Expat Insurance Poll

[dantilley]

The lack of interest in this thread as well as others that have been put up on the subject suggests to me that most expats are

1.Employed by a firm that offers them insurance (or have a wife in government service)

2.Young guys that are never going to get ill or

3.Old guys that can't afford insurance.

The problem is that these groups will never answer a poll like this.

I agree with Chiang Mai's remarks 100% but then again I like to gamble.

I fit into #1 and still answered it.

[JLCrab]

Once again from NHS website:

The right to seek NHS-funded medical care does not extend beyond Europe.

However, if you want to have treatment outside Europe, such as in Canada or the USA, speak to your local health commissioner about an individual funding request (IFR). It is up to the commissioner to decide whether you can get treatment outside Europe. If this is something you want to do, contact your local PCT.

[chiang mai]

Once again from NHS website:

The right to seek NHS-funded medical care does not extend beyond Europe.

However, if you want to have treatment outside Europe, such as in Canada or the USA, speak to your local health commissioner about an individual funding request (IFR). It is up to the commissioner to decide whether you can get treatment outside Europe. If this is something you want to do, contact your local PCT.

Agreed, I had taken it as understood that a UK citizen over the age of 65 living in Thailand, aka moi, would need to return to the UK for treatment.

When I wrote earlier that residency is not an issue I meant from the perspective of being allowed access to free NHS services. If a UK citizen under the age of 65 has been absent from the UK for more than six months there is a six month wait upon their return before free access is once again granted, over age 65 folks are exempt from that wait.

[jpinx]

The lack of interest in this thread as well as others that have been put up on the subject suggests to me that most expats are

1.Employed by a firm that offers them insurance (or have a wife in government service)

2.Young guys that are never going to get ill or

3.Old guys that can't afford insurance.

The problem is that these groups will never answer a poll like this.

I agree with Chiang Mai's remarks 100% but then again I like to gamble.

Add....

Guys who choose to self-insure

[JLCrab]

Some treatments can be readily handled following a return to the UK. Some emergency situations cannot be so dealt with and would require extensive hospitalization and medical care before one could be fit to travel. Especially when one is past the age of 65.

Then, upon arrival in UK, it seems you go into the queue for your (maximum) 18 week non-emergency waiting time. Of course, if you had an emergency while(st) in Thailand, you wouldn't be able to return to UK anyway. Sounds like fun.

[chiang mai]

THB 3,528,000 (at 49 per Pound) buys a lot of in country emergency health care where return visits can't be planned due to time constraints.

[JLCrab]

To the poster at #4 the standardized Blue Cross Medicare supplement programs including the most expensive one 'K' offered in my state says the following:

Foreign Travel (not covered by Medicare)

Medically necessary emergency services beginning during the first 60 days of each trip outside the U.S.A.

From above: Time constraints you say? NHS defines life threatening emergencies as

• loss of consciousness
  
• acute confused state and fits that are not stopping
  
• persistent, severe chest pain
  
• breathing difficulties
  
• severe bleeding that cannot be stopped
  

Even the hospitals in Thailand, although they will take an emergency patient, in fairly short order start to wonder from where comes the payment for this emergency patient. True -- 3+ million baht can go a long way for minor stuff - but at your age (and mine) and up that means one major event is covered for the rest of your life from that 3.5 million wad. BUPA platinum has coverages ranging from 2 million to 5 million per incident with no annual or lifetime limit.

And even for non-emergency but critical treatment, you're going to pass by all those excellent hospitals in Chiang Mai on the way to the airport for that long flight back to UK so you can go home to wait for your free non-emergency treatment in UK?

[chiang mai]

To the poster at #4 the standardized Blue Cross Medicare supplement programs including the most expensive one 'K' offered in my state says the following:

Foreign Travel (not covered by Medicare)

Medically necessary emergency services beginning during the first 60 days of each trip outside the U.S.A.

True -- 3+ million baht can go a long way for minor stuff - but at your age (and mine) and up that means one major event is covered for the rest of your life from that 3.5 million wad. BUPA platinum has coverages ranging from 2 million to 5 million per incident with no annual or lifetime limit.

And even for non-emergency but critical treatment, you're going to pass by all those excellent hospitals in Chiang Mai on the way to the airport for that long flight back to UK so you can go home to wait for your free non-emergency treatment in UK?

