The Grand Expat Health Insurance Poll

[walt]

Also covered by U.S. federal employees insurance (FEHP) as retired civil servant - no close option to select.

[QED]

This is a very important point you have raised and one that not many employed persons think of. As you say you need to ask your companies insurance company and some will allow you to continue BUT if you have had a problem during the time with the company scheme then that may well be excluded as a "pre-existing condition" when you swap to an individual plan.

The best solution is not to use your employers medical scheme but to ask for the money in lieu and get one's own individual plan set up.

Probably the most ridiculous thing I have ever read on this forum. Most employers will have a block policy which is not individually underwritten, to advise people to opt out of this type of scheme is blatantly poor advice, and a desparate sales tactic which you should be ashamed of.

Added to that I am sure 99% of employers would not offer a cash alternative.

[Jingthing]

This is a very important point you have raised and one that not many employed persons think of. As you say you need to ask your companies insurance company and some will allow you to continue BUT if you have had a problem during the time with the company scheme then that may well be excluded as a "pre-existing condition" when you swap to an individual plan.

The best solution is not to use your employers medical scheme but to ask for the money in lieu and get one's own individual plan set up.

Probably the most ridiculous thing I have ever read on this forum. Most employers will have a block policy which is not individually underwritten, to advise people to opt out of this type of scheme is blatantly poor advice, and a desparate sales tactic which you should be ashamed of.

Added to that I am sure 99% of employers would not offer a cash alternative.

Its not ridiculous at all if you know how insurance companies operate.

Typical scenario:

Person on employer based insurance

Person develops a health condition

Person loses their job for normal reasons

Person loses their employer based insurance

Person applies for new insurance, is completely denied or presented with exclusions for the conditions they need the most help with

The insurance companies are about profits, not your health.

[jazzbo]

Person applies for new insurance, is completely denied or presented with

exclusions for the conditions they need the most help with

The insurance companies are about profits, not your health.

At risk of sounding like an apologist for the health insurers, if you are part of a large group, the chance that any one person may have the conditions mentioned above might be 5%. When you apply for an individual policy when you ALREADY have a history of having that condition, the probability that you will submit a claim or claims for that condition is near 100%. Insurance is about quantified risks -- they may be sc--bags on other issues but some of the math is pretty straight forward.

[Jingthing]

Person applies for new insurance, is completely denied or presented with

exclusions for the conditions they need the most help with

The insurance companies are about profits, not your health.

At risk of sounding like an apologist for the health insurers, if you are part of a large group, the chance that any one person may have the conditions mentioned above might be 5%. When you apply for an individual policy when you ALREADY have a history of having that condition, the probability that you will submit a claim or claims for that condition is near 100%. Insurance is about quantified risks -- they may be sc--bags on other issues but some of the math is pretty straight forward.

No doubt you are correct from a business perspective. However the insurance companies are big boys and they have no problem taking care of their bottom lines. Its everyday people, on the other hand, that often get caught in the web of insurance company policies and that's my interest. In that vein, the concept that people with cover from employers are really not covered for the long term when they lose employment is quite relevant.

[jazzbo]

Kuhn JT -- One of the reasons that I live in Thailand is that I am denied (from chronic illness) individual health insurance coverage in the USA. I realize that a moving-to-Thailand option is not there for everyone... Making COBRA policies more affordable would go a long way to assist those who lose jobs. Now the COBRA policies are structured so that the insurance companies know that the only ones who would keep an expensive COBRA policy are those that have trouble obtaining -- most likely based on medical history -- an individual policy elsewhere.

For non-Tanks COBRA is mandatory Continuation of Benefits from employer group policies after an employee loses a job but can be very expensive especially if maintained for several years as rates can increase... acronym from Consolidated Omnibus Budget Reconciliation Act (COBRA)

[Jingthing]

Sadly as I have learned people with preexisting conditions in Thailand will have trouble similar to Americans in purchasing private insurance that covers their conditions. A big advantage here is that is you go to the right hospitals the cash payments for treatment can be much lower, if it comes to that.

[Naam]

Not every possible wrinkle could be covered in the choices; the intention was for people to vote for the CLOSEST choice even if not exact.

i would have liked to vote but being a German i hate expressions like "purchase" when it concerns insurance. i/we am/are privately insured, worldwide coverage, free selection of any hospital and/or treatment. we never purchased that insurance but pay an annual premium.

