Q: What insurance coverage is recommended / needed?

[Issangeorge]

The one thing I noticed about those premiums, and others I have looked at, is I find they are quite high if you are over 65. In my case I am quite happy to use a government hospital. Actually in my immediate area there are no private hospitals, and the closest big hospital is the Khon Kaen University Hospital, one of the best in Thailand. When I'm sick I don't particularly want to stay in a five star facility, that I'm too sick to take advantage of. I'd rather save that for when i'm well and stay in a five star facility on a beach. Reading what Sheryl has posted on other threads, ฿5 million, would probably be more than adequate in a government hospital, so if you can put that amount away, you are probably better off self insuring.

[cornishcarlos]

William Russell, based in U.K are very good I think. We have been with them for a couple of years. It does cost me nearly 10k baht a month but the level of service is exceptional.

Example :

My wife has to have emergency surgery at the end of last year, ruptured ovarian cyst. I called the insurance company once, sent one email and they took over from that point. An agent of theirs in Bangkok dealt directly with the hospital and all I did was sign a consent form.

The bill was only about 50k but the fact that the insurance looked after everything meant I didn't have to worry about that at all.

Had a pleasant 3 nights in the hospital on a comfy sofa bed, whilst my wife recuperated

[Swiss1960]

William Russell, based in U.K are very good I think. We have been with them for a couple of years. It does cost me nearly 10k baht a month but the level of service is exceptional.

Example :

My wife has to have emergency surgery at the end of last year, ruptured ovarian cyst. I called the insurance company once, sent one email and they took over from that point. An agent of theirs in Bangkok dealt directly with the hospital and all I did was sign a consent form.

The bill was only about 50k but the fact that the insurance looked after everything meant I didn't have to worry about that at all.

Had a pleasant 3 nights in the hospital on a comfy sofa bed, whilst my wife recuperated

Thank you, will have a look at this.

[Swiss1960]

The one thing I noticed about those premiums, and others I have looked at, is I find they are quite high if you are over 65. In my case I am quite happy to use a government hospital. Actually in my immediate area there are no private hospitals, and the closest big hospital is the Khon Kaen University Hospital, one of the best in Thailand. When I'm sick I don't particularly want to stay in a five star facility, that I'm too sick to take advantage of. I'd rather save that for when i'm well and stay in a five star facility on a beach. Reading what Sheryl has posted on other threads, ฿5 million, would probably be more than adequate in a government hospital, so if you can put that amount away, you are probably better off self insuring.

thanks for these thoughts. While I have also been thinking about self-insurance, I have a few caveat about it:

• I might be lucky to live for another 40 years and reach the age of 95 (well... maybe with a changed lifestyle but that is on another page of the book... )... and how can I be sure that I do not have several bigger issues within those 40 years that might require expensive treatments... how many such cases would you have to calculate to set aside for your self-insurance assets? Even when calculation an average of 120K Baht per year for insurance premiums over the next 40 years, this gives you a total of 4.8Mio Baht of premiums... which is less than what Sheryl said as a minimum cover and which would cover you for multiple events.
• I also read from many people that they say "if the shit hits the fan, i go back home to get treatment"... well the difficulties are that going back home for treatment means

  - maybe waiting time until you get admitted to the government health system

  - maybe non-covers for your problems due to "pre-existing" conditions clauses in the government health policies

  - for Switzerland, you would have to leave Thailand and take residence back in Switzerland in order to be taken up into a health insurance plan

People who want to do self-insurance really have to take into account that they can not only face one but multiple issues over their lifespan and that returning back to the home country is not always a guarantee for immediate, free and complete treatment...

[jpinx]

There's a couple of points worth considering.

Residency --

If you maintain residency in your home country that does not - afaict - affect Thai insurance companies covering you in Thailand. By maintaining your residency in your home country you will not drop out of the healthcare system there and can opt for a trip back to fix whatever medical issues might arise.

Excess -

I'm waiting for Pacific Cross to quote me for ambulance and inpatient only, with a huge excess. The intention is to get the premiums down whilst still covering the hospital bills for a major incident. I am thinking of somewhere between 500k and a million as an excess I can live with, but it'll depend on how much the premium is adjusted downwards for that.

