Health Insurance for my Thai wifey

[KWA]

On 10/12/2023 at 1:11 AM, Pumpuynarak said:

Has anyone actually got Pacific Cross Health Insurance cover that they have actually made a claim on or do you know of anyone who has ?, if so can you enlighten me as to your experience or anyone else ?

I'd like to be informed of policyholders claims experience. TIA guys.  

Yes, I've got it and yes I've claimed on it.

They were a pain in the a**e to start with as they wanted to check my medical history before giving the go ahead, which is OK in principle but in the time they were taking I could have gone blind (detached retina with extras).

I ended up paying for the operation etc. myself and claiming it back which went fine even with all the paperwork they required.

They have different levels of cover available and I'd increased mine the year before.  The original cover would have paid for the op, but another benefit of the increased cover was it covered 90 days of follow up appointments as an out patient, even though I had declined out patient cover when taking out the policy.  My last check up was on day 89 so it's something to be aware of when deciding what cover you want.

I tried to get them to pay for new glasses too but they declined that bit.

 

[Pumpuynarak]

14 hours ago, KWA said:

Yes, I've got it and yes I've claimed on it.

They were a pain in the a**e to start with as they wanted to check my medical history before giving the go ahead, which is OK in principle but in the time they were taking I could have gone blind (detached retina with extras).

I ended up paying for the operation etc. myself and claiming it back which went fine even with all the paperwork they required.

They have different levels of cover available and I'd increased mine the year before.  The original cover would have paid for the op, but another benefit of the increased cover was it covered 90 days of follow up appointments as an out patient, even though I had declined out patient cover when taking out the policy.  My last check up was on day 89 so it's something to be aware of when deciding what cover you want.

I tried to get them to pay for new glasses too but they declined that bit.

 

Thanks great info, i've been reading through the T&C's which are onerous to say the least, i like to be fully aware of what i'm buying and the extent of the cover together with any pitfalls, i just don't trust Thailand lol.

You say you ended up paying for the op yourself and then claimed it back, now that i find totally unacceptable. Its issues like this that determine whether i want to do business with said company, at a time of illness and the associated stress the last thing you need is treatment payment problems.

I'm looking at Maxima cover for wifey, i chose this level cos it has ''full payment'' of ICU stays which can be horrendously expensive. I also am not bothering with outpatient cover, i'll/wifey can pay, its no big deal.

One area i'm somewhat confused about is this waiting period but no doubt i can get a full explanation when contacting them by phone. Thanks again for your helpful reply.

 

 

[forcebwithu]

1 hour ago, Pumpuynarak said:

Thanks great info, i've been reading through the T&C's which are onerous to say the least, i like to be fully aware of what i'm buying and the extent of the cover together with any pitfalls, i just don't trust Thailand lol.

You say you ended up paying for the op yourself and then claimed it back, now that i find totally unacceptable. Its issues like this that determine whether i want to do business with said company, at a time of illness and the associated stress the last thing you need is treatment payment problems.

I'm looking at Maxima cover for wifey, i chose this level cos it has ''full payment'' of ICU stays which can be horrendously expensive. I also am not bothering with outpatient cover, i'll/wifey can pay, its no big deal.

One area i'm somewhat confused about is this waiting period but no doubt i can get a full explanation when contacting them by phone. Thanks again for your helpful reply.

The waiting period is standard on policies as they don't want people signing up for insurance for conditions they may have, or get within a short period of time of starting a new policy.

As for pre-paying for procedures and then getting reimbursement from your insurance, that too I found is SOP here. You just need to factor that into what you consider an adequate amount of cash reserves you keep in country.

I don't fault the hospitals for their pre-payment policy. If they didn't it would leave them open to insurance companies that after treatment deny coverage for whatever reason they can come up with.

It's probably easier for me to understand this policy as I'm from the US where medical care is a business first and foremost.

[Pumpuynarak]

6 minutes ago, forcebwithu said:

The waiting period is standard on policies as they don't want people signing up for insurance for conditions they may have, or get within a short period of time of starting a new policy.

As for pre-paying for procedures and then getting reimbursement from your insurance, that too I found is SOP here. You just need to factor that into what you consider an adequate amount of cash reserves you keep in country.

I don't fault the hospitals for their pre-payment policy. If they didn't it would leave them open to insurance companies that after treatment deny coverage for whatever reason they can come up with.

