Advice, Insurance
Medical Insurance Thailand. Advice, tips & guidance from Industry experts, AA Insurance Brokers.
Mar
Very likely most of us will have had worries and issues while going out to get quotes about medical insurance coverage here in Thailand. Do I need outpatients’ coverage? Will I be covered or will they refuse my claim for some reason? What does all that small print say and mean? Will I have to pay upfront and claim back, thus afterwards go through weeks of stress waiting to see if I actually get paid?
Of course, many decide Insurance is not worth the money. I have seen many online debates about saving money in each to cover any eventuality. But let’s be honest, most never bother putting that money aside and let’s be even more honest, how many of us can put aside 500,000 Baht or 2 million Baht, bill levels that are easy to rack up over here.
To a degree it depends on age, I guess. If you are a healthy under 40-year-old then maybe you think you can take the risk. But accidents & medical conditions are not age restrictive. Certainly, for people of my age (the over 50’s) then medical insurance really should be considered essential, because at our age, often the bigger operations (bills) come along…. hernia, knee issues, stent implants and so on.
For me, the costs are worthwhile, as it would take me at least 20 years to have paid anywhere near the level of the hospital bill I would get for a standard operation that I will likely have to go through in that 20-year period. At age 53 now, to age 73 in 20 years, I reasoned that I will probably at some point, end up under the knife to the cost of 500,000 – 1m Baht. With my premiums at around 40,000/year, well you do the maths.
Anyway, to help everyone learn a bit more about the important aspects you need to know when looking into medical insurance here, I have interviewed the team at AA Insurance Brokers, and here is what they have to say on the subject.
My discussion with Dorus at AA Insurance Brokers, Hua Hin Office, answered some of the questions and concerns many of us have when shopping for insurance advice.
Outpatients cover (OP) – An Idea
Often OP cover can lead to a substantial increase in premiums. Again, for some it is worth it, but if you are not so sure, here is an idea. If you feel like you have a cold, flu, sore throat, stitches for a cut, or have some skin rash or something minor along these lines, go to your local clinic first and get the checkup done as this is way cheaper than going into the major hospitals. If it does indeed turn out to be a minor ailment that can be cured with some medication, the clinic doctor will be able to help at a fraction of the cost of your private hospital. On the other hand, if the issue is a little more serious, the clinic doctor will advise you to visit the hospital. AT this point, you may become an in-patient and thus, it may become covered by your insurance.
Matthieu Heijligenberg (CEO) says;
“Going to the Hospital does not automatically mean you become an Inpatient. It will only become Inpatient when the patient is assigned to a bed (Note that some companies have different definitions of what is inpatient. Where one says being assigned to a bed is enough to make it inpatient, others talk about staying in bed overnight, others for minimum 6 hours etc.). Day Surgery is also often covered under an inpatient plan.”
“When going for an Inpatient only plan, it is also very important to check how the company deals with outpatient cancer treatments. Cancer treatment is often very expensive. Many companies cover all Cancer related costs in full (also outpatient when one has an inpatient only plan). Others do not cover outpatient cancer treatment when one has the Inpatient plan. This is an area you need to ask your broker about in great detail.”
Questions to ask yourself when considering insurance.
What do you want to be insured for? Do you want to be just covered for those big bills and overnight stays? What can you afford to pay for yourself when you need medical attention?
For many of us, a few thousand baht at the clinic or as an OP are affordable. But what about those much larger bills from accidents, more serious conditions. Can you afford to outlay THB 500,000 and more? If the answer is no, then you really need to consider insurance advice as an absolute priority, as the last thing you want is to be left lying in a hospital bed in urgent need or repair and unable to get it.
Pre-existing. What does it mean?
Dorus at AA Insurance Hua Hin says;
“Any health condition that a doctor has previously diagnosed you with prior to your health plan taking effect can be labelled as a pre-existing condition. Please be aware that if you decide to switch insurers the new insurance company may exclude any medical conditions you have had treated whilst insured with the previous insurer. Pre-existing conditions result in a higher risk for the insurer and therefore might lead to either an exclusion or loading of the Premium.”
“When you are admitted to the hospital for an inpatient treatment and the hospital contacts the insurance company for the payment, the insurance company will always ask for the medical records of the patient, going back many years. If you had a medical checkup in that hospital where a medical condition was found before the start of your insurance, the insurance company will find it out from the medical files sent to the insurance company. The insurance company will always follow the medical files they receive from the hospital, and if on one medical file it shows that the medical condition was diagnosed already before you had the insurance, but it was not mentioned on the application form, they might decline cover.”
