Walter van der Wal

Health cover for existing medical problems

Is it possible to get insurance to cover treatment of an existing problem?


Understanding Health Insurance: One example of someone not understanding the concept of health insurance was a woman who wrote to me saying that she was already pregnant and wanted to buy maternity coverage to cover the delivery of her baby. Nope. Sorry. Can't do that. It's already a pre-existing condition. Maternity coverage will only cover the delivery of a baby 10 to 12 months after applying for the coverage.

Another example of someone not understanding health insurance involved a man who submitted his application for medical coverage and then called me the very next day saying that he was in the hospital and they wanted to know his policy number. He had scheduled himself for an operation even before he had applied for the insurance.

His attempt to claim was rejected for two reasons: 1) the problem was clearly pre-existing and 2) there is a 30 day waiting period anyway before treatment of illness related conditions can be covered.

These two people clearly didn't understand that the concept of private health insurance is to "provide a necessary service and to make a profit" while doing so.

To simplify this, high claim losses force insurers to raise premiums. Higher premiums make them less competitive and less affordable to many people no matter how good their insurance is. I've seen it happen. Having said all that, it still bothers me that many people with existing medical problems can't get insurance to help cover the treatment of those problems.

But, there are some options. This blog will discuss these options and you can determine if any of these options can fit your needs.

Government Insurance: Expats in Thailand who go to work for an employer participating in the government Social Security Insurance scheme have a good shot at having treatment of their pre-existing conditions covered, if the medications and treatment they require are not too exotic and are readily available in Thailand, The Thai government is starting to tighten down on covering certain types of medications and treatments, though.

Large Multi-National Company Group Insurance: Many large international companies do offer group insurance that covers pre-existing conditions. (But don't get your hopes up about finding this in Thailand). The additional costs of covering pre-existing conditions are passed on to the employer in the form of a premium increase. The employer uses this increase as an employee-benefit tax write-off to keeps his taxes down.

Group Insurance Carry-Over Policy; If your pre-existing conditions were covered by your group insurer because they first appeared while you were covered by the group insurance, or possibly even before, many insurance companies will allow you to "carry over" your group policy to them, including coverage of pre-existing conditions. (In some cases, even personal insurance coverage can be carried over).

An Exclusion Moratorium: This is a waiting period of, typically, 24 months and during this time the condition will be excluded from coverage. If, however, no treatment is sought for the condition, no symptoms are displayed, and no medication is prescribed, then the insurer will reconsider providing coverage for condition.

Premium Loading: Some pre-existing conditions may be considered for coverage under an international medical insurance plan; however this will come with an increased annual premium. The type of condition will affect the amount of the loading, and not all pre-existing conditions can be covered by a premium loading.

A Fixed Yearly Treatment Allowance: A few international plans offer this for the treatment pre-existing conditions. For example, one company will pay up to 150,000 baht per year for the treatment of pre-existing conditions and up to 1,500.000 baht over a 10 year period. This begins after you have had the policy for 24 months. It doesn't matter, though, whether you have sought treatment for the conditions or not.

Pre-Existing Condition Exclusion: This is the way most insurance companies in Thailand deal with pre-existing conditions. They will cover you for everything else, but they exclude coverage for treatment of your already existing medical problems. Some insurers do tend to be a little more liberal in their underwriting than others.


For more information on healthcare and medical insurance plans in Thailand, please feel free to reach out to Pacific Prime Thailand Insurance Brokers, or email Walter directly at walter@pacificprime.com




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