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When I wrote about my cost of living in Bangkok a few weeks back, the most common question I received by e-mail was what health insurance I’m using. If that’s all you want to know – that’s easy. The company is called ACS. If you never heard of them, don’t worry, neither had I until 3 days before signing up with them.
However, those recommendations don’t stay up to date for long. My insurance prior to ACS was a French insurance that shall remain unnamed. They were pretty awesome … until they weren’t: One day – and to be more specific: one day two weeks before the renewal came up – they messaged me that they’d increase premiums by 30%. Effective immediately. I was seriously tempted to type up a reply that included colloquial terms for body parts for which I no longer required their coverage.
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Given that I’m borderline obsessive compulsive about insurance coverage, it can probably be counted as an achievement that I ‘only’ spent 3 full days researching, analysing and comparing different insurance plans. Saving myself (and you) some time for the next time an insurance pulls a stunt like this, I’ve typed up a quick guide on the crucial points of health insurance in Thailand.
I do hope this article answers most of your questions, though if there any open points, feel free to send me an e-mail and I’ll do my best to help you out.
- 1 Before You Come
- 2 Insurance Options
- 3 Coverage
- 4 Optional Coverage Choices
- 5 Paperwork
- 6 Comparison Websites
- 7 Brokers
- 8 My Own Insurance Plan
- 9 Going Without Insurance
- 10 Disclaimer
- 11 Your Thoughts?
Before You Come
When I first came to Thailand, I experienced what it’s like to have a German long-term travel insurance that covered everything under the (tropical) sun, without an upper limit and barely any exclusions or restrictions on pre-existing conditions. The cost? €55.35 a month (฿2,238.75). The reason I’m not with them anymore? It’s limited to your first 3 years abroad. A lot of similar plans are on offer by other insurance companies across Europe , covering you for the first 5 years of your stay.
A Swedish friend of mine was involved in a very severe accident. His insurance chartered a Bangkok Airways plane to fly him from Koh Samui to a hospital in Bangkok that was capable of treating him. Unfortunately it’s only available to Swedes.
In my experience, insurance offers that are based on your residency still being in your home country at the time of application are the best deal for younger expats. The downside is that if you don’t get them before you officially move to Thailand, it’s impossible to get them. Sometimes, as in the case mentioned above, they are also limited to certain nationalities.
Your local insurance broker can give you some pointers. In Germany I used a Lufthansa-owned brokerage firm called Albatros (airlines aren’t the most creative when it comes to naming subsidiaries…). It used to be an ‘intracompany’ insurance agent for its own staff, but have since started offering their services to non-Lufthansa employees as well. Germans can also check out this listing of temporary travel health insurance which lists a number of additional options.
While the majority of this article will deal with local and offshore insurance options, I also want to introduce two other low-cost options available to temporary and permanent visitors. You might find that those are sufficient or at least warrant a lighter coverage when selecting additional insurance coverage.
Travel and Temporary Insurance
As mentioned above there are insurance companies that offer limited time coverage – anything from a few weeks to 5 years – that is available for people applying from their home countries. Unfortunately those offers have an upper age limit. In addition, those companies don’t have to deal with expensive long-term care cases. As a consequence, their pricing is a lot more attractive than for more permanent solutions. They know that in case of any severe or long-term case they could repatriate you and hand you off to the social security system in your (European) home country.
You can always start off with a ‘temporary’ insurance that covers repatriation and switch to a more permanent one once it runs out. This can make sense even if you plan to stay long-term as probably you might reconsider that in case of a severe medical issue.
The best way to find a suitable insurance in this category is to ask a local broker in your home country or to search Google in your native language.
If you work legally in Thailand, you’re usually covered by social security. The payment for which gets deducted directly from your salary by your employer (5% of your gross salary, but not more than ฿750 per month). The social security system assigns you a hospital (you can state a preference) at which you’re then eligible to receive treatment and medicine free of charge.
In practice, social security means free treatment with the cost coming in the form of long queues, limited medication (some patented, more recent drugs might not be available) and rushed doctor visits: It’s common for doctors at social security hospitals to see between 80 and 100 patients during an 8 hour shift.
