Health Insurance - what to watch out for

[Sheryl]

I am in the process of changing insurers, because the one I have (a locally issued policy)  reserves the right to not renew a policy at any time for any reason, as well as to raise the rates to any amount at any time. They advertise lifetime guaranteed renewal but the actual policy wording is quite different and I have heard enough reports to indicate that they will avail of these clauses should I ever develop a serious chronic condition. I haven't had any problems with them yet, because I have had few claims and all of them one-time sort of issues, but I am looking towards the future as I age.

 

  I was looking  at another policy that seemed quite attractive but insisted on seeing the actual policy wording. It took some doing to get them to send it to me but when I remained firm, they did, and this is what I found:

 

"The Company reserves the right ;
4.1 To adjust the premium in accordance with the age and risk profile of the Covered Person(s).
4.2 To adjust any term and conditions, coverage as necessary."

 

Increase in premium based on age is to be expected with any insurance policy. But reserving the rate to change rates based on an individual's risk risk profile means that they can  increase the rates of a specific person, unrelated to the normal premium rates  for that person's age, , if at a later time they develop a serious chronic condition, (e.g. cancer, kidney failure, heart condition -- anything where they can see that you are likely to have a lot of claims in future). They can  raise the  rates to whatever level they  want. In that case a guarantee of lifetime renewal is meaningless as they can get rid of "undesirable" insured persons by simply pricing them out.

 

Section 4.2 also appears to give the insurer the right to reduce coverage or exclude certain conditions from coverage after the policy has been issued. (Any insurer will do so at the time they issue a policy, if there are pre-existing conditions - but afterwards is another matter).  So if I developed  a disease likely to entail many future claims, they  could then alter my coverage to exclude it.

 

Between these two clauses,  there is no real protection at all in case of developing a chronic condition.

 

This is the sort of "fine print" that everyone selecting a health insurance policy should look for.

 

I am doubtful that there are any locally-issued policies that do not do the same thing, since Thailand's regulatory framework for health insurance allows them to.  The one I have now has the same thing plus an outright clause that they can decline to renew at will (despite advertising lifetime renewal).  Most European countries however, regulate insurers much more strictly and will not allow contracts with what regulatory agencies would consider to be unreasonable provisions.

 

So I have decided to get an  internationally issued policy. It will cost more  in premiums now, but in a worst case scenario (which after all is what insurance is for) will cost much less and I have a reasonable chance of actually being able to maintain the policy for life.

 

Many TV members seem to prefer Thai-based policies because  the premiums are less than  internationally issued expat policies.

 

This is why they are lower. Buyer beware. Insist on seeing actual policy wording before you buy a policy, and take the time to read it.

 

 

 

 

 

[tonray]

I have brought up these same issues and for now maintain my local BUPA policy but soon (when start to draw pension and SS) will likely switch to an international insurer. As we age the expense is just part of what we need to do to stay covered for likely events and infirmity.

[JLCrab]

From Tilleke & Gibbins:

Regulations

Insurance companies are subject to extensive regulation in terms of capital adequacy, permitted investments, handling of claims, marketing activities, dispute resolution, and others. Policy wording may only be used following approval of the OIC. In addition, all advertising images and solicitation documents are regarded as part of the relevant insurance policy. If the meaning of any advertised wording or image is contrary to that written in the policy, such meaning is to be interpreted in favor of the insured or the beneficiary (as the case may be).

http://www.tilleke.com/resources/compliance-complete-insurance-country-guide-thailand

 

[jacko45k]

19 hours ago, tonray said:

I have brought up these same issues and for now maintain my local BUPA policy but soon (when start to draw pension and SS) will likely switch to an international insurer. As we age the expense is just part of what we need to do to stay covered for likely events and infirmity.

I don't know at what age you start to receive pension and SS, but for me, at 66, that would be a bad time to be looking for a new insurer. Some will only take new clients below a certain age and at that age I hope to be settled with one company.