It would depend on the scenario that's presented, low priority/high impact, high priority/low impact and that sort of thing. For a cardiac PCI I would do that in country, for a hip replacement (for example) I would also remain in country - both those treatments are routine mechanical processes from a medical standpoint. But given an unclear diagnosis of a condition, one that required knowledge/thinking expertise rather than mechanical expertise I would likely return to the UK. I have a condition at present that has been the subject of medical research/testing here in CM for the past year and we are no closer to a diagnosis, since it is not life threatening but is becomming serious, that could potentially be a candidate for a UK return.

I think the bottom line with all of this is that folks need to make an informed decision at the outset and model in all the possible scenario's, having made your choice whether to pay for insurance or not, be prepared to live with your decision and please, no whinging later if you made the wrong choice. For my part I would make the same decision again and in that respect I'm a satisfied customer of the no insurance group.

[JLCrab]

So I will end this friendly chat by saying that as of today you are "a satisfied customer of the no insurance group." But in my humble opinion, you are ill prepared for someone choosing to live in Thailand for what might happen tomorrow and/or in the many years to come.

[chiang mai]

And in addition to no whinging if it doesn't work out, a second aspect should be, no trying to convince people that only your own solution is the right one, because we're all different. (unless of course you happen to work in the inurance industry, in which case it's OK to try to scare the bejesus out of everyone, just to make them buy your product).

[JLCrab]

We're all different. Yes. Except an overwhelming majority of the population would tend to agree that health insurance is a good and reasonably priced thing. I don't work in the insurance industry. I just studied math and probability.

November 29, 2012

Majority in U.S. Still Satisfied With Own Healthcare Costs

Medicare/Medicaid recipients increasingly satisfied; private insured less so

by Jeffrey M. Jones

PRINCETON, NJ -- Fifty-nine percent of Americans are satisfied with the total cost they pay for healthcare, precisely in the middle of the 54% to 64% range in satisfaction Gallup has found since 2001.

[chiang mai]

Except an overwhelming majority of the population would tend to agree that health insurance is a good and reasonably priced thing.

In America perhaps you could find such sentiment, but I challenge you to produce evidence of the same sentiments in the UK.

[JLCrab]

Right.

Record fall in 'NHS satisfaction'

By Nick Triggle

Health correspondent, BBC News

Public satisfaction with the NHS has dropped by a record amount, the British Social Attitudes Survey suggests.

The poll indicates satisfaction fell from 70% to 58% last year - the largest annual drop since it started in 1983.

And that plus your 3+ million baht lifetime treatment reserve in Thailand is what you choose to rely upon?

[chiang mai]

Right.

Record fall in 'NHS satisfaction'

By Nick Triggle

Health correspondent, BBC News

Public satisfaction with the NHS has dropped by a record amount, the British Social Attitudes Survey suggests.

The poll indicates satisfaction fell from 70% to 58% last year - the largest annual drop since it started in 1983.

And that plus your 3+ million baht lifetime treatment reserve in Thailand is what you choose to rely upon?

And that has what to do with the your provision of proof that people think universally that health insurance is a great thing? Doubtless I could Google for an half an hour and find an article that talked about Americans disatisifaction with Blue Cross etc. and how the standards have fallen but thats not relevant to the debate either!

[richard_smith237]

A Medivac and 10 day stay in a Singapore Hospital cost my insurance company approximately US$50,000

I was covered personally by BUPA, but also through work - The Work Insurance handled the payments.

So, I can't say I'm ahead of the game, but I might not have quick access to such funds if required in such an emergency.

For My Wife and I (in our 30's - with BUPA) the insurance is not for the the small things we can afford, it's for the unforeseen and unpredictable major disaster which may or may not cross our paths.

[chiang mai]

A Medivac and 10 day stay in a Singapore Hospital cost my insurance company approximately US$50,000

I was covered personally by BUPA, but also through work - The Work Insurance handled the payments.

So, I can't say I'm ahead of the game, but I might not have quick access to such funds if required in such an emergency.

For My Wife and I (in our 30's - with BUPA) the insurance is not for the the small things we can afford, it's for the unforeseen and unpredictable major disaster which may or may not cross our paths.

I agree, the scenario is very different between 30 and 60 year olds, the need for the insurance and its cost are very different. Another aspect is that younger people might not be expected to have access to sufficient funds to cover such an emergency, as you point out, whilst many people of my age do. It's a horses for courses thing.