You can’t pick a hospital, but you can state a preference. Last time I was asked, there were 35 hospitals to choose from in Bangkok. Which hospital you end up being assigned to, will pretty much determine the quality of care you’ll receive. The difference between the hospitals can be significant.
The top government hospitals in Bangkok like Chulalongkorn and Siriraj provide great quality care (and are thus due to their popularity rarely available for choosing). People tend to avoid some the smaller clinics that are run for profit (not all social security hospitals are government operated). While they might be more conveniently located or have shorter wait times, things might get hairy if you end up requiring more expensive (read: unprofitable) treatment.
A big reason to state a preference for a large hospital is that in case of more severe cases, a smaller hospital has to officially refer you to a larger hospital before you can use their service. That referral process can be extremely cumbersome, making it much better to be with a large hospital (e.g. Lerdsin, General Police) to begin with.
My own social security hospital used to be Camillian Hospital in Thong Lor – it was known as one of the best social security options for expats, due to the availability of English-speaking doctors and the short waiting times. Unfortunately Camillian hospital has announced that it will cease their participation in the social security system. As an alternative I was provided with a list of available hospitals, out of which I was allowed to pick my top 3 choices. One of them included the Police General Hospital (Thai). Located on Rama 1, opposite Central World, it’s a very easy to reach option. A friend of mine had a surgery for a meniscus tear done there at his own cost (~฿27,000). He was satisfied with how it was handled, but pointed out they don’t speak a whole lot of English.
However, at the time of writing, every foreigner I know who recently moved Bangkok was assigned to Kluaynamthai Hospital – regardless which hospital they stated as a preference when they signed up. I’d link their website, but according to Google, the site may have been hacked. While I never went there myself, their Google ratings seem to indicate that you may want to explore other health insurance options if that’s your social security hospital.
I wouldn’t rule out that in the future foreigners will be able to register at other facilities for social security treatment. For this purpose I’ve compiled a list of Bangkok hospitals that are currently available for choosing for Thais and which were recommended for their quality of care to me by friends in the medical field:
|Lerdsin||Silom||crowded, good for orthopaedics (sports injuries)|
|General Police||Rama 1||one of the largest, lots of specialists on staff|
|Yanhee||Charan Sanitwong||social security allows you to use all their branches|
Please note that I’m not a medical specialist and can’t make any guarantees for any of these places.
Local insurance is the most common type of private insurance you’ll encounter in Thailand. They are what’s being offered by agents and brokers, and what you see advertised in local media. Coverage can be very limited in terms of amount covered (when compared with other countries), age they cover you (meaning quite a few will kick you out at 75) and exclusions (don’t be in a motorcycle accident).
My main reason for health insurance is that I want to safeguard against extremely expensive cases. For anything else, I’d be okay with just paying for it in cash. If you’re looking for that kind of coverage level, the prices at local agents seem to be higher than what I paid for when I was in Germany (admittedly, I’m also a bit older now …).
What does speak for local insurers though is that medical cost at most but the most luxurious hospitals are well within the coverage limits of the plans commonly sold to expats. Those are also price-wise a lot more competitive.
Another big upside of local insurance is that hospitals are used to dealing with them – you have a card that you can show on registration, and the insurance takes care of the rest. They require the least amount of paperwork compared to other insurance soltuions – as long as you go to a hospital with which the local insurance has direct billing set up.
One of the most well-known insurance companies in the local market is BUPA. It’s a widely-accepted insurance that I use for all my staff (a basic group plan). They seem to be quite happy with the coverage they receive through it. From what I gather, the major benefit for them is that they can pick which hospital they want to go and the queues for private insurance are significantly shorter than for social security patients.
One company I often end up recommending is MSH International. They partner with many top-tier hospitals including, Bunrungrad, Bangkok Hospital, and Samitivej where you can just simply show the insurance card and have all details taken care all. Their Asia Care Plus plan is one of the best value-for-money plans out there. In case you’d like to receive a quote for it, you can use the form on this page.
Other major players in the local insurance market include AXA, AIA, Aetna, and PacificCross. In addition I recently also heard about TMB bank offering health insurance (though I’m not sure if that’s in fact one of the other insurers offering their coverage through them).