[Swiss1960]

There's a couple of points worth considering.

Residency --

If you maintain residency in your home country that does not - afaict - affect Thai insurance companies covering you in Thailand. By maintaining your residency in your home country you will not drop out of the healthcare system there and can opt for a trip back to fix whatever medical issues might arise.

Excess -

I'm waiting for Pacific Cross to quote me for ambulance and inpatient only, with a huge excess. The intention is to get the premiums down whilst still covering the hospital bills for a major incident. I am thinking of somewhere between 500k and a million as an excess I can live with, but it'll depend on how much the premium is adjusted downwards for that.

Thanks for your ideas. Here my answers:

• Keep Residency in my home country Switzerland: This is not possible. In general, Swiss government sees you as expat after 180 days and you MUST re-register and register with the embassy of the country where you live. In addition, even if I could keep up residence in Switzerland, it would mean pay for the Swiss health care (which would cover me abroad) which is pretty expensive and it would also mean being taxable in Switzerland... which I definitely do not want to be. On top for me, it would mean that I can not cash-out my company pension, this is only possible under strict rules, i.e. having residency outside of the EU/EFTA countries.

  However, as I outlined before, I could at any time go back to Switzerland, register at any address (i.e. family members) and sign-up for basic health insurance (which can NOT be declined) and would be covered for all government regulated basic issues including pre-existing conditions that I bring with me (i.e. cancer). Disadvantage of course is that if I would want to go back to Thailand later, I would have to restart the whole VISA and resicency process.

• Pacific Cross as far as I have seen from the 4 options only offer 40K Baht deductible (25% premium reduction) to 300K Baht deductible (with 50% premium reduction). Inpatient only gives you 20% discount on the basic premiums for all plans. What they DO offer however (and I have not seen that in other insurances) are "no-claim" discounts of 10, 15 and 20% for 1, 2 and 3 years of no claims towards them. But if the would offer you even higher deductibles, please come back here and tell us about the discount given.

[jpinx]

There's a couple of points worth considering.

Residency --

If you maintain residency in your home country that does not - afaict - affect Thai insurance companies covering you in Thailand. By maintaining your residency in your home country you will not drop out of the healthcare system there and can opt for a trip back to fix whatever medical issues might arise.

Excess -

I'm waiting for Pacific Cross to quote me for ambulance and inpatient only, with a huge excess. The intention is to get the premiums down whilst still covering the hospital bills for a major incident. I am thinking of somewhere between 500k and a million as an excess I can live with, but it'll depend on how much the premium is adjusted downwards for that.

Thanks for your ideas. Here my answers:

• Keep Residency in my home country Switzerland: This is not possible. In general, Swiss government sees you as expat after 180 days and you MUST re-register and register with the embassy of the country where you live. In addition, even if I could keep up residence in Switzerland, it would mean pay for the Swiss health care (which would cover me abroad) which is pretty expensive and it would also mean being taxable in Switzerland... which I definitely do not want to be. On top for me, it would mean that I can not cash-out my company pension, this is only possible under strict rules, i.e. having residency outside of the EU/EFTA countries.

  However, as I outlined before, I could at any time go back to Switzerland, register at any address (i.e. family members) and sign-up for basic health insurance (which can NOT be declined) and would be covered for all government regulated basic issues including pre-existing conditions that I bring with me (i.e. cancer). Disadvantage of course is that if I would want to go back to Thailand later, I would have to restart the whole VISA and resicency process.

• Pacific Cross as far as I have seen from the 4 options only offer 40K Baht deductible (25% premium reduction) to 300K Baht deductible (with 50% premium reduction). Inpatient only gives you 20% discount on the basic premiums for all plans. What they DO offer however (and I have not seen that in other insurances) are "no-claim" discounts of 10, 15 and 20% for 1, 2 and 3 years of no claims towards them. But if the would offer you even higher deductibles, please come back here and tell us about the discount given.

