the info that they (SBC) request upon their website to give a quote and added detailed explanations of my two 'pre-existing' conditions. I was surprised that the broker came back with a positive response, no mention of my pre-existing conditions and also quoted the exact premium payable. 

[Etaoin Shrdlu]

21 minutes ago, The Fugitive said:

Thanks for your information. I supplied the info that they (SBC) request upon their website to give a quote and added detailed explanations of my two 'pre-existing' conditions. I was surprised that the broker came back with a positive response, no mention of my pre-existing conditions and also quoted the exact premium payable. 

 

Personal accident and travel insurance proposals don't require the same level of underwriting scrutiny as medical insurance policies for a number of reasons.

 

For starters, the limits are low and the coverage is fairly narrow in that it only covers urgent care and the policyholder is expected to return to their home country once able to fly if longer-term treatment is required. The insurer isn't going to pay millions of baht to treat cancer, stroke or heart problems on an on-going basis.

 

Also, the definition of pre-existing conditions is anything, whether diagnosed or not, that is present at the time of policy inception or start of travel. This gives the insurer broad latitude to deny or limit cover. 

 

Detailed disclosure of pre-existing conditions isn't normally required for the type and level of cover this policy provides.

 

 

[The Fugitive]

14 minutes ago, Etaoin Shrdlu said:

Also, the definition of pre-existing conditions is anything, whether diagnosed or not, that is present at the time of policy inception or start of travel.

That is pretty wide! Could refuse your claim even if you were totally unaware (no symptoms) at the time of taking out cover!

[Etaoin Shrdlu]

25 minutes ago, The Fugitive said:

That is pretty wide! Could refuse your claim even if you were totally unaware (no symptoms) at the time of taking out cover!

 

Yes, and this is also true of some medical insurance policies, so careful review of policy terms and conditions is advisable, as is clarification from the insurer in the event of any ambiguity, before entering into a contract of insurance.

[The Fugitive]

19 hours ago, The Fugitive said:

I have sent an email asking whether my previously raised BP has been regarded as falling under Article 6 or 8?

E mail reply received 15/02/2024; 'If the treatment was for arterial hypertension, the diagnosis of arterial hypertension only would not be covered'.

[Sheryl]

13 minutes ago, The Fugitive said:

E mail reply received 15/02/2024; 'If the treatment was for arterial hypertension, the diagnosis of arterial hypertension only would not be covered'.

This is to me unclear, particularly as to whether a complication for which hypertension was a risk factor would be covered.

 

We do understand that routine management of chronic diseases is nto covered, but the policy wording is contradictory regarding "acute deteriorations of Chronic Illnesses".

 

One other point to note is that the policy is issued out of Slovenia, and dispute resolution lies with Insurance ombudsman in Slovenia.

 

I would suggest you instead look for a policy issued out of your country of nationality.

[The Fugitive]

36 minutes ago, Sheryl said:

This is to me unclear, particularly as to whether a complication for which hypertension was a risk factor would be covered.

 

We do understand that routine management of chronic diseases is nto covered, but the policy wording is contradictory regarding "acute deteriorations of Chronic Illnesses".

 

One other point to note is that the policy is issued out of Slovenia, and dispute resolution lies with Insurance ombudsman in Slovenia.

 

I would suggest you instead look for a policy issued out of your country of nationality.

Agree Sheryl. Many thanks for your attention, time and advice.