At the time of writing, the easiest way to compare and apply for local insurance offers is Mister Prakan. The site provides an English-language interface to view health insurance plans from different companies in Thailand side by side. Alternatively you can also ask a local broker for selected offers though they tend to usually specialize in two or three specific companies.
A number of insurance brokers across the region provide offshore insurance coverage. Local brokers complain that those offers aren’t licensed to be sold in Thailand. The offshore brokers usually only provide services to expats and tend to keep a lower profile. I’m no lawyer, but I assume that means that in case of a dispute with the insurance company, you might not be able to pursue your claim in Thailand and have to take it to their jurisdiction in Hong Kong or France for example.
As far as I know, claims with local insurances can be disputed with the office of insurance commission and without involving a lawyer. This provides a realistic chance of disputing a claim, but also some kind of oversight. With international insurance offers, that’s a lot harder: They know that few people will have the funds and the will to fight a legal case in a foreign jurisdiction.
So why bother with offshore insurance? The main advantage is much higher coverage limits, allowing you to get treatment at top tier hospitals without ever worrying about maxing out your plan. They also tend to be more likely to guarantee renewal of your insurance without age limitations.
My own insurance (ACS) falls in this category.
The price of health insurance and the rough description of what’s included are usually just the tip of the ice berg. A lot of the things that matter are found in the fine print – especially when it comes to general exclusions, activities, services and pre-existing conditions.
Some standard exclusions you’ll find in every insurance plan – depression, alcoholism, self-inflicted injuries, car or motorcycle races, active participation in acts of war or terrorism (so if you ever get hit by a drone strike, you might not be able to file a claim). However, a number of important exclusions vary from insurer to insurer and it makes sense to take a good look at the fine print. Here’s what to watch out for:
- Motorcycles: Some plans don’t cover anything motorcycle-related. Not good. Being in Thailand you’re pretty likely to be on a motorcycle at some point of your life. Others are more sensitive and only exclude cover if you are driving without a license. It’s a good idea to pay attention to the details of this paragraph.
- Alcohol: While Alcoholism is excluded under all plans, there are also selective exclusions for acts committed under the influence of alcohol. The specifics of the phrasing here decide if that means ‘drunken bar fights’ or whether ‘no coverage for anything whatsoever as long as there is any traceable amount of alcohol in your blood’.
- Sports: If you take part in any form of competition or what could be considered to be a dangerous sport, you might want to check the exclusions regarding sporting activities. Some insurance companies exclude specific sports, others are more broader in their description. If you are at a serious risk of a sports injury, you probably want to get something specific from them to see if you’re going to be covered or not.
- Sexually Transmitted Diseases: Some insurers exclude coverage of any STD. Others exclude it, unless you were not at fault (e.g. due to a blood transfusion) – but the burden of proof may be on you.
- Disasters: Every insurance company excludes active participation in war and criminal activities. In several cases, there’s even a clause that excludes victims of natural and man-made disasters. Given recent bombings in Thailand, you might want to make sure this isn’t the case in your plan.
Terms and Conditions
There are additional terms and conditions that can seriously affect the viability of your insurance cover:
- Pre-existing conditions: This is usually the biggest single issue with any health insurance contract. You will often hear that insurance providers will consider pre-existing conditions on a case-by-case basis or offer insurance excluding pre-existing conditions. In my experience that’s only true for non-serious things (e.g. a rash, an allergy), conditions that are localized and don’t affect other areas (e.g. an elbow injury) or one time occurrences (e.g. limited time after effects from an accident). Anything really serious or that can lead to other problems in the future will usually lead to you being outright refused coverage. As a general guideline – if the condition is a major reason you’re seeking insurance, they won’t accept you. Beware of insurance providers that accept you and don’t check this until you actually make a claim: It’ll give you a false sense of security.
- Cancelation or non-extension: Is the insurance company able to cancel the policy or refuse to renew it? It’s very important to avoid plans that do allow insurance companies to cancel (or not renew) your policy. Because if you ever submit a lot of claims, get a chronic disease or are sick when the renewal date comes around – that’s exactly what the insurance company will do. I had one reader e-mail me who had that happen to him: A broker sold him a a very affordable plan that seemed really comprehensive. He only found out that it was an ‘annual plan’ when the insurance company canceled it the moment he became too expensive for them. In other words, precisely when he needed the insurance the most, the company was free to walk away without consequence.
