The Grand Expat Health Insurance Poll

[Jingthing]

Note -- I have put the above poster on permanent ignore. I am posting this publicly so people understand why there won't be any further replies to him by me.

[jazzbo]

Fine with me... In the USA, and I guess the UK as well, they have Fantasy Football. I guess Kuhn JT is off playing Fantasy Insurance where the HealthCare Universe - and maybe other parts of the Universe -- is as he thinks it should be.

[Wolfie]

I will ask you both to stop the bickering and petty arguments - you can either both put each other on ignore or simply actually ignore each other - failing that we can give you both a cooling off period, but i would rather it didnt come down to that to be honest.

[Lite Beer]

Post discussing a Moderation issue deleted.

[jazzbo]

Pending Legislation H.R. 3962 ‘Affordable Health Care for America Act’.

EC. 211. PROHIBITING PREEXISTING CONDITION EXCLUSIONS.

A qualified health benefits plan may not impose any preexisting condition exclusion (as defined in section 2701('b') (1)(A) of the Public Health Service Act) or otherwise impose any limit or condition on the coverage under the plan with respect to an individual or dependent based on any of the following: health status, medical condition, claims experience, receipt of health care, medical history, genetic information, evidence of insurability, disability, or source of injury (including conditions arising out of acts of domestic violence) or any similar factors.

2701 subject to definitions in 2702 Public Health Service Act (1946 as amended)

SEC. 2702. PROHIBITING DISCRIMINATION AGAINST INDIVIDUAL PARTICIPANTS AND BENEFICIARIES BASED ON HEALTH STATUS.

(a) In Eligibility To Enroll-

(2) NO APPLICATION TO BENEFITS OR EXCLUSIONS- To the extent consistent with section 701, paragraph (1) shall not be construed--

(' to prevent such a plan or coverage from establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the plan or coverage so long as--

(i) such limitations and restrictions are explicit and clear;

(ii) in the case of such limitations and restrictions in health insurance coverage offered in connection with the group health plan, such limitations and restrictions have been disclosed in writing to the plan sponsor in advance of the point of sale to the plan;

(iii) the plan sponsor and the issuer of the group health insurance coverage make available, to participants and beneficiaries in the plan in advance of the point of their enrollment under the plan, a description of such limitations and restrictions in a form that is easily understandable by such participants and beneficiaries; and

(iv) the plan sponsor and the issuer of the coverage provides such description to participants and beneficiaries upon their enrollment under the plan at the earliest opportunity that other materials are provided..

[dsfbrit]

Self insured - that way I'm not wasting 80% - 90% of my money on Insurance Sales commissions, Executives Salaries, Large Flashy Building, Expensive Advertising campaigns, internal beaurocracy etc, etc - all paid to a large company that usually won't pay up for the full amount of the medical bill anyway.

My feelings exactly. Then there is a big chance that when you try to claim - they say it was a pre-existing condition or whatever. Mind you 'accident insurance' may be of some benefit. It seems to be relatively cheap compared to a lot of medical insurance - so if I do get run over by a car whilst I am walking on the pavement (not that unlikely where I live in Pattaya) then I could get medical treatment OK.

I decided years ago that I will fund 'minor' operations like hip etc... myself. If it gets really 'bad' - cancer etc... then I will return to the UK and get some of the benefits from the NHS I paid into for 30 years and never used seems fair!

[dsfbrit]

In retrospect, based on the anemic response to this poll so far, it seems titling this "Grand" was a tad bit presumptuous. I am curious to know roughly what percentage of expats here carry ANY kind of health insurance good in Thailand. If I had to guess I would say under 50 percent.

I know about 10 farang very well. Of those 2 have medical cover from their 'Thai/International' company - not sure how it works though or what it covers. The other 8 just pay as they go. Recently one non-insured Brit - aged 52 - had a motorbike accident and was taken to the local Thai hospital at his request and the overnight stay and medical treatment was not that expensive. I dont have the figures, it was a few thousand baht or so, but nothing like as expensive as the International Hospitals such as Bangkok Pattaya charges.

I think for road accidents like this - if you can get taken to a Thai hospital first then it may be a lot cheaper than going to an 'International Hospital' for effectively the same treatment.

