Feeling like you would like to pull your hair out of your head, don’t let health insurance policies frustrate, confuse or discourage you in Thailand, South East Asia or anywhere else for that matter, a must read article that will show you all the hidden tricks and answer all the questions you did not have the courage to ask…
Insurance companies do not make our lives easier, choosing the right health insurance nowadays seems to be a mind-boggling experience and it appears as if insurance policies are intentionally being made to be overly complicated so that people will not understand what they are getting themselves into or to be able to determine whether the health coverage is good and sufficient.
This article attempts to help people understand the web of complexities of health insurance in Thailand in particular, and South East Asia in general; the importance of having health insurance and understanding health insurance policies by breaking them down to their basic components and providing comprehensive comparison of the selected ‘best’ health policies available.
The table below provide you with a comprehensive overview of the important elements to each of the components and allow you to examine and compare each separately.
Here are a few key guidelines as to how to decide which health insurance policy is best suited for you:
1. There are many types of insurances and each person, depending on its age and personal circumstances, may pick an health insurance that suits his situation best, however, bear in mind that the basic elements of each health insurance (outlined in the table below) do not materially change (notwithstanding the glitzy brochures of jolly happy families and sea of professionally made marketing materials that are mainly there to obscure the real nature of the policy and to entice you to join the health program) – RULE I: Ignore all marketing materials and READ THE POLICY itself and the table of benefits carefully!!! This is what counts!
2. If the policy is too long or too difficult to read (which they are usually and purposefully are), or you are simply too lazy to read it, the attached table below will help you sift through your health insurance policy with accuracy and purpose. Do not let it frustrate you, this will save you money, and more importantly, your health when you really need it. RULE II: Do not be discouraged or frustrated, READ THE POLICY!!! Or ask someone who can help with it to read and explain it for you and/or use the table below for guidance.
3. Insurance brokers and insurance website are helpful, mostly in focusing your search on what type of health insurance policies are most applicable to you in according with your personal preferences and criteria. However, as with estate agents, they live-off their commission and their job is to sell, and not necessarily sell you the best product out there. Therefore listen to insurance brokers, make them work for their commission and chase information for you, however, do not trust them entirely and what they are trying to sell to you, sometimes they may be unaware; the information they provide may not be entirely accurate; or they will not give you the full picture, so remember, they are sales person, they are there to sell. RULE III: Use insurance brokers and websites to focus your search and obtain information with more ease, however, their answers and info is not a substitute to READING THE POLICY!!! or seeking consents and clarifications from the insurance company itself, the insurance broker does not bind the insurance company, at the end it is what is written in the policy that matters and not what comes out of a broker’s mouth no matter how convincing he may sound!
4. In order for you to understand the different components making up an health insurance policy (as specified in the table below), each component and its meaning and implications are discussed herein as follows:
(a) Maximum Limit (total value amount of policy cover)
(i) Can be yearly or for the life time of the policy, in either case once exhausted, you will have to pay from your own pocket and you will not be covered in terms of any medical expenses.
(ii) Here the name of the game is the bigger the amount the better (save for as stated in 4(a)(iii) herein below). However, check the total amount of the policy no only in terms of the amount but also its frequency (lifetime or yearly budget), since once this amount has been exhausted, you will be out of cover; in other words, ensure that the amount is not only sufficient for a one-off serious injury but an amount that can last you for a life time, however many years that may be!
(iii) Also, people tend to see this ‘big amount’ and think they are fully covered for all conditions, however, this is not the case, almost every policy includes exclusions and sub-limits, which essentially means that for a particular sub-limit, you cannot use the full ‘big amount’ but only the small sub-limit capped amount (example will be for a policy that has value of USD2,000,000 whereas the transplant coverage will be limited to only maximum of USD100,000). RULE IV: Be wary of exclusions and sub-limits and understand them and their implications.