- Area of Coverage: Are you covered when traveling to your home country and other destinations? If so, for how long? Not a big deal really, since travel insurance can be had for cheap: As long as you don’t forget signing up for it every time you go abroad.
- Chronic Diseases: Not a limitation you see very often. Most of the time, insurance companies exclude previously existing conditions, but anything new is covered in full. A few exceptions limit coverage of chronic diseases. That’s something I would be worried about. Especially in the case of OPD coverage, some of the really expensive claims are chronic diseases (diabetes, kidney diseases…)
- Medical Evacuation: Some insurance companies offer this as an optional benefit. The usefulness depends on where you’re based (e.g. in Bangkok or in the countryside). Most competitive-priced plans will not fly you to your home country, but only to the next suitable center of treatment (which in 99% of all cases is Bangkok). If you don’t leave Bangkok much or get travel insurance when you do, there’s little point in requiring medical evacuation. The exception? If your limit is very high, I imagine the insurance might even offer it themselves (regardless if you selected it or not) – because flying you home might be cheaper for them than paying for an extended stay at a top tier hospital in Thailand. But don’t count on it.
This isn’t a complete list of course. Nora from ‘The Professional Hobo’ published a nice wrap-up on expat insurance a while back that still includes a lot of up to date information on conditions as well as a nice glossary and what the different terms mean.
If in doubt, I recommend sending an e-mail in advance, listing out what you are concerned about and see if you can get some statement from your broker or insurance company that clarifies the issue. I’m not a lawyer or insurance expert and this isn’t legal advice, but I assume this should improve your position if it ever comes to a dispute.
Plan Coverage Limits
Coming from Germany, the fact that an insurance would have a maximum amount they reimburse, was something entirely new to me. In Germany, most insurance companies have a certain co-pay requirement (usually for dental work) and that’s it. Doesn’t matter if you are in a coma for 10 years or more. What are they gonna do? Kick you out? Well, that’s exactly what can happen in Thailand.
In Thailand, every private health insurance sold has a limit. If you’re new to the country it’s a tough call to decide what amount of coverage is enough. So what limit should you choose?
Bumrungrad Hospital – the most reputable hospital in the country (with prices to match the quality of care and level of comfort they provide) – offers some data on their cost of surgery. Few procedures seem to cost more than ฿500,000. However, the real heavy hitters for hospital costs are less the specific surgeries, than potential long-term stays and treatment in the ICU due to accident or illness.
In order to give you at least a rough guideline: The single most expensive case I’ve heard of involved heart surgery with a total hospital stay of nearly 6 months. The cost for that came to ฿12 million. Most of that was accumulated in the first few weeks in the ICU (which clock in at an estimated ฿500,000 per day!).
My personal biggest health bill (cover in full by my insurance) was for a nose operation due to breathing problems (endoscopic sinus surgery, septoplasty, and radio frequency turbinate redirection): A 2.5 hour operation under general anesthesia, followed by a single night admission. Total cost for the operation and admissions was ฿260,208 (this does not include pre- and post-operative care and follow-ups).
No broker I talked to knew of anyone who incurred more than ฿16,500,000 in expenses. If I were to sign up for new insurance, that’s what I would aim for in coverage (for offshore plans that would mean a range of USD 500,000 to USD 1,000,000).
On the lower end you might want to keep in mind what the Thai government considers an absolute minimum: Thailand’s social security system has a coverage limit of ฿2,000,000. In other words: That’s the health care coverage every 7-Eleven employee is guaranteed. You really don’t want to go below that.
Procedure-Specific Coverage Limits
In addition to overall limits, insurance companies specify limits for specific procedures. Here’s in an overview of the most common procedures with a maximum spending cap:
- Organ Transplants: Some insurances have limits on donor costs in the case of organ transplants (e.g. Now Health International’s WorldCare Excel plan limits them to $50,000). I assume if a liver is too expensive, they’ll pass and wait for a cheaper one to become available? Most of them are about expenses for the donor. I assume they want to avoid the hospital pulling a fast one on them by invoicing them for previously occurred ICU expenses by the late donor. In some cases (like ACS) they refuse to pay for any donor expenses whatsoever.
