Health Insurance - what to watch out for

[xylophone]

7 minutes ago, Sheryl said:

The issue with self insuring is what will you do when a large expense wipes out or substantially reduces the amount you set aside? How will you replenish it? Andd, if you "self insure" by paying an amount equivalent to insurance premiums into a savings account, what will you do if a large expense occurs early on before the amount has accumulated to much?

 

Actually paying the equivalent of an insurance premium into a savings acct is not self-insuring. Self insuring would be putting aside at least 1-2 million baht first, with some clear plan/systemfor replenishing it.

 

Dr_lucas: your premiums would be substantislly less, possibly by as much as half, if you dropped the outpatient cover which is seldom worth it as the increased premium is often about the same as the maximum opd cover. Note that inpt only cover will still cover day surgeries, expensive scans and the like.

 

Of course if you switch to self pay for opd you will want to stop getting meds from the hospital and rather buy at an outside pharmacy. Hospital mark ups on drugs are huge (300% or more in most cases).

 

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Great post from Sheryl, covering some excellent points.

 

I thought about self-insuring when I came here, however eventually settled on BUPA and have had a policy with them now for about 10 years.

 

If one self insured and had a serious illness, then any attempt later on to take out a health insurance policy would mean that this illness/condition would have to be excluded from ongoing cover. Furthermore if after such an event one decided to take out health insurance, then some companies will not include "lifelong cover" unless you join before a certain age, and you may well have missed that age deadline?

 

Like Sheryl suggested, I don't include outpatient cover as I can cover this sort of stuff quite easily out of my everyday expenses, and I also inform the doctor if I do go for an outpatient appointment that I will buy the drugs he prescribes outside of the hospital as they are much cheaper, and believe it or not, every doctor I have spoken to about this agrees and some even encourage me to do so!

[dr_lucas]

26 minutes ago, Sheryl said:

Dr_lucas: your premiums would be substantislly less, possibly by as much as half, if you dropped the outpatient cover which is seldom worth it as the increased premium is often about the same as the maximum opd cover. Note that inpt only cover will still cover day surgeries, expensive scans and the like.

 

Of course if you switch to self pay for opd you will want to stop getting meds from the hospital and rather buy at an outside pharmacy. Hospital mark ups on drugs are huge (300% or more in most cases).

 

Yes, @Sheryl, thanks, I am aware of that. AFAICR Cigna was tricky enough to bundle a few more very important things into their OPD coverage and dropped them from other modules, but I will have to look into it again.

TBH, Psychologically, knowing I have 100% unlimited OPD coverage makes me go to see the doctors and run (or even re-run) as many (newest and most expensive) diagnostic scans as I can in cases I have symptoms without diagnosis, and doing that in the most expensive places, picking the most expensive doctor. I doubt if I would have done that if I didn't have OPD cover and had to pay from my own pocket for every visit and test, even if that may have cost a lot less than OPD cover in the long run.

I had a case like this recently when I had a few symptoms that could possibly be very dangerous, and had to see a Pulmonary specialist, then heart specialist then requested further investigation and was referred to a rheumatologist and then infectious disease specialist.

With all of them I insisted on running the best and widest range of tests to get correctly diagnosed.

None of them was able to find the cause for my symptoms or the origin of the few of my abnormal test results yet, but the point is that all of these cost over 200,000 baht so far.

That more than I pay for a full year of OPD cover. And if I want, I can still go to do more and more tests and go to as many hospitals as I want to get 2nd and 3rd opinions, just to make sure the doctor didn't miss anything, as in some cases - time may be critical.

Again, I probably wouldn't have done that if I wasn't insured and in some cases, this could have put my life in danger if I didn't do that.

 

As for the meds, Bumrungrad markup is probably much higher than 300%, definitely much higher than any other private hospital I compared it to in Bangkok, especially if you compare the meds to their generic alternatives.

For example, 1 original (imported) antibiotics cost there 1,500 THB per package.

A local generic antibiotics (the same exact active ingredients) cost 100 THB in my neighborhood's pharmacy.

So you can also save on meds even more if you shop around for cheaper generic alternatives.

[norrska]

On 1/30/2018 at 12:22 PM, dr_lucas said:

 

Yes, @Sheryl, thanks, I am aware of that. AFAICR Cigna was tricky enough to bundle a few more very important things into their OPD coverage and dropped them from other modules, but I will have to look into it again.