[connda]

I've just switched to an International policy too.  However!  Once you do that you are at the whims of that insurance company's under-writing department for probably at least 2 years, i.e., within a period of time ranging between 2 to 5 years any chronic illness will be considered a pre-existing condition and simply not covered.  This is the way insurance companies operate.  There is no real way of getting around it. 

[JLCrab]

Since  -- according to the MSH Int's website --  "The medical evacuation coverage of Asia Care is provided & managed by Mondial Assistance (Allianz Group)" there may be restrictions imposed by Allianz as to in what (stable?) medical condition one must be in prior to their authorizing evacuation from Myanmar to Thailand that is one might be necessitated to be treated in Myanmar for a period of time before one is in condition to be evacuated to Thailand for further treatment.

[Fairynuff]

Basically insurance companies are in the business of taking your money and finding any way they can not to give it back. 

[siam2007]

I am in the same process of changing insurers as I still have a rather inexpensive but most probably not adequate Expat-insurance from a company of my home country.

Talked about this to my excellent and experienced Doc at Bumrungrad last week, and he warned me of signing up for an insurance from a Thai based company (though I was rather looking into an international company that covers the entire ASEAN region in case the current PM thinks he does not want me here any longer).

The main point indeed is the "pre-existing conditions" thing. I will only sign a new contract somewhere else if those conditions are clearly listed in the policy, and the way they can raise the premium or exclude chronic illnesses as well.

Saw two reputable insurance agents already and went through a lot of brochures, but so far haven't found anything that would me want to sign with the respective company. That the insurers r reluctant to provide you with the exact policy wording is certainly concerning

Edited November 12, 2016 by siam2007

[JLCrab]

The easiest way to get around any pre-existing condition complications is to have had the underwritten policy for 10 or so years before you start to make any major claims. If you start your major claim regime shortly after signing up for the insurance, they certainly are going to look to see that all medical history was properly disclosed when the policy was started.

[thailand49]

No matter what company you go with here in Thailand, Bupa, AXA, LMG, the wording is pretty much the same.  Although they say after a number of years they will not cancel you the premium can rise to a level where you yourself cancel the policy. Whether you use it or not generally the premiums will rise in the range of 2000-4000 per year. Then there is the age bracket premiums like 55-60 / 61-65.  Majority all have exclusion and a waiting period and if you come down with cancer for example the medication and outpatient treatment will not be covered.

Here it is a mine field.  AXA through Pattaya Expat club has a pretty decent policy that allows you to get in at 65 and renew beyond 70, but as noted but you got to be in pretty decent shape before they continue to you and one has to wonder what the premium is going to be?

ACS, I have now is a French Company selling in SEA, but you got to get in before 60, and the premium is around 2500 USD per year covers in dollars 500,000 in baht around 15 million in coverage.

If I had to do it all over again,  I wouldn't move around looking to beat the system.  I recently looked into Cigna, they have international policies but expensive with how deductibles 1,000.000 USD coverage. It covers in and out patients expenses.

Good luck, 

 

[sead]

Nothing unusual.  All companies adjust your monthly cost after you have been sick or let's say smashed your car etc.

But if it says it cover up to 2 million in costs then that's what you'll get. After that your price goes up.

[sandemara]

Generally, the insurance industry in Thailand is a joke.  Check out the analysis of insurance of any sort offered by Thai-based companies and be prepared for a shock on the siamfirm interlaws website.  The principal of Siam Firm Inter Laws (who has run the same law firm for more than 30 years- somsak chopaka) describes the Thai insurance industry as a "swamp full of crocodiles". There are many articles from Somsak Chopaka on the website discussing legal issues of vital interest to farang residents, covering business (how to stay safe), various scams targeting foreigners, how to deal with the police, family law matters divorce, child custody, keeping your assets safe, company law, the real philosophies/beliefs behind Thai law and how it applies to foreigners etc.  It will clarify a lot of concerns and misconceptions TVF posters seem to suffer from.  Save yourself a lot of heartache by getting basic answers from the articles.