- HIV: A big topic in South East Asia. Lots of insurance companies exclude it if sexually transferred, some even exclude it outright. Those that don’t, often put a limit on the maximum expenses you can claim with it (e.g. $40,000 by MSH International’s Asia Care Optimum plan). From what I gather, HIV treatment in Thailand isn’t too expensive as medication gets produced locally. However, it might mean that future, more expensive treatments might not be covered.
- Pregnancy: Not something I looked much into for obvious reasons, but to my knowledge maternity is an optional add-on, often with specific coverage limits and nearly always with a waiting period before coverage (usually 10 months). You can check out this post on giving birth in Thailand for further details as well as the costs involved.
I’m not entirely sure at the reasoning for procedure-specific limits: It might be an attempt to limit artificial cost inflation by hospitals for especially expensive treatments. In practice this may limit your choice of hospital for those specific procedures though the impact on overall quality of care you receive is not that big.
The general guideline for maximum age is that if you sign up before the age of 60, you can still find health insurance with lifetime coverage.
Once you turn 65, it’s hard to obtain comprehensive health insurance. One reason for the de-facto age limit is that on average people accumulate 80% of their health care expenses in the last 5 years of their lives. Of course acceptance is just one part of it – the other is the premium: Above the age of 60 any form of insurance coverage won’t come cheap. Insurance plans in Thailand don’t subsidize older age brackets with premiums from younger members. This means coverage at an advanced age comes at a much higher markup than you might be used to from back home.
As mentioned under conditions already, it’s important that your insurance can’t cancel your coverage and that they can’t refuse to renew your coverage. You also want to watch out for any specified maximum age: Lots of companies specify an age at which coverage automatically ends. That’s something you especially see with lower cost, local insurance plans. It might not matter if you’re 33, but at 55 this is something you really need to take into account. Of course that doesn’t protect you from increasing premiums, but that may still be a lot cheaper than suddenly finding yourself without coverage after falling seriously ill.
MSH International is one of the few health insurance companies still willing to accept new members beyond the age of 65 (up until age 79). If you only need coverage for the most serious issues, it’s still somewhat affordable: You can choose one of their plans without IPD coverage (meaning, the insurance only pays if you get admitted to the hospital, but you pay normal doctor visits yourself) and a significant deductible (meaning, you pay expenses up until a certain limit each year yourself): Choosing those options brings the premium of someone in their 60s down to roughly THB 80,000 a year (otherwise you’d be looking at THB 150,000 and more). A medical check-up is required in any case though.
If you’re looking for more details on health insurance for ages 60 up, Don’s website has some great pointers.
The premium is usually the most transparent part of the policy. It’s the fine print that’s trickier to understand. But even with this straight-forward number, there are a few things to keep in mind:
- Payment terms: A lot of insurers (especially offshore ones) have a hefty surcharge for monthly instead of yearly payments. Since your contract runs the full year anyway, you might as well pay in full.
- Inflation: Medical inflation in Thailand is very high. Premiums increasing by ~10% per year isn’t unheard of. You might want to get information on the last few price hikes: Does this insurer increase their premiums massively every year? Has there not been an increase in years, making a big one more likely to come next year?
- Deductibles: Your premiums will be a lot lower if you agree to pay for the first thousand or two thousand dollars of treatment expenses each year yourself. In practice, that means you won’t be able to claim anything but the most severe cases. Make sure to keep all receipts (and file them within their deadlines). A lot of people forget about that because they don’t expect to be occurring expenses beyond their deductible anyway (until they do…). An easier, more hassle-free option with a similar results and less paperwork would be to just leave out OPD coverage.
