Health Insurance - Beware of Hidden Clauses

[Pormax]

This is just a warning to others about the sharp practise of a certain very large Thailand Insurance Company.. I don't think I am allowed to give the name of the company here.

I had taken out Health Insurance policies for my wife, daughter and myself and it is only now when one of us had to go to hospital that we found out that the cover implied is not all that it seems.

The agent never informed us that certain procedures, in fact the majority, only a percentage of between 5 and 75% can be claimed and there is a maximum amount to be paid out on each group of procedures. For instance our invoice from the hospital was 73,000B (after I got a 10% reduction with the hospital card) but the Insurance company only paid out 38,700B.

When the Insurance agent sold us the policies, we agreed on what was shown to us on the program on his computer and then signed the contract and paid the money. About two weeks later a large blue folder containing more than 50 pages was given to us.(all in Thai do not supply the policy in English) There on pages 43 -46 was a list of procedures and the percentages they would pay. in some cases it was as low as 10%. For instance for a cataract operation they will only pay 50%.

I can not be certain but........ my feelings are that the agents are not informed of this or told not to tell the customer so as not to lose sales.

The agent who sold the policies to us is a cousin of my wife's and he clearly knew nothing about this and when I asked him to check his computer program to see if there was anything on it regarding the percentage that can be claimed on any procedure, there was nothing there.

I am presently taking this appalling practise up with the Company but don't hold out too much hope that their sales policy will change.

In the UK I feel this sort of practice would end up in the courts but TIT.

[churchill]

I have a policy with AIA , very difficult to read the fine print , as after numerous requests nothing seems available ..perhaps only in Thai /

[Sheryl]

Do NOT take out any policy which is not available to you to read through in English. The major insurers in Thailand all provide policies i nEnglish AFAIK. BUPA provides all documentation in both English and Thai.

I find the idea of paying a fixed percentage (rather than a baht limit) for specific surgeries etc very bizarre. Most policies have some sort of limit on what they will pay for surgery, doctors fees, hospital room etc but a straight percentage of whatever was charged I have not heard of before and it hardly seems to make sense, since the insurance company would end up paying vastly different amounts for the same procedure depending on the hospital/doctor used. Are you sure you read this correctly? Most policies will list a maximum benefit for surgery and then have a surgical schedule will indicates, for each type of surgery, what percent of the maximum benefit they will reimburse. For example, if the maximum benefit is 1 million baht, they will pay up to 500,000 for anything listed as 50%. It does not mean they will pay 50% of what the hospital charges you.

[Pormax]

Do NOT take out any policy which is not available to you to read through in English. The major insurers in Thailand all provide policies i nEnglish AFAIK. BUPA provides all documentation in both English and Thai.

I find the idea of paying a fixed percentage (rather than a baht limit) for specific surgeries etc very bizarre. Most policies have some sort of limit on what they will pay for surgery, doctors fees, hospital room etc but a straight percentage of whatever was charged I have not heard of before and it hardly seems to make sense, since the insurance company would end up paying vastly different amounts for the same procedure depending on the hospital/doctor used. Are you sure you read this correctly? Most policies will list a maximum benefit for surgery and then have a surgical schedule will indicates, for each type of surgery, what percent of the maximum benefit they will reimburse. For example, if the maximum benefit is 1 million baht, they will pay up to 500,000 for anything listed as 50%. It does not mean they will pay 50% of what the hospital charges you.

I can assure you that the Company that sold the policy is extremely large, a very major player in the Insurance world in Thailand. I totally agree with you about a fixed percentage, this is ridiculous. For certain procedures there should be a maximum as you quite rightly pointed out, different hospitals have their own prices structure, some much higher than others. I have been making some phone calls enquiring about Standard Lens Cataract operation prices and they range from 20,000B including one night stay in hospital to 38,000B and no stay in Hospital. So the Company should take the average price and set this as a limit of claim.

Yes I am sure that what I stated is correct. I have the invoice and how they worked it out, in front of me.