[Sheryl]

5 hours ago, thailand49 said:

No matter what company you go with here in Thailand, Bupa, AXA, LMG, the wording is pretty much the same.  Although they say after a number of years they will not cancel you the premium can rise to a level where you yourself cancel the policy. Whether you use it or not generally the premiums will rise in the range of 2000-4000 per year. Then there is the age bracket premiums like 55-60 / 61-65.  Majority all have exclusion and a waiting period and if you come down with cancer for example the medication and outpatient treatment will not be covered.

Here it is a mine field.  AXA through Pattaya Expat club has a pretty decent policy that allows you to get in at 65 and renew beyond 70, but as noted but you got to be in pretty decent shape before they continue to you and one has to wonder what the premium is going to be?

ACS, I have now is a French Company selling in SEA, but you got to get in before 60, and the premium is around 2500 USD per year covers in dollars 500,000 in baht around 15 million in coverage.

If I had to do it all over again,  I wouldn't move around looking to beat the system.  I recently looked into Cigna, they have international policies but expensive with how deductibles 1,000.000 USD coverage. It covers in and out patients expenses.

Good luck, 

 

 

You can get inpatient only from Cigna, and it will cost a lot less. Deductibles/copays are an option you can take or not as you prefer.

 

Cigna's inpatient only policy fully covers outpatient cancer treatments, as does MSH (which is actually local insurance, though managed by an international company). Most inpatient policies include this because if they don't they end up paying for people to be admitted to the hospital to receive the same treatment and that only costs them more. Obviously one should read the benefits schedule of any policy carefully to be sure, but  most that I have ever seen do cover this. The problem comes at renewal time, when knowing you have cancer, if it is a locally issued policy they may seek to get rid of you by charging a premium so high that you may as well just pay out pf pocket for your care.

 

Indeed, all the locally issued policies as far as I can tell allow the company to effectively get rid of you if you become "high risk" i.e. chronically ill. They may do it by refusing to renew you, or by just raising your premium to a level no one could afford, well beyond the normal premium for your age. Usually they do the latter and all of the locally issued policies explicitly state that they can.

 

The only way around this as far as I can see is to get an internationally issued policy.

 

Car insurance is not a good analogy - it is possible to never have a car accident, and certainly possible to never have a serious one. It is not possible to grow old without ever being ill, and no one dies a natural death in good health. Health insurance policies up premiums with age precisely because it is a given that older  people will have more claims. To then arrange to dump people once they are chronically ill is IMO unconscionable and directly contrary to the spirit and intention of health insurance. But they do it, because they can, and the can because the insurance regulations in Thailand allow it.

[jpinx]

There was a posting in TV recently relating to a story of someone being stone-walled when making a claim from BUPA, and one hears many similar tales.  Cigna oversell extensively, but I have not heard any specific rejection of a claim by them.  There's the usual confusion between health, accident and travel insurances.  It is a minefield and none of them want to pay out on a claim unless they can see an endgame where you either recover completely, or pop your clogs. They dread the long, drawn-out medical conditions.

 

[Sheryl]

Yes, of course they do, but they have set the premium increases for  age with that in mind. A decent policy/company understands that insurance is based on risk-sharing and in that system there will be those who end up costing the company very little and those who end up costing them a lot - and that they have to pay out for the latter group, like it or not.

 

I too haven't heard of Cigna being unreasonable about this or jacking up rates (beyond their normal schedule) even with serious chronic conditions like cancer.

 

But the local insurers can and many will.

 

 

[Grubster]

I went nuts trying to get answers out of all these insurers, but not Cigna yet, thanks for the post I will contact them.

[jerojero]

Insurance is a scam that rarely pays out. Just think about it....if they pay out too easily or too often, they are out of business, fast. Restricting payouts in any every way is normal process at all insurers.