“Always be honest, else it could come back to haunt you. If you have had a checkup for a condition and the result was a small positive, but not serious enough to need attention, best to mention it, because if that condition worsens over the years and you go back to get tested again, likely it will not be covered. Do you have ongoing issues with eyes, ears, nose, throat etc. If you do, then again you need to mention this as one day if it becomes a more serious condition, you may not be covered.”
“In some cases, a pre-existing condition can be covered, but only if you have been upfront and honest about it from day one. In some cases, they just accept the condition (if it is something minor), or they might decide to add a premium loading, or cover a part of it, or totally exclude the medical condition. Some ailments and conditions that do not count as pre-existing. Most of us gets these kinds of illnesses during their lives. They are not pre-existing, unless they have left you with a lasting legacy, and underlying permanent condition.”
- Tonsillitis
- Flu
- Appendicitis
- Broken bone that totally healed
Are Premium increases long term?
A great many insurance providers use age brackets in determining a premium, such as 31 – 35, 51 – 55 or 56 – 60 etc. Of course, it goes without saying that the older you get the more the premium will increase. But there are other factors to be wary of that could see your premiums suffer a significant increase.
Medical inflation correction is usually around 5-9% PA. Some providers have been known to offer a form of no claims discount to negate this, but that can come back to haunt you again later in your life, especially if you have to make a claim.
If you are looking for a ‘Way to Win’ with insurance, this is not really going to happen. Medical costs increase all the time, so premiums have too. We do not think twice about insuring our car or bike, both of which are totally replaceable, but we often do not insure our own self, which is totally irreplaceable. Consider winning with insurance as being well, never having to claim and living with a relaxed peace of mind, not a care in the world attitude as you know your insurance there is anything bad does come to you.
Question for you.
If you get very sick (cancer etc.) where do you want to be treated? Here? Your home country. Some people decide they want to go back to their home country for the much more serious illnesses, to be around family and familiar surroundings. Be aware that you need to actually state this when getting coverage to be treated back at home. A very important and often missed point.
Some quotes from Benny at AA Insurance Brokers, Pattaya.
Benny says.
“Indeed, when you are one of the lucky ones and do not need medical treatment, the premium is a waste of money from your own perspective. But when you need medical treatment the most private hospitals are relatively quite expensive.”
“We always advise everyone to have a cover for at least U$100,000. But for those who really want total peace of mind, we recommend coverage of U$500,000. Cancer treatments are very expensive and U$100,000 will not last more than a few months. So, if you consider yourself high-risk for this type of condition, it would be wise to select a much higher coverage amount than the base levels.”
“We try to select insurance companies’ that people can be insured with for their lifetime and stay affordable at a later age. Some insurance companies offer very attractive rates at age 60, but they then double when you receive your quotes at the age of 70. We try to negate this by placing people with providers that work best for the long term when taking into account age increases. As brokers we inform the client of the essential and most important pros and cons of every company, so they can easily make the right decision.”
Will my insurance provider pay out? What about bankruptcy issues?
Matt (CEO) says,
“This topic was in the news recently, after 2 Thai Insurers went into bankruptcy as they could not pay for the claims of the COVID policies they sold. In Thailand Insurances are covered by the General Insurance Fund. All Insurance Companies have to contribute a fixed percentage of their turnover to this fund, so in the eventuality of a Company going bankrupt, the policies will still be valid until their original expiry date. If an Insurer cannot fulfil their obligations anymore after a claim, the General Insurance Fund will pick up the costs.”
Will the Thai Insurance Companies pay if I have a claim?
“This is a question we often get at AA Insurance. Contrary to what many people think, the insurance industry in Thailand is pretty well organised & professional. The OIC (Office of Insurance Commission) controls and regulates the entire insurance industry, from the insurance providers to brokers to general terms & conditions. All areas and aspects must be licensed and approved. An insurer in Thailand will always follow their own terms and conditions of course, and sometimes a dispute arises. It is good to know that the OIC also has an Ombudsman body, where a consumer can go to for support. It is also interesting to note that 80% of these consumer dispute cases are won, in favour of the claimant.”
If you would like to speak to the team at AA Insurance Brokers and get your own personal advice and guidance based on your own worries, concerns and circumstances, see the contact details for each of them below.
Dorus at Hua Hin Office – dorus@aainsure.net
Benny at Pattaya Office – benny@aainsure.net
Matt (CEO) – matt@aainsure.net
