This week I submitted a complaint to SKGZ with the text below. It may also prompt others to submit a complaint in their own terms. Together we can make a bigger fist than individually.
If, in the event of rejection, we have to submit the case to the civil court, it may also be useful to do this with more people. If anyone feels the need to respond, my email address is [email protected]
File number: 202102113 OHRA Zorgverzekeringen NV
Due to the corona pandemic, various governments, including the Thai government, have set the condition that access to the country can only be granted if it can be demonstrated that the traveler concerned is sufficiently insured against the consequences of illness (including COVID-19), accidents, etc.
Since our public health insurance system has very extensive worldwide coverage, this should not be a problem were it not for the fact that the Thai government sets specific requirements for the insurance policy (statement of insurance). Provided the insurance conditions (mainly the emergency care condition) and standards (max. Dutch standard amounts for basic insurance) are met, our policies cover unlimited care provided abroad. What the Thai government asks is to specifically state an amount on the policy, namely a cover of USD 100.000 or 3.500.000 Thai Baht, and that is precisely the problem that is not really a problem. In Thailand, people are used to so-called sum insurance, especially when it comes to health insurance. However, if a Dutch resident falls ill in Thailand and must and can be treated there, our health insurance will pay for the full treatment regardless of the amount, even if it costs more than USD 100.000.
So you would say what is the problem in giving an accurate description of the Dutch coverage conditions and stating that USD 100.000 or more will also be reimbursed if necessary. After all, unlimited is more than USD 100.000, if necessary.
However, despite many attempts by me and many others, we are unable to get most insurance companies to issue the statement of insurance with the desired text. In my opinion, my insurance company OHRA has an obligation to guarantee that my policy provides worldwide coverage so that I can visit the countries I want without hindrance for any reason and for reasons relevant to me. So it doesn't happen. To date, I have managed to take out another (travel) insurance policy in Thailand at high cost. This insurance does meet the conditions. However, in not too long I will be 75 years old and that is the age at which these insurance companies will not take on new customers and I will therefore no longer be able to insure myself. This also applies to all elderly people and/or to people with poor health.
In short, despite the fact that I pay for insurance with worldwide coverage, my company refuses to cooperate in adapting the text of the cover - within the conditions and standards - to the wishes of the Thai government in this case. not her duty of care. Their excuse ranged in the past from is not legally possible through every country can have their own requirements and we don't get into that until we don't offer sums insurance and a number of things in between. In the beginning it was also indicated that there was a fear that an amount of USD 100.000 would soon be declared or that work would be done towards this amount. However, if an insured person is admitted to a hospital in Thailand, that hospital will always contact the representative of a company directly to obtain a guarantee for treatment. The hospital must submit a treatment plan and cost estimate, so that argument does not hold water and I have not heard this since.
Living proof that all these arguments are not given anywhere by the insurance company DSW. It publishes the statement with amount requested by the Thai government in an appendix. We assume that DSW does not operate illegally, otherwise this company would have long since been reprimanded by its umbrella body health insurers in the Netherlands and/or the Dutch government.
Conclusion is my company OHRA deprives me of the opportunity to make optimal use of my insurance and therefore prevents me from traveling outside Europe or now only at very high extra, unnecessary costs.
Once again, I am of the opinion that insurance companies have a (care) duty to allow their policyholders to make maximum use of their insurance, of course within the insurance conditions.
The attitude of DSW, a company that provides exactly the same insurance as all other companies, proves that the request to specifically state cover of USD 100.000 falls within those conditions, as this concerns statutory insurance and not company-related insurance.
In the first instance, I will submit this dispute to you, the SKGZ. I understand that a similar dispute has already been decided negatively in the past. I may argue and substantiate my complaint in a different way. If a negative decision is also made on this complaint, the case will be submitted to the civil court.
To avoid questions why I didn't just switch to DSW. If I do that I lose my right to litigate because I am no longer an interested party. I want this issue to be resolved in general and not every company to follow its own course and arbitrarily decide in favor - but in practice, by far in most cases, to the detriment of customers. After all, it is about an insurance policy set up by the government where conditions, etc. are exactly the same for all companies. And once again, the duty of care is increasingly reflected in a number of court cases and decisions and considerations by the civil court, which mainly banks, employers, etc. are increasingly experiencing personally. I think that here too the companies have a duty to ensure that their customers can move freely, they pay a fairly high annual premium for worldwide coverage for a reason. The fact that some countries are not used to unlimited cover but to maximum amounts (summary insurance policies) and therefore ask for this should not be an obstacle.
A tip or actually two. Possibly the umbrella organization of the Dutch health insurers can make an attempt to draw up a text for a statement of insurance that is acceptable to both the Thai government and the insurance companies, or to enter into consultation with the Thai government in person at the Thai embassy in order to try to convince them to accept the Dutch statements of insurance because our insurance simply offers much more far-reaching cover. The difference is simply limited (USD 2) their wish and unlimited, our coverage.