(b) Deductibles – Economically speaking and based on cost/benefit analysis, with having deductibles a person usually ends up paying more (it means you pay first out of your pocket for medical coverage prior to the insurance coverage kicking-in). Nevertheless, someone may not have the necessary funds to have a minimum appropriate medical coverage, in which case, he may be forced to opt for deductibles to have it (note that you always must ensure that inpatient treatment is fully covered regardless as to whether you opt for deductibles or not). RULE V: Deductibles are a waste of cash unless you are short of it, in which case, do not compromise your impatient coverage and opt for deductibles to get better and full coverage.
(c) Geographical Coverage – Pretty self-explanatory, for more global coverage you can always pay higher premium. Be wary of excluded countries with 0% coverage and short staying periods’ limits outside primary zone coverage, in which case, you will not be covered for any emergency medical cases.
(d) Renewability – This is a critical condition! No matter what your insurance broker tells you or what the marketing materials trying to sell you, if you check anything in the policy check that it is for a lifetime. Lifetime means that the Insurer can never refuse to renew your policy. Lifetime characteristic means, that the only time the insurance company can cancel your policy is:
(i) Dishonesty/fraud (lied on your application/medical questionnaire/claims, etc.);
(ii) Did not pay your premium; and
(iii) Did not comply with the policy Terms & Conditions.
A policy that is renewed on a yearly basis or that can be terminated due to increase of health risk of the insured or due to changing circumstances of personal nature (in contrast to certain group of people and age), is not a lifetime policy!
The implication of not having a lifetime policy is that if you have a condition occurring during your current policy, the insurer will be able to stop it at the end of the year, meaning that your coverage will stop and you will be responsible for all your medical expenses from your own pocket. You will also most likely not be able to obtain any new medical coverage by any other new insurance company with your pre-existing condition which occurred under the previously health insurance, in other words, you will be uninsurable and this is the worst situation you could ever get yourself into. Imagine if you have a horrible accident or get cancer and your insurance will be terminated at the end of the year, who will be paying for all future medical expenses which could mount to hundreds of thousands a year, this will bankrupt you and your family. RULE VI: DO NOT EVER TAKE A HEALTH CARE POLICY WHICH IS NOT A LIFETIME POLICY and do not let any broker and/or marketing materials confuse you, READ THE POLICY and understand whether or not it is a LIFETIME policy (as per the explanation herein).
(e) Termination by Insured – Pretty self-explanatory, not of great importance and more a matter of convenience.
(f) Increase of yearly Premium – Most policies will increase premium on a group basis (increases by age and inflation), however, be wary of increase based on ‘personal circumstances’ (i.e. if your health situation has changed), in which case, the insurance company can increase its premium to a level so high so as to make it impossible for you to pay and thereby have the right to terminate your insurance. It is not uncommon to raise premium if you change coverage of policy or zone coverage (as medical expenses vary from one zone to the next). In addition, Insurance companies’ premium increases are usually capped by the relevant regulator of the insurance sector and the medical industry.
(g) Claims Handling – Pretty self-explanatory, most people prefer direct billing and not reimbursement so as not to be out-of-pocket, but this is of low consequence if you have insurance company that reimburse you promptly, in other words, do not make this a key factor in your decision to choose what type of policy to take, the coverage is more important than the way you are getting your payments back.
(h) Payment Frequency – Pretty self-explanatory, not of great importance and more a matter of convenience. Be wary of some companies’ brochures showing cheaper prices if you pay annually without mentioning that if you pay monthly, quarterly or semi-annually, the premium will increase substantially, this is important when comparing different policies and different prices to compare apples with apples and not with oranges.
(i) Total Annual Premium in USD – The cheapest option is usually the worst option, chose the cheapest policy out of the best policies and not the other way around, meaning, limit your search to a maximum budget of x amount (don’t go looking for the cheapest health insurance policy) and within that maximum budget limit look for the best policy, firstly in terms of the best coverage and secondly in terms of the price. Make use of the below table by clearing its information and inserting your searched policies’ information into it to enable and ensure accurate comparison, it will also ensure that you will ask all the right questions and ask for any critical missing info prior to making your final choice.
