Ask Tony Dabbs (Our Health Insurance Expert) - Page 14 - Ajarn Forum

tonyd · 25th July 2008, 11:34

HEALTH INSURANCE IN ACTION - This is taken from an e-mail I received this week from a client whose policy is due to renew for the third year. When he enrolled, he had a few pre-existing conditions which were excluded. They are still excluded. This year his premium was increased, although he had no claims. He is not happy.

Dear long-term client,

The things that you are concerned about are standard poicy with most private (not taxpayer supported) health insurers.

The cost of this policy has risen by 17% but nothing has changed

Yes, it has. Your age has changed. Health insurance premiums are determined by age band. This year you have moved into a higher age band.

nothing has changed in the exclusions.

Health insurance doesn’t work that way. Unless they stated a certain time period when an exclusion will be removed, the exclusion stays with you for life. BUT…if you feel that a certain exclusion is no longer justified, you can have it removed by getting a doctor to certify that the problem no longer a danger to your health.

The two-year period is up

That is why you might want to consider keeping the coverage. Now, they can’t refuse to pay for treatment that has not already been excluded, no mater what. If you get another health insurance, the two year period for discovering pre-existing conditions begins all over again.

in the instance of (the problem with) my leg, three years has gone.

See answer # 2.

tonyd · 2nd August 2008, 18:44

WE GET E-MAIL - This letter arrived this week

I purchased (name of insurer) directly and have not used a broker before.
If you would like, it is possible for you to switch to using us as your broker. It doesn’t cost any more to go through us and it gives you some back up support in dealing with the insurance company.

I am in my third year
That means, that they cannot tack on any more exclusions and all claims not already excluded in your coverage must be paid.

My age is 62
That means that (name of insurer) is now the only guaranteed renewable for life option that you have in Thailand.

(EXCLUDES) Dyslipidemia and anything related to it or caused by it.
What your treating physician says about the relationship is the determining factor in whether or not a potentially “related to or caused by” claim is paid.

I take a small amount of cholesterol lowering drug because in 2000 my doctor thought it had a good influence on the blood vessels.
BINGO!! No further explanation necessary. You take it because your doctor advised it.

Could you give me some information on how (name of insurer) will use this kind of clause
We have been through this type of thing before with (that insurer) and got the claim paid in full. That was because the doctor certified that his heart attack was not related to his history of hypertension. It still took a few months to settle the claim, though, because the policy was fairly new. They wanted to find out if the insured had a history of heart problems. He didn’t.
The delay was caused partly by the fact his medical records were in Canada, his doctor sent the wrong information and he provided some wrong supporting documents.

Are there cheaper options available that do guarantee lifelong coverage?
No.

I am contemplating to take the risk myself as I could afford bills for a few millions, although with pain.
Continue to buy protection while it is still affordable. But also start preparing to be able to self-insure when the premiums become too prohibitive in cost. There are still an awful lot of potentially high cost medical problems that your policy will cover.

tonyd · 9th August 2008, 20:01

QUESTIONS & ANSWERS - from an e-mail received on 8 August 2008

i have been looking through all the options available by your site (excellent work btw)
Thank you. You have done a good job of gathering information from it

i am now just a bit to confused (too much info?).
You are right. I think that if we prepared a set of spreadsheets for you they would help to put things more in perspective for you. And, I could help guide you more

For the Mega series, if i take a 20% discount by limiting area of cover, can I in a later policy year, re-enable the areas of cover?
Yes, you can. But, unless you travel to the limited cover areas a lot it would be cheaper just to get travel insurance.

i dont like it where i have to pay the whole year at once, but as it seems, that brings us to only mega series for semi annual and to NZI?
Yes, if you have a credit card NZI will draw from your credit card on a monthly basis. All other insurers accept credit cards for annual pay.

NZI looks good, i think they really do cover everything, its just really expensive for me.
That’s why they allow you to pay monthly (by credit card).

i thought 15.000 baht would get "good" insurance, but reading the terms, they are disappointing at these price ranges, it seems a lot of possible issues are not covered?..
You may be misreading some of the terms and conditions.

what is your opinion on OPD cover? this gets charged heavily into premiums, but only covers small monetary amount, so it almost does not seem worth it.
You got that right! The reasons the premiums are so high in relation to the coverage is because the insurance companies have no control over your usage. Insureds can use OPD to seek treatment for any imaginary complaint. Hospital Inpatient (IPD) is much cheaper for the coverage you get because you can’t get admitted unless the doctor says you really have a problem.

i heard BUPA wont cover many things if you drink more then 3 beer's a day, is this true? i did not see it mentioned in the policy
That is not true. That comes under the category of BUPA Legends (or Myths). But most health insurance policies (not just BUPA) exclude coverage for treatment of injuries caused by the insured’s irresponsible behavior. Injury caused by drunk driving could be a ground for refusing a claim. Some insurance policies list the blood alcohol level that could get a claim rejected.

