Lmg Pacific Healthcare Increases Premium Because Of Last Year Claims

[cheeryble]

I would urge posters to avoid health insurance altogether if they have sufficient funds to withstand a worst-likely hit or series of hits.

One should be aware

1 Many people start getting a problem then get insured then claim (personal knowledge of).

2 Insured people will be more likely to get chargeable treatment which self-funders might sensibly avoid.

3 Insurance company needs to pay for its infrastructure and make a profit.

4 Health providers may charge up for the insured....(builders do!)

5 Drugs: I take my expensive hospital prescription and get it filled at a much cheaper pharmacist......AFTER filtering out the unnecessary overprescription so common here.......the insured will simply get the whole lot and the company pays

6 Europeans like me, if they get a particularly expensive problem, may be able to go home for treatment even if it means re-registering as resident there.

7 A self insurer will choose providers carefully to get value but can still spend when he chooses to

I think the problems above are ubiquitous and all these things mean the payout is way higher than the average self insurer. My guess is much more than double. So your average self insurer will pay much less.

The question is if you, an individual, can afford the hit. How to manage self insurance would be a very useful and valid debate for Thaivisa. If there's interest we could sa

cheers Cheeryble

[tonydabbs]

Health insurers cannot arbitrarily raise premiums without across the board approval from the OIC.

But they can increase individual premiums under 2 conditions: age and claims

Individual premium increases are determined by your age bracket. These "premium increase age brackets" are public knowledg and are the same for everyone. You might call this age increase a "Happy Birthday!" age increase.

Normally if your claims exceed 80% or more of your annual premium the insurer will raise your premium. This increase depends on the total cost of the claims you had in relation to the annual premium you pay. They won't raise your premium more than 100%, though. 50% is fairly common. And, one insurer won't raise premiums more than 25%. But that insurer also raises premiums across the board more often. If you are insured as a group or family, the premium increase that would normally be charged to the claiming individual will be spread out among the group or family.

Health insurers in Thailand are not supported by taxpayer money like health insurers in many countries are. If their claims run too high, they have to raise premiums. Raising the premiums of claimants allows insurers to keep their premiums lower and remain more competitive.

Edited September 25, 2011 by tonydabbs

[vagabond48]

I had LMG health insurance for a number of years. My yearly premium the first few years was 13,000 baht. Over the years I had one claim for appendicitis. I have now cancelled the policy because I refuse to pay the 28,000 baht premium per year. The last year I paid the premium it was 25,000 baht. When I bought the policy it was promised that they would not cancel me because of age. They said nothing about eventually pricing me out.

Gary, of course, I don't know the particulars of your situation....and the details involved...

But in general, for others here, it would seem three different price factors can come into play:

1. the age-band based premium structure LMG uses, whereby the standard premium rates increase gradually every 4 or 5 years as the policyholder gets older... no surprise about that.

2. the marketplace driven premiums overall, reflecting their overall claims experience and expenses... In other words, the general price increases they may adjust their entire premium structure by from time to time... LMG went several years without any annual across-the-board increases, then passed along a single pretty large increase a year or so ago...across their entire policyholder base...

Unfortunately, in my case, I believe their one big annual increase happened to coincide for that year with me moving to a higher/older age band, so my policy premium at renewal that year took a big hit upward.... But overall, during the 4 years I've had my policy with them, their general increase (1 year out of 4) wouldn't be considered too excessive relative to annual cost of living/inflationary levels.

3. And then, in what for me was a hidden factor until it became clear here, the special up to 25% adjustment applied on a discretionary basis to individual policyholders based on their claims experience.... I don't have any personal experience with other Thai health insurance providers here as a policyholder... But the LMG folks made it sound like such adjustments are a common feature of coverage here.... I'd be interested to know more about that issue....

In my case, the 25% premium surcharge potential led me, this most recent year, to change my policy from a full coverage, no deductible one that I'd had to now a 40,000 baht annual deductible one... which of course included a reduction in my premium, a 20 or 25% reduction based on the deductible, I believe...

What I also confirmed is, that if I don't go over my annual deductible and thus have no claims for a year, then their 5% no claim discount would apply for my next renewal... notwithstanding the fact I might have paid for my own medical stuff under the 40,000 deductible amount...

Thus far, in 4 years of policies with them, I've fortunately never come anywhere close to exceeding 40,000 baht on annual medical expenses... So it seemed kind of pointless to continually be eating away at my lifetime policy limits with small amount claims, and then losing out on the 5% no claims discount, and then paying the higher premium each year for the no-deductible policy...

So my intent moving forward will be to pay the small stuff out of my own pocket, and reserve the medical insurance for big/bigger ticket issues...hopefully as few and far-between as they may be...