I would not fancy more major ops - like cancer surgery as a local Thai Hospital though. My gut reaction is that if its that serious, then best to return to the UK and use the services of the NHS - which as I posted above - I have paid a lot into and never used.

A lot of people often say the NHS is 'free' - it isn't. Its only free at the point of delivery - in other words people get the treatment free, but some of us have paid a LOT of money for then to have this 'free' service - I can assure you

Edited November 27, 2009 by dsfbrit

[jazzbo]

If it gets really 'bad' - cancer etc... then I will return to the UK

What if the nature of really 'bad' is a heart attack, or brain aneurysm, or some serious injury or other illness that prevents you from traveling back to the UK for an extended period of time?

[dsfbrit]

If it gets really 'bad' - cancer etc... then I will return to the UK

What if the nature of really 'bad' is a heart attack, or brain aneurysm, or some serious injury or other illness that prevents you from traveling back to the UK for an extended period of time?

yes - and thats how the insurance people sell it to you. 'What if a meteor falls on your head?' etc... the probability of a 'brain aneurysm' (whatever that is) occurring to me is miniscule - if it does I will fund it myself. I could fund the cancer operation myself as well - but the thought of returning to the UK to get some of the 'free' NHS service seems fairer to me as I have paid so much into it.

At least if I have a heart attack I will be sure that the cost will be covered by me - I know of many many stories (I suspect you do as well) where insurance companies have refused to pay up when they 'should'. Pre-exisitng condition blah blah...

I may need a minor hip operation soon and even for that I have considered returning to the UK and have it done privately - since the pound/baht exchange rate nose-dived - paying for an operation in the UK is not so expensive nowadays...and perhaps I have more confidence in the hospital system in the UK - not sure of that one!!

edit: come to think of it - even if the treatment is free in the UK - the reason I would rather have any operation in Thailand - is because the nurses are much cuter!!! pretty basic really!

Edited November 27, 2009 by dsfbrit

[jazzbo]

refused to pay up when they 'should'. Pre-existing condition blah blah... Mostly when you have mis-represented something on your application 'What if a meteor falls on your head?' the probability of xxx occurring to me is minuscule If you walk into any hospital critical care ward it will be full of people who thought that it could not happen to them. if it does I will fund it myself. I guess that is why wealthy people never purchase health insurance.

Am I a health insurance representative or broker? No..just a former systems design guy who specialized in probability / logic analysis.

BTW What is a Brain Aneurysm?

A brain aneurysm, also called a cerebral or intracranial aneurysm, is an abnormal bulging outward of one of the arteries in the brain. It is estimated that up to one in 15 people in the United States will develop a brain aneurysm during their lifetime. ( www.brainaneurysm.com )

[dieter1]

I did write it before:

limited health insurance (be it 500.000 or 5 Mill) is just bull-shit. It is just good for the insurance company !

The biggest costs for "normal" insurance companies ( like in my home-country, where there is at least some control by the state) is for long intensive care in hospital. And it is not (!) real cheaper, if you get this treatment in one of the best/most expensive hospitals in Thailand.

You may need some very expensive treatment, costs can be easy above 10.000 Baht a day. And having 2 big OP´s (surgical treatments) could easily cost up to 2 mill. And you could need that treatment for a very long time ! You, like most of us, will not totally recover from our last diseases we will have in our last years (on earth). We would need expensive care all the time.

I think, in western countries, these limited insurance are not allowed. Think about that: You get intensive care for one year and after this, the money (limited) is all used up. You are warned ! Here in Thailand, they will not care for you any more. They will let you die !

So if you have some money to pay for treatment (for smaller bills, that would mean less then 200.000/year), it would be much wiser, to have an insurance which would pay everything ABOVE 500.000 baht !!! and not for the small bills! Insurance is only necessary for the worst case ! And you can be sure (!!!) This case will come in the last 5 years of your live ! 100% But it could even be the case before !

And it is not that important, what you have to pay(for insurance) when you are less then 60 years old ! You need to know, what you have to pay, when you are beyond 60 !