A whole lot of items on the bill from the hospital were added up and placed in one category for a 50% reduction in the claim , these were: Drugs administered in hospital and to take home. Medical supplies!! Laboratory investigation and Pathology, Diagnostic Radiotheraphy - x-rays and CT scan.Operating room, Operating room equipment and packaged medical fees!!.

All the above were reduced by 50%. and then made sure did not exceed the limit allowed on the policy for that category.

I was also charged 450B for meals and yet had none as I left the hospital before lunch and was not offered breakfast. I will take this up with the hospital when I go back for a follow up appointment.

What does surprise me is that they do not seem to have any realistic idea of how much some procedures cost now and therefore their limits are not high enough. For example take x-rays. Now very rairly are the old type x-rays taken instead it is a CT Scan which costs on average 15,000B a time.

Witout doubt though it is generally thought that Thailand is a much cheaper place to live due to low cost of wages and infrastructure, Health Insurance, for what you get is very expensive.

[rhythmworx]

All insurance companies worldwide, no matter what the insurance is for may it be a car a house etc... are all thieving <deleted>.

[Pormax]

All insurance companies worldwide, no matter what the insurance is for may it be a car a house etc... are all thieving wanke_rs.

You've hit the ail on the head, but it seems some are much worse than others.

I would also include many, maybe not all, private Hospital services.

In these establishments it is not the care of the patient that is the priority but about making as much money as possible and meeting targets for the shareholders and directors of the company who owns them..

That is why the NHS service no matter it's faults, and there are many, is is a far superior service.

[Sheryl]

Insurance is indeed comparatively expensive for what you get in Thailand, because the pool of insured people is so small (as Thais have universal coverage already).

Most insurance companies offer a wide range of policies, you may have gotten the least expensive premium option. Have you reviewed the full range of policies available? And did you personally contact the company to see about getting a policy in English? I am not aware of any "major players" in health insurance in Thailand which do not have policy booklets in English. First time I have ever heard of such a thing. There are some companies that basically do life insurance and also have health policies, which are usually very scanty in what they cover, that this would be true of but I am not aware of any primary health insurance providers like that.

[Pormax]

Insurance is indeed comparatively expensive for what you get in Thailand, because the pool of insured people is so small (as Thais have universal coverage already).

Most insurance companies offer a wide range of policies, you may have gotten the least expensive premium option. Have you reviewed the full range of policies available? And did you personally contact the company to see about getting a policy in English? I am not aware of any "major players" in health insurance in Thailand which do not have policy booklets in English. First time I have ever heard of such a thing. There are some companies that basically do life insurance and also have health policies, which are usually very scanty in what they cover, that this would be true of but I am not aware of any primary health insurance providers like that.

The answer to your question is YES. I have comtacted and spoke to a number of Managers including the head office in Bangkok,regarding getting the policy in English and the answer is the same. No we do not have.

I think though perhaps you are right about the Company mainly dealing with life Insurance. Thai Life, oops I have said the name, is a massive Company that has been going more than 50 years with local offices in most towns or cities as they like to call them..

This Company also has a VIP Health policy and I recently asked about upgrading to this. I abandoned this enquiry when yet again nothing was available in English and they could produce nothing to show me what clauses would be on this policy. So yes they have varying degrees of cover, but you don't know what you are actually getting until you have signed up and paid the fee.

My only concellation is that I have got the money back from my premiums this year and will still be in pocket after my next premium is paid. Ok I paid out of my own pocket a further 60,000B for which the Company would not pay but it would have been 50,000B more if I has no cover.

I will now carefully consider what hospital I go to if I need medical treatment in the future. I went to the Bangkok Hospital in Korat and without doubt they are the most expensive in my area.

[Sheryl]

Life insurance companies are usually best avoided when it comes to health insurance. Stick to a company that makes health insurance their primary business.