[jpinx]

Why does this page say

(48 member(s) have cast votes)

but at the same time it says

1. Life insurance (0 votes [0.00%])
   Percentage of vote: 0.00%
   
2. Medical care (1 votes [25.00%])
   Percentage of vote: 25.00%
   
3. Other (please state in post below) (0 votes [0.00%])
   Percentage of vote: 0.00%
   
4. None (3 votes [75.00%])
   

Am I missing something ?

[richard_smith237]

A Medivac and 10 day stay in a Singapore Hospital cost my insurance company approximately US$50,000

I was covered personally by BUPA, but also through work - The Work Insurance handled the payments.

So, I can't say I'm ahead of the game, but I might not have quick access to such funds if required in such an emergency.

For My Wife and I (in our 30's - with BUPA) the insurance is not for the the small things we can afford, it's for the unforeseen and unpredictable major disaster which may or may not cross our paths.

I agree, the scenario is very different between 30 and 60 year olds, the need for the insurance and its cost are very different. Another aspect is that younger people might not be expected to have access to sufficient funds to cover such an emergency, as you point out, whilst many people of my age do. It's a horses for courses thing.

I'm not so sure.. I have access to sufficient funds... But not when I'm incapacitated and in dire need of a medivac jet and on the dark side of a remote island.

Of course, for those who do not travel to remote locations this is a non-issue.

But, I have a friend who was struck with a debilitating illness. A stay in Bumrungrad ran into excess of 4MB (she was there for a number of months).

Insurance is invaluable for times like this.

How many people really have access to large amounts of money at the drop of a hat ?

I can see the logic in a lot of older people not paying what may seem extortionate premiums for cover, however I do also suspect that there is an element of risk involved.

The alternative to adequate insurance may be to have money sitting in a bank (i.e. in excess of 1 MB and sellable assets) and someone trusted to oversee you are treated adequately and there are no delays due to potential questions of whether or not you have insurance or sufficient funds.

You may not be conscious... A little card that says BUPA (or any other) might make a lot of difference at the time...

[qdinthailand]

i have Medicare supplement insurance with blue Cross from the USA which covers out of USA medical as if it was covered by Medicare in the USA

really? what's your co-pay? premiums and deductible?

[chiang mai]

A Medivac and 10 day stay in a Singapore Hospital cost my insurance company approximately US$50,000

I was covered personally by BUPA, but also through work - The Work Insurance handled the payments.

So, I can't say I'm ahead of the game, but I might not have quick access to such funds if required in such an emergency.

For My Wife and I (in our 30's - with BUPA) the insurance is not for the the small things we can afford, it's for the unforeseen and unpredictable major disaster which may or may not cross our paths.

I agree, the scenario is very different between 30 and 60 year olds, the need for the insurance and its cost are very different. Another aspect is that younger people might not be expected to have access to sufficient funds to cover such an emergency, as you point out, whilst many people of my age do. It's a horses for courses thing.

The alternative to adequate insurance may be to have money sitting in a bank (i.e. in excess of 1 MB and sellable assets) and someone trusted to oversee you are treated adequately and there are no delays due to potential questions of whether or not you have insurance or sufficient funds.

Maybe that's why I'm so relaxed about all of this, I do have substantial cash resources.

[JLCrab]

I guess this is a point of disagreement: I and apparently the actuaries at BUPA Thailand do not think that a 3 million baht reserve is sufficient for someone past age 60 for the rest of their lives even in Thailand as BUPA Platinum would cover multiple such incidents per year with no lifetime limit.

And it took about 3 seconds not 30 minutes on Google to find what your fellow Brits think of NHS.

[chiang mai]

I guess this is a point of disagreement: I and apparently the actuaries at BUPA Thailand do not think that a 3 million baht reserve is sufficient for someone past age 60 for the rest of their lives even in Thailand as BUPA Platinum would cover multiple such incidents per year with no lifetime limit.

And it took about 3 seconds not 30 minutes on Google to find what your fellow Brits think of NHS.

Nobody said the THB 3.5 mill was reserves, except you, the money is savings from 12 years of not paying insurance premiums but you knew that!

And why attack the NHS again, it has no relevance to this debate!!

Again, where's your proof that all people in countries other than north america love health insurance and think it's really a great idea? You and your country men are conditioned into having it, it must be galling to know there are others who don't need to do the same and/or who are in a position to pay directly for their health care needs and who don't have to pay insurance premiums.

Your posts are becomming tiresome and very troll like, you're not trying to debate the pro's and cons of buying health insurance but instead you're trying to denigrate those who chose not to hence I'm out of this thread.