And the contract:

Believe me:

Even in my homecountry, it´s normal that these shitty companies do write a lot in these contracts, but when you need them, they do everything to avoid to pay. And think about it: In what state you are (lets say you are 80 years old, just had a big surgery, handicapped ...) and need to have a lawsuit (for some years) to make them pay ! You will die before the case will be come to an end.

[dieter1]

I got the feeling, it is preaching to the pigs ....

sorry ..

[jfchandler]

Dieter, what you're really talking about is the potential for people incurring LONG-TERM CARE expenses later in life that can be very expensive because of their duration.

Those could be incurred in hospitals. But I think just as, or maybe even more likely, those can be incurred outside of hospitals where people may need supportive nursing or other care at home, which regular health insurance policies generally won't cover.

In the U.S., coverage for such care is provided by separate LTC (Long Term Care) policies... I've inquired about those kinds of policies offered by companies here in Thailand. So far, I haven't found any.

There are international companies that do provide LTC coverage to people living outside the U.S., but I haven't narrowed down the field on those as yet. It's easy to find and purchase an LTC policy for a U.S. person living in the U.S. It's not so easy to find such a policy when you're living outside the U.S., such as in Thailand.

I presume the reason for that situation in Thailand is society here still thinks of those kinds of care obligations being handled by relatives (or simply not being provided at all).

However, not everyone living here has family/relatives who would be capable of providing that kind of care.

If anyone has info on suitable LTC policies that would cover people living in Thailand, I'd appreciate hearing about those here.

[jazzbo]

from Gallup.com September 23, 2009

Cost Is Foremost Healthcare Issue for Americans / But public largely skeptical that healthcare reform will bring relief

by Lydia Saad

PRINCETON, NJ -- Americans are broadly satisfied with the quality of their own medical care and healthcare costs, but of the two, satisfaction with costs lags. Overall, 80% are satisfied with the quality of medical care available to them, including 39% who are very satisfied. Sixty-one percent are satisfied with the cost of their medical care, including 20% who are very satisfied.

There is a clear gulf in these perceptions between the health insurance haves and have-nots. According to a Sept. 11-13 USA Today/Gallup poll,

the 85% of Americans with health insurance coverage are broadly satisfied with the quality of medical care they receive

and with their healthcare costs. At 79%, satisfaction with costs among Medicare/Medicaid recipients is particularly high.

The 15% who are uninsured are far less satisfied with the quality of their medical care (50% are satisfied), and only 27% are satisfied with their healthcare costs. (Sixty-nine percent are dissatisfied with their costs.)

So I guess there are a lot of pigs out there that need some preachin'. (Palin-ese)

And it is not that important, what you have to pay (for insurance) when you are less then 60 years old ! You need to know, what you have to pay, when you are beyond 60 ! At least in Thailand that is an easy answer: If you do not become a subscriber before the age of 60, you will pay the Insurance company ZERO Baht per year after the age of 60 because they will not take you as a new subscriber.

[jazzbo]

Kuhn JFC -- from Wikipedia:

Long-term care insurance

generally covers home care, assisted living, adult daycare, respite care, hospice care, nursing home and Alzheimer's facilities. If home care coverage is purchased, long-term care insurance can pay for home care, often from the first day it is needed. It will pay for a visiting or live-in caregiver, companion, housekeeper, therapist or private duty nurse up to 7 days a week, 24 hours a day (up to the policy benefit maximum).

The cost of such benefits, while prohibitive in the USA or UK, are relatively inexpensive in Thailand to the point that structuring a bank annuity (not life insurance annuity as you probably do not need the tax benefits) starting at your current age would most likely cover those expenses in the Kingdom for as long as you would need them...

[jfchandler]

Thanks for the comment Jazzbo... I'm certainly willing to view this with an open mind... but...

An LTC has the advantage of one making relatively modest monthly payments, and saving one's capital resources for hopefully better-earning uses.

A bank annuity, if we're thinking about the same thing, involves one putting up a substantial amount of capital at the outset, and then basically locking that into the annuity. And, the amount of the annuity would need to be large enough to generate an income flow sufficient to cover monthly care expenses.

I'm thinking, the amount of capital one would need to put into such an annuity would need to be pretty darn large in order to generate a sufficient income stream to accommodate long-term care expenses, even in Thailand.