[ClutchClark]

19 minutes ago, jerojero said:

Insurance is a scam that rarely pays out. Just think about it....

 

Yep....health insurance is a scam until the day you have a medical emergency and need to pay for the medical bills.

 

There have been plenty of news stories on TVF of farangs who were barred from leaving the country until they could collect enough funds to pay their medical costs.

 

 

[thailand49]

12 hours ago, Sheryl said:

Yes, of course they do, but they have set the premium increases for  age with that in mind. A decent policy/company understands that insurance is based on risk-sharing and in that system there will be those who end up costing the company very little and those who end up costing them a lot - and that they have to pay out for the latter group, like it or not.

 

I too haven't heard of Cigna being unreasonable about this or jacking up rates (beyond their normal schedule) even with serious chronic conditions like cancer.

 

But the local insurers can and many will.

 

 

No matter what company you go with here in Thailand, Bupa, AXA, LMG, the wording is pretty much the same.  Although they say after a number of years they will not cancel you the premium can rise to a level where you yourself cancel the policy. Whether you use it or not generally the premiums will rise in the range of 2000-4000 per year. Then there is the age bracket premiums like 55-60 / 61-65.  Majority all have exclusion and a waiting period and if you come down with cancer for example the medication and outpatient treatment will not be covered.

Here it is a mine field.  AXA through Pattaya Expat club has a pretty decent policy that allows you to get in at 65 and renew beyond 70, but as noted but you got to be in pretty decent shape before they continue to you and one has to wonder what the premium is going to be?

ACS, I have now is a French Company selling in SEA, but you got to get in before 60, and

 

Not sure what is going on but each time I wanted to quote someone it goes right back to my original post?

 

You are right about everything regarding insurance.  It is all smoke and mirror here.  I've come to a point here they are pretty much the same and same is play on words but the final is they will find a way to cut you off if you become high risk. 

I recently spoke to a Agent who called me all the way from UK,  we spoke for a hour on his time expense but came across that their policy would cover all expenses In and Out patients, even when I travel etc... he sent me a bunch of quotes etc... but in the end too steep for my budget 2500 USD a year with a 5,000 deductible. 

At the ripe old age of 65 tomorrow, I decided for the final time, to go with a small local policy 1.5 million inpatient, I'm now covered Medicare Part A/B with a zero cost HMO, in my zip code area by Anthem Blue Cross. If I get sick I hope my 1.5 million gets me fit enough to hop on a airplane and go home.

[dinga]

On 11/11/2016 at 6:50 PM, JLCrab said:

From Tilleke & Gibbins:

Regulations

Insurance companies are subject to extensive regulation in terms of capital adequacy, permitted investments, handling of claims, marketing activities, dispute resolution, and others. Policy wording may only be used following approval of the OIC. In addition, all advertising images and solicitation documents are regarded as part of the relevant insurance policy. If the meaning of any advertised wording or image is contrary to that written in the policy, such meaning is to be interpreted in favor of the insured or the beneficiary (as the case may be).

http://www.tilleke.com/resources/compliance-complete-insurance-country-guide-thailand

 

+ SHERYL

 

Did you ask specifically what "Risk Profile" means?   Am thinking you are reading far too much into the wording.

 

Perhaps (fingers' crossed as this is my biased interpretation since it suits my policy) is that, in context,  'risk profile' covers factors like age, gender, family size, geographic area [if there is an explosion in health care costs in a particular location], occupation, health habits (smoking, exercising, drinking).   Don't imagine any discriminatory practices against the sick would be allowed by either governments/regulators or indeed the industry (trust I'm right).

 

 

 

 

 

[brewsterbudgen]

Like some others who have posted, I've just switched from a Thai Insurance policy, to an International (UK based) policy, to cover me, my wife and young son.  The deductible is high, but I'm reassured that we're covered for anything major. 

[dinga]

44 minutes ago, brewsterbudgen said:

Like some others who have posted, I've just switched from a Thai Insurance policy, to an International (UK based) policy, to cover me, my wife and young son.  The deductible is high, but I'm reassured that we're covered for anything major. 