[Jingthing]

Not every possible wrinkle could be covered in the choices; the intention was for people to vote for the CLOSEST choice even if not exact.

i would have liked to vote but being a German i hate expressions like "purchase" when it concerns insurance. i/we am/are privately insured, worldwide coverage, free selection of any hospital and/or treatment. we never purchased that insurance but pay an annual premium.

Now that's splitting hairs. Purchased, schmurcashed, you are shelling out the shekels, nu?

[jazzbo]

When I purchased my health insurance here in Thailand, they put a rider on the pre-existing condition. It does not require expensive medication which I purchase here in Thailand... and I am covered for everything else which is the real important component. In USA I could not purchase insurance for anything.

Again, unless you are in a large insurance pool, the concept of insuring a pre-existing chronic condition is really a contradiction in terms -- some insurers here in LOS will put a 2 to 5 year waiting period for other-than chronic conditions.

[jfchandler]

In Naam's case, I believe the correct terminology would be 'Deutchmarks"...

Not every possible wrinkle could be covered in the choices; the intention was for people to vote for the CLOSEST choice even if not exact.

i would have liked to vote but being a German i hate expressions like "purchase" when it concerns insurance. i/we am/are privately insured, worldwide coverage, free selection of any hospital and/or treatment. we never purchased that insurance but pay an annual premium.

Now that's splitting hairs. Purchased, schmurcashed, you are shelling out the shekels, nu?

[jfchandler]

I too had a pre-existing condition (which is pretty much anything you received treatment for and declared prior to taking our your new policy in Thailand) upon moving here. Fortunately it was only ONE thing...

My insurer, LMG, has indicated they have a two-year waiting period, as in, if I don't see a doctor for that issue or have any symptoms during a two-year period, then I can request to have the exclusion lifted. It will be interesting to see what happens in another year or so when I make that request to them.

When I purchased my health insurance here in Thailand, they put a rider on the pre-existing condition. It does not require expensive medication which I purchase here in Thailand... and I am covered for everything else which is the real important component. In USA I could not purchase insurance for anything.

Again, unless you are in a large insurance pool, the concept of insuring a pre-existing chronic condition is really a contradiction in terms -- some insurers here in LOS will put a 2 to 5 year waiting period for other-than chronic conditions.

[jazzbo]

Kuhn JFC -- I had a similar situation when I first applied with BUPA for an orthopedic situation (not the chronic condition referenced above). I had surgery on my knee years 5 years prior to the application which I so indicated. The doctor at that time in the USA said that I would probably require further more extensive surgery on my knee down the road. BUPA put a 2 year waitng period on the policy document for either knee. After 2 years, BUPA themselves removed the wording of the exclusion from the renewal policy document.

Within 3 months following the 2 year waiting period, I could no longer walk. The Thai doctor said that I required full ACL reconstruction; BUPA concurred and paid for the operation 100% (except for a can of CocaCola) within 5 months of the end of the 2 year waiting period. 6 days inpatient in a private room -- in the USA they would have sent you home after day surgery and only admitted you if you had complications following the surgery.

[Jingthing]

Again, unless you are in a large insurance pool, the concept of insuring a pre-existing chronic condition is really a contradiction in terms -- some insurers here in LOS will put a 2 to 5 year waiting period for other-than chronic conditions.

I agree this is completely understandable from a business point of view. However, from a health care point of view for individuals, it causes a lot of hardships, especially for the huge number of people with lifetime CHRONIC conditions that will never be cured, and thus never excluded from insurance riders (when even offered). Currently in the US one of the major features of the soon to be passed health care reform is to forbid insurance companies from excluding people with preexisting conditions and also to force insurance companies not to drop people who get sick. The compromise for the companies is to try to force all Americans to obtain insurance, one way or another, thus massively increasing the pool. So there is no free lunch, for sure. Bottom line, for profit companies will always work in their own self interest.

Some countries have a decent national health care system where resident expats can get into (examples France and Mexico). Thailand's 30 baht system or whatever they call it these days is not something most expats would find adequate care, so most of us are either going to have to pay cash for services or obtain private insurance (if available) with its limitations in covering any preexisting conditions. It is what it is.

[jazzbo]

one of the major features of the soon to be passed health care reform is to forbid insurance companies from excluding people with preexisting conditions...