BUPA is the largest health insurance co in Thailand, all the hospitals are very familiar with it. All relevant material is bilingual Thai and English. Reimbursement for specific procedures is set at a percentage of a total maximum amount allowed per illness event, not a percentage of what you are billed. That said, need to carefully consider as many of the plans have coverage levels which are too low to be realistic. Not worth considering cover of less than 2 million baht/episode and preferrably the 5 mill which is their highest level of cover.

[Sheryl]

Life insurance companies are usually best avoided when it comes to health insurance. Stick to a company that makes health insurance their primary business.

BUPA is the largest health insurance co in Thailand, all the hospitals are very familiar with it. All relevant material is bilingual Thai and English. Reimbursement for specific procedures is set at a percentage of a total maximum amount allowed per illness event, not a percentage of what you are billed. That said, need to carefully consider as many of the plans have coverage levels which are too low to be realistic. Not worth considering cover of less than 2 million baht/episode and preferrably the 5 mill which is their highest level of cover.

[Sheryl]

P.S. By far the best hospital in the Issan area is Khon Khaen University Hospital, which being a government hospital entails some red tape but has rates just a fraction of the private hosps, along with a much higher level of expertise. It is a major teaching hospital. http://www.md.kku.ac.th/en/index.php?index_page=med_serv&page=hospital

[Suradit69]

Health Insurance - Beware of Hidden Clauses

There on pages 43 -46 was a list of procedures and the percentages they would pay. in some cases it was as low as 10%. For instance for a cataract operation they will only pay 50%.

So they weren't hidden, but the effort to read through it all was too much for you. Surely even in the enchanted UK Nanny State you're expected to request something in writing before signing a contract or handing over payment??

In the UK I feel this sort of practice would end up in the courts but TIT.

I recall having BUPA (British United Provident Association) policies for a number of years and having to wade through pages of information, codicils, limitations, stipulations to find what they would pay for various procedures, but I guess that's how Brits conduct their business as well.

Edited March 1, 2014 by Suradit69

[Card]

Insurance is indeed comparatively expensive for what you get in Thailand, because the pool of insured people is so small (as Thais have universal coverage already).

Most insurance companies offer a wide range of policies, you may have gotten the least expensive premium option. Have you reviewed the full range of policies available? And did you personally contact the company to see about getting a policy in English? I am not aware of any "major players" in health insurance in Thailand which do not have policy booklets in English. First time I have ever heard of such a thing. There are some companies that basically do life insurance and also have health policies, which are usually very scanty in what they cover, that this would be true of but I am not aware of any primary health insurance providers like that.

The answer to your question is YES. I have comtacted and spoke to a number of Managers including the head office in Bangkok,regarding getting the policy in English and the answer is the same. No we do not have.

I think though perhaps you are right about the Company mainly dealing with life Insurance. Thai Life, oops I have said the name, is a massive Company that has been going more than 50 years with local offices in most towns or cities as they like to call them..

This Company also has a VIP Health policy and I recently asked about upgrading to this. I abandoned this enquiry when yet again nothing was available in English and they could produce nothing to show me what clauses would be on this policy. So yes they have varying degrees of cover, but you don't know what you are actually getting until you have signed up and paid the fee.

My only concellation is that I have got the money back from my premiums this year and will still be in pocket after my next premium is paid. Ok I paid out of my own pocket a further 60,000B for which the Company would not pay but it would have been 50,000B more if I has no cover.

I will now carefully consider what hospital I go to if I need medical treatment in the future. I went to the Bangkok Hospital in Korat and without doubt they are the most expensive in my area.

Why not get an electronic version of the policy and translate it from Thai to English with Google translate?

[thailandbeachisland]

Isn't it the case everywhere in the world ?

These companies are not here to help you but to make money on your axx.

Edited March 1, 2014 by thailandbeachisland

[sawadee1947]

.Advice: take the simple Thai Insurance for foreigners and book a private room in case of emergency. Cheap and efficient. Saving a lot money you are paying now to your precious insurance company

[4u2mad]

I can understand that naming and shaming would leave TV open to litigation in Thailand. Maybe the mods should think about an 'off shore' site that members can access to warn others of these sharp practices? Or alternatively, 'rhymes with' or 'sounds like' references?