TBH, Psychologically, knowing I have 100% unlimited OPD coverage makes me go to see the doctors and run (or even re-run) as many (newest and most expensive) diagnostic scans as I can in cases I have symptoms without diagnosis, and doing that in the most expensive places, picking the most expensive doctor. I doubt if I would have done that if I didn't have OPD cover and had to pay from my own pocket for every visit and test, even if that may have cost a lot less than OPD cover in the long run.

I had a case like this recently when I had a few symptoms that could possibly be very dangerous, and had to see a Pulmonary specialist, then heart specialist then requested further investigation and was referred to a rheumatologist and then infectious disease specialist.

With all of them I insisted on running the best and widest range of tests to get correctly diagnosed.

None of them was able to find the cause for my symptoms or the origin of the few of my abnormal test results yet, but the point is that all of these cost over 200,000 baht so far.

That more than I pay for a full year of OPD cover. And if I want, I can still go to do more and more tests and go to as many hospitals as I want to get 2nd and 3rd opinions, just to make sure the doctor didn't miss anything, as in some cases - time may be critical.

Again, I probably wouldn't have done that if I wasn't insured and in some cases, this could have put my life in danger if I didn't do that.

 

As for the meds, Bumrungrad markup is probably much higher than 300%, definitely much higher than any other private hospital I compared it to in Bangkok, especially if you compare the meds to their generic alternatives.

For example, 1 original (imported) antibiotics cost there 1,500 THB per package.

A local generic antibiotics (the same exact active ingredients) cost 100 THB in my neighborhood's pharmacy.

So you can also save on meds even more if you shop around for cheaper generic alternatives.

you sound like a hypochondriac....would you go to the hospital as much if you didn't have Outpatient coverage?

Edited February 5, 2018 by norrska

[dr_lucas]

Definitely not a hypochondriac. You don't know my medical history and my medical experience, and I won't share them here, but one thing I will say, which is based on my many years of experience in the medical world in general and with many Thai doctors (mostly in Bumrungrad) in particular, I don't trust doctors much, especially not Thai doctors. I think the biggest problem with Thai doctors is that most of them think that their medical training ended when they received their diploma. They don't stay up to date with latest researchers, studies and technologies, unless they are being "forced" to do so.
In my own personal experience here, when it comes to things that are even a bit more complex than the common diseases/conditions, most of them tend to be outdated, overly-conservative, misinformed and provide lots of misinformation to patients. I personally corrected them many times during consultations and personally had to push them to run more tests when they said nothing wrong and then those tests found the issues I had. Shocking, isn't it?

As for your question, I think I pretty much answered that in the post you quoted.

In any case, it's all quite off topic. I am not the discussion topic here.

[xylophone]

33 minutes ago, dr_lucas said:

I think the biggest problem with Thai doctors is that most of them think that their medical training ended when they received their diploma. They don't stay up to date with latest researchers, studies and technologies, unless they are being "forced" to do so.
In my own personal experience here, when it comes to things that are even a bit more complex than the common diseases/conditions, most of them tend to be outdated, overly-conservative, misinformed and provide lots of misinformation to patients. I personally corrected them many times during consultations and personally had to push them to run more tests when they said nothing wrong and then those tests found the issues I had. Shocking, isn't it?

Have had the same experience here and totally agree with you comments.

[Scott]

Baiting post and reply removed.   Stay on topic.  

[lyseoy]

On 2/5/2018 at 10:49 AM, dr_lucas said:

Definitely not a hypochondriac. You don't know my medical history and my medical experience, and I won't share them here, but one thing I will say, which is based on my many years of experience in the medical world in general and with many Thai doctors (mostly in Bumrungrad) in particular, I don't trust doctors much, especially not Thai doctors. I think the biggest problem with Thai doctors is that most of them think that their medical training ended when they received their diploma. They don't stay up to date with latest researchers, studies and technologies, unless they are being "forced" to do so.
In my own personal experience here, when it comes to things that are even a bit more complex than the common diseases/conditions, most of them tend to be outdated, overly-conservative, misinformed and provide lots of misinformation to patients. I personally corrected them many times during consultations and personally had to push them to run more tests when they said nothing wrong and then those tests found the issues I had. Shocking, isn't it?

As for your question, I think I pretty much answered that in the post you quoted.

In any case, it's all quite off topic. I am not the discussion topic here.

 

I think you have just the right amount of regard for doctors in general. Yes, many doctors are shockingly arrogant. I've had similar cart-before-the-horse experiences to yours. It often doesn't take you more than an hour of self study on google to learn something about your condition that your doctor doesn't know....

