I have recently purchased expat medical insurance as my experience of the health service here hasn’t been that wonderful, and I suspect there are or will be soon a lot of things the Jian Bao will not pay for. Like medical treatment, for example. I am aware that there are people here who think that the Jian Bao system here is the greatest thing since sliced bread, and I know people who have had excellent treatment for very little money and so on and so forth. My doctor at the moment is wonderful as he actually cares about me the patient and he is knowledgeable about his subject. One thing I am sure the Jian Bao won’t do is make an apathetic doctor more interested - just as a crap doctor (i.e. one that doesn’t care) will not get less crap depending on who pays for the treatment.
Generally, I found there were two types of insurance: (1) for Americans who intend to return to America; (2) for anyone, including Americans for whom returning to America and continuing the medical coverage is not an issue.
1. The American type
This sort of insurance is what you get from American companies. It is very expensive. Like five times what the usual stuff costs. It covers pre-existing and chronic conditions and is designed to be (it appears) a replica abroad of a domestic insurance policy (but see below for one that covers nothing!), including pre-existing conditions, palliative treatment for chronic conditions, and dental costs. Anyone who investigates American medical insurance will soon discover Americans are obsessed with dental insurance. This is why they say Brits have “bad teeth”. It is because they have to pay eleventy billion pounds a year just to get fillings done and they bloody well want you to notice.
If you are American, then you may know all about American insurance, and there may be some benefit to using an American company. For non-Americans, I wouldn’t bother, unless you want to. In summary there are huge medical questionnaires, you have to have a medical, and there are literally hundreds of pages of legal bullshit to wade through. The actual benefits apart from paying for surgery are very stingy in most cases, but I wouldn’t trust an American firm to pay up having looked at their legalese.
2. The normal type
Contingency insurance against the cost of medical events. Split into “basic” schemes which only provide in-patient cover, and “comprehensive” schemes which cover in-patient and out-patient cover. My wife used to have comprehensive cover with Interglobal which meant for her seeing the doctor for whatever reason cost nothing (no excess) in theory. In-patient schemes do not apply excesses (check that though) and there is usually a small excess for outpatient treatment under the comprehensive schemes, which sometimes is large enough to make it not worthwhile in Taiwan. Should be no more than £30. The are “rich bastard” schemes which include dental treatment and having your chequered lumberjack shirts and plus fours changed every few years just as they go out of fashion again. They appear to be a waste of money as they only give you four and sixpence worth of dental treatment anyway, and there is a “co-insurance” charge which means you have to pay 20-25% yourself, which is an odd thing.
I decided to look at UK firms only as I am aware there is a very strong regulatory environment there and I would be in a better position to sue the bastards if they decided not to pay up. I know that if I attempted to sue an American firm they would just put me in a room full of lawyers until I ran out of money. The main worry I have with insurance companies is that they will try to not pay. Any indication of this and I’m not interested. So I ask a lot of questions from the claims department, and I have the following odd things to report:
3. Shocking and surprising exclusions
William Russell told me they do not cover SARS if a patient has asthma. They are the only firm to say that. They are off the list straight away, because as the guy from BUPA said, SARS and asthma are unrelated. What William Russell are doing there is basically not covering your lungs because you have asthma.
William Russell also have a clause where they can require you to chase a third party for whatever he might owe you, from say an accident, at your own expense. I queried them on that, and, yes, it’s true. All the other firms I surveyed just want your co-operation. They actually do the suing through their own lawyers and the process is invisible to the client.
Another company (Healthcare International) have a clause (Article 21) where they want you to claim from the government first, and then they will pay the rest. This would mean you use your Jian Bao card, pay the bill, and then they will cover the rest. That kind of defeats the purpose of having insurance in the first place, but it also precludes direct billing. Other firms, Goodhealth in particular, the firm I chose, will try to get money back themselves afterwards if the patient is in a government scheme. This is transparent to the patient. Sometimes they get some back, and sometimes it’s too much hassle or they just don’t. But it’s their problem, not the patient’s.