[4u2mad]

P.S. By far the best hospital in the Issan area is Khon Khaen University Hospital, which being a government hospital entails some red tape but has rates just a fraction of the private hosps, along with a much higher level of expertise. It is a major teaching hospital. http://www.md.kku.ac.th/en/index.php?index_page=med_serv&page=hospital

Yes I do agree, to some extent Sheryl. However the procedures both pre and post op are a little different to those carried out in the west. The other hospital,'just down the road', used by more farangs, I wouldn't touch with a 10ft pole!

[cooked]

.Advice: take the simple Thai Insurance for foreigners and book a private room in case of emergency. Cheap and efficient. Saving a lot money you are paying now to your precious insurance company

http://www.thaihealth.co.th/2012/index_eng.php

Good advice!

[pauleddy]

It depends on the "level" of the policy. I have BUPA platinum, and they cover everything, but it costs 85,000 a year for one man.

Lesser BUPA, like the Silver or Bronze, may have a schedule of % that you pay. Many of the cheaper policies have this, or some kind of excess. I am also in the Social Security scheme, which costs about 360b per month. With the SS, you pay some costs of certain operations, although not others. My partner had an angiogram last year, and it cost nothing (100,000 to 400,000 private, depending on place and if balloon and stent are used).

As stated here, go for something which covers you up to 2m or 5m. If you have a stroke, you may require many months of care, and 2m can go quite rapidly.

Consider also OPD cover. If you want to see a doctor in a clinic, that is covered under a separate part of the main policy. You can specify 20k, 30k or 40k of OPD cover. Each doctor visit will cost about 800-1000b but then there is a charge for nursing and medicine and admin. The OPD section adds a fair bit to the yearly cost, but if you often go for minor stuff then it is worth having, or else you pay every time for OPD.

Eddy

[Sheryl]

.Advice: take the simple Thai Insurance for foreigners and book a private room in case of emergency. Cheap and efficient. Saving a lot money you are paying now to your precious insurance company

http://www.thaihealth.co.th/2012/index_eng.php

Good advice!

I do not think he was referring to this private company (whose website provides no details in English on their policies) but rather tho a government scheme. However only some hospitals in some provinces are enrolling expats in this and some that did, have since been told to stop as the system as currently priced is intended for migrant workers.

Private insurance companies here are never "cheap" for a worthwhile level of cover.

[Sheryl]

I can understand that naming and shaming would leave TV open to litigation in Thailand. Maybe the mods should think about an 'off shore' site that members can access to warn others of these sharp practices? Or alternatively, 'rhymes with' or 'sounds like' references?

There is no "naming and shaming" about it that I can see here. The OP took out an insurance policy without knowing what it covered. There is no indication that the company in anyway failed to provide what its policy stipulated. He just did not know what that was and assumed it to be more substantial than was the case.

Again, nio one should take out insurtance without reading the policy detaisl first carefully, and if they are unavailable in English that alone is a red g=flag and indication to go elsewhere.

[Sheryl]

I can understand that naming and shaming would leave TV open to litigation in Thailand. Maybe the mods should think about an 'off shore' site that members can access to warn others of these sharp practices? Or alternatively, 'rhymes with' or 'sounds like' references?

There is no "naming and shaming" about it that I can see here. The OP took out an insurance policy without knowing what it covered. There is no indication that the company in anyway failed to provide what its policy stipulated. He just did not know what that was and assumed it to be more substantial than was the case.

Again, no one should take out insurance without reading the policy details first carefully, and if they are unavailable in English that alone is a red flag and indication to go elsewhere.

[personchester]

Life insurance companies are usually best avoided when it comes to health insurance. Stick to a company that makes health insurance their primary business.

BUPA is the largest health insurance co in Thailand, all the hospitals are very familiar with it. All relevant material is bilingual Thai and English. Reimbursement for specific procedures is set at a percentage of a total maximum amount allowed per illness event, not a percentage of what you are billed. That said, need to carefully consider as many of the plans have coverage levels which are too low to be realistic. Not worth considering cover of less than 2 million baht/episode and preferrably the 5 mill which is their highest level of cover.

