This subject comes up with regularity on every forum in Thailand, and each time and on every thread the importance of it gets completely lost very quickly; the thread drifts off topic and no really useful information is exchanged.
If anyone is seriously interested in getting proper medical insurance they need to approach a brokerage firm with people who specializes in it; who are really fluent in English and know the products..which are complicated and quite technical.
All you get otherwise is BS cookie-cutter policies from agents who are trained to peddle policies...and usually captives of one company. There are a number of well known companies here flogging very impressive looking packages of totally inadequate and at best, marginally useful insurance. The agents know virtually nothing about insurance in general but can put on a nice dog and pony show with their sales aides and broad smiles. It's all bullsh*t...and designed for the benefit of the insurance company exclusively. It's a classic situation of the blind leading the blind.
On the other hand, there are quite a number of companies selling broad, comprehensive medical coverage on the international markets through independent brokerage firms. Any one of these companies may be just right for any one individual, but not another, beause insurance companies tend to have their preferred or target market groups, where they will be highly competive; but horribly non-competitive outside their target market. That's where the broker comes in. Different companies handle pre-existing conditions and exclusions in different ways as well. Some have "elimination periods" after which a pre-existing condition can be fully covered, others keep it excluded for the duration of the policy. Some will renew for life...others will cut you off at some pre-determined age.
All of these terms and conditions will effect premium
The important things to be familiar with are:
Limit per occurence which is the maximium amount that will be paid for one event/illness or injury.
which is the maximum that will be paid for all claims occuring in a policy period.
There are often sub-limits placed on all kinds of things.....which you need to take notice off.
The policy could have a 5 million occurence limit but have a 500K sub-limit on cancer treatment. Finding this out when you need a 2 million treatment program is not the best way to go.
specifies where in the world the policy will respond. Thailand only...or. All territories except USA, Canada, Switzerland. There are many variations...and the premiums will vary considerably with the scope of territorial coverage.
Most of the cheap cookie cutter policies have the appeal of low or zero deductibles. The problem is that the occurence limits are far too low to deal with anything serious and the insurance is actually very expensive if you calculate it on the amount premium paid for each unit of insurance (a unit being 1000 Thb or $1000 ...or whatever currency the limits are stated in)
Good policies will have high limits per occurence and in aggregate and will have options to choose various deductibles to help manage the premiums. The higher deductible you choose the more premium discount you get. Insurance is best used to cover for the big financially damaging events and not as some kind of maintenance contract for every little expense that crops up.
All these insurance polices exclude payment for treatment of medical conditions that already exist or have existed in the past....but not entirely. Depending on the company and the condition; it is quite often possible to have a pre=existing conditon covered provided it is declared to the insurer up front. The company may then insert a clause to the effect that after a waiting period of 3 years or whatever, it will then be included in the coverage. You may also be allowed to pay additional premium to have a pre-existing conditon covered. Companies are all over the map on these things so again a good broker can be of great help in selecting a company and policy. No such options are availabe on the programmed cookie cutter policies. That would make it far too hard for the poor agents who might have to think and actually negotiate on behalf of their clients.
"Don't worry...everything's covered" is a favorite line.....
All policies have exclusions such as "self inflicted injury" "sexually transmitted disease"
or "Injuries caused by participation in hazardous sports" and in Thailand "injuries caused as a result of riding or being a passenger on a motor cycle" You may wish to pay special attention to this gem.
Different companies can and do add all kinds of exclusions, so you need to be very aware of that section of the policy. There are some standard exclusions as shown above but they can add in quite a few non standard ones ...especially outside of the developed world where regulations are slack or non-existent.
Many policies are only renewable up to a pre-determined age. Usually 70 or 80. You should where possible avoid policies that do not have a lifetime renewability agreement. Imagine you have just been paying premiums for tweny years and now just as you are starting to fall apart and likely to really need your medical insurance; the company sends you a nice letter thanking you for all your premium payments and loyalty and then the last line says that the policy will not be renewed when it expires in 30 days time....and you get really sick on the 31st day.....and spend a month in hospital.......