(j) Pre-existing Conditions – Almost all insurance policies will exclude pre-exiting conditions, meaning, they will not cover it or pay for it. However, some may be willing to discuss including them with the combination of: (aa) waiting period; (bb) increase of premium; (cc) minimum insurance period; (dd) geographical area limit for treatment; and/or (ee) deductibles.
(k) Waiting Period for Coverage – Most policies will have some short waiting period or none, but some will have long waiting periods and for key conditions, look closely at those to avoid not being covered. The length of the period is key factor as if it is too long, the chances that within that period an episode might occur which firstly you are not covered for and secondly which will then be totally excluded from the insurance thereafter and not covered by it as a pre-exiting condition.
(l) Impatient – This is the most important component of the medical insurance as it deals with the more serious conditions and the ones that would cost the most if they occur. Therefore, for all the sub-categories of impatient you would want to see the least sub-limits in terms of time, amount and/or level of coverage. RULE VII: Do not ever sacrifice your inpatient coverage for any other component or consideration (including financial) you may well live to regret the day you will be of need of it god forbid!
(m) Outpatient –
(i) Some insurances will allow you not to have any outpatient care at all and only cover impatient, which will be relatively cheaper to have. However, on a cost/benefit analysis, do your own calculation based on previous years how much you spent on average for your early medical expenses and work out if it higher or lower than what you will be paying for outpatient coverage. In any event, as we grow older, medical expenses mount up, so take into account that what you pay today for outpatient care will invariably increase throughout the years, regardless that in addition medical costs increase periodically and consistently throughout the world.
(ii) This is an area where the sub-limits get tricky, first of all pay attention to the all-inclusive sub-limit for all type of outpatient treatments (usually an annual limit of few thousands of dollars); then pay attention to the category specific sub-limit and consider whether or not such category is of importance to you. Under this component insurance companies become ‘most creative’, by providing may different programs and endless combination thereof in order to entice you to join the policy and in order to contain their actuary risk as low as possible (for example:, USD45 per visit, 10 visits, USD600 maximum per year and 6 months waiting period; and so on and so forth for other insurance policies combination which you are trying to compare). RULE VIII: Your guiding principle here should be to decide what is most important for you under your personal circumstances and to pay close attention to the tricky bits of the said combinations when trying to compare different policies to determine which one is the most attractive. Obviously the preference will be to have the least restrictions and caps, if any.
(n) Governing Law – Some countries and their laws are more socialist and favorable towards protecting the insured interests rather than that of the insurance company (such as France and Israel). Be wary of insurances that are governed by tax-haven jurisdictions like islands in the Caribbean’s, they may do this for tax purposes but they may also try to shield themselves from liability against your claims and make it difficult for you to sue against them.
Exception Note for Expatriates who are living in Thailand or Expatriates who are living in South East Asia and their country of Nationality has a good national health care system
Special note of consideration for expatriates who have a good national health care system in their country of nationality (France for example). For comparison purposes, we will take LMG being one of the ‘lesser coverage’ and cheaper policies (and surprisingly a popular policy due to its low comparative cost) in comparison to David Shield, as one of the ‘higher coverage’ and more expensive policies in order to better illustrate this. For LMG the yearly premium is 1,345 (Silver) and 1,725 (Gold), respectively, whereas for David Shield it is 2,895.
1. Pros
(a) Annual savings of approx. 1,523 (Silver) or 1,143 (Gold), as the case may be.
(b) In any scenario that LMG does not cover the medical condition or such coverage proves to be insufficient (medically or financially), the expat is entitled to rely and use its national health care system and go back to its country of origin to do so.
2. Cons
(a) Check what basket of coverage is available under your national health care system, it could be far less than the private insurance coverage, and therefore, you back up option might not be as good as you may think;
(b) Usually under national systems (in contrast to private health) there are long waiting lists and the service is not as good as private care.
(In some cases and for these reasons some people chose to have additional private insurance coverage)
(c) There can be future change to laws and regulations for the level of coverage and basket of products available under the national health care system.