[JimmyJ]

Very helpful thread. Lots of excellent tips from Sheryl.

 

Sheryl - If you don't mind, can you please post what company you went with, and also what your final list of "possibles/acceptables" was.

[jdgalipeau]

I am a Canadian, 59, currently with CIGNA within the UN system. Planning to retire in Huahin in the next year. 

 

I will check with Cigna to continue the coverage but any make-or-break points that I should look at or avoid? Thx for any advice. 

[Grumpy Old Man]

1 hour ago, jdgalipeau said:

I am a Canadian, 59, currently with CIGNA within the UN system. Planning to retire in Huahin in the next year. 

 

I will check with Cigna to continue the coverage but any make-or-break points that I should look at or avoid? Thx for any advice. 

 

I currently use "Aetna" formally "BUPA" at a "Platinum" service level . . . Compare the level of cover between "CIGNA" and "AETNA" and you'll get a good idea of any service deficiencies . . . . . "AETNA" have discounts for making an application and taking a medical insurance online; they also offer a "No Claim" discount of approximately 12% for the next year of cover.

 

I did consider "CIGNA" three years ago as my medical insurance provider in Thailand but at the time the cover was not as good as "BUPA" now "AETNA" for the same cost.

 

I hope this helps   

Edited June 25, 2018 by Grumpy Old Man

[stevenl]

22 hours ago, Grumpy Old Man said:

 

I currently use "Aetna" formally "BUPA" at a "Platinum" service level . . . Compare the level of cover between "CIGNA" and "AETNA" and you'll get a good idea of any service deficiencies . . . . . "AETNA" have discounts for making an application and taking a medical insurance online; they also offer a "No Claim" discount of approximately 12% for the next year of cover.

 

I did consider "CIGNA" three years ago as my medical insurance provider in Thailand but at the time the cover was not as good as "BUPA" now "AETNA" for the same cost.

 

I hope this helps   

Cigna is an international company, governed by western rules, Aetna is a Thai company (unless you talk about UK). This means e.g. Cigna will not end policy at 70 years or dramatically increase the premiums, Cigna can not increase premiums or limit coverage after health issue, etc.

[Sheryl]

As above. This is a key issue.

The policies that give "no claim" discounts or rebates are often the same ones that increase premiums on an individual basis if you have large claims or have developed a chronic condition that alters your "risk profile". This can result in effectively pricing you out, making the guarantee of lifetime cover meaningless.

If you are planning on living out your old age in Thailand it is essential IMO to have a policy which falls under the insurance regulations of a western country.

If you do not and will just be here for a few years while still comparatively young then you need to weigh the pros and cons. The disadvantage of Thai issued policies is as above, but they have the advantage of incountry offices and usually much greater ease in getting preauthorizations etc accordingly. Thai hospitals have a lot of difficulty understanding and meeting international insurance documentation requirements which can delay both reimbursements and preauthorizations and you can end up having to do a lot of work yourself to get it sorted. With a Thai policy, it is Thai insurance staff talking to Thai medical staff so goes more smoothly.

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[keithsimmonds]

Is there any need to have Accident and Emergency Insurance Policy as well as a Health Insurance Policy. I have just spoken to an independent broker who  says everything would be covered in the Health policy.

Any thoughts??

[Sheryl]

It depends on the details of the main health insurance.

 

I personally have both because my main policy (1) is inpatient only and (2) has deductible and copays (both by my choice, to decrease premium costs).

 

As personal accident insurance is quite cheap I took that out so that I have full coverage (up to the maximum) for in & outpt without any deductible (accidents only, of course).

 

If your main health insurance covers outpatient as well as inpatient with no deductibles or copays then indeed no need for an accident policy (unless you want the disability/death benefit). But that will mean you have a very expensive main  health policy. An inpt only, with deductible, main health insurance policy plus a separate PA policy is a good compromise cost/benefit wise.

 

But be careful which PA policy you select, many have ridiculously low medical benefit. You want the highest available medical benefit for your age. For people under 65 this will usually be Siam City S1 plan (625 k), for those 65-79 years Bangkok Insurance PA 45+ plan (200 K). 80 years onward the maximum benefit is so low that may not be worth getting.

 

 

[keithsimmonds]

1 hour ago, Sheryl said:

It depends on the details of the main health insurance.