I have heard that there will be no offer of health insurance for people over age 65 ... is this correct ?

[mosch]

I can understand that naming and shaming would leave TV open to litigation in Thailand. Maybe the mods should think about an 'off shore' site that members can access to warn others of these sharp practices? Or alternatively, 'rhymes with' or 'sounds like' references?

There is no "naming and shaming" about it that I can see here. The OP took out an insurance policy without knowing what it covered. There is no indication that the company in anyway failed to provide what its policy stipulated. He just did not know what that was and assumed it to be more substantial than was the case.

Again, no one should take out insurance without reading the policy details first carefully, and if they are unavailable in English that alone is a red flag and indication to go elsewhere.

I clearly understand the situation of OP and how it feels. Sometimes the website simply doesn't have all the information and the agents don't want to tell or don't know all information. Just got a Bupa insurance and got this brochure couple days ago along with policy cards. Will ask the agent about what it is. Surely am shocked to see this "Maximum payable benefits". FYI, bought Emerald800 for me and my wify and Platinum for my son. There was no mention of any restriction anywhere until I got this blue brochure! Anyone can explain what's going on or has similar experience. Please see attached pdf.

Bupa Policy Details.pdf

[Sheryl]

Life insurance companies are usually best avoided when it comes to health insurance. Stick to a company that makes health insurance their primary business.

BUPA is the largest health insurance co in Thailand, all the hospitals are very familiar with it. All relevant material is bilingual Thai and English. Reimbursement for specific procedures is set at a percentage of a total maximum amount allowed per illness event, not a percentage of what you are billed. That said, need to carefully consider as many of the plans have coverage levels which are too low to be realistic. Not worth considering cover of less than 2 million baht/episode and preferrably the 5 mill which is their highest level of cover.

I have heard that there will be no offer of health insurance for people over age 65 ... is this correct ?

They guarantee lifetime coverage if you enroll before a certain age (and keep up the premiums, obviously) but will not newly enroll people after a certain age, not sure if it is 65 or earlier.

It is very hard to find policies that will enroll people over 60 let alone 65, this is a big problem.

[Sheryl]

I clearly understand the situation of OP and how it feels. Sometimes the website simply doesn't have all the information and the agents don't want to tell or don't know all information. Just got a Bupa insurance and got this brochure couple days ago along with policy cards. Will ask the agent about what it is. Surely am shocked to see this "Maximum payable benefits". FYI, bought Emerald800 for me and my wify and Platinum for my son. There was no mention of any restriction anywhere until I got this blue brochure! Anyone can explain what's going on or has similar experience. Please see attached pdf.

Those percentages are not a percentage of what is charged but rather of the maximum benefit under your plan. So for example with emerald, the maximum benefit is 500,000 (way too low IMO by the way). Appendectomy is listed as 50% the maximum benefit so they would cover surgical fee for appendectomy up to 250K. Incision of an abscess is 5% so they would cover a surgical fee of up to 25K for that. Note that this is the surgical fee only and charges for the room, nursing, medication, doctor visit etc are covered separately.

In the Platinum Plan there is also provision for major medical i.e. costs in excess of what is otherwise covered.

[Overcome]

<script type='text/javascript'>window.mod_pagespeed_start = Number(new Date());</script>

Life insurance companies are usually best avoided when it comes to health insurance. Stick to a company that makes health insurance their primary business.

BUPA is the largest health insurance co in Thailand, all the hospitals are very familiar with it. All relevant material is bilingual Thai and English. Reimbursement for specific procedures is set at a percentage of a total maximum amount allowed per illness event, not a percentage of what you are billed. That said, need to carefully consider as many of the plans have coverage levels which are too low to be realistic. Not worth considering cover of less than 2 million baht/episode and preferrably the 5 mill which is their highest level of cover.