Had one of those too, but - at my age of 62 - the premium climb-path as you move up into age brackets soon becomes prohibitive (even with ever increasing deductibles and reducing coverage), making the re-insurance guarantee worthless.  

 

My gamble is that a semi-local policy (with an International Insurer) and continued access to Thai Social Security coverage works best for me.

 

Very much an individual-by-individual evaluation/decision according to his/her unique circumstances.  

 

No good or easy answers I'm afraid.   

[Sheryl]

3 hours ago, dinga said:

+ SHERYL

 

Did you ask specifically what "Risk Profile" means?   Am thinking you are reading far too much into the wording.

 

Perhaps (fingers' crossed as this is my biased interpretation since it suits my policy) is that, in context,  'risk profile' covers factors like age, gender, family size, geographic area [if there is an explosion in health care costs in a particular location], occupation, health habits (smoking, exercising, drinking).   Don't imagine any discriminatory practices against the sick would be allowed by either governments/regulators or indeed the industry (trust I'm right).

 

 

 

 

 

Unfortunately you are not.

 

Age related risk is built into the age-related premium rates.

 

Things like smoking drinking etc are ascertained at the time of application and never again.

 

What this sort of clause means is development of a disease that makes it likely you will require future expensive care.

 

There will not be a problem at the time of the initial claim for a serious chronic disease, it will come at the time of renewal. This has happened to a number of TV members, always with a locally issued insurance policy. Thai insurance regulations do, unfortunately, allow this. Most western regulators do not.

 

Insurance is not a "scam" if obtained from a reputable company.  It operates in accordance with the terms of the contract, whatever those are.  The problem is that most people seem never to read those terms, and insurance agents certainly don't encourage them to. Hence the point of this thread.

 

 

[Sheryl]

From one of the international policies I looked at:

 

"Once accepted, (company)  commits not to cancel your policy due to above average medical expenses, nor to raise your fee beyond the general annual premium increase."

 

That is what one wants.

 

Unfortunatley this specific company does not enrol past age 60...but there are others. This kind of assurance can be obtained with internationally issued policies, but not AFAIK with locally issued ones.

[Chongalulu]

49 minutes ago, Sheryl said:

Unfortunately you are not.

 

Age related risk is built into the age-related premium rates.

 

Things like smoking drinking etc are ascertained at the time of application and never again.

 

What this sort of clause means is development of a disease that makes it likely you will require future expensive care.

 

There will not be a problem at the time of the initial claim for a serious chronic disease, it will come at the time of renewal. This has happened to a number of TV members, always with a locally issued insurance policy. Thai insurance regulations do, unfortunately, allow this. Most western regulators do not.

 

Insurance is not a "scam" if obtained from a reputable company.  It operates in accordance with the terms of the contract, whatever those are.  The problem is that most people seem never to read those terms, and insurance agents certainly don't encourage them to. Hence the point of this thread.

 

 

Thanks for highlighting this revealing issue. I've been here two years and although considering insurance really haven't grasped the nettle due to a lot of things like this. I'm not being complacent but although 64 I am in very good health,neither smoke nor drink,eat sensibly,not overweight,exercise and have no cancer or major health issues in the family . I feel that my premiums would effectively be subsidising those with a less healthy lifestyle and to an extent have the means to self insure. I am of course concerned that I am not of course immune,especially from an accident,and fear the unexpected big hit. I could of course limp back to the uk where I still have a uk address and am on the electoral roll but understand that certain events may even preclude that. I'm interested in hearing suggestions to suit my situation,including accident only cover and/or major medical only. That way I may end up paying premiums more reflective of my actual risk profile. Grateful for considered opinion.

[siam2007]

1 hour ago, Sheryl said:

From one of the international policies I looked at:

 

"Once accepted, (company)  commits not to cancel your policy due to above average medical expenses, nor to raise your fee beyond the general annual premium increase."