 

I personally have both because my main policy (1) is inpatient only and (2) has deductible and copays (both by my choice, to decrease premium costs).

 

As personal accident insurance is quite cheap I took that out so that I have full coverage (up to the maximum) for in & outpt without any deductible (accidents only, of course).

 

If your main health insurance covers outpatient as well as inpatient with no deductibles or copays then indeed no need for an accident policy (unless you want the disability/death benefit). But that will mean you have a very expensive main  health policy. An inpt only, with deductible, main health insurance policy plus a separate PA policy is a good compromise cost/benefit wise.

 

But be careful which PA policy you select, many have ridiculously low medical benefit. You want the highest available medical benefit for your age. For people under 65 this will usually be Siam City S1 plan (625 k), for those 65-79 years Bangkok Insurance PA 45+ plan (200 K). 80 years onward the maximum benefit is so low that may not be worth getting.

 

 

Thankyou Sheryl that is really helpful. 

[Chongalulu]

1 hour ago, Sheryl said:

It depends on the details of the main health insurance.

 

I personally have both because my main policy (1) is inpatient only and (2) has deductible and copays (both by my choice, to decrease premium costs).

 

As personal accident insurance is quite cheap I took that out so that I have full coverage (up to the maximum) for in & outpt without any deductible (accidents only, of course).

 

If your main health insurance covers outpatient as well as inpatient with no deductibles or copays then indeed no need for an accident policy (unless you want the disability/death benefit). But that will mean you have a very expensive main  health policy. An inpt only, with deductible, main health insurance policy plus a separate PA policy is a good compromise cost/benefit wise.

 

But be careful which PA policy you select, many have ridiculously low medical benefit. You want the highest available medical benefit for your age. For people under 65 this will usually be Siam City S1 plan (625 k), for those 65-79 years Bangkok Insurance PA 45+ plan (200 K). 80 years onward the maximum benefit is so low that may not be worth getting.

 

 

Interesting information on PA. But 200k max (I’m 66) is so low I could cover that easily from my own funds. I’m looking for something to cover me for a more catastrophic accident say 500k to 1million. Any suggestions? 

[Sheryl]

AFAIK at 66 there is no PA policy you can get with better benefit.

I could cover 200k if I had to also, but for premium of only 6k a year and with coverage that includes outpt etc it seems a good deal. Of course I also have 1 million USD cover through my main policy.

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[topt]

On 6/26/2018 at 3:01 PM, Sheryl said:

For people under 65 this will usually be Siam City S1 plan (625 k),

Just in case anyone else is looking at this the premium is 14,800 baht - according to the info I have just been sent.

 

Edit - also cover for m/c accidents whether passenger or driver is extra and there is currently no English translation of their contract.

Edited June 27, 2018 by topt

[bbi1]

On 11/26/2016 at 4:07 PM, Sheryl said:

My current company is BUPA Thailand (Platinum Plan) but I am looking to change as they do not meet criteria #2 and 3. I want to switch to a policy which does while I am still healthy, one I can expect to stay with for life.

 

Still searching, just emailed a broker to help me. My "short list" was (in no particular order)

• Cigna Global
• A+ (SEA plan)
• Globaility
• William Russell
• April

Any reasons why you didn't consider ACS in your list even though you  mentioned some good things about them in a previous post?

 

 

[Flow]

I agree with Sherryl. After many years with local insurers here in Thailand I left for an international one (Cigna). A friend of mine got kicked out of Thai Health Insurance Co. Ltd and others have had problems with Bupa, LMG, AIA, Pacific Cross, AXA and there are dozens more local ones - all operating in the same way. Once one reaches 50 it is wise to go with an international insurer based outside of Thailand. I'm insured inpatient only from Cigna with a deductible of 1,500 US$ in Thailand and in my home country Sweden. Can't comment on what Cigna are like because I haven't had to use them and hope to never have to use them. I pay 50,000 Baht a year.  

Edited January 13, 2019 by Flow

[claynlr]

On 11/26/2016 at 4:07 PM, Sheryl said:

My current company is BUPA Thailand (Platinum Plan) but I am looking to change as they do not meet criteria #2 and 3. I want to switch to a policy which does while I am still healthy, one I can expect to stay with for life.

 

Still searching, just emailed a broker to help me. My "short list" was (in no particular order)

• Cigna Global
• A+ (SEA plan)
• Globaility
• William Russell
• April

 

Though the last one looks iffy as it seems, if I read correctly, that they require a second opinion by a doctor of their choosing. If so, that is out as I am not going to give an insurance company veto power over my health care, which is what that would amount to. But I may have misunderstood that provision.