I have heard that there will be no offer of health insurance for people over age 65 ... is this correct ?

They guarantee lifetime coverage if you enroll before a certain age (and keep up the premiums, obviously) but will not newly enroll people after a certain age, not sure if it is 65 or earlier.

It is very hard to find policies that will enroll people over 60 let alone 65, this is a big problem.

I have health insurance with LMG Pacific Healthcare ... the policy information, forms and the full policy document was all provided in English and they have an Australian on staff specifically to make sure English speaking expats get the right assistance and advice to set things up correctly and answer any questions, which I appreciated. The various terms and conditions are all quite clearly explained and appear to make sense. One thing that was explained is that the amount the company will reimburse for any particular procedure or treatment is limited to the 'normal and customary' charges for that treatment in the market - this is designed to stop medicos charging whatever they like or for doctor/patient collusion to try and get the insurance company to pay more than they should (I can't imagine such a thing ever happening in Thailand!). I believe this definition is used by most companies so this is a possible area of surprise for some people.

With LMG Pacific I think you can apply for a new policy up to age 65 and once you have a policy it's renewable for life. I think with BUPA you can't apply for a new policy if you are over 60 but once you have a policy the same lifetime renewals applies. BUPA seems to have a good reputation as does LMG Pacific and I also hear AXA has a good reputation as well. I am very happy with the level of service from LMG Pacific and can't fault them on the claims I have had since I have been a client, and they have been excellent in all respects with a friend who has been in a life and death battle with liver cancer - he says they have been professional, and sensitive to his circumstances; they have kept him fully informed about what he is covered for and the progress of his treatment and have even negotiated discounts with hospitals and doctors to stretch his coverage as far as possible.

Seeing this has totally convinced me of the value in getting insurance cover from an insurance company in the local market and came across this article just yesterday which strongly recommends this approach and cautions expats about dealing with advisers as well as insurers that aren't registered/licensed locally - http://inversionpoint.com/sleeping-dogs-integrity-insurance-offshore-advice-whats-connection/

[peergin]

I am just wondering why an English translation of a policy is useful. Surely, the Thai policy will contain a clause to the effect that the Thai-language policy will prevail????? Meaning, an insurance company can leave anything out of an English-language policy that it wants to hide.

[peergin]

I can understand that naming and shaming would leave TV open to litigation in Thailand. Maybe the mods should think about an 'off shore' site that members can access to warn others of these sharp practices? Or alternatively, 'rhymes with' or 'sounds like' references?

An offshore site is a brilliant idea. I believe EVERY foreigner here has bad experiences that he/she could share with other TV members. I know that I do! Lots of people could save lots of money and life would become more pleasant as well! Also, there is no need to limit such a reference site to bad experiences. Listing good experiences would be just as useful.

Finally, I think that ThaiVisa would become an extremely popular site!

Would the moderators kindly comment whether this is feasible?

[impulse]

One thing that was explained is that the amount the company will reimburse for any particular procedure or treatment is limited to the 'normal and customary' charges for that treatment in the market - this is designed to stop medicos charging whatever they like or for doctor/patient collusion to try and get the insurance company to pay more than they should (I can't imagine such a thing ever happening in Thailand!). I believe this definition is used by most companies so this is a possible area of surprise for some people.

My worst insurance nightmares were related to the "reasonable and customary" clause where the insurance company's rate schedule was 30-50% less than the lowest price on offer at any service provider in my state. Effectively, my advertised 80% coverage was paying less than 50% of the bill. Even after I met my out of pocket maximum where coverage should have gone to 100%, they were still paying according to their rate schedule leaving me paying between 30-50% out of my pocket.

When I decided to try to get treated in a bigger city (more competition- lower prices), their rate schedule was very different to reflect the lower prices, and I was still stuck paying 30-50% out of pocket.

That's one of the reasons I left that job (Fortune 500 Company in the oil services business)- I figured out that if I had cancer or a heart attack, I'd be bankrupted- even with a Fortune 500 company's health coverage.