[qdinthailand]

To the poster at #4 the standardized Blue Cross Medicare supplement programs including the most expensive one 'K' offered in my state says the following:

Foreign Travel (not covered by Medicare)

Medically necessary emergency services beginning during the first 60 days of each trip outside the U.S.A.

From above: Time constraints you say? NHS defines life threatening emergencies as

• loss of consciousness
  
• acute confused state and fits that are not stopping
  
• persistent, severe chest pain
  
• breathing difficulties
  
• severe bleeding that cannot be stopped
  

Even the hospitals in Thailand, although they will take an emergency patient, in fairly short order start to wonder from where comes the payment for this emergency patient. True -- 3+ million baht can go a long way for minor stuff - but at your age (and mine) and up that means one major event is covered for the rest of your life from that 3.5 million wad. BUPA platinum has coverages ranging from 2 million to 5 million per incident with no annual or lifetime limit.

And even for non-emergency but critical treatment, you're going to pass by all those excellent hospitals in Chiang Mai on the way to the airport for that long flight back to UK so you can go home to wait for your free non-emergency treatment in UK?

And I have to ask - what's your deductible, what's your co-pay for this healthcare?

Outside the U.S., my Aetna plan only covered 50% of the costs of such life-threatening health care (absolutely nothing for chronic condition treatments, serious but non-life-threatening illnesses or accidents like an emergency room visit for a broken arm or leg). A 50,000 Euro medical emergency in Europe - say a heart attack - would have cost me 25,000 Euro out of pocket. What a great insurance plan!

That's what my employer provided - with me sucking up the first $1000 - my deductible - and having nearly $100 deducted from the pay check each month for my 'fair share' of the premiums.

Every U.S. employer providing health insurance is playing games with coverages and costs. In case you haven't noticed, typical workers earnings are flat for nearly a decade now, while health care costs to the employee are continually climbing.

America's for-profit corporate health system, and insurance coverage provided by employers, is a dysfunctional, expensive way of providing health care. For the corporate health care industry and their shareholders/investors - its a great system. Oh, and if you are wealthy and can afford insurance payments. But if you are uninsured, poorly paid - like nearly all Walmart workers, restaurant and fast food workers, minimum wage employees, etc - YOUR HEALTH CARE SUCKS!!!

[craigt3365]

I guess this is a point of disagreement: I and apparently the actuaries at BUPA Thailand do not think that a 3 million baht reserve is sufficient for someone past age 60 for the rest of their lives even in Thailand as BUPA Platinum would cover multiple such incidents per year with no lifetime limit.

And it took about 3 seconds not 30 minutes on Google to find what your fellow Brits think of NHS.

Nobody said the THB 3.5 mill was reserves, except you, the money is savings from 12 years of not paying insurance premiums but you knew that!

And why attack the NHS again, it has no relevance to this debate!!

Again, where's your proof that all people in countries other than north america love health insurance and think it's really a great idea? You and your country men are conditioned into having it, it must be galling to know there are others who don't need to do the same and/or who are in a position to pay directly for their health care needs and who don't have to pay insurance premiums.

Your posts are becomming tiresome and very troll like, you're not trying to debate the pro's and cons of buying health insurance but instead you're trying to denigrate those who chose not to hence I'm out of this thread.

Let's not forget the 17% or so of Americans who do not have health insurance. My experience with insurance in the US is a mixed bag. Most I know do have it, but the hassles lately of taking advantage of it are getting worse and worse. Especially if you are on Medicare. Private insurance is usually much better, but very expensive. Usually some 600-900 USD per month and up.

[PoorSucker]

Flame removed

[JLCrab]

Even if it may not prove to be the least expensive way to go, if one buys insurance from one of the reputable insurers here in Thailand (when one is still eligible to do so) and is forthright in the application process, it certainly is the easiest way to go. No worrying about cash deposit or payments to the hospital at critical times, no winging it back to one's home country for free treatment, no looking at the clock and saying if I spend one more day in or out of the country my coverage is void, etc. And no worrying that one might turn out to be one of the very unfortunate very few who experience some catastrophic illness that might exceed one's cash reserves.

Wealthy people often buy the insurance and pay the premiums (or their business managers do) since it is such a trifle compared to their net worth and/or annual income and compared to the potential gain should the unfortunate occur. And they do so even in countries where healthcare is provided free by their government assuming they are willing to wait. Thailand hospitals have a very good inflow of patients from those 'free healthcare' countries as people in some cases are just not willing to wait or their condition makes such wait perilous.

