Implications of New Government Health Insurance Policy in Chiang Mai

[Thailand]

Mentioned the scheme to a guy I know who does not have insurance , not particularly wealthy,and not in the best of health.

His response was "I wouldn't be seen dead in a government hospital" - classic!

[Frank James]

#53"...after age 70 they can refuse to insure you at any price. This has been my experience (using Bupa)...."

I'm surprised that, your having been a BUPA subscriber, do not understand that BUPA is one of the few insurance agencies that will ensure you for life; provided you enrolled before age 60(?) and continuously insured with them each year. Too late for you now FJ; but you are misleading those who, regardless of cost, want lifetime coverage.

For those that do, why not check their site or pay a visit to their Chiangmai office across from Wat Yed Yod.

I had BUPA coverage for years well into their lifetime coverage but threw in the towel at the growing expense of it all.

Try here:

http://www.thaivisa.com/forum/topic/625739-health-insurance-for-70-s/

I didn't mean to mislead anyone. I didn't arrive here until I was 64, therefore was ineligible for their lifetime coverage. Perhaps I should have mentioned that, but the post was already too long. The first premium year was about 62,000 baht. This was for the so-called "platinum" plan. The second year it jumped about 10,000 baht, and in that year I made a modest claim against a week I had spent in a local hospital. They were very fussy over the paperwork, to the point where I had to enlist the help of my agent, who very graciously assisted me with the daunting forms, for free. The next year, they asked for an annual premium of 82,000 baht. That's when I chose to bail out.

I know that I am actuarily speaking, at almost 69 years of age, a "bad risk" for an insurance company. No matter how well I try to take care of my health, sooner or later I will need to file a claim. I have nothing against Bupa, they are in business to make money, not to pay it all out in claims.

This new program is better than nothing, and I am ready to enroll. And judging by all of the interest in this thread, I will find a line of people already there when I show up.

Chok dee to all, even the rich ones who will never need such a service. We're all on different cars, but on the same train.

[Mike45]

#53"...after age 70 they can refuse to insure you at any price. This has been my experience (using Bupa)...."

I'm surprised that, your having been a BUPA subscriber, do not understand that BUPA is one of the few insurance agencies that will ensure you for life; provided you enrolled before age 60(?) and continuously insured with them each year. Too late for you now FJ; but you are misleading those who, regardless of cost, want lifetime coverage.

For those that do, why not check their site or pay a visit to their Chiangmai office across from Wat Yed Yod.

I had BUPA coverage for years well into their lifetime coverage but threw in the towel at the growing expense of it all.

Try here:

http://www.thaivisa.com/forum/topic/625739-health-insurance-for-70-s/

I didn't mean to mislead anyone. I didn't arrive here until I was 64, therefore was ineligible for their lifetime coverage. Perhaps I should have mentioned that, but the post was already too long. The first premium year was about 62,000 baht. This was for the so-called "platinum" plan. The second year it jumped about 10,000 baht, and in that year I made a modest claim against a week I had spent in a local hospital. They were very fussy over the paperwork, to the point where I had to enlist the help of my agent, who very graciously assisted me with the daunting forms, for free. The next year, they asked for an annual premium of 82,000 baht. That's when I chose to bail out.

I know that I am actuarily speaking, at almost 69 years of age, a "bad risk" for an insurance company. No matter how well I try to take care of my health, sooner or later I will need to file a claim. I have nothing against Bupa, they are in business to make money, not to pay it all out in claims.

This new program is better than nothing, and I am ready to enroll. And judging by all of the interest in this thread, I will find a line of people already there when I show up.

Chok dee to all, even the rich ones who will never need such a service. We're all on different cars, but on the same train.

Yes I believe we are all on the same train. I also believe that most nations understand that and that is why governments create medical plans for people over 65. I don't know of any insurance company that wants to take the risk on someone over 65. I think they would have to increase premiums exponentially to protect themselves and hopefully to get you to stop insuring with them.

[worgeordie]

BUPA don't want to know you when you reach 70,when you most likely need cover,

Insurance, Lawyers and Bankers,the fine print is always in their favour,they can wriggle out

of any situation.

regards Worgeordie

[Sheryl]

"The new Thai public health policy was designed to take care --- in consonance with other ASEAN countries --- of the healthcare needs of regional ASEAN partners."

Sorry but this is not my understanding of it at all.

It is designed to address a financial problem faced by already cash strapped public hospitals, namely that they have to write off care given to migrant workers and border residents who can't pay for it, and they do not get any subsidization from the government for this.