Hello JT -- I'm not sure that is 100% accurate; I think the official word used in the official House HR 3962 summary is 'limit' as in:

(2) prohibit rescission of health insurance coverage without clear and convincing evidence of fraud;

(3) require the option of extending coverage for children under 27 years of age;

(4) limit preexisting condition exclusions;

At any rate, you can read the House version here (all 1990 pages)... and it still is not free depending upon your income relative to the poverty index:

http://docs.house.gov/rules/health/111_ahcaa.pdf

[BSJ]

Hi jfchandler, you said "Age 50 male, 5 million baht maximum per event, 20 million lifetime,". The 20 million (baht?) lifetime....is that your lifetime? Or do you mean lifetime of the policy?

[Jingthing]

one of the major features of the soon to be passed health care reform is to forbid insurance companies from excluding people with preexisting conditions...

Hello JT -- I'm not sure that is 100% accurate; I think the official word used in the official House HR 3962 summary is 'limit' as in:

(2) prohibit rescission of health insurance coverage without clear and convincing evidence of fraud;

(3) require the option of extending coverage for children under 27 years of age;

(4) limit preexisting condition exclusions;

At any rate, you can read the House version here (all 1990 pages)... and it still is not free depending upon your income relative to the poverty index:

http://docs.house.gov/rules/health/111_ahcaa.pdf

I'm not going to open that file. I'd be afraid it would crash my computer.

Some points --

I never said or implied that the insurance in the US is going to be free (it will mandate getting insurance one way or another subject to penalty) and the US is not going to get a Canadian/Euro style universal health care system

The intention was not to debate the specifics of US health care system or reform

The intention was to demonstrate that private health insurance companies don't act in consumer interest unless they are forced to act that way, in the US case, through proposed government mandates. Left unregulated, of course they won't be interested in private policies for people who are sick. Thailand is a case where it appears that the private insurance companies are not mandated to offer coverage to sick people. That is all. We are talking about THAILAND, I used the US situation to make a point about Thailand.

[jazzbo]

The intention was not to debate the specifics of US health care system or reform OK, Kuhn JT... I was not debating either, but rather trying to explain especially to those non-USA citizens how the health care insurance system works in the USA. That is one of the main reasons WHY I choose to live here in Thailand where I have been able to purchase excellent affordable (to me) health insurance.

I would say that that in the USA the health insurance industry does work generally in the public interest for the 80-90% or so of those who are covered and in surveys say they are pleased with their coverage; where the real tragedy is, as you point out, are those who are NOT covered, or inadequately covered, or lose their insurance, and that is hopefully what the new legislation will address.

Thailand is a case where it appears that the private insurance companies are not mandated to offer coverage to sick people. which is why it is important to start to buy insurance when you are young and healthy; in arrears, other than in a large non-underwritten group plan, it does not exist... and on these pages you often read about young guys bragging they they are 'self-insured'.

[jfchandler]

I'm not a lawyer, but I believe they mean, 20M baht is the maximum they will pay for my covered medical expenses for anything and everything under my coverage with that policy, however long it may be in effect.

Hi jfchandler, you said "Age 50 male, 5 million baht maximum per event, 20 million lifetime,". The 20 million (baht?) lifetime....is that your lifetime? Or do you mean lifetime of the policy?

[lioness]

With regard to the OPs comment that the best care is expensive and costs are rising faster than inflation.

" best care " is not necessarily the most expensive. The big hospitals who I won't name are expensive, but there are options which provide the same level of care at a fraction of the cost. You just don't get the same level of English speakers and fancy bits.

I am having my cancer treatment at Tonbury 1, quite often I am the only Farang in the place, the nurses on the whole don't speak English, but the highly qualified specialist does and the level of care has been excellent for a fraction of the cost of the Big 4.

[Jingthing]

Thailand is a case where it appears that the private insurance companies are not mandated to offer coverage to sick people. which is why it is important to start to buy insurance when you are young and healthy; in arrears, other than in a large non-underwritten group plan, it does not exist... and on these pages you often read about young guys bragging they they are 'self-insured'.

Not going to argue with you about the US system (obviously I disagree with you but why bother debating that here?).