(d) Relocation for treatment and associated costs:
(i) Insured cannot choose to go back to its country of nationality and LMG may insist that he can be treated here in Thailand (pre-authorization requirement). Once treatment has been provided, you will not be considered to be an emergency case and LMG will not cover any emergency evacuation costs. Therefore, you might end up paying at least a cost of a normal flight 1,000, or even higher, should a medical transportation be required which can end up to be tens of thousands. In addition, at the beginning of the following year, LMG can terminate the insurance and the inured will not be covered and will not be able to obtain coverage from another insurance.
(ii) Relocation costs – Moving the center of your life back to your country of origin (expenses will differ based on personal circumstances as determined by belongings, assets, family size, etc.).
(iii) Monthly living expenses at your country of nationality presumingly will be much higher than in Thailand.
(e) Permanent relocation with inability to return abroad – Relocating the center of your life to you country of origin (including your work, family, business, etc.) especially if you are to be treated on a long term basis, with potentially not being able to return to Thailand or abroad for that matter.
(f) Following a critical event and long term treatment at your country of nationality, you may be unable to obtain again an overseas insurance, or even if you could, it will be at a very steep premium. LMG is not a life time policy and it can terminated at the beginning of each year. In addition, as you grow older so will your medical expenses, and most insurance companies will not accept you after the age of 70 regardless as to your then existing medical condition.
(g) Key differences in terms of coverage costs that may affect your choice (especially financial considerations):
(i) Food poisoning and back pains – cumulative uncovered expenses which may increase your overall expenses to be added to the ‘cheaper’ premium.
(ii) Paying the reminder of a very low capped coverage for transplants, in the case that LMG insists that treatment takes place in Thailand, or alternatively, refusal for medical evacuation to your country of nationality.
(iii) Rehabilitation and home nursing to be paid from your own pocket.
(iv) Annual check-up to be paid from your own pocket.
(v) Dental coverage almost non-existent in LMG, even if you increase premium and pay deductibles (which does not even include coverage for emergencies) as compared against Maccabi Dental (which includes emergencies coverage). Yearly dental costs can be substantial, for example one crown will cost approx. 1,500 (let alone emergency treatments), whereas at Maccabi Dental approx. 35 deductible per crown (and also full cover for emergencies with no deductibles).
(vi) Payment is THB and not in USD (both premium and reimbursement of claims) – it is likely that as Thailand economy advances, the THB will appreciate against other currencies (i.e. it will be more expensive comparatively to pay premium and claims will be lower for treatments outside Thailand).
To summarize, it may be the case that LMG at first glance might look to be the more attractive, cheaper and rational policy to choose, especially in conjunction with the backing-up option and approach of ‘if I get stuck with my bad and cheap local insurance, I can always be covered back home by my national health care system’. However, given the above mentioned cons that may materialize at any given moment (such as cancer, road accident, transplants, etc.), in coming to your final decision, take into account and compare between the total of the premium you will have to pay for the expensive policy for the rest of your life (or at least until the age of 70) against your so-called savings. If you estimate that paying less will save you more, than by all means choose LMG, but it is probably unlikely that this would be the case, and in any event, add to you final financial calculation the non-financial restrictive cons mentioned above.
Thailand-Insurance-Comparison-Table-English-11.02.2017.pdf
Researched and written by Joseph Y. Merling, an English Solicitor in Bangkok, Thailand, expert on foreign law, international transactions and legal systems in Asia, SE Asia Legal, Thailand, dated 21.01.2017.
Important Disclaimer
This article is an opinion of the writer and it is made without any representations, warranties or guarantees (whether express or implied) and/or without any assurances that its content is accurate, complete or up-to-date and it is not intended to amount to an advice on which you should rely on. The writer disclaims all representations, warranties or guarantees (whether express or implied) and any and all liability with respect to acts or omissions made by you on the basis of this article and its content and you hereby waive any and all such claims against the writer. This disclaimer forms an integral part of the article and cannot be separated from it and must be read, understood and acknowledged by you together with it.
