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BANGKOK 22 May 2019 05:54
Orton Rd

Pacific Cross health insurance ?

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Has anyone experience of claiming from them? They seem OK but you never can tell until you have to put a claim in. I only intend to get the basic cover, but better than nothing as you can't always get on a plane and go home if you have many acute illnesses which may well prevent travel. I have lived here 12 years with no cover, but in that time Hospital costs seem to have gone up quite sharply in Bkk.

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They are the most conservative of all the insurance companies, or so the broker tells us, certainly, the restrictions they imposed on my quote were truly amazing and totally unlike the other quotes we received.

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But you have to know after you do a claim, which is more than your yearly payment, then the next year your yearly fee will increase (actually they told me, when you do a claim or claims worth more than double of the yearly fee) and it's then still depending on the claim and other factors which only the BackOffice is aware off.

 

That I think is actually the only bad part about the insurance I can tell till now.

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1 hour ago, simoh1490 said:

They are the most conservative of all the insurance companies, or so the broker tells us, certainly, the restrictions they imposed on my quote were truly amazing and totally unlike the other quotes we received.

who did you go with then?

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5 minutes ago, Orton Rd said:

who did you go with then?

I didn't, I continue to "self insure".

 

Despite having a medical exam which didn't really show anything untowards, PC quoted premiums of 18k a month and that was with a 300k deductible. Thereafter, the first 300k was co-pay plus so much of my body was excluded from coverage that it simply wasn't a viable option.

 

 

 

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12 minutes ago, simoh1490 said:

I didn't, I continue to "self insure".

 

Despite having a medical exam which didn't really show anything untowards, PC quoted premiums of 18k a month and that was with a 300k deductible. Thereafter, the first 300k was co-pay plus so much of my body was excluded from coverage that it simply wasn't a viable option.

 

 

 

18k a month! I must have misread the info I was expecting to pay about twice that a year, no that's not worth it better to save it.

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I've had Pacific Cross, and their predecessor LMG, for quite a few years. Fortunately, never had any big claim with them.

 

In the earlier years under LMG, I had a lot of small outpatient claims that were almost always covered without any problem. In those situations, the LMG insurance was honored by the hospitals for most or all of the payment, and I either paid nothing or a very small portion extra.

 

I've discussed the claims "penalty" notion with my broker, and gotten feedback on that directly from Pacific Cross in the past. Without digging into my files to find my notes on that, my memory says the question of whether they'd raise your premium at the next renewal time, in the event of a large claim, has to do with the amount of the claim vs. your total paid premiums during the life of your coverage. In other words, what the insurance industry would call your loss ratio. And if they did decide to raise your premium, I believe there's some percentage limit on that, like 25% or so...again, doing this from memory.

 

My coverage with them is 20 million baht lifetime, and the policy pretty much covers 100% of normal, customary charges for both OPD and IPD with a daily hospital room rate capped at $8K per night. The coverage obviously excludes any pre-existing conditions noted on the policy at the time it was first issued.

 

They used to have a 5 million baht per incident limit, but I believe they did away with that in the past year or two. And I pay less than $1400 U.S. per year for my coverage, which includes a no recent claims discount and an additional 20 or 25% premium discount for accepting a 40,000 baht annual deductible on my policy.

 

Obviously, if I had insurance claim on the policy, I'd lose the smaller (10%?) no claims discount for that year. But I'd still be entitled to the deductible-based 25% discount, regardless of having a claim/claims and even if I were to end up with a premium increase. Then the deductible discount would simply be taken off the new higher premium.

 

 

Edited by TallGuyJohninBKK
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33 minutes ago, Orton Rd said:

18k a month! I must have misread the info I was expecting to pay about twice that a year, no that's not worth it better to save it.

The premiums etc are based on age and medical history and we're all different, there's no reason why you couldn't try and see how much they want.

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2 hours ago, TallGuyJohninBKK said:

My coverage with them is 20 million baht lifetime, and the policy pretty much covers 100% of normal, customary charges for both OPD and IPD with a daily hospital room rate capped at $8K per night. The coverage obviously excludes any pre-existing conditions noted on the policy at the time it was first issued.

 

 

Sorry, that should have read, maximum 8,000 baht per night hospital room charge -- not $8K.

 

BTW, I also have the impression, though can't confirm it, that they have a somewhat better rate structure for customers who kept their policies from the original LMG company vs. customers who have taken out newer policies under Pacific Cross.

 

Edited by TallGuyJohninBKK

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15 hours ago, simoh1490 said:

I didn't, I continue to "self insure".

 

Despite having a medical exam which didn't really show anything untowards, PC quoted premiums of 18k a month and that was with a 300k deductible. Thereafter, the first 300k was co-pay plus so much of my body was excluded from coverage that it simply wasn't a viable option.

 

 

 

I'm in same boat, but Thai wife and adult daughter are insured with Pacific Cross. Wife is invincible so no claims. 40K deductible, self pay for OutPatient keeps the annual premium down.. Daughter has had a couple of claims and all good, they come through, but then exclude similar condition for two years. 

 

I trust recommendations from AA Insurance Agency, a sponsor of the TV insurance forum. We started with AA in Chiang Mai, and are now with the Pattaya office for our health and auto and home insurance, even though we don't live there. All business efficiently handled by email.  Mr Peter and K Nam and other ladies in the office are efficient and super good communicators in English or Thai, and have never steered us wrong.  

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43 minutes ago, drtreelove said:

Daughter has had a couple of claims and all good, they come through, but then exclude similar condition for two years. 

 

 

That's a new one on me.... AFAIK, once your policy is issued, the pre-existing conditions are the ones that are listed on the policy at the time, and they can't add new exclusions for things that occur in the future.

 

Just as an example, assuming someone had OPD coverage. You go to the doctor for stomach flu now and are treated and covered by Pacific Cross for the visit. Are you suggesting that their insurance then would exclude any coverage for stomach flu for the next two years. I've never heard of that kind of thing with Pacific Cross, nor have I seen any thing like that in the written policy document.

 

 

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I too have never heard of an insurer doing that - unless you try to increase the coverage level in which case the new level of cover might exclude the prior claim leaving that condition covered at the old level.

 

To exclude a condition that newly developed after the policy was initially issued upon the next renewal would seem to negate the whole value of insurance. Insurers would not  be allowed to do this in most western countries.

 

 

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Just to be clear, I know the prior poster was NOT talking about the idea that they'd add an illness/condition to the list of permanently excluded pre-existing conditions. Rather, he mentioned a two year exclusion period.

 

I have a vague feeling there may be something in the policy that limits their coverage for what's considered chronic conditions, though I'd need to go back and re-read on that, not sure. But I'm pretty sure I've never heard of or read of a two-year exclusion period with Pacific Cross once you've been treated for something. Of course, that doesn't necessarily mean it's not something hidden in the fine print somewhere.

 

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Perhaps it does come under a "chronic condition" clause. but such clauses are to be avoided...especially by people planning to grow old in Thaialnd. You want a policy with no exclusion for (new) chronic conditions.

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6 hours ago, Sheryl said:

I too have never heard of an insurer doing that - unless you try to increase the coverage level in which case the new level of cover might exclude the prior claim leaving that condition covered at the old level.

That may have been the case. I may have interpreted the issue wrong, due to my pet peeve about exclusions. Daughter handles her own policy renewals now. 

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