Questions to ask - Google Drive


1	Questions to ask Regarding Medical Insurance
2	#	QUESTION	OUR ANSWER
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4	1	Is the provider an insurer or a managing agent?	Managing agents cannot guarantee renewal as they are not insurers. Examples of managing agents include: NowHealth, A PLUS, ALC, April, MSH, William Russell, Henner / GMC, Morgan Price, and IMG
5	1	Is the provider an insurer or a managing agent?	As a customer, you have no right to appeal to the insurer, as the insurer only recognises the agent as its client. Be aware too, that managing agents tend to be closely scrutinized when it comes to claims and they will usually have to report all claims over a certain amount to an insurer for approval.
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7	2	Is renewal guaranteed?	Because health insurance plans are annually renewable contracts, it is technically not possible for an insurer to guarantee renewal. Some, such as Foyer Sante get around this by promising 'tacit' renewal. Some, such as Allianz Partners go so far as to promise renewal but ONLY if the product is still available.
8	2	Is renewal guaranteed?	Unless the insurer is subject to some kind of judicial oversight, there is nothing to stop it from increasing its prices by 50% or more. We have seen this happen with Nordic Healthcare and Globality (DKV). It could also scale back on its benefits. Interestingly neither BUPA Global nor AETNA in Hong Kong guarantee renewal of their new suite of products.
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10	3	If the provider offers 'Moratorium Terms' should I prefer this approach or should I be underwritten and give my medical history?	"Moratorium terms" mean that anything for which you have not needed treatment or monitoring over the past 2 years, will be covered.
11	3		If you take this approach you will be underwritten at the time of your claim and face the possibility of your claim being rejected. We counsel against the approach due to the inherent uncertainties it creates.
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13	4	What are the provisions for arbitration or dispute resolution?	Currently in Hong Kong there is an Insurance Complaints Bureau - https://www.icb.org.hk/en/index.html, where rejected claims can be contested.
14	4		Hong Kong law does not prohibit the sale of insurance products from overseas, but insists that clients complete a 'Notice to Client' form which by signing means you acknowledge you have no protection from local authorities and if may this need to take the insurer to court in a foreign country.
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16	5	Are children guaranteed cover from birth?	Children born in later life or children born as the result of assisted reproduction, face a greater chance of being born with health problems. Many people focus on the cost of bearing a child and overlook the fact that the cost of their child being born with a lifetime of medical problems, could be far greater.
17	5	Are children guaranteed cover from birth?	The better quality plans will normally provide such plans if the mother has been insured for the maternity waiting period, but most will exclude cover if the conception has been assisted. Foyer Sante allows children born by natural means to be insured after the mother has been insured for only three months.
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19	6	What is the construction of the policy?	Some policies are designed such that everything is covered EXCEPT what is excluded.
20	6	What is the construction of the policy?	Other policies say something like, only those conditions specifically mentioned in the table of benefits are covered..
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22	7	If I stop being an expatriate and return to my home country, under what conditions, if any, can cover continue?	Medical insurers understand the claim patterns of expatriates but lack in depth experience as to the claim patterns of local people. They argue that once a person becomes a local resident in their own environment, they should take up cover with a local provider. The benefit to the international insurers of such an approach is they can avoid paying claims that may beset us in our older age.
23	7		There is also the argument that if the insurer was to actively do business in the local environment, it should set up and be registered there. Cigna Global takes the view for example, that a person can retain cover after move, providing they are set up in the country concerned. So for example a person could at the time of writing, take out a policy in Hong Kong and move to Singapore or the UK and keep the cover.
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25	8	How important is full cover for Chronic Conditions?	Chronic conditions like diabetes are conditions that can be maintained but never reversed. We have one client who in her early 40's suffered a stroke. Her medical and speech therapy bills, including medication, are costing c.USD5,000/ month. Her plan has a USD15,000 pa chronic conditions cap.
26	8	How important is full cover for Chronic Conditions?	Some providers play with words and talk about 'full cover' for acute episodes. This means that if you fainted and were taken to hospital, the insurance in this example would pay for your hospitalization and treatment, but may not pay ongoing costs for subsequent visits to a doctor or medication.
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28	9	Do I take hospital only cover or hospital and outpatient?	Hospital bills may seem your major risk, financially, but if you need ongoing maintenance, these outpatient bills could be significant.
29	9	Do I take hospital only cover or hospital and outpatient?	In the world of the future, medicines are increasingly tailored to your exact needs and with annual price tags of anywhere from USD50,000- USD 200,000. Be wary of any plan with caps on medication.
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31	10	How much can I trust the provider?	In the end we only have the contract. If for example, the contract allows the insurer to cancel the cover, do not tell yourself 'They'd never do that'. The provision is there for the express purpose that it could be used.