At the time, we also had frequent contact with Ms Aukje de Vries, a member of the parliamentary group of the VVD. She assured us that Zorgverzekeraars Nederland was working on this case. Unfortunately, we never heard anything concrete about this.
It's just a suggestion.
As you know, I have universal complete at VGZ, with Thailand as my country of residence since I was deregistered in 2009.
I had a phone call with them about a month ago.
Asked what it's like if I'm tested positive for the pandemic.
She told me then, if I test positive, and need medical attention, it will be fully reimbursed.
But not reimbursed, if I just have to lie there alone, they know that Thailand is rather quick to put people who have tested positive in the hospital in Quarantenne.
And not at home in quarantine.
This was told to me verbally.
Hans van Mourik
You may wonder how unlimited the concept of unlimited is.
Not everything is reimbursed in the Netherlands either, for example with preferred medicines and medicines costing tens of thousands or hundreds of thousands of Euros.
I can therefore imagine that insurance companies are reluctant to offer guarantees for an amount of 100.000 dollars.
Sure, because it's a ridiculously high amount.
Oh yes, I would like a few more.
Indeed, for example, medicines that are not registered in the Netherlands are not reimbursed by the basic insurance, but they are reimbursed by the travel insurance. Costs above Dutch standards are also not reimbursed, but are again covered by the supplementary insurance.
If you are admitted to a hospital, the insurance company will be contacted directly to obtain a guarantee.
A treatment plan and cost estimate must then be submitted and approved. Never heard that this - if the help is urgent - has not been approved.
If the “tons” of drugs are proposed, the insurance company will provide alternatives.
Incidentally, if you are really sick, 100.000 usd is a pittance that you will gain very quickly.
Additionally.
After the interview, I did not continue with questions.
Because I stayed here from 2019, but want to go back this year, so I know what to do.
My guess, but could be completely wrong.
If they put the amounts on it, and people are tested positive, but have to go to Quarantenne without medical treatment, they don't want to pay for it.
And can the hospital or the government claim it, with the insurance.
They are afraid of that.
That's how I feel about it.
Hans van Mourik
You can assume that no Dutch health insurer will pay the hospital bill if you are placed in a hospital without medical necessity - i.e. exclusively for isolation purposes.
The damage insurance for your car will also not pay if you have no damage, but you still have to leave the car in the workshop for a few weeks, I suspect.......
Well, Hans. If you don't get paid, you just won't get out of the hospital.....
Let's wait and see how this ends. Gonna be a long story I'm afraid...
Exactly for the pure COVID cover asymptomatic or with mild complaints you will indeed have to take out separate insurance. But that can be done.
What is now known about home quarantine is the following (no decisions are considerations yet):
1. does not apply to persons who have entered the Kingdom from outside, in those cases always quarantine, although this may not have to take place in an expensive hospital:
2. in other cases, the following conditions must apply:
A. age 65 or younger;
B. no serious underlying diseases;
C. there must be space where the infected person can isolate himself.
Again, nothing is final yet and like everywhere everything can change at any time.
Nice week.
When you submit a complaint, you must of course come up with the correct amounts. That 100.000 USD has long since ceased to apply and has become USD 50.000. I really don't understand why everyone is so fussy about insurance. I switched from CZ to DSW (a very good health insurer) and got the desired statement without any problems. Doesn't cost a penny extra!! But yes, switching is no longer possible after December 31.
Perhaps you should look into the matter better. USD 100.000 is required to obtain an OA visa and an equal amount of in-patient and out-patient coverage is also requested.
What you are talking about is the coverage for the Thailand Pass and that is quite different. And I already wrote that I stayed with OHRA just to try to get all insurance companies on the same page from DSW. If that doesn't work - not even through the civil court - I will of course switch to DSW.
It is too ridiculous for words that one does what the other refuses when it concerns the same insurance policies.
I have the same problem with VGZ. I do receive a letter stating that all health and dental treatments are paid for including COVID related, unless I am making this trip for cosmetic reasons. Last time I got my test and go certificate. In addition, I have now received a letter from my travel insurance (ASR) which specifically states the cost coverage with regard to COVID 19 plus an amount of € 100.000. I also think this is something that should be raised by the Dutch embassy, especially because it concerns so many. They represent our interests in Thailand.
Reports from Phuket also indicate the problem of insurance. Especially now that the Omnikron variant is starting to emerge. The (mild) complaints it usually causes make tourists do not want to go to a hospital, because the costs are not reimbursed with the necessary statement of $ 50.000. People are already starting to talk about a necessary statement from a Thai insurance company. On Phuket, hotels are starting to be suitable for quarantine in case of mild complaints.