It's probably easier for me to understand this policy as I'm from the US where medical care is a business first and foremost.

Trouble i have mate is i spent most of my working life in the UK insurance industry (retired in 2000) and thought i had a good handle on T&C's and procedures but i now realise how times have changed and no doubt Thailands policies are inferior to what i'm used to.

I've never seen a 'waiting period' on UK health insurance, well my company never had as all applicants had to undergo an extensive medical examination along with a thorough inspection of an applicants medical records before policy issue but i'm probaly hopelessly out of date.

[forcebwithu]

4 minutes ago, Pumpuynarak said:

Trouble i have mate is i spent most of my working life in the UK insurance industry (retired in 2000) and thought i had a good handle on T&C's and procedures but i now realise how times have changed and no doubt Thailands policies are inferior to what i'm used to.

I've never seen a 'waiting period' on UK health insurance, well my company never had as all applicants had to undergo an extensive medical examination along with a thorough inspection of an applicants medical records before policy issue but i'm probaly hopelessly out of date.

I would imagine the UK insurance industry is quite a bit different from other countries that don't have an NHS. It would have to be as countries that don't have NHS operate on a different health care model.

Thailand, while it does have universal coverage for their citizens, it's unfortunately unavailable to ex-pats. So as it stands, the health care model for ex-pats is more inline with what we have in the US.

[Pumpuynarak]

5 minutes ago, forcebwithu said:

I would imagine the UK insurance industry is quite a bit different from other countries that don't have an NHS. It would have to be as countries that don't have NHS operate on a different health care model.

Thailand, while it does have universal coverage for their citizens, it's unfortunately unavailable to ex-pats. So as it stands, the health care model for ex-pats is more inline with what we have in the US.

Yes indeed what you say regarding expats is very relevant but i'm proposing to purchase a policy for my Thai wifey. Despite being in the NHS as a British citizen i and my entire family living with me had TOTR health insurance with BUPA provided FOC by my company, the cover available was second to none, it could'nt be beaten, it was totally comprehensive in every respect.

God knows what my company was paying for it.

[Yessongs]

Wifey and I both have health coverage through "AIA" here....I can attest to the fact that in Jan 2016 when I got it, there was no "waiting period" at all. Got a physical here the following week, and have continued to do so every Jan when here. 

[Pumpuynarak]

8 minutes ago, Yessongs said:

Wifey and I both have health coverage through "AIA" here....I can attest to the fact that in Jan 2016 when I got it, there was no "waiting period" at all. Got a physical here the following week, and have continued to do so every Jan when here. 

Thanks Mike, i'll get a quote for wifey.

[Glasseye]

Some companies require a physical exam. Some do the question and answer thing extensive (mind numbing), then they will dig into your insurance history (amazing how much they can/will find out).

They will load you up on pre-existing conditions (unless you go in and are in good health and they can;t find anything), age when you get the policy is also an important factor.

Some of the prexisting factors have time limits. For example they will say will not cover you for any prostate issue for up to two years. But following that (if you provide the proper info.) they will begin coverage. 

Either way.... it is easy to get fcuked.

I went with PC primarily to have something to "get into the door". Once the intial diagnoses is made and I am stabilized I figure I will have to battle out how it's all going to be paid for, or if I will have to go back to the U.S. use Medicare and battle with them over there.

It's a nightmare no matter how you break it down.

[fforest]

If you have the money just put 1,000,000 baht in the bank and never touch it.....Thats a health care plan that never denies a claim....And the rates never go up...No monthly payments ever for the rest of your life...

[forcebwithu]

20 minutes ago, fforest said:

If you have the money just put 1,000,000 baht in the bank and never touch it.....Thats a health care plan that never denies a claim....And the rates never go up...No monthly payments ever for the rest of your life...

That then enters into the discussion of how much is enough to self-insure. Personally I'd at least triple that amount, which is what I'm expecting I'll have to do when I turn 70 and health insurance becomes prohibitively expensive.

[Glasseye]

49 minutes ago, forcebwithu said:

That then enters into the discussion of how much is enough to self-insure. Personally I'd at least triple that amount, which is what I'm expecting I'll have to do when I turn 70 and health insurance becomes prohibitively expensive.

 

Interesting question.