 

It is also possible I have overlooked some, this is just what I have unearthed so far that looks possible.

 

 

Hi Sheryl- Since you have gone with April, was the “second opinion” in their policy? Thanks for all your research....I have an email in to AA for help.

[Sheryl]

5 hours ago, claynlr said:

Hi Sheryl- Since you have gone with April, was the “second opinion” in their policy? Thanks for all your research....I have an email in to AA for help.

No, no such requirement. There  is a pre-authorization process (as with ll insurance) but based on information provided by your own doctor/hospital. No mandatory second opinion.

 

this is the MyHealth International Plan, not the MyHealth Thailand plan.

[claynlr]

Yes Sheryl, the international one. AA actually quoted about $60 dollars a year cheaper than April’s home site.

 

The first suggestion from AA was David Shield for US 1.25M versus 1M annual coverage for April, no deductible and cheaper than April. Everything else seems to be the same. David Shield wanted a blood test for over age 60 (cholesterols and a few other things checked) You ever look in to them Sheryl? $2076 first year, age 64

[pontious]

On 2/12/2019 at 4:59 PM, claynlr said:

Yes Sheryl, the international one. AA actually quoted about $60 dollars a year cheaper than April’s home site.

 

The first suggestion from AA was David Shield for US 1.25M versus 1M annual coverage for April, no deductible and cheaper than April. Everything else seems to be the same. David Shield wanted a blood test for over age 60 (cholesterols and a few other things checked) You ever look in to them Sheryl? $2076 first year, age 64

Just a warning if you are looking at April 'Essential Plan' They will only cover private room cost's for accident and emergencies. They will NOT cover private room costs at all for 'scheduled hospitalisation'.

[expatfamily]

For anyone who plans on living in Thailand for a long time single or with family recommend Asia Insurance.

Asia Insurance 1950 PCL

183, Regent House Building, 12th Floor, Rajdamri Road, Khwaeng Lumphini, Khet Pathum Wan, Krung Thep Maha Nakhon 10330

http://asiahealth.com/

[topt]

5 hours ago, expatfamily said:

For anyone who plans on living in Thailand for a long time single or with family recommend Asia Insurance.

Asia Insurance 1950 PCL

183, Regent House Building, 12th Floor, Rajdamri Road, Khwaeng Lumphini, Khet Pathum Wan, Krung Thep Maha Nakhon 10330

http://asiahealth.com/

Can you tell us why you recommend them?

According to what I can see from your link they are only "advisors" - which to me sounds like a glorified broker.....

Quote

Who are we? 

We are an international health insurance advisors, featuring the best health insurance plans for Asia. 

 

[dr_lucas]

To make a long story short, if you want a good and reliable health insurance company that follow proper western standard insurance regulations, go for an international company with an international plan, not a Thai one (and not an International one with local plans, such as Bupa Thailand that was recently bought by Aetna. Bupa International plans is a different story of course). It may cost more, but IMHO worth it, if you can afford it.

Here is a good place to start your research:

https://www.internationalinsurance.com/compare/global-medical.php

Edited March 7, 2019 by dr_lucas

[marcusarelus]

4 minutes ago, dr_lucas said:

To make a long story short, if you want a good and reliable health insurance company that follow proper western standard insurance regulations, go for an international company, not a Thai one. It may cost more, but IMHO worth it, if you can afford it.

Here is a good place to start your research:

https://www.internationalinsurance.com/compare/global-medical.php

I'd wait and see what the Thai government wants expats to get if they do before making a substantial commitment of money. 

[dr_lucas]

6 minutes ago, marcusarelus said:

I'd wait and see what the Thai government wants expats to get if they do before making a substantial commitment of money. 

Meaning?

[brewsterbudgen]

To make a long story short, if you want a good and reliable health insurance company that follow proper western standard insurance regulations, go for an international company with an international plan, not a Thai one (and not an International one with local plans, such as Bupa Thailand that was recently bought by Aetna. Bupa International plans is a different story of course). It may cost more, but IMHO worth it, if you can afford it.
Here is a good place to start your research:
https://www.internationalinsurance.com/compare/global-medical.php

While I have used Western insurers, I recently came unstuck as Regency for Expats, which has otherwise been good, only provide full cover for "semi-private" rooms, irrespective of the price of the room. Our local hospital only has private rooms.

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