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Thailand Insurance Comparison Table (dated 11.02.2017)
Methodology of Insurance search:
– All amounts in USD
– Premium limited to USD3,600 per year
– Premium price does not take into account personal circumstances and pre-existing conditions which may lead to ‘Loading’ due to pre-existing personal circumstances
– Age range 41-45
– With no deductibles
– Selected best policies (i.e. not all policies reviewed are shown but only the best selected few)
– Source of policies obtained from recommended insurance brokers and from various website such as: compare now, pacific prime, globalinsurancethailand, bestexpatinsurancedeals, etc.
– Highlighted sections are the things to be concerned about and to watch out for
| Insurance Company | David Shield | MSH Asia Care | April | Regency | LMG |
| Plan Name | Global Zone 5 | Opt B-Harmony Zone1 | Asia Health-Comfort | Comprehensive[1] | Gold[2] |
| Maximum Limit | 5,000,000 per lifetime | 1,000,000 per year | 1,000,000 per year | 1,000,000 per year | – USD2,500,000 per year
– 560,000 (per disability) – THB (USD converted) |
| Excess/Deductibles | None (but possible) | None (but possible) | None (but possible) | None (but possible) | None (but possible) |
| Geographical Coverage | – Thailand, India, Israel (90d+equivalent alternative coverage thereafter for Israel)
– Emergency (rest of the world) |
– Thailand, Myanmar, Cambodia, Philippines, India, Maldives, Brunei, Pakistan, East Timor, Vietnam, Indonesia, Laos, Malaysia, Nepal, Bangladesh, Bhutan, Sri Lanka
– Emergency (rest of the world) 60d |
– Cambodia, Indonesia, Laos, Malaysia, Philippines, Taiwan, Thailand and Vietnam;
– While traveling: Europe (save for UK and Swiss); – Emergency-Israel, 90d, rest of the world 60d (0% coverage- Bahamas, Canada, US, Japan, Swiss) |
Worldwide excl. USA | [Worldwide excl. USA /Thailand, rest of the world emergency only] |
| Renewability | Lifetime | Lifetime, except:
–change residency to outside Zone |
Lifetime, except:
– No longer expatriate – Age 71 for repatriation assistance benefits. |
Lifetime | No:
– It subject to Insurer’s agreement for renewal – Terminated at age 90 |
| Termination by Insured | Monthly basis, and yes for refund on pro-rated basis | On 1 yr basis no early cancellation | On 1 yr basis, early cancellation 2m advance notice | On 1 yr basis, no early cancellation | At any time by giving notice in writing
refund on pro-rated basis with reduced short rate |
| Increase of yearly Premium | Only by Group (increases by age and inflation) | Only by Group (increases by age and inflation) | Only by Group (increases by age and inflation) | Increase due to use of more than 120% of premium | Increase due to Risk of insured (but subject to Insurance Commission rate range) |
| Claims Handling | Direct Billing | – Direct Billing
– Reimbursement- outside network hospitals |
– Inpatient ≤24h+ – Direct Billing
– Outpatient- Reimbursement |
– Direct Billing
– Reimbursement- outside network hospitals |
Reimbursement |
| Payment Frequency | A/Q/M | A (free of charge) /SA/Q | A/SM/Q | A/SM(10%)/Q(7%)/M(5%) | A/SM/Q/M |
| Discount for Annual Payment | None | None | None | None | None |
| Total Monthly Premium in USD | 239 | ——- | ——- | [ ] [3] | 144 |
| Total Annual Premium in USD | 2,868 | 2,795 (subject to frequency) | 2,240 | – 2,697 (subject to frequency)
– 2,947 (250 increased premium) |
1,725 |
| Pre-existing Conditions | – Excluded