Optional Coverage Choices
I’ve logged my own OPD expenses for the years 2011 to 2014. While not necessarily representative, it gives you an idea of the cost of OPD treatment at top tier international hospitals in Bangkok for a guy in his 30s. Nearly all treatments took place at Bumrungrad, with the remaining few occurring at Samitivej Sukhumvit.
|Year||Visits||Average Cost per Visit||Total Cost|
Keep in mind, that during those years I didn’t have anything major(e.g. MRIs) done. The most expensive single procedure was a food allergy test at Bumrungrad, which, including doctor and facility fees, came to ฿4,475. During that time ฿3,407 (or 4.8%) out of the total ฿71,349.34 were declined by my insurer due to them being ‘pre-existing conditions’.
Most people I know skip the OPD coverage by insurance companies. Main reason being that treatments aren’t that expensive here. Seeing a doctor in Bangkok usually costs anywhere between ฿300 and ฿1,800, depending on the fanciness of the hospital and (to a lesser degree) on their chosen medical field.
Medication is usually sold with the treatment at a mark-up in the hospital itself. Mark-ups range from two to ten times the cost in a pharmacy. Total cost for medication when received inside the hospital is often in a similar range as the actual doctor’s fee.
As you can see from the above data, my own expenses are at the higher end of that spectrum. Going to cheaper hospitals, that don’t have free juice and a hotel lobby style waiting room, would lower your OPD expenses significantly. If you’re not living in Bangkok, the OPD facilities you are most likely to use are going to be a lot cheaper.
A close second in why you might not want to bother with OPD insurance is the paperwork: A lot of people dread having to fill out forms, mail claims and dispute rejections. It’s especially frustrating to do that for a minor claim, and then have it subsequently denied. You’re often better off paying straight out of your own pocket.
Last but not least, the overall limit: Most OPD insurances are limited to a few thousand dollars per year (my own OPD insurance is capped at ฿217,311). In most cases, the math doesn’t make sense: What you pay for insurance coverage far exceeds the amounts you are likely to claim.
Things might look different if you’re looking at expensive long-term OPD treatments like diabetes-related treatments or kidney failure. You should also be aware of some insurance companies classifying certain procedures as OPD – even though in fact you might be admitted for a day or two. This way they can refuse a claim unless you did actually opt for OPD coverage.
In the end, I opted for it because I feel the amount I overpay is worth the fact that I’ll never put off a hospital visit due to cost. Call it a psychological effect.
Coverage for dental expenses varies a bit. Some insurance companies require a co-pay or only cover one routine check per year. In my experience though, they’ve always covered dental expenses 100% for the minor claims I filed.
From 2011 to 2014, the cost of my dental treatments was on average 1,883.33 THB per year (all paid in full by insurance). The treatments received were fairly standard: Checkups and cleanings twice a year with the occasional filling.
All work was done at the Bangkok International Dental Center (BIDC). It’s not the cheapest place out there (about 25% more expensive than a high quality, independent dentist), but still offers significant savings over other English-speaking dental clinics in Bangkok.
One major reason I go to them is that they are right opposite my office. Bangkok has an abundance of both dentists and traffic jams, so location becomes a major factor. Also, BIDC dentists don’t seem to drill very often. It’s either that, or my dental hygiene improved around the same time I switched to them. The company has a few other branches, but the main on Rachadaphisek Road one is by far the best.
Being the overly cautious German that I am, I use my annual Christmas vacations back home to get a second opinion from my village dentist on all work done in Thailand. I pay him in fruit and bakery baskets and he’s absolutely awesome. So far he didn’t have any objections, so I guess the standard of care measures up to that of German dentists.
Most insurance options I saw in Thailand include dental work. Considering the costs of treatment it’s not something I would worry about too much though. While international hospitals with English-speaking doctors and little wait time charge a significant premium, their dental counterparts are still a bargain.
Applying for insurance itself is very similar in Thailand to anywhere else. They’ll ask you questions about your past health and illnesses and if you lie about it, it might void your cover. Each insurance has their own survey.
One thing to keep in mind, is that some companies ask if other companies rejected you. If you think you are at a risk of getting rejected by some companies, apply for all of them at the same time. This way you don’t have any ‘rejections’ at the time of application.
