Questions about Work Permit & Paying for Prescription Medication

[transplanttraveler]

Hello everyone,

I have traveled back-and-forth to Thailand a few times, and am now planning on coming back again in a couple of months to work as an ESL teacher.

I received a liver transplant a decade ago and take two anti-rejection medications. These medications -- Gengraf (cyclosporine) and Myfortic -- are quite expensive, both in America and in Thailand.

Back when I was taking my TEFL course a few months ago down in Phuket, the instructor told me that as long as I have a work permit, I am eligible to receive my medication free of charge. I have heard this from other expats, too, but am having difficulty finding information about this online. Honestly, it seems to good to be true . . .

So, for you experts out there, I thought I'd throw out a few questions:

1). If I have a legal work permit and am paying taxes on my wages, am I eligible for free medication? Am I eligible for some sort of discount on my medication? Or, will I have to pay for my pills straight out of pocket?

2). I read a thread on here that teachers employed by private schools were not eligible for health insurance (social security), but that they can pay 432 baht per month to their local SSO for some sort of government-based health coverage? Assuming I've got a legal work permit but happen to be working at a language institute, could I pay the fee to my designated SSO for free/discounted medication?

3). I would like to purchase health insurance when I get back into Thailand. Will companies refuse to cover me because of my pre-existing condition (transplant)?

Thanks!

Edited August 25, 2015 by transplanttraveler

[Issangeorge]

You would have to belong to the social security system, which if you work for a government school, you probably will. You will then have to wait for three months. If the Social Security Insurance covers your medicines, you should be able to get them after three months.

[Sheryl]

Several issues here:

1. Will you get Social Security coverage? Definitely yes if working at a government school. It will be paid for out of small deductions to your pay check. No pre-exisitng exclusions and once you have been in it over a year you can keep it for life, even after no longer working, if you keep up the payments. It is an excellent deal.

Private schools are except from the requirement to be in the SS system. Some opt in, some instead provide private insurance (usually of such low level of coverage as to be of limited use) and some maybe offer nothing. Need to ask the specific school. As to whether there is a way that people employed in a private school that is not included in SSA can pay into the system on an individual basis, I have no idea, should ask the SS Office (contact details at bottom).

2. If covered under SS, will it cover the cost of these medications? SS covers both inpatient and outpatient including medications but there are some drugs -- mostly new imported ones -- not included. Cyclosporine is an old drug, long off patent and available here in relatively cheap regionally made generics (India etc) so I would be surprised if not covered. Myfortic on the other hand is new a Western import and expensive. You would again have to check with the SS office to see if it is covered or not. Might well not be.

As to getting a private policy, in Thailand as anywhere else, pre-existing conditions will not be covered. If it is a group plan (such as some private schools have) then this is not a factor (but beware insufficiently low coverage caps). In getting individual cover, depends on the view of the underwriters. Some insurance companies might take the view that having had a renal transplant puts you ate so much increased risk of multi-system problems that they won't insure you while others would simply exclude anything related to kidney disease from the policy but still issue it covering everything else.

Be aware that Thai health insurance is not regulated as strictly as in the West. They can for example drop someone at will or raise their premiums after a large claim (beyond the normal age related increases). An internationally issued policy that covers Thailand is an option and would be regulated according to the laws of the country it is issued from.

If you are not necessarily going to be here more than a year, a travel insurance policy is also an option. Some will provide limited coverage for acute exacerbations of pre-existing conditions (though not the cost of ongoing chronic treatment i.e. meds).

Frankly for someone who has had a renal transplant I would strongly urge only accepting employment from a school which is in the SS system. Even if you still have to pay for some meds, you'll have coverage for everything else including any repeat hospitalizations related to pre-exsiting problem and can maintain this for life should you decide to settle here long term.

SS Office contact info: http://www.sso.go.th/wpr/eng/contactus.html They are usually quite helpful though might take some time to find a good English speaker.

[transplanttraveler]

Thanks, George & Sheryl!

Sheryl -- The social security system really is a great deal! I'll be doing everything in my power to ensure that I can find a job that allows me to be eligible.

The problem with the cyclosporine is that my doctors want me to take a specific brand -- an import -- so there's the possibility that I'll still have to pay for both out of pocket. Oh, well. It's still worth a shot . . .

Thanks for telling me more about Thai health insurance. Maybe we are misunderstanding each other, but American insurance providers are not allowed to charge me a higher premium because of my transplant. At least that's what my mom has been telling me, and she works in human resources here in the States.

I found this thread about paying into the social security system as an individual/private school teacher: http://www.thaivisa.com/forum/topic/738854-social-security/.

I'm not sure what to make of it. It definitely seems possible, though, so long as you've got the WP. Sheryl, what do you think? Anyone else out there have an opinion/advice?

Thanks!

Edited August 26, 2015 by transplanttraveler

[Sheryl]

What insurance companies in the US (and other Western countries) can and can't do is entirely different from Thailand where laws regulating health insurance are few. A Thai insurer can drop you or raise your premiums because you've had large claims and they think you are now a higher risk, if they so please. Cannot in the US or Europe but can in Thailand. Hence recommendation that if you get a private policy it be one issued by a Western-based company. They will be bound by the laws of the country where they are based. There are many European based expatriate specific policies that will cover you in Thailand (though not your pre-existing condition). Best to use an insurance broker as they can give you comparative data on multiple companies. I used AOC brokers but there are many, google expatriate insurance + broker.

As to whether there is a way for a teacher at a private school to pay personally to get under SS, I doubt it (and info on the link you provide is contradictory) but only way to be sure is to ask the SS office. I do know that in general, SS does not have a private entry channel -- you have to be in it under an employer who is registered. So if private schools aren't part if the system you prpbably can't get in, but again, ask SS for a defintiive answer.

[Soutpeel]

Thanks, George & Sheryl!

Sheryl -- The social security system really is a great deal! I'll be doing everything in my power to ensure that I can find a job that allows me to be eligible.

The problem with the cyclosporine is that my doctors want me to take a specific brand -- an import -- so there's the possibility that I'll still have to pay for both out of pocket. Oh, well. It's still worth a shot . . .

Thanks for telling me more about Thai health insurance. Maybe we are misunderstanding each other, but American insurance providers are not allowed to charge me a higher premium because of my transplant. At least that's what my mom has been telling me, and she works in human resources here in the States.

I found this thread about paying into the social security system as an individual/private school teacher: http://www.thaivisa.com/forum/topic/738854-social-security/.

I'm not sure what to make of it. It definitely seems possible, though, so long as you've got the WP. Sheryl, what do you think? Anyone else out there have an opinion/advice?

Thanks!

Thai private insurance providers will not charge you a higher premium either, they just will not cover pre-existing conditions, and without stating the obvious, your Mom is in the states so what ever the rules are there don't apply in Thailand