– 12m waiting period for coverage if not excluded unless otherwise agreed |
Excluded | Excluded | Excluded | Excluded (effectively after 3yrs automatic coverage, unless existed 5 years prior to policy, in which case, excluded) |
| Waiting Period for Coverage | None | None | 3m (unless had equivalent or prior higher insurance coverage) | None | – First 30d- All
– First 120d- Several key exclusions (incl. tumors, hemorrhoids, hernia, etc.) – All time exclusions: All type of Infections; Food poisoning; Backache unless as a result of accident; [Riding motorcycle (rider/passenger)]
|
| Inpatient (Hospitalization) & Sub-limits: | |||||
| – Pre-Authorization | – Emergencies-post-notification 48h
– Non-emergency- 72h before |
– No, for direct billing network
– yes, (a) outside direct billing network; and (b): (i) Hospitalization, out-patient surgery, medical transportation; (ii) Dental crowns, bridges and dentures Orthodontia; (iii) orthodontic treatment, one or two weeks before or within 72h after admission |
Yes-All | Impatient-Yes
Outpatient- No (yes only for surgical) |
Yes:
– Cumbersome claim procedure, must submit original docs – Within 30 days after discharge |
| – Emergency Room | 2 visits per yr+must hospitalization | 100% | 100% | – Surgeon’s Fees including pre- &
post-surgical services- 25,000 – Anesthetist’s Fees-30% of Surgeon’s Fees Professional Fees ( physician, specialist, radiologist, physiotherapy & pathologist)- 25,000 |
100% |
| – Emergency Evacuation | – Ambulance – 2,500
– Air/Sea – 25,000 per event – Only Insurer selected provider |
– Ambulance – 100%
– Air/Sea – 100% – Only Insurer selected provider |
100% | – Ambulance – 100%
– Air/Sea – 100,000 (250 increased premium) |
– Ambulance – 100%
– Air/Sea- 843,000 |
| – Transplants | – 500,000 lifetime
– Donor costs – 5,000 per case |
100%
Donor costs – 0% |
100% (200,000 per yr) | 100,000 | 56,000 |
| – Cancer | 100% | 100% | – 100% | – 20,000 | No tumor coverage for first 120d |
| – Renal failure | 100% | 100% | [ ] | 100% | [ ] |
| – Rehabilitation | 100% | 30d per condition | 5,000 per yr | 30d | 0% |
| – Nursing at Home/ convalescent | 100% | 1,000 per yr | – 182d per yr
– 20 per yr≥ – pre-approval |
0% | 30d per yr
|
| – Accommodation Type | – Semi-Private | Private Room-280 per day | Private Room (limited to R&C) | Semi-Private | Private Room-450 per day |
| – Parent accommodation | 0% | Emergency ≥8d, 59 per night/586 max | 0% (only for below 18yr) | 100% (add bed same room) | 0% |
| – OP Treatment Pre/Post Hospitalization | 100% | 100% | 3,000 per event | 30d pre-2,000
30d post- 2,000 |
0% |
| – Family Unification | 1,000 per event | 0% (save for Parent accommodation) | 0% | 0% | 0% |
| – Death | 0% | – Transportation of body-no limit
– Transportation of family- no limit |
– 100%
– 2,200 (coffin)
|
10,000 | – 28,000
– Personal accident (limited to x% of body parts and payment of only the organ with the highest amount will be paid not all damaged organs in one incident) – per benefit – 5,620 |
| – Hospice & Palliative | 50,000 lifetime | 35,000 per yr | 0% | 0% | 100% |
| – Chronic Condition | 100% | 100% | [ ] | 1,000 | [ ] |
| Outpatient Surgery / Day patient
& Sub-limits: |
100% | 5,500 per yr | 5,000 per yr | 100%
(Yearly sub-limits) |
100%
(Yearly sub-limits) |
| – Specialist | 100% | Up to 250 per visit | 100% | – Surgical-25,000
– GP/Specialist-750 |
100% |
| – Prescribed Medication | 100% | 100% | 100% | 750 | 100% |