32	10	How much can I trust the provider?	Insurers past behaviour is NO indicator of future behaviour. Nordic healthcare had 14 years of 5% pa price rises before successively raising prices 10%, 15% and then over 50%. And the fact an insurer is strong financially today, is no guarantee it could go out of business tomorrow. Furthermore government oversight offers little help in the end. Pacific Cross, a privately owned insurer based in Western Samoa has been successful in its business for decades, whereas HIH, an Australian insurer listed on the stock market, went into liquidation.
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34	11	How convenient is it to claim?	Some providers require original receipts and some also require doctors' signatures! Others insist to receive originals only over a certain amount, such as USD500 or USD800.
35	11	How convenient is it to claim?	Some providers too will insist you only submit claims via their portal and will not accept submission by any other means.
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37	12	IF I stay abroad, how am I going to afford private medical care in my older age?	Once we are into our 40's the rates charged for our age will probably increase by a couple of percent each band of 5 years so by the time we are into our 60's premiums will inexorably rise say 5% pa, just on account of our age. Add to this medical inflation of 7-10%, due to increases in doctors fees, improvements in technology and more advanced medicines and your will seldom avoid a price rise of less than 7% in a year and it could be as high as 20%.
38	12		Some people address this challenge by making sure they can downgrade their plan as they age. It has been our observation however, that not long after a person decides to try and save in this way, they then need to claim and wish they had been able to retain their former cover.
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40	13	How long will the plan I choose last before the provider revamps in some major way or discontinues?	Plans are typically tweaked every year and may face more major reviews every three. Some like Bupa Global in 2015 revamped its range after about 6 months. Our observation is that 10 years is a good period for any plan to survive..Foyer Sante is an exception to this práctice, having made no changes to its plans since they were launched in 2015.
41			If you enter in the early years of a plan the provider will be eager to gain market share and will not normally be facing significant medical claims, so will likely be more aggressive on pricing. After reality hits after 2 or 3 years however, you will likely find that price / benefit correction will begin to occur, especially if the insurer has a generous maternity provision.
42			The greater threat is the insurer stops sale of the product. In such a case, there will be an aging pool of people and escalating claims, so premium increases will soon outpace 'medical inflation'. This problem is exacerbated by the fact that in such a situation, the people who can leave the plan will leave, thus putting more pressure on price rises as those remaining will be those that can not get cover elsewhere.
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44	14	How will my claims be regarded if I have had no sickness before the plan begins and yet, once I have the cover, I really have to claim?	If you are a part of a group plan that has accepted you without asking any medical questions and if what you are claiming is covered by the policy, there should be no problem.
45			If however, you have made a full disclosure of any past problems and been accepted without reservation, then you can be sure to expect the insurer will closely inspect all claims you make in the first one to three years.
46			The reason is that insurers have found that there is often a disproportionate spike in claims during the first three years a person is insured. Naturally this concerns the insurer as it suggests there may have been some non-disclosure of past ailments. If an insurer discovers we have not disclosed something, no matter how inconsequential it seems to us, such as 'acne' for example, the insurer will likely exclude future cover for that ailment or cancel the cover.
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48	15	If I am on a company group plan, can I not simply transfer to a similar individual plan from the same insurer, no questions asked?	It all depends on what has been negotiated at the outset or renewal of the group policy. Generally there will be a waiting period of anything from 1-3 years. April for example insists on 1 year, Henner 2 years and Bupa Global, 3 years, ´AXA Global meantime, has no waiting period.
49	15		If you have not been underwritten as a group member, you will either have to complete a full application with no certainty of cover, or you may be charged more, especially if you have cancer or are expecting an operation at the time. Foyer Sante's group transfer rules allow transfer to an individual plan, even if you were not underwritten at the beginning. for Most insurers will have an equivalent individual plan you can transfer to, but some such as Cigna offer a plan that only accepts people leaving from a Cigna group plan. This CIGNA plan is called 'Horizon'.
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51	16	Should I take a deductible?	If you are paying for this policy with your own money, then our advice is to choose the deductible that fits with your level of comfort. So if it becomes a financial strain to have to outlay more than USD 1000, or more than USD10,000 choose what best fits you budget. It seems little sense to pay an insurer a dollar of more to then give you that dollar back when you claim, especially for smaller bills.
52	16	Should I take a deductible?	Most insurers, like AXA Global, Allianz Partners , AETNA International, BUPA Global etc offer deductible that relates to total medical expenses, whether hospital, out patient of a mix of the two. Others such as Cigna Global offer deductibles that are different for hospital and outpatient. In addition Cigna offers the option of different levels of co-insurance, depending on whether of hospital or outpatient. Uniquely, Foyer Sante only offers a deductible for outpatient treatment
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54	17	What if I need help with my claims or to arrange a guarantee of payment to a hospital	Navigator staff are to hand anywhere anytime, 24/7 to help:
55			Robin - tel +852 5917 2530
56			Romi - tel +852 9094 8602
57			Clive - tel + 852 98337335