I'm grateful for your commentary on the specifics of Switzerlands rules, which re-inforces my view that we all have differing requirements. Also grateful for your take on Pacific Cross terms. I'll be interested to see what they come back to me with and I'll post here. I had not noticed the no-claims bonus -- which might be an interesting incentive - given the steep rises in premiums after 65.

In days gone by I had car insurance and would just not claim for small stuff, thereby keeping my no-claims-bonus.

BTW -- there's another thread on pretty much the same topic here....

http://www.thaivisa.com/forum/topic/777691-accident-insurance-cover-help-please/

[jpinx]

Just a quick aide-memoire of the calculation here -- very approximate - based on the information on Pacific Cross here...

Age 66-70 = premium 44k

20% inpatient only discount = 35K

3 years no-claims 30% discount = 25K approx.

Assuming an age-group change after 3 years = 67K less 20% inpatient only = 53K less 30% NCB = 37K approx

It certainly looks more reasonable - assuming you have the 300K excess available quickly when needed

[PacificCrossInsurance]

Please remember if you are reviewing this thread, that the premium table we provided was for just one (mid-ranked in features/benefits/costs) of nine different policies, and we showed only two of the variations out of the approximately 1000 different ways these 9 base plans can be configured with the inclusion of various modules which provide discounts for exclusions or add specific benefits like dental and vision cover. This is why we encourage potential clients to take advice either from our direct sales consultants or from an insurance broker (only Thai registered brokers are able to represent Thai registered companies such as Pacific Cross Health Insurance and only they have the necessary information to advise you correctly).

+Swiss1960 the deductible options are actually zero (base plan standard); 40,000 baht (25% discount); 100,000 baht (32.5% discount); 200,000 baht (40% discount) and 300,000 baht (50% discount).

+Jpinx the reason for adding these larger deductible options is two-fold: firstly to accommodate some people who are provided with a very basic scheme by their employer which allows them to add a policy as a 'top up' without duplicating those costs, and secondly to provide a means by which older clients who are challenged by the premium cost (which we have explained previously is a function of the cost of claims in each age band and not an attempt to drive customers away) an option to retain the cover they need but keep the premium costs as low as possible.

We are cautious about keeping the no claim discount quite separate from the premium cost is because this can't obviously be guaranteed, and from experience, it's very easy for clients to misread this or over time carry certain assumptions in their mind which can sow the seeds of a future problem which we would rather avoid - but as you say it can make a material difference to the long term cost.

+Issangeorge as noted above the figures quoted were two out of a thousand different options and by implying that it's a binary choice - the option illustrated or nothing - you are demonstrating the reason why many companies that offer products that have many variables and an individually tailored solution are reluctant to offer specifics in a public forum - because although the advice might be correct for one person it will not be the best for many more who are likely to read the post. There are hundreds of options that lie on the scale of cost between the ones published and nothing.

Relying on access to free Government hospital cover in Thailand is certainly a course of action that is possible, provided you are confident in your eligibility for this at least in the short and medium term, and provided you recognise the limitations of the services provided and are happy with this.

Not everyone needs health insurance - if you have the resources to provide the health care at a level you are comfortable with, happy to accept the risk and do so without causing any difficulty or future hardship, why would you pay an insurance company to do what you can do yourself? This scenario would be typically referred to as 'self-insurance' which ideally is a decision reached after consideration of the facts and options - so it is a positive choice, and in your circumstances as you have explained you have the confidence in relying on access to the Thai Government free hospital system to meet your requirements, and that is your prerogative.

However in the majority of cases expats who choose the default position of depending on the safety net of access to public hospitals free of charge aren't doing so as a balanced and conscious choice - and as such are better simply described as 'uninsured'.

[JAS21]

Yes, health insurance is a concern.

Prior to retiring here in 2007 with my wife, who is Thai we were in a works scheme with an International Healthcare Company... they covered everything. We had to come out of that scheme but stayed with the same company. This time though we were only covered for inpatient except MRI/CT and Cancer.. we were not covered for USA and Canada but the premium did include travel insurance.

These are the premiums in GBP 2008-3668, 2009-4063, 2010-4300, 2011-5336, 2012-6042, 2013-6776, 2014-7486 and this year they are asking for 8257. Next year I will be 70 and my wife will be 60 and no doubt a huge jump in premiums again.