And then, what about the years when hopefully one doesn't need any long-term care?? What is happening with the annuity proceeds during that period?

And further, right now, I'd imagine the return that any Thai banks would pay on an annuity would be pretty miserably low. And I'm guessing they'd also be taxed in Thailand as well.

All in all, it's hard for me to see how an annuity would be any kind of advantage over a traditional LTC policy, which one could price and match the benefit amount to be suitable for expenses in Thailand.

[jazzbo]

well JFC I suggested some variation on an annuity (maybe without the big upfront load and with periodic contributions) because as of today, annuities exist in the USA and Thailand; and LTC at least in Thailand and in the mode described TTBOMK does not exist... and again, finding something like 24 hour live-in care will not be that expensive in Thailand vs. Western countries.

[jfchandler]

Re the availability of LTC here in LOS...

I had a state government based LTC back in the U.S., but I dropped it when I moved here, because they would not pay any benefits outside of the U.S. -- why, I can't figure, because in the case of Thailand, as you pointed out, any obligation would clearly be less costly than the comparable service provided in the U.S. And I'd think most non-U.S. residences would involve lower prospective costs compared to U.S. services.

In checking with my pretty good Thai insurance broker here, she searched around, and came up with some life insurance options that included some care benefits ... but nothing Thai based that was solely LTC...

However, my ex in the U.S. is/was an insurance broker, and while she personally doesn't deal with LTC, she checked and advised me that a number of different international insurance companies offer LTC policies that supposedly would pay benefits regardless of where they live, including outside the U.S. ... That's the topic, I need to get more info on through personal research and checking.

[dieter1]

jfchandler

yes, you are right. There is a big chance, that you will need Long-Term-Care outside the hospital.

And someone has to pay for this. (beside the bills for the hospital)

"I presume the reason for that situation in Thailand is society here still thinks of those kinds of care obligations being handled by relatives (or simply not being provided at all). "

As in other societies (western) the old family system in Thailand is eroding (disintegration) at a very fast speed ! Family members are already split up and are not living together anymore. It is sometimes even worth, compared to western societies, cause many parents do not live together with their (young!)children any more. Parents move to the big cities , leaving their children back.

And: The young adults, do not have that many children like their parents. So in the future, they will be not many young people, who can take care for the old ones. And, beside this, most people will be still poor, so will not be able to pay for long-time -care.

[jazzbo]

Kuhn D.: Yes, you are right. There is a big chance, that you will need Long-Term-Care outside the hospital...And someone has to pay for this. (beside the bills for the hospital)

A Kiplinger report in the USA says the chance that a person in the USA over age 65 sometime needing LTC is about 70%. So IMHO when an event has a 70% chance of occurrence, you really are talking more about financing than insurance... which is why I tend to look at LTC as closer to an annuity situation than true insurance especially since such LTC product is not currently available here in the Kingdom...

... but there may be options.

[BSJ]

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?

Thanks for clarifying that!

* For those in the U.S.A. that think a national health scheme is the panacea to all ill's (no pun intended), you may be sadely mistaken!

[sceadugenga]

I didn't see fingers crossed and hope.. on your survey.

No one would be that stupid, and if they were they would never admit it anyway...

[dieter1]

jazzbo

yes, I think you are right: If there is a 70 percent chance , you do not need insurence, you need a way of financing !

(especially, because for insurance, you will have to pay for their profit, for bureaucracy etc.)

In my country, it is a kind of "insurance", everybody has to have. Mostly it is kind of non-profit state regulated insurance.

You have to pay for the old ones know and hope, that the next generation will pay for you (or is able to pay for you) when you will need it. They call it contract of generations (because it simple means, that young people pay for the old people)

In fact these kind of insurance do have a smaller percentage of using money for bureaucracy, compared to profit orientated insurance.

[timekeeper]

In retrospect, based on the anemic response to this poll so far, it seems titling this "Grand" was a tad bit presumptuous. I am curious to know roughly what percentage of expats here carry ANY kind of health insurance good in Thailand. If I had to guess I would say under 50 percent.

i have top coverage plan with William Russell

its worldwide but i choose to exclude USA as it discounts the plan significantly

i pay £104 a month

[jfchandler]

If you're going to talk about an insurance company and their pricing, you really need to add what age range that premium applies to, and some kind of info on the extent of the policy's coverage in terms of either per event maximum or nightly hospital benefit, and including or excluding OPD.