 

That is what one wants.

 

Unfortunatley this specific company does not enrol past age 60...but there are others. This kind of assurance can be obtained with internationally issued policies, but not AFAIK with locally issued ones.

 

 

as there are still a few TV members below the age of 60, mind to share which company that is ?

[Sheryl]

It was ACS (ALLIANZ) but note that I did not read any further so can't say re other terms/conditions.

 

http://www.acs-ami.com/en/expatriate-health-insurance/acs-asia-lifetime-docs

 

(they have 2 plans, one gives  lifetime cover and the other covers you only up to a certain age. the latter  would not make sense if one was planning ot staty permanently abroad).

 

Having niow waded through a number of international policies, I can tell you that there are a lto of differences among them and close reading of policy documents is essential.

 

For example, I found one that excludes coverage for all chronic diseases even if newly developed afterwards. That basically rules out all the illness to which an older person is subject...heart disease, cancer etc.

 

Another policy required a second opinion for all hospitalizations costing more than US 2,000 (i.e. most hospitalizations) and it looks like the doctor will be of their choosing, or possibly employed by them...

 

The above 2 things are not universal, in fact they were each found in only one policy examined. the point is, one has to read carefully and policies do differ, significantly.

 

 

[Don Mega]

14 hours ago, jerojero said:

Insurance is a scam that rarely pays out. Just think about it....if they pay out too easily or too often, they are out of business, fast. Restricting payouts in any every way is normal process at all insurers.

 

Recently I suffered a mild stroke and my insurance company had no issue  covering all costs as well as the ongoing monthly expenses associated with the stroke.

Edited November 13, 2016 by Don Mega

[1FinickyOne]

1 hour ago, nchuckle said:

Thanks for highlighting this revealing issue. I've been here two years and although considering insurance really haven't grasped the nettle due to a lot of things like this. I'm not being complacent but although 64 I am in very good health,neither smoke nor drink,eat sensibly,not overweight,exercise and have no cancer or major health issues in the family . I feel that my premiums would effectively be subsidising those with a less healthy lifestyle and to an extent have the means to self insure. I am of course concerned that I am not of course immune,especially from an accident,and fear the unexpected big hit. I could of course limp back to the uk where I still have a uk address and am on the electoral roll but understand that certain events may even preclude that. I'm interested in hearing suggestions to suit my situation,including accident only cover and/or major medical only. That way I may end up paying premiums more reflective of my actual risk profile. Grateful for considered opinion.

 

Hi NC - Yes, you will be subsidising others who will be subsidising you. Just being 64 is a health risk but that is why you will be paying more than a 40 yr old who is also in good condition and does not smoke or drink. You qualify your answer, whether or not you have the means to self insure [to an extent] - - the few policies that I have seen also have upper limits of insurance beyond which people are not covered. The fact that you can go back to UK is a great safety net and I would pretty much agree with your self insuring and taking the chance that you can be at worst patched up and go back home - - though the questions that arise are, if retired here, what happens when you are 80? Do you have a long term plan? Are you actually saving [putting away] the money that you are saving on premiums? 

 

I also self insure and face many of the same questions. Medical costs are rising here and I just had a friend go in for an operation that did not go as planned. Thankfully he survived but at 8x the original estimate... My concern and part of the reason that I do self insure is that the policies available do not have catastrophic coverage - I don't mind self insuring the lesser costly events. 

 

As to your actual risk profile, what will that be in ten years? But, I think that insurance companies definitely take that into consideration, your history, your family history and your risk activities. But, why not shop it out and get proposals from a few companies, read carefully and then make your decision.. Good luck and stay healthy. 

[JLCrab]

With insurance, there is the possibility with a covered claim that you will get out of it more than you put in. What generally goes for 'self-insurance' on here is actually a reserve. Since there is no possibility of getting out of it more than you put in, it is not insurance.

Edited November 13, 2016 by JLCrab