Ask Tony Dabbs (Our Health Insurance Expert) - Page 4 - Ajarn Forum

tonyd · 9th February 2006, 22:55

Quote:

Originally Posted by Bangkok Phil

As I understand it, THI has 2 types of personal health care coverage, one is called "Simply Healthy" and the other is called "Wealthy Healthy".

Actually, Phil, there are 3 types. But the third type provides stand-alone Major Medical coverage with 6 choices of deductibles and plan maximums.

Quote:

Originally Posted by Bangkok Phil

"Simply Healthy" and "Wealthy Healthy". What are the major differences between the two?

"Simply Healthy", for the most part, offers much lower Daily Room and Board coverage and provides more traditional kind of basic hospital protection and premium structure. In that, it has a limit on the number of days in the hospital it will pay for per sickness or injury; it uses a "surgery schedule" to determine how much will be paid for each type of operation and it sets maximum limits for each area of coverage. Another traditional feature of the coverage is that women are charged more than men.

"Wealthy Healthy" allows an unlimited number of days stay in the hospital and pays 100% of the cost for surgery up to the plan maximum. Both plans offer a 2,000 baht Daily Room and Board benefit with similar plan maximums. But "Wealthy Healthy" includes Major Medical coverage that acts like a large bank account the insured can draw from to pay 90% of the additional expenses once any of the basic plan maximums have been exceeded, up to the over-all plan maximum. Unlike the base plan, there are no internal limits for the Major Medical coverage (Daily R & B is not included, though). Women are charged the same premium as men.

Quote:

Originally Posted by Bangkok Phil

Which of the two do you think most people should purchase? Why?

I think that most people would be wise to go with a "Wealthy Healthy" plan. It may cost a little more, but the coverage included in a WH plan provides much better protection for the money.

hillbilly · 11th February 2006, 18:24

double post

Citan · 12th February 2006, 03:49

Dearest Sir,
This is my first post here and I just wanted to throw this out to some of you. I lived in thailand for a year (biiiig deaaaal right?) as an exchange student, and I have since, very sadly, been forced to return to the USA to get my degrees, just so I can return to Thailand and Teach, which is one of my few life goals.
When i was there i was in the emergency room THREE separate times. Granted, I had exchange student insurance, but my parents showed me the bills and they were a bit low compared to the service I received. I was in two hospitals in Grungthep and one near Pattaya and, the one near Pattaya was no picnic, I was in to get my head shaved and get my head stitched up, as I had just split it open on a rock diving into the ocean. I got 22 stitches, was given anesthetic 8 times (It just was not working...) and then I was given no water or pain medication (not even aspirin or paracetamol) for 24 hours as well.
I would kill to have that kind of service here in the states. Every hospital I as out simply outclassed any hospital I have ever seen here or anywhere else I have been. I suppose being able to speak and read and write Thai helped a bit.
Point?
I would trust my life to such hospitals and caretakers,. On the subject of health insurance, do your employers not provide some form of minority emergency health care pay? If so, It surely can't be all THAT bad when your ill, I got 22 stitches and was in the hospital for nearly a week and it did not even cost me 175$ it was closer to 140$.
love-
Norng Citan

tonyd · 12th February 2006, 07:06

Thanks for sharing that with us, Citan. Yes, Thailand does have a very good reputation for providing top class medical care. Most medical insurance plans, employer provided or personal, provide the kind of coverage you are referring to.

Citan · 12th February 2006, 07:30

Ahh Ok! You're much welcome, glad I could be of some help to you all. I was just kind of throwing it out there. One thing my friend Ajarn Chris told me, when I was studying in Thai was that you must stop, stop, STOP seeing things as "X baht = x pounds sterling, dollars etc etc." He had been there for 5 or 6 years and he always said "If you want to live by the dollar or pound, go home, to compare things to baht is a waste of time. You live by the baht now, so act like it."
Anyway, glad to be of help.
love-
Norng Citan

Bangkok Phil · 13th February 2006, 17:47

What is Major Medical insurance? Who should consider purchasing Major Medical insurance, and why?

tonyd · 13th February 2006, 22:04

Major Medical insurance is coverage that pushes medical protection beyond the limits of basic hospital coverage. It covers the high end medical expenses that we are least likely to incur, but fear the most. Major Medical coverage kicks in after a pre-determined deductible has been satisfied and then shares the cost of medical care with the insured. Traditionally the insurance company pays 80% of the costs with no built in limits, up to the plan maximum per occurrence. THI’s Major Medical pays 90% of the medical expenses.

Both THI and BUPA offer basic hospital plans with Major Medical built in. The deducible is satisfied by the basic hospital coverage. So, in effect, there is no deductible.

THI also has stand-alone Major Medical coverage with deductibles of 12,000 baht to 75,000 baht for protection coverage of 100,000 baht to 1,500,000 baht per occurrence. The deductible can be satisfied by basic hospital coverage issued by any insurance company.

Major Medical insurance is good for anyone who doesn't want to spend a lot of money for medical insurance, but would like to be protected against being wiped out financially by a costly medical probem. Also, anyone who has just a basic hospital plan should consider supplementing it with Major Medical insurance.

Why? Because Major Medical insurance provides high end protection for a relatively low cost.

Bangkok Phil · 18th February 2006, 10:21

Tony, why do health insurance companies like BUPA and THI, and others, include outpatient (OPD) for accidents in their basic plan and then charge another 50% to 80% more to add very limited OPD coverage for illness?

tonyd · 19th February 2006, 13:36

Quote:

Originally Posted by Bangkok Phil

Tony, why do health insurance companies like BUPA and THI, and others, include outpatient (OPD) for accidents in their basic plan and then charge another 50% to 80% more to add very limited OPD coverage for illness?