 

Depending what the rates are, and what they may be down the road (estimated) maybe balance having both of them.

 

One key thing I have learned is that getting a policy prior to 65 and maintiaining with proper premium payments is important to keeping rates down. 

[Pumpuynarak]

19 hours ago, Glasseye said:

 

Interesting question.

 

Depending what the rates are, and what they may be down the road (estimated) maybe balance having both of them.

 

One key thing I have learned is that getting a policy prior to 65 and maintiaining with proper premium payments is important to keeping rates down. 

The main issue i believe is to arrange cover BEFORE you suffer any meaningful ill health, the issue of pre-existing conditions virtually makes health insurance not worth the paper its written on, so many ways for your insurer to deny claims. Take me for example, i was diagnosed at age 60 with type 2 diabetes which means any insurer can deny most claims so in effect i'm uninsurable.

Now wifey is fit and healthy at age 41, exercises virtually everyday, never smoked anything well other than me lol, only drinks socially, eats healthy. She's recently had a full medical check up and no probs other than some small cysts around her tits which are insignificant in the grand scheme of things, the hospital checked them out. So getting her comprehensive cover NOW at a reasonable premium is ok BUT the longer you leave getting the cover you run the risk of suffering ill health and then the problems start getting decent cover.

Its a delicate balancing act as to when is it time to effect the insurance, after all who wants to pay years of premiums for nothing other than peace of mind.

[lazarus]

4 minutes ago, Pumpuynarak said:

Its a delicate balancing act as to when is it time to effect the insurance, after all who wants to pay years of premiums for nothing other than peace of mind.

Buying insurance is like keeping a lawyer on retainer...

You really don't want to, but eventually you will need it.

[Glasseye]

2 hours ago, Pumpuynarak said:

The main issue i believe is to arrange cover BEFORE you suffer any meaningful ill health, the issue of pre-existing conditions virtually makes health insurance not worth the paper its written on, so many ways for your insurer to deny claims. Take me for example, i was diagnosed at age 60 with type 2 diabetes which means any insurer can deny most claims so in effect i'm uninsurable.

Now wifey is fit and healthy at age 41, exercises virtually everyday, never smoked anything well other than me lol, only drinks socially, eats healthy. She's recently had a full medical check up and no probs other than some small cysts around her tits which are insignificant in the grand scheme of things, the hospital checked them out. So getting her comprehensive cover NOW at a reasonable premium is ok BUT the longer you leave getting the cover you run the risk of suffering ill health and then the problems start getting decent cover.

Its a delicate balancing act as to when is it time to effect the insurance, after all who wants to pay years of premiums for nothing other than peace of mind.

You are 100% correct. The sooner you get her on something the better.

 

It might be helpful to seek out a non profit Thai professional that can give advice for a one time fee. One that is not associated with any insurance company (difficult to find I'd reckon, but they are probably out there).

[Glasseye]

2 hours ago, Pumpuynarak said:

The main issue i believe is to arrange cover BEFORE you suffer any meaningful ill health, the issue of pre-existing conditions virtually makes health insurance not worth the paper its written on, so many ways for your insurer to deny claims. Take me for example, i was diagnosed at age 60 with type 2 diabetes which means any insurer can deny most claims so in effect i'm uninsurable.

Now wifey is fit and healthy at age 41, exercises virtually everyday, never smoked anything well other than me lol, only drinks socially, eats healthy. She's recently had a full medical check up and no probs other than some small cysts around her tits which are insignificant in the grand scheme of things, the hospital checked them out. So getting her comprehensive cover NOW at a reasonable premium is ok BUT the longer you leave getting the cover you run the risk of suffering ill health and then the problems start getting decent cover.

Its a delicate balancing act as to when is it time to effect the insurance, after all who wants to pay years of premiums for nothing other than peace of mind.

 

 

BTW - this has got me to thinking. After I sort out the multitude of other things I am working on I may look into getting some kind of insurance plan for a Thai friend of mine and her daughter. Something to supplement their national plan.

Not sure how it all works. So if/when I find someone indepenent who can explain it all and my cash situation allows it I may go for something. 

If I find someone who knows what they are talking about I will let you know.

The girl and her daughter, my friend in Buriram.

[Krapow]

This has turned into a great thread, very informative.

Makes a change from @Pumpuynarak's usual 'I've been hacked again, don't respond to any emails' threads