Some companies pay for helicopter ambulances (Goodhealth) and some specify “road ambulance”. Tight arses.
Some will pay for outpatient surgery, some will only pay if you occupy a bed, even if you’re having a head transplant. (This obviously only applies to in-patient only plans, the most basic kind.)
Some are so outrageously expensive (BUPA) you wonder how they stay in business.
Some when they evacuate you will not pay for a spouse or whatever to accompany you. Most, IIRC, will pay for the flight home, or to where you were before you were evacuated. Some, including Goodhealth, allow you to choose the country to which you will be evacuated, which could be country of origin. Goodhealth charge an extra US$85 a year for that I think.
4. Things they tend to have in common
4.1 Global coverage – you are covered no matter where you are, except America, where you either have no cover, or limited cover, for accidents, or for a certain number of days, or up to a certain amount of money. The insurance works at home too, and it will cover Americans on trips home too, but not if they end up living there. You can also choose to fly wherever you like (within your area of coverage) for treatment, but you pay the airfare. I’d like to fly to Thailand for my elective surgery and recuperate afterwards on a beach with a huge spliff and a margarita and some bint, I mean “physiotherapist”, massaging my sore bits until they’re all better, but that’s just me. The hospital in Pook Ett is supposed to be very good, and there’s one called the Bumrubalong in Bangkok which looks very comfy.
4.2 They pay all of your in-patient costs for the things you are covered for, including accommodation in a private en-suite room. I have seen insurance from an American company which was over US$3,500 and it expected you to share a room with another person. This company also would only pay US$50 a throw towards ambulance fees. Outrageous. I now have a lot of sympathy for the poor buggers in America paying for health insurance and nothing but contempt for the British government which is prepared to let the NHS go down the tubes. Oops. Minor political rant there. Well, at least I didn’t mention Chinese banking IPOs. Damn!
4.3 They all pay for cancer treatment.
4.4 They all pay for transplants, but with widely varying benefits. Some pay a benefit per lifetime, and some per year. None pay for the donor’s costs or finding and typing the organ.
4.5 None pay for pre-existing conditions. Some, as noted above, will use any illness you’ve had in the past 5 years (or 3, or 2) to exclude an entire part of your body, so that needs to be investigated. In my case when I told Goodhealth about two previous ilnesses I had had, they decided to cover them anyway.
4.6 The basic schemes tend not to cover chronic illnesses. With some, after two (or whatever) years if the illness is really gone then they’ll cover it again. This and the no medical history underwriting is the major difference with the American insurance schemes. Just remember that some of the American schemes have per lifetime limits of US$1mn and stuff. Madness. Don’t understand them at all.
4.7 The premiums tend to go up with age, although InterGlobal have no-claims bonuses. William Russell have a system where you pay the premium for the age you were when you joined until you make a claim. Then you have to pay your “real” premium, but are frozen at that level until your next claim, and so on. The lot I chose just bung the price up every year, so I will have to shop around again next year. Don’t fancy that much, which is why I have an agent to do that for me.
I wanted a scheme to cover the big stuff and use the Jian Bao for going to see the doctor for runny noses and getting sick notes. I wanted:
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Inpatient treatment paid in full with no “excess” and accommodation to mean a private room with ensuite bathroom in a hospital of my choice, going fully private and not using the Jian Bao at all.
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Amount per year must be reasonable – at least a million pounds.
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Direct payment to the hospital
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A company with a presence in China, Taiwan, or Hong Kong and staff who speak Mandarin.
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Bird flu treatment.
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Full evacuation with accompaniment paid for, on a separate flight if necessary, and return flights. Flights must be to a “centre of excellence” and not just wherever is cheapest. I asked Goodhealth about this and they said they usually use Singapore or Bangkok in Asia as they have the best treatment at the best price. I’ve asked around, and it appears Bangkok at least is very highly regarded. Don’t know about Singapore at all except that I’d rather be in Thailand.
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Must cover outpatient surgery done in the doctor’s office.
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Organ transplant amount must be per year, not per life. I might need two livers.