In some cases, insurance companies require prior authorization for treatment. This is quite standard for any non-emergency admittance to a hospital. Some also require it for more expensive OPD treatments (e.g. MRIs). That tends to result in a bit of a back and forth between hospital and insurance and in you waiting a day or two until the insurance comes through. I never heard of it being refused, but I assume it does happen (otherwise, why have it?).
In some very odd cases, I even saw fine print requiring prior authorization in case of an organ transplant (the Southeast Asia Serene Plus plan by A Plus II for example). That’s a bit weird in my opinion. Is there really a danger of people getting unnecessary organ transplants?
Denial of Claims
What good is insurance cover if your claim gets denied? My current insurance company has so far declined two claims. Nothing major, but just something they considered pre-existing. However, pre-existing is not only any illness you have at the time of signing up, it’s also anything you had that’s considered ‘recurring’. In my case for example, a minor claim of THB 635.00 for ‘dishydrosis’ was denied. That wasn’t entirely surprising since it’s considered a chronic condition. The fact that they even bother checking for that amount though surprised me.
It’s very hard to get good data on how often or how likely an insurance denies a claim. I’m currently trying to get some data from hospitals – after all, they would have data on insurance denying claims for in-patient treatments. If you happen to have some and would like to share, please contact me.
The main advantage of using a comparison website is that you can search offers yourself easily with filters and searches, rather than having to compare sales brochures and broker-provided Excel sheets. In addition you can fill out medical questionnaires and apply online for plans directly.
For Thailand-based expats, Mister Prakan offers the most comprehensive comparison of locally licensed health insurance plans. The website seems to cover all major companies on site, sorts them by price, allows you to filter them by desired coverage level, provides details about coverage limitations and displays editorial ratings of each company. They also act as a broker and have English-proficient staff available to handle any additional questions.
In case you’d like to look into offshore insurance plans, you can give BrokerFish a try. It offers comparisons, search and filters for a range of international insurance plans. Unfortunately though they are missing some of the more competitive offshore plans and do not have any information about plans sold within Thailand which sometimes offer better coverage.
In general you shouldn’t have any trouble finding a brokerage firm in Thailand. The rate you receive when going through a broker is the same as when you go the insurance directly. The main advantage of a broker is that they can offer you a wider range of plans than any single insurance company. If you don’t already know which plan you want, they can provide details on what best suits your needs. In theory, brokers are neutral and act in your best interest. In practice, in Thailand that’ll be true for good brokers and maybe less so for others.
One thing to keep in mind is that sales commissions for brokers are recurring. For every year you stay with them, they usually get between 15% and 18% of your yearly premium. If you go through the insurance directly, the insurance just keeps that sales commission. This means brokers have an incentive to not only sell you an insurance plan, but to also keep you as a client in the future.
This recurring commission payment means that the broker will have a financial interest to help you out when it comes to dealing with insurance. However, the help a broker can provide when it comes to helping you out with a claim or dispute is limited: Aside form the details of the claim and your individual case, it depends on their relationship with each insurance provider (meaning: do they send them a lot of business?) and of course on the insurance itself (meaning: do they care?). In case you’re not happy with the support provided by your broker, you should also know that you can actually change brokers without changing insurance plans.
In short, signing up through a broker means you have one more person you can consult before signing and complain to after signing. On the other hand, a broker might not know every single detail about every insurance plan for sale.
My current insurance broker go-to recommendation is Mister Prakan. Main reason being that they’ll allow you do to do initial research yourself, making it easy to compare plan benefits and costs online and at your own pace before talking to an agent of theirs. If you’re looking for a locally licensed, THB-paid insurance plan, they’re a one-stop shop. For legal reasons they don’t offer any offshore insurance plan (e.g. ACS – the one I’m using), though the Asia Care Plus plan by MSH International that they have in their inventory is a decent alternative.
My Own Insurance Plan
As mentioned before, I’m insured with ACS. I’ve listed out the specific factors that lead to my decision below. Please note that conditions are as of the time of signing up (unless stated otherwise) and are based on my personal notes:
- HIV/AIDS: Included
- Medical Evacuation: Included
- OPD: Included (limit: $6,000)
- Dental: Included (90% coverage, limit: $1,000)
- Exclusions: Numerous common exclusions, donor expenses in case of organ transplants
- Overall Limit: $1,000,000
- Premium (for 2015): $2,251.00 / year (for a 32 year old male)
The bullet point list is based on my own understanding of their insurance plan and lists out selective attributes according to my own priorities. It’s not meant to be an ‘official’ or a comprehensive list.