I too have LMG with the 40K deductible and have not made a claim for the last 3 years but I was lead to believe that if I made a claim(s) even though the total amount the claim(s)was under 40K, I would not receive the 5% discount. I also understood that you have a limited time period to make a claim or you would lose that amount towards your deductible. So, if you had, let's say a 30K claim at the beginning of the year which you didn't put in and then got another claim for 100K at the end of year, then you would only get back 60k since you didn't put the 1st 30k claim in on time.

What is your understanding?

[TallGuyJohninBKK]

Vagabond, you're raising two different questions here...

One is the timing of submitting claims to LMG. I don't have a direct answer or info from LMG on that... But I do have what my Thai insurance broker advised, as follows... Since this is going to be my first year using LMG's 40K deductible plan, I wasn't sure about the process for that... So I spoke with her, my broker, at length about it, and she spoke with LMG...

The upshot is... basically, she strongly advised me to submit to her office any eligible claims as soon as I incur them. We never talked, and she didn't mention, anything about LMG having any set time period for that. But rather, she counseled that by submitting each eligible claim as it occurs, my broker and I will know beforehand that LMG has accepted the amounts involved as eligible toward my total deductible, or if they don't for some reason, that we'd then have plenty of time to work out any issues...

I had started out suggesting to her that I'd simply save up the various receipts I might incur, and if/when they were getting close to my deductible cap, that I'd pass them along to her and then she'd pass them along to LMG... She pretty strongly counseled against that, saying she didn't want to dump a bunch of claims on LMG all at once. And especially if I ever had any urgent, serious thing like an inpatient operation, she said I wouldn't want to have that hung up for coverage while LMG was processing a bunch of months old claims...

I figured I'd end up having to mail the receipts into my broker in BKK every time. But I was surprised to hear her offer to have a messenger come and pick them up at my home, any time I incurred a medical expense. When I asked about the trouble of doing that, she replied that that was a normal thing and they do it all the time with other clients... So I said, OK... can do.

As for the 5% no claims discount, I didn't get that answer direct from LMG, but from my broker, who usually is pretty good and accurate about such things, and is used to dealing with LMG. But I wondered the same question as you, and so I specifically asked her about it, and she answered that I'd get the 5% discount in the subsequent year as long as LMG didn't pay out any amounts toward my coverage in the current year... and it didn't matter for qualifying for the 5% discount what expenses I myself covered as part of my policy deductible.

If anyone hears anything different about that, please chime in, and if necessary, I'll re-raise the question again. But her answer kind of makes normal sense, since LMG really ought to only care whether THEY are paying out any money toward my policy, not whether I'm paying for any expenses myself.

Just to be clear, though, on a related issue, I also asked about medical expenses that might not be covered under a person's policy for various reasons, either general policy exclusions or pre-existing conditions that have been excluded for coverage... And not surprisingly, any expenses in those categories that an individual might incur don't count toward the annual deductible, because they're not covered items under the policy.

[tonydabbs]

Vagabond, you're raising two different questions here...

One is the timing of submitting claims to LMG. I don't have a direct answer or info from LMG on that... But I do have what my Thai insurance broker advised, as follows... Since this is going to be my first year using LMG's 40K deductible plan, I wasn't sure about the process for that... So I spoke with her, my broker, at length about it, and she spoke with LMG...

The upshot is... basically, she strongly advised me to submit to her office any eligible claims as soon as I incur them. We never talked, and she didn't mention, anything about LMG having any set time period for that. But rather, she counseled that by submitting each eligible claim as it occurs, my broker and I will know beforehand that LMG has accepted the amounts involved as eligible toward my total deductible, or if they don't for some reason, that we'd then have plenty of time to work out any issues...

I had started out suggesting to her that I'd simply save up the various receipts I might incur, and if/when they were getting close to my deductible cap, that I'd pass them along to her and then she'd pass them along to LMG... She pretty strongly counseled against that, saying she didn't want to dump a bunch of claims on LMG all at once. And especially if I ever had any urgent, serious thing like an inpatient operation, she said I wouldn't want to have that hung up for coverage while LMG was processing a bunch of months old claims...

I figured I'd end up having to mail the receipts into my broker in BKK every time. But I was surprised to hear her offer to have a messenger come and pick them up at my home, any time I incurred a medical expense. When I asked about the trouble of doing that, she replied that that was a normal thing and they do it all the time with other clients... So I said, OK... can do.

As for the 5% no claims discount, I didn't get that answer direct from LMG, but from my broker, who usually is pretty good and accurate about such things, and is used to dealing with LMG. But I wondered the same question as you, and so I specifically asked her about it, and she answered that I'd get the 5% discount in the subsequent year as long as LMG didn't pay out any amounts toward my coverage in the current year... and it didn't matter for qualifying for the 5% discount what expenses I myself covered as part of my policy deductible.