| – Annual Check-Up | 500 per yr | 200 per yr | 500 per yr | 185 per yr | 0% |
| – Physio, occupational therapy speech and chiropractic | – 50 per visit
– Max 12 visits – Max 600 per yr |
– Chiropractic, Acup- 250 per visit, 15 visits
– Physio – 500 per yr |
– Chiropractic, Acup- 45 per visit, 10 visits
– 6m waiting period (unless equivalent or higher prior insurance coverage)
|
– Chiropractic, Acup- 0%
– Physio – 750 5 visits |
Physio -100% (provided made within 30d of discharge) |
| – Mental Health | – 10,000 per yr
– 20,000 lifetime – 12m waiting period |
Inpatient:
– Max 20d – 10m waiting period Outpatient: – 0% |
[ ] | 100% | – Inpatient-5,620
– Outpatient-0% – 12m waiting period
|
| – Eye Care | 0% | 0% | 0% | Eye test- 250 per yr | 0% (optional for added premium) |
| – Hearing Care | 0% | 0% | 0% | 0% | 0% |
| – Sexual Diseases/HIV/AIDS | 0% | – 5yr*25,000
– 2yr waiting period |
100% | 0% | 0% |
| – Vaccinations | 0% (child yes) | 0% | 0% | 185 | 0% |
| Dental | |||||
| – Routine/Major — Maccabi Dent (Israel), incl. small excess fees; excl. implants, [ ]
– Outside Israel, only for Emergency-100% |
Routine/Major – 1,000 per yr (10% Co-pay)
|
– Routine/Major – 1,000 per yr
– Emergency– 50,000 per yr
|
– 6 month waiting period
– Routine – 0% – Major – 560 per yr – Emergency- 100% |
0% (optional for added premium 420 for 80% of Routine up to 2,247) | |
| Key Exclusions | |||||
| Maximum Joining Age | 64 | 65 | 70 | 70 | 70 |
| War, terrorism | No coverage | No coverage | No coverage | 150,000
Hostage neg-100% |
No coverage |
| Extreme Sport | No coverage | No coverage | No coverage | No coverage | No coverage (incl. boxing) |
| Violation of law involvement | No coverage | No coverage | No coverage | No coverage | No coverage |
| Unreasonable risk taking | No coverage | No coverage | No coverage | No coverage | No coverage |
| Time limitation of claim | 3 yrs | 1 yr or within 90 days of termination of policy | Depends on type of claim | No limit, but notification of claim ASAP | No limit, but notification of claim without delay |
| Treatment of addiction (incl. smoking) | No coverage | No coverage | [ ] | No coverage | No coverage |
| Sleeping Disturbance | No coverage | No coverage | No coverage | No coverage | No coverage |
| Subject to R&C Costs | Yes | Yes | [ ] | Yes | Yes |
| Governing Law | Laws of Israel | English Law, ICC Rules Paris | French Law | Laws of Nevis (Caribbean’s)
Nevis Financial Services Regulatory Commission |
Laws of Thailand
Arbitration regulation, Department of Insurance |
| Insurance Company | Now Health Intl. | Aetna Pioneer | |||
| Plan Name | Essential | Pioneer 2500 | |||
| Maximum Limit | 3,000,000 per yr | 2,500,000 per yr | |||
| Excess/Deductibles | None (but possible) | 10% up to 2,000 | |||
| Geographical Coverage | Worldwide excl. USA | Worldwide excl. USA
(USA Emergency Max 15,000) |
|||
| Renewability | Lifetime | No, It subject to Insurer’s agreement for renewal
|
|||
| Termination by Insured | [No, on 1 yr basis] | No, on 1 yr basis | |||
| Increase of yearly Premium | Only by Group (increases by age and inflation) | Only by Group (increases by age and inflation) | |||
| Claims Handling | – Reimbursement
– Impatient-Direct Billing only with 5d pre-arrangement – Outpatient- Direct Billing Network. |
Reimbursement | |||
| Payment Frequency | A /SA/Q/M | A/Q/M | |||
| Discount for Annual Payment | [None] | 5% | |||
| Total Monthly Premium in USD | ——- | 277 | |||
| Total Annual Premium in USD | 2,763 | – 2,959