Overall I’d rate my satisfaction with their service as ‘okay’. Could be better, could be worse. There were no deal-killers and it seemed to provide the best value for money for the coverage I desired.
Going Without Insurance
Some people prefer no insurance at all. According to a broker I’ve talked to, the price for health insurance in Thailand is driven up by expats picking the most expensive hospitals and following a not too healthy lifestyle. If you speak Thai, go to local hospitals and live a healthy life, skipping health insurance altogether might work out for you. In case you decide to forego insurance, that’s not the end of the world in Thailand. You can keep your medical costs low while still receiving good coverage. Here are some suggestions:
- Google your doctors: Many doctors at top end hospitals were trained at government hospitals and still have a contractual obligation to work there. If you find a specialist at a top tier hospital, you can google them and check where else they work (you might have to look up the Thai spelling of their name). This even works for surgeries. Equipment will be a bit older at their government location, but costs can be a fraction of what you would pay otherwise.
- Find good value hospitals: The social security system above lists a number of good hospitals that provide great value for money. You can go to any of them and just pay in cash. Waiting times will be shorter than with social security. In addition to the social security hospitals listed above, I heard very good things about the private clinic at Ramathibodi Hospital, Veterans General Hospital and Rajavithi Hospital (especially for Ear-Nose-Throat issues). Make sure you compare prices though – the ‘private’ department of some government hospitals can get quite pricey as well.
- Carry credit cards: Even though required by law, some hospitals refuse emergency care if they believe you won’t be able to pay. Proving otherwise can be difficult if you’re unconscious. This is the reason why I never leave the house without some sort of ID and a credit card. I’m not sure if that will help, but I assume it improves my chances.
- Stay Put: If you ever get admitted to the emergency department of a government hospital: Don’t leave the building until you’re completely recovered if you don’t have the necessary funds on you. Even though hospitals are required to take in emergency cases (and more reputable ones will do that regardless if you are able to pay or not), once you leave the building, their obligation ends and they can and will discharge you. I saw that happen with a guy involved in a motorcycle accident. Not a good situation to be in.
- Get prescriptions: Try not to buy medication from the hospital. You can always tell the doctor you’ll need a prescription for traveling abroad and then use that to buy it from an external pharmacy. They are not happy about it, but it’ll cut your medication costs by 50% to 90%. You might still be forced to buy some medication from the hospital, in which case you can at least ask for the minimum supply and then buy any additional medication you need later on yourself.
- Stay healthy: You can also reduce medical costs is by reducing the need for medical treatments. Aside from common sense things traffic safety, having the right vaccinations, and not missing out on regular checkups, it pays to be aware of local health hazards. Reading up on health issues in Thailand (especially in the countryside) is a good way to get started.
However, what happens if you run out of cash? In practice the hospital might keep you there, won’t allow you to be transferred out, and bill you for that time on top – until you paid whatever you owe them. You can check newspaper reports and interviews that detail cases like this.
Unfortunately, things can go even worse: The half-brother of a friend of mine is said to have died because the hospital refused to provide emergency treatment until ‘funding was secured’.
In the end, even if you yourself don’t consider it worthwhile to get insurance, keep in mind that it might be your relatives footing the bill if things go seriously wrong.
Please note that I did my very best to research and fact check all information provided in this article. However, mistakes and misunderstandings happen and I can’t offer any guarantees for the provided details. I’m also no lawyer, doctor, insurance broker, or professional proofreader – so don’t take any of this as provided by one. I’m not endorsing any of the listed insurance companies, brokers, or hospitals. Most of the plans mentioned in this article you can find by googling for it. I’m not advertising, referring, endorsing, or selling any of them specifically. Please do check with a professional provider for your own, personal situation before making any decision.
How about yourself? What insurance option did you pick? Got any insights yourself on health care in Thailand? Please let me know in the comments!