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“Ambulance” must cover air ambulance. I suspect Taiwan doesn’t have them, but elsewhere does.
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Must pay for outpatient MRI and CT scans. InterGlobal’s basic one doesn’t.
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Must cover emergency dental work done in hospital after an accident (some don’t)
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Must cover outpatient treatment after inpatient treatment, including physiotherapy. Most benefits though are limited in terms of time or money, but that’s OK.
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Prefer cover for AIDS. None cover STDs but most cover bad blood aids or whatever. The £30k or whatever is better than a poke in the eye with a blunt stick and would help whilst sorting out who’s going to pay for the next year. Apparently they can string you out for quite a while now with these new expensive drugs.
So I chose the Major Medical plan from Goodhealth. Other firms may do better stuff, and William Russell does seem to be the cheapest, but I am paying US$150 a month for me and the war department (together) which I reckon it is worth it. I suggest you ask these people all the questions you need to in case I’ve got something wrong here, and keep copies of the emails. Make sure your questions are put to the claims department, and make sure you know you’re relying on the answers. Vague answers will tell you a lot about the response you’ll get when the claim is real. I struck InterGlobal off the list because they told my wife CT scans were not covered in the “Wellbeing” benefit, which was £150. So she had to cancel all the appointments she’d made to have the tests. Turns out after all that they were eligible, or so said another claims adviser after the policy had expired. It appears then that these so-called “Wellbeing” or “Checkup” benefits are just there to look good. Any tests or health checks that could actually cost that much are excluded. Beware also if the only difference between one level and another is an extra £1,000 on the mortal remains benefit. What use is that?
Seems to make a difference to coverage for some which office you sign up with. Can’t remember now which insurer. Might as well just sign up with the London office really. Payments are by credit card anyway.
Example of a bad response to “do you cover SARS if a person has asthma?”
…and if she leaves the inhaler at home? Note “all respiratory conditions” - most unsatisfactory.
After I objected, and quoted BUPA:
I preferred to buy insurance from a company that can give a straight answer to a straight question. After all this is about trust for a large part.
Example of a good response:
I couldn’t find any sites on the interweb discussing expat insurance, or giving much case history details. If anyone knows of any I’d be interested to find out the web address.
Here’s a list of the companies I looked at. The ones I have bolded are IMHO contenders.
Goodhealth – appears to be the best for basic plans
InterGlobal – well worth considering for the Comprehensive plan, probably better than Goodhealth’s equivalent, but not impressed with their claims department’s response to enquiries even as existing policyholder
William Russell – but not for asthma sufferers; under certain circumstances they appear to want you to become their unpaid legal counsel; I would grill their claims department before buying; seem to be cheapest
HealthCare International – if you have to use your Jian Bao card and pay first, then it’s not really private medical insurance.
BUPA – very expensive, I mean several hundred pounds a year more expensive than the rest. Why? The coverage appears weak. Only company to acknowledge existence of Taiwan: they list the Adventist on their website as a “partner” hospital or whatever. I wasn’t that impressed with the Adventist, but you can go anywhere you like.
Allianz – Can’t remember.
Morgan Price – Dunno. Don’t they make shirts? Maybe it’s a bank?
IMG Europe – the European version of IMG. An expensive and odd mixture of in and out-patient cover.
[color=blue]MNU – Comedy insurance![/color] Have a look at mnui.com/about.asp It’s about the same price as the Goodhealth Major Medical for the good Lady and myself, but the benefits! You’d have to be insane to buy this! US$1,000 for ambulance, for life !!! US$1mn in total – for life!!! No evacuation, no repatriation, huge US$250 excess for no particular reason. Madness – I mean, who on earth would buy this? What’s it for? Am I missing something?
Other posts on expat medical insurance:
forumosa.com/taiwan/viewtopic.php?t=38478
forumosa.com/taiwan/viewtopic.php?t=11703
forumosa.com/taiwan/viewtopic.php?t=1462
[NHI coverage when going abroad
[Int'l Health insurance for Taiwan expats not covered by NHI