I've had a couple of bad years ... had my carotid artery raked out at Bangkok Hospital last year (300,000 Baht) and this year a stent fitted but I had the angio done and the stent fitted at the government Heart and Chest Hospital ... where I have moved all my records to, my wife is registered there too. The stent itself was very expensive but in total the stent fitting plus angio was about 130,000Baht ... compare that to a Private Hospital.

We also have records at the Government Stroke Hospital. Okay we have had a few problems but fortunate to have access to good government hospitals. eg a heart CT is about 9000Baht and a Brain MRi/MRA is about 12000Baht and these are on the latest machines.

So we have discussed and realize that in a few years time the premiums will be 'just silly' so we will not continue the heath insurance ... But will put the money aside each year. I suppose fortunate that I can foot a large bill if I have to. Annual cancer checks are done at the Princess Chulabhorn Research Institute and a very reasonable price.

This is our view ... right or wrong ... only time will tell. So consider registering with any government hospital that you think you might need ... they have 'extra clinics' which drastically cut waiting times for procedures.

Unfortunately out of Bangkok most of the government hospitals are pretty basic and people we know always make their way to Bangkok for treatment. If you are seriously ill in the sticks it's not good news.

Having said all this ... if money was no object I would more than likely stay with BNH or Bangkok Hospital. Staying as an inpatient is like being in a hotel.

Edit ... I forgot to say ... as an inpatient in a Government Hospital the food in just edible ... well some of it is!!...

[Swiss1960]

^^ thanks for sharing, JAS21

[jpinx]

Yes, health insurance is a concern.

............................

So we have discussed and realize that in a few years time the premiums will be 'just silly' so we will not continue the heath insurance ... But will put the money aside each year. I suppose fortunate that I can foot a large bill if I have to. Annual cancer checks are done at the Princess Chulabhorn Research Institute and a very reasonable price.

This is our view ... right or wrong ... only time will tell. So consider registering with any government hospital that you think you might need ... they have 'extra clinics' which drastically cut waiting times for procedures.

Unfortunately out of Bangkok most of the government hospitals are pretty basic and people we know always make their way to Bangkok for treatment. If you are seriously ill in the sticks it's not good news.

Having said all this ... if money was no object I would more than likely stay with BNH or Bangkok Hospital. Staying as an inpatient is like being in a hotel.

Edit ... I forgot to say ... as an inpatient in a Government Hospital the food in just edible ... well some of it is!!...

Many thanks for taking the trouble to write your story. It kinda proves the point that it's not the same for everyone, and good knowledge of the hospitals in your area is essential. If there was a list of the "good" government hospitals and their specialisations, that would be interesting

[TallGuyJohninBKK]

At least in BKK, I've always looked at the insurance cover level from this perspective.

Most of the bigger private hospitals have info on their websites listing what their various room types and room prices are per night for inpatient care. Sometimes it takes a bit of digging, but the info is usually there.

If you've lived here a while, you probably have some sense of what hospitals you might want to be treated in as an inpatient, if the need arose, vs. what ones you would not.

Start with the acceptable hospitals list, and then see what kind of room accommodation you'd want or be willing to accept. That then will give you a pretty good feel for what kind of per night inpatient hospitalization benefit you'd want to have in your insurance policy.

The per night inpatient coverage rate certainly isn't the only factor to consider in choosing an insurance policy. But it's a good step in the direction of determining how much insurance you may need with whatever insurer you choose for all the many factors that go into choosing an insurer.

Most of the hospitals also have quite a range from high to low of different room accommodations, ranging from 4 person wards to fancy VIP suites, with the prices varying accordingly. So oftentimes, you can pick a higher priced hospital if you feel the medical care/doctors are better there, but still save by picking a lower end room option with them.

[Sheryl]

Room costs are usually the least of the bill in the case of a major illness or injury.

consider costs of major surgery, and also of care in an ICU. My rule of thumb is not less than 2 million baht per episode cover, preferrably 5 mill especially if you want the option of care in a private hospital.