Lifetime renewability costs more simply because they can't refuse to insure you down the road if/when you develop something that will cost them a load of cash. The only problem of course is that the premiums will go up as you get older and may get beyond your means at some point.....but at least the option to renew is always open, and the choice is yours...which has to be better than being arbitarily cut off by the company just cause you turned 70.
In order to quality for a lifetime policy you need to get in before you reach the cut off age....which varies between companies. Some are as low as 60 others will do it up to 65.
IN PATIENT vs OUTPATIENT (usually referred to as IPD and OPD)
You have the option of coverage for outpatient treatment but it will increase the premiums considerably. Again if you take the position of using insurance for the more serious and expensive events, you would likely decline outpatient coverage and live with the costs of the routine and less costly medical treatments which are handled on an outpatient basis. This would be espeically true if you had chosen a high deductible because the outpatient charges would likely be under the deductible anyway.
That covers the core coverages. There are options for "medical evacuation" to your home country...maternity....optical, dental and so on..... if money is no object.
I was a professional broker and corporate manager in the Insurance industry for 35 years. You can take that for whatever you think it's worth. I would not feel inclined to recommend any particular insurance company or policy to anyone without knowing a few things about them. Gender and age are the raw basics but there are many more questions to be answered before making a sound recommendation.
If you go to a real profressional they should ask you a lot of questions...or you will be asked to complete a questionnaire or survey. I don't know how anyone can recommend a company in good consience or give you an accurate premium quotation without knowing a great many things about you and what you need/want. You also need to be prepared to pay for good coverage, and there really is no shortcut or way around that.....however much you may wish to kid yourself that it is otherwise, or how much you want to believe the advise you get from expat forums contributers who have no background or qualifications whatsoever and more often than not, have no clue as to what they are talking about. I've been challenged a number of times to "look over" someones medical insurance....and to date I have yet to see a really good one. The owners always seem to think they are "well covered" or have the best deal in town, when in fact they have a piece of colorful packaging with little of real value inside. Any advise I can give them will almost certainly be ignored because what I tell them is almost certainly going to cost them a lot more....so the nice colorful package will remain...and the insurance benefit will contine to be a figment of the owners imagination.
There is no such thing as a "standard" policy...although there are certain policy standards when you buy from good companies based in civilized regions of the world. Thailand is an absolute wasteland as far as insurance is concerned. Not just medical insurance.....it's all crap and does not come close to the standards of western countries, unfortunately. Even homeowner policies have been gutted since last years flooding....and of course they don't bother to mention that half the coverages have been deleted or restricted when they offer renewal. Full and accurate disclosure is not one of Thailand's strong points.
(The exception would be the high level commercial stuff that is handled by the big international brokers, companies and re-insurers......but that is way beyond the scope of this little diatribe)
What is sad is that really good comprehensive medical insurance could be made available to all of us in the expat community of Thailand......but it has never happened simply because we as a group never stick together on anything and you need large numbers and good support to make it work. The expat community could have a powerful lobby here in Thailand......but it seems when anyone puts their hand up all we get is the typical bitching complaining and negative sh*t that we are so good at....so no support mechanisms have ever been established and we go on year after year in this state of denial and just hoping that the bad things always happens to somebody else.
There is a thread running on another forum about a guy (UK) who sustained extensive head injuries and is still in the ICU of a Pattaya hospital. The medical costs are running over 100K Thb a day!!! and the costs to transport him back to the UK are 3.5 to 4 million Thb. It should be possible to have insurance good enough to cover things like that.......but it is never going to happen if everybody is going it alone and pretending that things like this could never actually happen to them...and live with the idea that if they buy insurance and don't get ten times the amount of premium paid back by having claims...then they are being ripped off.
I think there must be more myths, misinformation, and BS talked about insurance than just about any other subject....with the possible exception of medicine where everybodys Aunt Flo knows more that the best specialists in every field...and insists on telling everyone so..