If anyone hears anything different about that, please chime in, and if necessary, I'll re-raise the question again. But her answer kind of makes normal sense, since LMG really ought to only care whether THEY are paying out any money toward my policy, not whether I'm paying for any expenses myself.

Just to be clear, though, on a related issue, I also asked about medical expenses that might not be covered under a person's policy for various reasons, either general policy exclusions or pre-existing conditions that have been excluded for coverage... And not surprisingly, any expenses in those categories that an individual might incur don't count toward the annual deductible, because they're not covered items under the policy.

Any valid claims you have before before the deductible (40K) has been reached are meaningless to LMG. They only become important when your valid claims exceed 40K. Then they need to be submitted to LMG so that you can start getting paid for the rest of the valid claims during that policy year.

[TallGuyJohninBKK]

Tony, what you say above is technically correct, but I'm not sure that suggesting by implication that a person hold onto all their claims paperwork beforehand and not submit them to LMG is good advice...

The reason, of course, is your correct use of the term "VALID claims." And who's going to determine what constitutes VALID claims that count toward your deductible? LMG of course...

The only way any policyholder is going to know for certain that their medical expenses during the policy year are being tallied by LMG and credited toward the person's deductible is if they submit those expenses to LMG as they occur.

I had a situation with LMG during the past year in which I had a two-years past outpatient doctor visit that I did under my outpatient coverage, and assumed LMG had paid for it... after signing the paperwork at the hospital and presenting my insurance card. And then last month, about two years after the fact, I got a registered letter in the mail from the hospital totally out of the blue seeking payment for the visit and informing me LMG had never paid...something LMG had never informed me of... And I only then found out they had (IMHO) wrongly classified the visit as being for something excluded under my policy.

Bottom line, if I'm going to have the 40K deductible policy, I want to know for certain if I've reached my 40K deductible... And I don't want to end up being hospitalized for something unexpectedly and then at that point having to argue with LMG about that status of some medical expenses that happened months before, while I'm in the hospital, just as one potential example.

[tonydabbs]

Tony, what you say above is technically correct, but I'm not sure that suggesting by implication that a person hold onto all their claims paperwork beforehand and not submit them to LMG is good advice...

The reason, of course, is your correct use of the term "VALID claims." And who's going to determine what constitutes VALID claims that count toward your deductible? LMG of course...

The only way any policyholder is going to know for certain that their medical expenses during the policy year are being tallied by LMG and credited toward the person's deductible is if they submit those expenses to LMG as they occur.

I had a situation with LMG during the past year in which I had a two-years past outpatient doctor visit that I did under my outpatient coverage, and assumed LMG had paid for it... after signing the paperwork at the hospital and presenting my insurance card. And then last month, about two years after the fact, I got a registered letter in the mail from the hospital totally out of the blue seeking payment for the visit and informing me LMG had never paid...something LMG had never informed me of... And I only then found out they had (IMHO) wrongly classified the visit as being for something excluded under my policy.

Bottom line, if I'm going to have the 40K deductible policy, I want to know for certain if I've reached my 40K deductible... And I don't want to end up being hospitalized for something unexpectedly and then at that point having to argue with LMG about that status of some medical expenses that happened months before, while I'm in the hospital, just as one potential example.

Tall Guy, you are correct. I checked with LMG and they confirmed that it is entirely up to you. You can submit the batch of claims all at once when they total up to 40K or you can submit them as you pay them and LMG will keep them in your file until they build up enough to satisfy your deductible. Also, they will let you know if any of the claims you submit don't qualify towards satisfying your deductible. So, while you have two options, I strongly agree with you that submitting the claims as they occur, rather than building them up, is by far the best option. Thanks for correcting me on that, Tall Guy.

[TallGuyJohninBKK]

Thanks for re-confirming that, Tony... I know insurance is your area of expertise... So much appreciate your contributions here....

BTW, do you happen to know anything about the RBI outfit that was mentioned earlier in this thread... I'd never heard of them before....

[tonydabbs]

Thanks for re-confirming that, Tony... I know insurance is your area of expertise... So much appreciate your contributions here....

BTW, do you happen to know anything about the RBI outfit that was mentioned earlier in this thread... I'd never heard of them before....

I have never heard of them either, TallGuy. They seem to be new. They are not an insurance company, they operate as a group. That is why the age 55 limit to apply and the maximum age for coverage is age 65.

They don't say who the insurance company is; but; they seem be the administrator of the group. They can change insurance companies as needed just like any group. The group shares the risk among themselves.

That is why they don't raise premiums on individuals for claims or age. They raise premiums on the overall group based on increased claims and medical costs for the group as a whole. This is good for people who have a lot of claims and would prefer to spread the cost of their claims among the whole group.