Have a question about health insurance? Check out the questions below; chances are we've got your query covered!

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What factors should an insurance buyer consider when choosing which source to buy through?

A very sensible question indeed, and one I am pleased to answer. Put simply, you need to consider the following factors for each source, when deciding which insurer to go for:

Premium

The amount you will have to pay them for your health insurance policy

Deductible

The amount you must spend on healthcare services in a given year before your health insurance company will start covering them.

Network of hospitals

The places you can attend for medical treatment that have a set agreement with your insurer.

Exclusions

These are a basic list of certain treatments or diseases that are generally not covered under a health insurance plan.

Waiting periods

These indicate the time that must pass before one can lodge claims to an insurer.


Do any of the medical insurance companies in Thailand cover the cost for cosmetic surgery?

Yes and no, as it depends on the situation of your health or concern, and if it is considered life-threatening by your doctor. As a general rule, if the cosmetic surgery is to be covered under your health insurance policy, your doctor needs to issue a report stating that cosmetic surgery is medically necessary. Of course, this totally depends on your policy.


Can you explain why OPD charges are relatively high for illness coverage?

Well, it all comes down to the frivolous and unnecessary usage of outpatient (OPD) care for illness. Additionally, OPD care is much more difficult to control than inpatient (IPD) care and emergency OPD care for accidents. This means providing OPD as a benefit on a health plan can be very costly to insurance companies.


What is Major Medical insurance? Who should consider purchasing Major Medical insurance, and why?

Major Medical insurance is coverage that pushes medical protection beyond the limits of basic hospital coverage. It covers the high-end medical expenses that we are least likely to incur, but worry about the most.

Major Medical insurance is good for anyone who doesn't want to spend a lot of money on medical insurance, but would like to be protected against being wiped out financially by a costly medical problem. Also, anyone who has just a basic hospital plan should consider supplementing it with Major Medical insurance.

Why? Because Major Medical insurance provides high-end protection for a relatively low cost.


What is a chronic condition?

A chronic condition is defined as an illness or disease from which the sufferer will not recover, and for which there is currently no cure. 

These include:

▪ Heart Disease

▪ Diabetes

▪ Hypertension

▪ Diabetes

▪ Arthritis


Is there any advantage to purchasing a health plan with high room and board coverage?

The room and board rate that you choose determines the premium charge and defines the overall level of your coverage.

Each plan has built-in limits for each area of coverage, for example, surgery or outpatient accident care. Increasing the daily room and board benefit increases those limits as well.


What happens if the Daily Room and Board coverage provided by my health policy isn't enough?

Will you still be admitted without any hassle? Yes, you will! But, of course, you will have to settle with the hospital for the difference at the time of discharge.

Both Bumrungrad Hospital and Bangkok General Hospital (BGH) verified this process for us.

This is one of the advantages of purchasing medical insurance through a locally based insurance company that has a large selection of participating hospitals. You just show the hospital your card and you get admitted without any delay.


I hear some people talking about “5 Star” hospitals here in Thailand, how are they rated?

Although there are a wide variety of ratings and recommendations a hospital can receive from various sources, there is no industry standard for rating hospitals in Thailand. Those hospitals most often considered to be "5 Star" are the ones that meet or exceed international standards and have been the most successful in attracting patients from around the world.

The Samitivej Hospital, Bumrungrad Hospital, Bangkok Nursing Home Hospital (BNH) and Bangkok General Hospital (BGH) are the ones most often considered to be in the "5 Star" category. BGH also has satellite hospitals in the popular tourist areas throughout Thailand, like in Pattaya and Phuket. I'm sure that there are a few other hospitals worthy of being in this category also, but these are the ones mentioned the most often.


Do major Thai insurance companies often stall and dispute payments to foreigners?

Yes but not because you're a foreigner. If the insurer can find external info that invalidates your claim, they may reject your claim accordingly.

Furthermore, some claims can be quite complex, and your insurer may require more time to carefully evaluate the supporting material. If this happens, your insurer may ask you to pay the medical costs yourself and then submit the claim to them for payment.


I don't understand what pre-existing conditions are?

Pre-existing conditions are medical conditions (problems) that exist at the time you apply for medical insurance. A few examples are shown below:

Surgery, while going through the healing process, can be considered a pre-existing condition. The healing process can normally be up to five years. This can also be true for fully removed cancer. But this may not be true for heart surgery; no matter how successful the surgery is, a heart surgery can weaken the heart a bit.

A hernia operation 30 years ago was recently declared to be a pre-existing condition by a client's treating physician; apparently, the original surgery never fully healed properly. The insurer, therefore, declined to pay for the new surgery.

Conditions like Diabetes and Hypertension, that can be controlled but not cured, are always considered "pre-existing conditions" no matter how well they are controlled.



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