Otherwise, tossing in 104 pounds a month is pretty meaningless...

i have top coverage plan with William Russell

its worldwide but i choose to exclude USA as it discounts the plan significantly

i pay £104 a month

[Jingthing]

I wonder who you're insured with because that sounds like an excellent policy you signed onto. I'm retired and I have regular medicare coverage and also a good medicare supplement plan that just provides extra coverage. I want to retire in Thailand but I'm not sure if American policies actually cover much over here. I have to do a lot more research before I settle here for good, I think.

I am fully covered by my employer (and my dependents would be too, if I had any). The coverage is excellent. I go to one of the nicer private hospitals, and my insurance almost always covers everything. No complaints here.

US Medicare covers NOTHING outside the US.

[thaiericsweden]

A few points that members should note when looking at local health insurances.

Cheaper overall premiums with corresponding lower coverage limits.

Health cover benefits are very generous when compared to premiums charged.

Many plans include a range of sub-limits to costs of treatment, such as Surgeons Fees, Hospital General Expenses, Room and Board, Ambulance….etc.

Premium rates do not reflect the actual cost of insuring persons at each age group because premium rates are not adjusted annually to compensate for changing medical costs and inflation.

Renewal Premium rates are not guaranteed. If you are a healthy person with no claims, you can expect to pay the same premiums as other persons in your age group.

If you are sick and have claims that have cost the insurance company money, your renewal premiums will be loaded by a percentage based on the size of the claims incurred by the Insurance Company.

These loadings can range anywhere from 10% to 25% by reputable companies and 10% to over 100% by a few less-than-reputable companies.

Loadings are applied each year as a factor to the basic premium you pay.

In later years, these loadings are compounded for each significant claim paid by the Insurance Co.

In a worst-case-scenario, you could be paying a higher premium for a "cheap" local health insurance than a million dollar plan from overseas.

Renewal of your Local Health Insurance is not automatic. The policy is year by year. If the Insurance Company decides not to renew your policy, they have the right to refuse renewal. This is allowed by the Office of Insurance Commission.

Local Health Insurances have time limits on travel outside of Thailand; some companies limit you to 90 days travel each year.

[HampiK]

Insurance i think is a very difficult part.

I also checked many insurance already. I have to agree with some posters, that you need an insurance for the bigger problems, lets say above 100'000 Baht.

I am lookiing for something still not to expensive (cheaper than 150$ per month) if cheaper then better, but should be a good one, and also make sure, that they would give you a renew if you become 60 and older.

I checked a few out.. but it seems very complicated.. Good for me i still have a few years (5) till i need this.. but want to start look, so i can put this in my calculation.

[bbradsby]

Thanks to the OP, great subject!

Currently looking for a healthcare solution, and am considering self-insurance/no insurance depending on your definition. In the US, as an entrepreneur, am paying USD $900/month for me, wifey & 10 year old son... all healthy. ridiculous. So, if I put 12 months' worth in an interest-bearing instrument now, and pay half $500/month, I could cover pretty much anything via cash payment to a local expat hospital. I call that self-insured, with a bonus to my son when I head off to that great Temple BBQ. And NO buying into the insurance racket.

Few other items:

First, the best insurance here will still not get you physically to a hospital with Western-spec cardiologist on-time if you have a heart attack, based on emergency response system here and the typical traffic. No one here can or works to get out of the way of an ambulance! If this is a risk for you, address it as best you can!

Second, if you do have a motorbike accident and go to a local clinic, be sure to track your wounds' progress daily - I almost lost a leg or worse due to some miniscule gravelly bits not being completely cleaned out from a low-speed biff. Can you say gangrene?

Best,

-bruce bradsby

[jazzbo]

Your definition of self-insured is essentially betting against the house -- who in large measure are the actuaries at Lloyd's of London... You are betting that you can build up a large enough reserve to cover you and your family before any eventuality strikes...

Excellent coverage for three 60 year-olds in Thailand is available for a lot less than $900 per month let alone your health family... maybe you should re-assess your coverage.