Frivolous and unnecessary usage of outpatient (OPD) care for illness is much more difficult to control than inpatient (IPD) care and emergency OPD care for accidents are; and providing it can be very costly to insurance companies. Both BUPA and THI, therefore, charge more to include OPD coverage, limit the number of doctor visits per year, and put a low ceiling on the amount they will pay per visit.

By contrast, getting admitted to the hospital for IPD care requires the signature of a qualified physician on a form stating the need. While qualifying for emergency accident OPD care, of course, requires an accident to happen and some sort of trauma to the body to occur.

Anyone with insurance that has limited or no OPD coverage for illness who visits the doctor often with the same complaint, and receives only temporary relief for that complaint, should request to be admitted to the hospital for more thorough testing and observation. All it takes is a 6 hour stay in the hospital to qualify for payment under the IPD coverage.

Side Note: My compliments to your cosmetic surgeon, Phil. It's quite obvious that the surgery went well. You're looking good!

Bangkok Phil · 22nd February 2006, 16:16

Do any of the medical insurance companies in Thailand cover the cost for cosmetic surgery?

tonyd · 22nd February 2006, 20:29

Quote:

Originally Posted by Bangkok Phil

Do any of the medical insurance companies in Thailand cover the cost for cosmetic surgery?

Not normally. As I’ve said before, insurance companies are not kind hearted philanthropists when it comes to paying out money for unnecessary medical care. As a rule, they need doctor certification that there is a serious health threatening need for the surgery.
• THI excludes: “Any cosmetic surgery except re-constructive surgery which is needed for medical reason.”
• BUPA goes into much more detail. They exclude: “Any cosmetic or beautification treatment including lasik surgery, the treatment of acne, freckles, dandruff, weight reduction and weight gain, hair loss. Reconstructive surgery is also excluded unless injury is sustained as a result of an accident and reconstructive surgery is necessary to restore functionality. Reconstruction of breasts and sexual organs is not covered.”

Your question is very timely one, Phil. We received a call just yesterday from an insured asking about having an operation that would definitely be classified as a form of cosmetic surgery. I explained the above to her, but she went on to assure me that the surgery was needed to deal with a serious health problem she had. She said that she would have no difficulty getting a doctor to certify the medical need for her operation.

I told her to have her doctor write up the medical justification for the operation and I will submit it to THI for their determination as to whether or not they will cover the surgery. Will the insurance company pay for the “cosmetic” surgery she wants? I have no idea. But, if the doctor writes up strong enough medical support for the need, they might.

Bangkok Phil · 26th February 2006, 18:41

Tony, how good is the medical coverage under the Thai goverment's Social Security scheme? Why do some expat teachers want out of the program? How can they get out of paying for it if they don't want it?

tonyd · 27th February 2006, 16:15

Quote:

Originally Posted by Bangkok Phil

Tony, how good is the medical coverage under the Thai goverment's Social Security scheme?

Except for the small amount SSI pays for the hospital room, Phil, the coverage is very, very good! So much so, that the program has become a victim of its own success and is losing money. Too many people are taking advantage of the coverage. Medical facilities and medical support are being stretched to the limit and more and more private hospitals are dropping out of the program.

Quote:

Why do some expat teachers want out of the program?

Most likely because the hospital they are now required to use is so overcrowded and understaffed that they are frightened about having to receive medical care there.

Quote:

How can they get out of paying for it if they don't want it?

If they work or teach in a government run facility, their only option is to quit their job if they don't like paying for the coverage. Otherwise, they should just consider it a small price to pay for keeping their job. Then go out and purchase coverage on their own.

Bangkok Phil · 7th March 2006, 05:39

Tony, there seems to be a lot of confusion about the need for Work Permits when buying medical insurance. Some people say that insurance buyers have to have a work permit and others, including yourself, say that they don't. Some go so far as to say that even if the agent does sell you insurance without asking for a Work Permit, the insurance company will refuse to pay your claim unless you can show that you have one. What are the real facts about the need for Work Permits and why does this confusion exist?

tonyd · 7th March 2006, 10:12

Quote:

Originally Posted by Bangkok Phil

Tony, there seems to be a lot of confusion about the need for Work Permits when buying medical insurance. Some people say that insurance buyers have to have a work permit and others, including yourself, say that they don't. Some go so far as to say that even if the agent does sell you insurance without asking for a Work Permit, the insurance company will refuse to pay your claim unless you can show that you have one. What are the real facts about the need for Work Permits and why does this confusion exist?

Phil, there are two different types of insurance companies marketing health insurance in Thailand. One type of company is a Life Insurance company and the other type is a General Insurance company.

Life Insurance agents who sell health insurance must sell it as a rider to a life insurance policy. That may be the reason why they require a Work Permit. In any case, Life Insurance companies do require foreigners to have a Work Permit to buy health insurance. They are stricter in other ways also.

BUPA, Thai Health Insurance, NSi and AXA are General Insurance companies and don’t require Work Permits to purchase health insurance. Ironically, though, AXA has a new health insurance policy out now and the brochure says that non-Thais do have to have a Work Permit. That shocked me! So I asked the lady who is in charge of that program, “Why?” She explained that a Work Permit is not really necessary. They just want make sure that the foreign insurance buyer is actually living in Thailand (???).

Is a Work Permit required when filing a medical insurance claim with a General Insurance company? Absolutely not! Is one required when filing a claim with a Life Insurance company? Possibly, depending on the company.

The confusion over the need for Work Permits exists because one of the biggest Life Insurance companies in Thailand has a very large marketing force. Anyone looking for medical insurance will most likely talk with one their agents and leave their meeting convinced that a Work Permit is a requirement for purchasing health coverage in Thailand. They will tell their friends, and the myth goes on.