The solution that has been formulated is to require migrant workers to purchase a government health insurance card.

A similar problem exists regarding resident expats and, to a lesser extent, the odd tourist, and the government has had long-standing plans to address these issues likewise. Not because they want to "take care" of expats but because hosp[itals i nconscience can't turn away seriously ill people and in the absence of access to insurance, ineveitably some patients can't pay their bills and it becomes a financial problem for the hospitals.

For resident expats this will probably be solved through access to a government health insurance scheme that does not exclude based on age or pre-exisitng conditions (thus making it possible for everyone to be insured, not currently the case) and then linking extensions of stay to proof of insurance.

Due to some kind of mix up the scheme designed (and priced) for migrants went out with a directive that simply says "foreigner" and some (only some) hospitals have issued cards to resident expats at the migrant worker rate. This is going to rebound badly because the premium is too low for that group given their age etc, hopefully this will all get sorted out. In the interim, it's still the lesser of the evils for people who due to age and/or pre-existing conditions cannot get private insurance..and there are quite a few of these.

"It was NOT designed to help people from more economically-developed countries to get a nominally "free ride" when it comes to health care!"

It was not designed to give a "free ride" to anyone, it was as mentioned designed to do the opposite.

It is not the fault of expats that the directive was so worded as to provide the long needed and awaited government insurance plan for expats at an unrealistically low rate. What are they supposed to do? Staying uninsured is in neither their interests nor that of the Thai health system which will still end up shouldering the burden if catastrophic health care costs are incurred. They can't pay more than the 2,600 baht as that is all the hospitals are currently authorized to charge. I'm sure that most will have no problem paying a more realistic premium once one is set. In the meantime, getting the card where offered at the rate now offered is still the best choice for those who cannot obtain private insurance.

[Sheryl]

BUPA don't want to know you when you reach 70,when you most likely need cover,

Insurance, Lawyers and Bankers,the fine print is always in their favour,they can wriggle out

of any situation.

regards Worgeordie

Actually BUPA guarantees lifetime coverage if you enrol by a certain age and AFAIK they honor that. The premiums do rise with age, of course.

The big problem people have is that many arrive here already over the age they would have had to be to get that guarantee. BUPA (or any other insurer) cannot offer lifetime cover to people enrolling past a certain age, the viability of the scheme is based on expected gains during the earlier part of the insured period.

[Mapguy]

Thanks, Sheryl, for your post above. We are talking about basically the same problem that the Thai public health care system is experiencing.

One part of that problem happens to include foreigners migrating to Thailand from economically-developed countries, not poor neighbors. And I suggest that the former are a lot noisier and demanding as a group. Regrettably, the expectations and demands of this group, as opposed to migrants from adjacent countries, could possibly choke --- or at least create a lot of confusion at ---receiving medical facilities in areas like Chiang Mai and other more or less notorious locations. You did mention Udon Thani somewhere, I think. I would consider that a possible center, particularly for retired US enlisted troops from the Vietnam conflict days who now have grey locks, if they have any locks left !

You, I, and others wonder at the actuarial validity of this proposed solution, which has "lumped" groups together. We do seem to disagree on what is a free ride, but you seem to agree that the current fee is absurdly low. That is why I asked a question earlier about relative cost of health insurance plans which are available to foreigners.

I hope that you can continue to devote you attention to the "latest news" sorts of things and practical considerations.

Edited October 27, 2013 by Mapguy

[Mapguy]

One of the implications, not so far (I believe) mentioned, is that this program apparently does not include all foreigners. If that is true --- no proof of residence, no valid visa, perhaps no valid passport --- then there may still be a substantial problem with many foreigners "under the radar" in Chiang Mai and other popular haunts for foreigners.

[NancyL]

One of the implications, not so far (I believe) mentioned, is that this program apparently does not include all foreigners. If that is true --- no proof of residence, no valid visa, perhaps no valid passport --- then there may still be a substantial problem with many foreigners "under the radar" in Chiang Mai and other popular haunts for foreigners.

This is a valid point, although there are reports that the hospitals aren't looking too closely at visas. Certainly the embassies/consulates are more than willing to issue new/replacement passports to people on overstay, with (maybe) a comment that "you really ought to clear up your visa situation". (In all fairness it's not their responsibility to enforce Thai immigration law) So, it's rare to find people without valid passports, but those without valid visas are more common.

But there is an intermediate group -- those without visas who are here legally.