This issue came up when a poster suggested it was silly to suggest that people getting insurance through their employers in THAILAND reject the employer based insurance and try to get PRIVATE insurance instead and ideally money from their employer to help pay for it. I agree that they should do that if they can even though most won't, because employment doesn't last for life, but your life lasts for life. If you develop a health condition during your employment, there is a good chance you won't be able to cover it if you want to apply for private insurance after your employment ends.

[jazzbo]

obviously I disagree with you but why bother debating that here Kuhn JT -- I do not see that we are in any disagreement.. you are describing the way -- whether in Thailand or the USA -- you would like things to be... I am trying to analyze things as how they exist today and how best one can work within those obvious constraints.

[Jingthing]

obviously I disagree with you but why bother debating that here Kuhn JT -- I do not see that we are in any disagreement.. you are describing the way -- whether in Thailand or the USA -- you would like things to be... I am trying to analyze things as how they exist today and how best one can work within those obvious constraints.

Completely off base, sorry.

Don't even begin to presume the ways in which I actually do disagree the way in which you characterized the US situation. I am not going to discuss the US part of it further, except if it directly relates to illustrating issues with the Thai private insurance system. As both countries rely on private insurance and employer bought insurance for better quality care, they do have a lot in common. Cheers.

[jazzbo]

Don't even begin to presume the ways in which I actually do disagree the way in which you characterized the US situation. How presumptuous of me to characterize anything... especially the Thai private health insurance system for which I am entirely grateful and about which I will no further characterize... especially as whether they should be compelled to take on sick people as new subscribers.

[Jingthing]

Don't even begin to presume the ways in which I actually do disagree the way in which you characterized the US situation. How presumptuous of me to characterize anything... especially the Thai private health insurance system for which I am entirely grateful and about which I will no further characterize... especially as whether they should be compelled to take on sick people as new subscribers.

It seems you have misunderstood the intent of my posts on this subject. Another poster asserted insurance companies BY DEFINITION will not accept new sick members (or at best exclude the conditions). Of course. I just contested that this was BY DEFINITION, as there is an option to regulate such companies so that they do invite sick people into the pool. Its hard to imagine they would do that without being forced to do that by law and/or promised a much larger pool to work with. I am not saying should or shouldn't, just contesting the definition. My personal opinion is that private health insurance companies and employer based insurance is a bad model. The best systems in the world have government run universal coverage for all citizens and offer a buy in option for expats. My understanding is that Thailand has a kind of universal coverage but the cost structure is so low they can't really deliver good care, so it isn't something expats would usually be interested in participating in anyway. Of course Thailand is a poor country and that is not too shocking. However, I know some expats in Mexico who are on the Mexican government health care system and they find it not perfect, but very useful.

[jazzbo]

The Topic herein is Expats, how do you handle health insurance in Thailand? So I guess I misunderstood as the topic is not Expats, how in a perfect world would you like to have health insurance handled in Thailand? It is my understanding that in UK and other countries with universal coverage the delivery rates are so poor that that their citizens travel all over the world to obtain major services so that they don't die during the waiting period.

[Jingthing]

The Topic herein is Expats, how do you handle health insurance in Thailand? So I guess I misunderstood as the topic is not Expats, how in a perfect world would you like to have health insurance handled in Thailand? It is my understanding that in UK and other countries with universal coverage the delivery rates are so poor that that their citizens travel all over the world to obtain major services so that they don't die during the waiting period.

No, you've got it right. The topic is indeed about how expats handle their health care needs in Thailand, whether through insurance or not. Otherwise, I ain't taking the bait. Cheers.

[jazzbo]

Jazzbo -- The topic is not Expats, how in a perfect world would you like to have health insurance handled in Thailand?

JT -- Thailand is a case where it appears that the private insurance companies are not mandated to offer coverage to sick people... Its hard to imagine they would do that (accept new sick members and/or with chronic conditions) without being forced to do that by law and/or promised a much larger pool to work with. I am not saying should or shouldn't, just contesting the definition.

My personal opinion is that private health insurance companies and employer based insurance is a bad model...

Otherwise, I ain't taking the bait. Cheers.

You already took it..

[Jingthing]

You win the prize. Back to topic.

[jazzbo]

The topic was always how expats can handle health insurance in Thailand... You took it into the realm of how you would like insurance to be handled in Thailand... and then you resort to insult by emoticon... maybe you should join the "Where is gold headed" crowd as that is their modus operandi as well.