See also https://www.bangkokpost.com/business/2242283/phuket-preps-hotel-guest-isolation and other publications last week.
I think this already indicates why Dutch health insurance companies do not want to mention an amount.
Strange to read this because we were called back after request that they do not offer insurance in orange or red countries on the corona map. By the way, the insurance was called Russia / Cuba insurance, in which amounts are therefore mentioned. We now have the Enirates plus an Axa Thailand insurance.
I still hope that as a member of the Ohra I will certainly get a “favorable admission” in Thailand as far as the health service is concerned. As an 80-year-old, it is impossible for me to take out insurance for about 800 euros with the AA for 90 days. My hope remains pinned on the Ohra. Haven't visited my wife for 2 years now… and I continue to find this abnormal. Although….Tribute to DSV.
Eric you are right about that.
If I don't pay, you won't get out of the hospital.
Experience despite my ZKV gives a bank guarantee, but has not yet received the money.
Hand in your passport, or pay, or wait at the hospital.
Hans van Mourik
Hello dear fellow readers
I have taken out continuous travel insurance with the ANWB. They provide an English statement with the amount required. This is accepted by the Embassy. They don't set an age limit. For my wife and myself I pay 168 per year. For my brother, he is 75 years old, the premium was 114 euros per year.
Kind regards, Dik Lenten.
Dear Dik, could you provide the text of your statement? Seems like a very affordable alternative.
Thank you travel insurance for your reply. Part of my intention was and is to get responses from people who have managed to get accepted insurance – at hopefully reasonable prices. This may allow others to benefit from it.
It would be even better if those who succeeded published not only the society but also the text of the statement.
I have the impression that in quite a few cases the insurance has not been checked when applying for the Thailand Pass, only the QR code of the vaccinations.
The Pass from acquaintances was received within seconds of the application being submitted, even before the acknowledgment of receipt. Hence.
Mattheus, just like you, I also suspect that in quite a few cases the insurance statement has not been subject to verification, but has been rolled through in an automatic procedure. Otherwise statements without amounts would never be accepted (while that is now the case) and it would not be possible – as some readers reported on this blog – that even a scan of an insurance card alone would be accepted as sufficient proof.
So if you are lucky enough that the computer does not select your Thailand Pass application for manual checking, then you do indeed have the chance to receive your approval very quickly.
Dear Theo!
As you may remember, I also submitted the same dispute to the SKGZ a year ago (file no.: 202101169)
In the end, my insurer (CZ, sister/mother of OHRA) was found to be right, relying on a lot of legal posturing. All rightly so, but people ignored the fact that the insured, we, are also entitled to some leniency, customer service! That fact was not mentioned at all in the decision of the SKGZ committee. Nor that there is indeed a health insurer, DSW (also a member of the Zorgverzekeraars Nederland group), which has no problem whatsoever in issuing the desired statement and therefore clearly does not follow the decision of the SKGZ committee!
And don't forget to include in your speech that we, all Dutch people registered in NL, are legally obliged to take out health insurance with a Dutch health insurer! So we have no choice!
Then I would like to urge you to make any decision “NOT binding” (you will automatically be given that choice at the SKGZ), otherwise you could mow the grass in front of others. I also did that with my "dispute", so that you can now give carefree Zorgverzeraars Nederland a headache again. Otherwise they could have just shown you the door.
You should also know that shortly before the Christmas recess, during my presence in Thailand, I presented the matter here. Whether that will be successful is still unknown.
I wish you the best of luck in your attempt to “show the light” to health insurers.
Khaki
Dear Haki,
Yes I remember that and I also referred to it in my speech as you can read.
I will also indicate that I do not want a binding decision and then I hope that individual records will be made en masse so that the insurance companies and health insurers in the Netherlands will think again.
If SKGZ rejects the appeal, even ignoring the duty of care that companies simply have and to which I emphasize, I am still open to the civil court.
Banks, employers and many others have already experienced in the recent past that the court attaches great importance to the fact that a company must take care of its customers, employees, etc. with due diligence.
DSW is living proof that the legitimate wishes of the insured can be met without any problems. It's a matter of finding the right wording.
The problem remains that the Thai government wants different COVID coverage (including admission in the absence of complaints) than the Dutch health insurance can offer and there is nothing we can do about that.
As insured persons, we will probably have to solve this ourselves by taking out extra insurance only against admission in the event of a positive test for COVID-19.
Given what we currently know about the Omicron variant, this is particularly topical, it seems that many infections are asymptomatic or with mild symptoms.
It must be determined afterwards or in advance who has to pay, the Dutch health insurance or the extra COVID insurance.
Greetings and have a nice week.