.i do remember seeing motorcycle accidents arent fully covered...
Bullhicky!! No health insurance policies in Thailand limit coverage of treatment for motorcycle accidents. BUT!! Most policies include Personal Accident (PA) insurance. PA insurance is actually Accidental Death & Dismemberment insurance. It has nothing to do with treatment. It pays a lump sum if you die or lose an arm or a leg. Many insurers, including BUPA, limit the payout for motorcycle accidents under PA insurance. But, they all pay fully for treatment.

Could you please give me advice on what policy is best value for money?
Since you have already provided me the ages of both you and your girlfriend, we will prepare a set of Health Insurance Plan Comparison Spreadsheets for you. Then, let’s talk.

tonyd · 30th August 2008, 10:28

Chosen from an e-mail received on 25 August 2008

About BUPA....do they really pay out on health insurance if you don't have a work permit? I'm a bit worried in regards to this.

No. Absolutely for certain, BUPA doesn't check for work permits in any way what so ever.

The work permit myth got started because of AIA. They have a very strong marketing organization. They sell health insurance as a rider on life insurance. Since life insurance is a financial product, you are required to have a work permit to buy it.

Non-life health insurance policies sold through companies like BUPA don't have that requirement in any way, shape or form. All that they require is that you reside in Thailand. Nobody even checks to see if you have a visa.

But, they do require personal ID, such as the ID page of your passport. Nothing else, though.

Addendum

Non-life health insurance policies sold through companies like BUPA don't have that (WP) requirement in any way, shape or form?

Okay. Okay. There are two possible exceptions:

One health insurer actually states in their marketing brochure that expats require a Work Permit. We have placed a lot of health insurance with that insurer over the years and a WP has never, ever been an issue. We have sold to people who haven’t even arrived in Thailand, yet.

But, we recently picked up a client who had just been rejected by this insurer, after being rejected by AIA for no WP. We resubmitted his application again for him and it was approved with absolutely no problem. (What the other agent did – I have no idea.)

MSIG health insurance underwriters do require a Work Permit, though. Their petty rationale on this is that a WP reflects financial stability and assures the applicant’s ability to pay the premium. We sometimes are able to get around the WP thing by showing other proof of financial roots here.

Hailfromtheshire · 10th November 2008, 21:55

I'm trying to figure out what type of health insurance is good for me. My employer's buPA kicks in at the end of the month, and I was looking at the website for the supplement. It seems pretty good, I think. I want coverage for in case something happens to me - I have already been hospitalized twice this year - THAILAND is kinda not so good in this respect, I guess. I would need to pay monthly, however, since I do not make that much and could not pay the whole year out of pocket.
What kind of health insurance do you recommend so that I do not have to carry cash around in case of an emergency for health care? I live on Sukhumvit, and would prefer a good hospital (definitely not the likes of bangkok General medical center). I was also thinking a worldwide plan is better in case I visit home or for when I move back there someday. Thanks

Oh yeah, sorry, I forgot. How much insurance coverage would I need? The last hospital stay was almost 100,000 baht. What is a good amount? Is it that expensive at all hospitals or only because i am farang? Thanks again!

tonyd · 12th November 2008, 08:16

Quote:

I'm trying to figure out what type of health insurance is good for me. My employer's buPA kicks in at the end of the month, and I was looking at the website for the supplement.

BUPA's Extra Care major medical supplement might be a good way for you to go. It will ride on top of your existing group plan to expand your coverage and it isn't costly.

Quote:

I would need to pay monthly, however, since I do not make that much and could not pay the whole year out of pocket.

Only NZI-InterGlobal will allow you to pay monthly, and only if you have a credit card. Your only other monthly pay alternative is to buy life insurance and attach a small health insurance rider to it.

Quote:

What kind of health insurance do you recommend so that I do not have to carry cash around in case of an emergency for health care? I live on Sukhumvit, and would prefer a good hospital.

We represent all of the health insurance companies in Thailand. They all issue health cards that will get you admitted to most private hospitals in Thailand and they will pay directly to the hospital.

Quote:

I was also thinking a worldwide plan is better in case I visit home or for when I move back there someday.

All health insurance plans provide worldwide coverage except BUPA Crystal. But, remember, the medical costs in Thailand are much lower than in Europe or America. So, coverage that is adequate for Thailand probably won't be adequate for traveling to First World countries. I recommend that you supplement you coverage with low cost travel insurance when traveling home.

Quote:

How much insurance coverage would I need?

For Thailand, I recommend having at least 800,000 baht of coverage. 1 million baht would be better. But, most people can get by with less - if they make merit and pray a lot.