Currently, I'm encouraging some people I know who hop in and out of Thailand several times a year, always on 30 day visa exempt status to try to enroll at Nakorn Ping to see the reaction. They're in the country legally, just not with a visa. They have a believable story about why they'd want to buy the insurance -- I just have to convince them that it's worth their time to serve as a guinea pig.

Anyone else with this status care to volunteer as a guinea pig?

Edited November 14, 2013 by NancyL

[Mapguy]

Seems to me that those who "pop in and out" ought to be covered by travel insurance (which, understandably,normally has some time limit on the length of stay) or have some sort of private international insurance policy. For 90-day border runners and others gaming the system, I suggest that it is just that. Gaming the system. Why should they be eligible for Thai medical coverage?

There is also serious consideration of a "health insurance tax" on short-term visitors. That seems fair. I wouldn't, however, want to be the actuary that tries to deal with that except to say that a modest fee given the huge number of tourists might work out quite handily!

[fcgprg]

One of the implications, not so far (I believe) mentioned, is that this program apparently does not include all foreigners. If that is true --- no proof of residence, no valid visa, perhaps no valid passport --- then there may still be a substantial problem with many foreigners "under the radar" in Chiang Mai and other popular haunts for foreigners.

This is a valid point, although there are reports that the hospitals aren't looking too closely at visas. Certainly the embassies/consulates are more than willing to issue new/replacement passports to people on overstay, with (maybe) a comment that "you really ought to clear up your visa situation". (In all fairness it's not their responsibility to enforce Thai immigration law) So, it's rare to find people without valid passports, but those without valid visas are more common.

But there is an intermediate group -- those without visas who are here legally.

Currently, I'm encouraging some people I know who hop in and out of Thailand several times a year, always on 30 day visa exempt status to try to enroll at Nakorn Ping to see the reaction. They're in the country legally, just not with a visa. They have a believable story about why they'd want to buy the insurance -- I just have to convince them that it's worth their time to serve as a guinea pig.

Anyone else with this status care to volunteer as a guinea pig?

Why should someone who is here as a tourist be allowed to enrol in a scheme that is not designed for that purpose?. That would be one way for it to be ruined for everyone.

[LivinginKata]

A number of off topic exchanges have been removed.

[elektrified]

There is also serious consideration of a "health insurance tax" on short-term visitors. That seems fair. I wouldn't, however, want to be the actuary that tries to deal with that except to say that a modest fee given the huge number of tourists might work out quite handily!

Are you talking about the 500 Baht entry fee for tourists coming to Thailand that is being considered? "That seems fair." Are you an agent of the Thai government? You are the first person I have heard of who considers such a measure "fair". It will go straight into someones pockets.

[hellodolly]

If you are over 60 years of age, and enroll in a health insurance scheme in Thailand, the cost will rise significantly every year, and after age 70 they can refuse to insure you at any price. This has been my experience (using Bupa). I finally dropped it altogether, and just pay as I go for outpatient care and drugs at a local hospital. So far, so good, but any serious illness requiring hospitalization would be a major hit on scarce resources (mine).

If a plan is now made available to foreigners at such a reasonable cost, I am going to go for it. I know the care will be of the most basic kind, but it's better than being bankrupted. One shouldn't be made to feel like a lowlife leech for taking advantage of what is there. It's not taking anything away from anyone else.

I don't look at this as "Obamacare", and anyway, why is that now a dirty word to some? If you are fortunate enough to be retired here and have a good stack of money to live on, that's beautiful. Enjoy, enjoy, and God bless. But those who make snide comments about old guys hanging on by their fingernails, living in 40sm rooms, how we should all go back where we came from...that's a low shot, and you really need to look at yourself in the mirror. Live and let live.

I inquired at 69 years of age and was told that the best price would be $1,650 U S. I was also told that it was imposable to get after the age of 71 and there was a lot of conditions attached to it. I believe one of them was a $2,000 U S deductible. I see no harm in having a fall back plan at less than $100 U S a year. It may not and will not be the best but it is better than nothing.

As for Obama care being such a dirty word look at where it is coming from. A country helping Nations all over the world while it leaves it's own poor at the mercy of big business Insurance companies and other highly payed people. The facts are that the opposition is coming from the industry that is getting fat with out it. Also it is a plan still in it's infancy and does need a lot of work on. The people who are opposing it think it should not begin until it is perfect . Those same people had a chance to do it them selves in 1994 and 95 but chose to do nothing then and want it stopped now. Basically they are more interested in money than they are in people.

[Mapguy]

This move by the government has been anticipated:

http://www.chiangmaicitynews.com/news.php?id=2687