[longwalker]

Being under 60, this does not apply, but the fact that I suspect many years of high-risk living may be catching up on me pushes me to think that perhaps I would break even (or better) if I had health insurance. I have had none for the last 20 years. I just forked out several thousand baht on lab tests today. I'm keen to learn who has the most economical, yet comprehensive coverage. If you are healthy, it is not at issue. I no longer am, it would seem.

[JLCrab]

One thing you can do is to read the application form for any of the insurers in Thailand. They will ask many questions that will require detailed answers as to your medical history.

The application form for e.g. BUPA Thailand Platinum can be downloaded from here:

http://bupa.co.th/en/individuals/customer-care/form-download.aspx

[mackes]

It seems that most of the votes have been canceled, only 6 left.

Can everbody who polled please reenter their data?

You do this by deleting your vote and reenter it.

[DavidChristensen]

I self insure and have done so sucessfully for the past ten years, that despite having paid a couple of not insignificant hospital bills, one of which was for heart surgery which cost under 200k baht at Bumrungrad four years ago, not the 1 mill. you mention! When it comes to assessing how much I have paid out for health care treatment vs how much I would have paid in premiums, I am well ahead of the game and will stay that way regradless, insurance in general preys on fear and health insurance is no different.

Insurance is a way of allowing someone who could not afford the financial impact of an event to be able to afford this, by means of 'sharing' that risk.

When treasure ships brought back precious cargo to Europe, the average loss was one in every four would sink. If you were the owner or the funder of such a venture, the average loss ratio of 25% was something you could live with. But the problem was if it happened to be your ship that sank, that year your loss was 100%. Good in theory, but tough in practice - and if you were unlucky enough for that to happen two years in a row you could easily be in trouble. So the owners got together and formed a cartel that would average the risk by creating a 'pool' of funds ... with each owner contributing 25% of the value of their cargo every year into this pool (plus a bit more to cover extremely bad years) the uncertainty of a crippling single loss was exchanged for the certainty of a relatively predictable annual cost.

This is still the basic principle involved - and it embeds the understanding that of the four contributors to the pool, assuming one ship sinks it takes all four contributions to be able to repay the one who lost their ship. Does that mean one winner, and three losers? One who profits from the arrangement and three who paid their dues but received nothing? Not at all - they all received the same value and they all came out with 75% of the value of their ships each year.

I am not against the concept of self-insurance, and in fact this is sensible if you can afford to bear the risk yourself. But your argument needs to be seen in light of the facts that:

- medical treatment costs can and regularly do become 1, 2, and even 3 million baht or the equivalent. If you think you are self-insuring but you are not in a position to put your hands on this sort of money and pay it without causing yourself a major problem, then you are only deceiving yourself - that's not self-insurance, it's non-insurance and no different from Russiam Roulette with longer odds

- your comment about being 'well ahead of the game' sees insurance as a 'game' where there are 'winners' (those who receive a claim) and 'losers' (those who pay their premiums and don't make a claim). In this 'game' theory it takes many losers to make one winner. But I don't think that is at all the way insurance should be seen. It's a way of exchanging an uncertain but possibly catastrophic loss into a certain and relatively affordable recurring cost - there are no winners and losers, and those who don't make a claim receive just as much benefit during their term of cover as those who do make a claim

- insurance was/should never be seen as anything other than a partial recompense for a loss - never something to profit from in any way

Insurance companies charge premiums that cover their anticipated cost of claims, their administration margins, their reserves as a way of ensuring their ongoing financial stability, and in most cases their profit margin. If you can afford to self insure then you save on the cost of paying someone else to do this - but you take on the risk yourself.

I have very wealthy friends who once asked for my honest answer on whether they should have health insurance. I said - hypothetically if you didn't have health insurance and went to the doctor this afternoon and were told you needed serious heart surgery immediately, without which you would be dead within 24 hours - at a cost of US$250,000, what would you do? (We were in the US at the time).

The answer was of course have the surgery ... obviously not happy to have to write out a check for $250k but it would be no problem and done without hesitation.

My response was the same as it still would be now - if it was me, I would go home, talk to my family, and try and put my affairs in order as much as I could and try to savor my final 24 hours - because without health insurance there was no way I could have the life-saving medical treatment. For me, health insurance is a necessity - for them self-insurance quite sensible.

But I would question whether for you, what you think is self-insurance is not treu self-insurance at all but in fact more like bravado and ignoring the true risk with the same logic that says because you've never been diagnosed with cancer, for example, you never will.