– Price will be higher to remove deductibles |
|||
| Pre-existing Conditions | Excluded | 2 yrs waiting period to be covered | |||
| Waiting Period for Coverage | None | None (save for pre-existing condition coverage) | |||
| Inpatient (Hospitalization) & Sub-limits: | |||||
| – Pre-Authorization | Yes
|
[Yes] | |||
| – Emergency Room | 100% | 100% | |||
| – Emergency Evacuation | – Ambulance – 100%
– Air/Sea – 100% (Pre-Authorisation) |
– Ambulance – 100%
– Air/Sea – 100% (Pre-Authorisation) |
|||
| – Transplants | – 100%
– Donor costs- max 50,000 |
100% | |||
| – Cancer | 100% | 100% (incl. Palliative) | |||
| – Renal failure | Impatient – 6w
Outpatient – 0% |
100% | |||
| – Rehabilitation | 30d per condition
– Must be admitted within 14 days of hospitalization |
60d per condition (prior ≤3d impatient treatment) | |||
| – Nursing at Home/ convalescent | 0% | – 100% | |||
| – Accommodation Type | Private Room | Private Room | |||
| – Parent accommodation | 0% (only for below 18yr) | – 0% ((only for below 17yr)
– 100% (Emergency) |
|||
| – OP Treatment Pre/Post Hospitalization | 100% | Pre- 1,000
Post- 90d max |
|||
| – Family Unification | 0% (save for Parent accommodation) | 100% | |||
| – Death | – Transportation of body-100%
– Transportation of family- 0% – Burial- 10,000 |
100% (with excl.) | |||
| – Hospice & Palliative | In-Patient/Day-Patient- Max 50,000
lifetime |
100% | |||
| – Chronic Condition | 0% | 100% | |||
| Outpatient Surgery / Day patient
& Sub-limits: |
4,500 per yr | 5,000 | |||
| – Specialist | – 100%
– max 10 sessions |
100% | |||
| – Prescribed Medication | 100% | 100% | |||
| – Annual Check-Up | 0% | 0% | |||
| – Physio, occupational therapy speech and chiropractic | – Chiropractic, Acup- 0%
– Physio – 0% |
– Chiropractic, Acup- 300
Physio – 1,500
|
|||
| – Mental Health | – Inpatient- 100%, max 20d (pre-authorization)
– Outpatient: 0% |
– Inpatient- 10000 (30d waiting period)
Outpatient: 2,000 |
|||
| – Eye Care | 0% | 0% | |||
| – Hearing Care | 0% | 0% | |||
| – Sexual Diseases/HIV/AIDS | – Only occupation accident or blood transfusion
– 25,000 – 3yr waiting period |
5,000 | |||
| – Vaccinations | 0% | 0% | |||
| Dental | |||||
| – Emergency– 100% (accident)
– Routine/Major- 0% |
– Emergency– 100% (accident)
– Routine/Major- 0% |
||||
| Key Exclusions | |||||
| Age for Joining | 79 max | No Limit | |||
| War, terrorism | No coverage | No coverage | |||
| Extreme Sport | No coverage (incl. martial arts) | No coverage | |||
| Violation of law involvement | No coverage | No coverage | |||
| Unreasonable risk taking | No coverage | No coverage | |||
| Time limitation of claim | 12m or within 90 days of termination of policy | 180d notification after claim, 3 yrs to claim | |||
| Treatment of addiction | No coverage | No coverage | |||
| Sleeping Disturbance | No coverage | No coverage | |||
| Subject to R&C Costs | Yes | Yes | |||
| Governing Law | Laws of HK, HK courts | Law of Bermuda |
[1] Fully comprehensive more lucrative but at premium of 3,371.
[2] Comparing between Silver and Gold, the key difference is that the Maximum Limit is 25% of Gold and the impatient sub-limits are half the cap of Gold. The Outpatient coverage is however identical and also medical evacuation and the premium is substantially less in almost 30%, 1,345.
[3] All square-brackets are information that was capable of being obtained from the insurance companies notwithstanding repeated attempts.