Expat Health Insurance Analysis

[Chiron]

On my recent trip to Indonesia one of my goals was to understand what various people are doing in the way of health insurance. I spoke to both expats and locals (basically my wife's family) and came away with an interesting hodgepodge of answers and recommendations. Here are some of the observations:

1. Of the nearly 40 close relatives in my wife's family, I believe that only two are using BPJS.
2. In this same group, about five are using Prudential (in Solo). However, these are not only health insurance plans, but have other things like investments, and life insurance combined.
3. Of the 5-6 expats I spoke with, only one was using BPJS - the others were self-insuring.
4. One expat, who stays in Indonesia by stringing together Sosial Budaya visas (for 8 years now), was very enthusiastic about a particular company called Morgan Price International (UK based) - which I will analyze below.

As for me, the plan is to eventually move to Solo (if you've followed my posts), and get a spousal ITAP. As I understand it, this will require me to get BPJS (KIS) after Jan. 1, 2019. That said, I'll likely get the Class 1 BPJS for both my wife and I, at 80.000 IDR x 2 per month.

With BPJS in hand is there a need for anything else? My wife's family generally don't like or "trust" BPJS, and opt to either stay away from hospitals and doctors, or get Prudential at about 20-30 million IDR per year. However, that position may change over time, as I understand the government will require compliance. So that leads to the persuasive argument/discussion for something like Morgan Price (MPI). I had MPI send me a quote for the plan my expat acquaintance has. This is their lowest cost plan, and basically includes hospitalization (surgery and other invasive procedures) and air evacuation. It specifically excludes healthcare in Singapore and USA. The air evacuation is only for the "nearest suitable medical facility" at the location you happen to be. In other words, if there is "suitable" facilities in Solo, then don't expect to be air lifted to Kuala Lumpur or Perth for that hernia surgery you may need. The other interesting thing about MPI is they will cover someone up to the age of 74, which is a bit longer than others. That means my wife and I could theoretically get coverage for the next 17 years. There are different rates for the various age brackets, but with a 10% discount and $250 deductible the total out-of-pocket premiums would be roughly $100,000 total, or about 1.35 billion IDR. In that same time, I would be paying about 33 million IDR for BPJS. The BPJS system is about 3% of what MPI is quoting over that 17 year period - not considering inflation.

No matter how great this international health insurance is, I believe I'd be better off with BPJS and using the 1.3 billion IDR savings for filling in the gaps when needed. Purely speculating, it's likely that I'd never hit that amount. I'm still trying to find out what Prudential Indonesia has to offer - especially as it relates to health insurance. I've also noticed that some banks like HSBC and BNI have supplemental hospital benefits if you open a premium account.

 

[Daniel50]

My plan was, and would be, to pay for medical expenses as they arise. There is no way I will be paying ever increasing premiums to an insurance company. Then possibly have them give me a hard time esp. if treatment is costly ( I don't have a great trust for insurance companies). If I should need mandatory insurance, I would find the lowest cost one possible.

 

[Balifrog]

I would tend to agree with Daniel 50.

Insurance premiuns ar crazy once you become a bit older (like me..). Better have a bit money ready "in case".. Any major issue I would be on the plane home. Well, if I can...
Meanwhile going with the minimum requirement.

 

[Davita]

For information....I'm now over 80 and when I was 75 I was rejected for medical insurance. There are some Companies that will insure the elderly but are limited, extremely expensive and don't offer coverage for everything.....so I set up my own savings account and put in what I would have paid the cheapest company. It grew to become my medical self-insurance plan.

Just under 2 years ago I was diagnosed with a colon tumour. I live in Bali and the hospital I had my colonoscopy has a cancer wing and one of the foremost cancer surgeons in the land.....so I elected to have my surgery done there.
I could have returned to Canada and used the Medical Services Plan there but I'd need to wait 90 days, after returning, to be eligible and I don't know how long to wait for a hospital bed. As we no longer own any property in Vancouver this would have entailed renting accommodation....and that's not cheap.

I tell the whole story on my forum blog so suffice to say I'm very happy with the hospital and the total cost is under US$30,000, which is less than what I'd saved in my self-insurance account, and the service was considerably more than what any insurance company would have paid for.

 

[Anglian]

Like Daniel I found the insurance premiums for my age way too high, we pay as we go along, this year Gall Stones, just about affordable, hopefully nothing in Davita’s league as that really would break the bank, travel insure for over 75 generally only covers 50% of medical costs, 80 in a couple of months, only problem osteoarthritis in both my ankles, very rare here I’m told, 100,000,000rp to repair one ankle, with a possible 10% failure,but 9 months recuperation, could pop off by then.

I forgot to add I do have BPJS, never used it as yet, my wife has and was reasonably satisfied

 

[scouser59]

Bpjs works well for me in bali , although iv only used it for minor problems dental etc , it seems in high population areas it does not ,big ques etc, ie jakarta area .

Be aware the pru is mainly an investment product, with a "bit" of health insurance tagged on to the end , to my knowledge all locally issued policies have a cancellation clause ,so at the end of the insured period they can cancel if you get sick ,as far as im aware ,you can do " nowt about it " , hardly fair .

 

[Chiron]

Thanks for all the replies here! ...and so the journey for knowledge continues.

The thing that still puzzles me about BPJS is what are you actually entitled to? If some feel the need for supplemental insurance (i.e. Prudential) or having a special savings for medical events, what is BPJS not covering?

There are some things that do make sense. For example, I went to www.biaya.net and quickly found the bed rates for most hospitals in Solo. One of the most popular hospitals is RS Dr. Oen. In biaya.net you will see the rates for hospital beds, clearly there are prices for Class I, Class II, and Class III. I'm sure these are related to the BPJS level premiums you're paying. However, there is also Utama, VIP, and VVIP rates. VVIP is 975.000, and Class I is 370.000 - about a 3x difference. I can certainly understand that if you're a BPJS patient, and want your own private luxury suite while recovering, then you better have the resources to pay for it.

The more important question, is what about the actual treatment or procedure? Does money make a difference here, and if so - how does that play out? I actually don't care what hospital bed I end up on, but I do hope that the doctors/nurses performing the procedure were at the top their game. So does additional money over what BPJS provides, make a difference when it comes to a highly recommended doctor, or special equipment? If so, are there other areas where "money talks"?

For what it's worth, I spoke with a Dutch expat who's been living in Indonesia for more than 20 years. He's now in his early 70's and looked to be in pretty good health. He exercises regularly, eats healthier options, and maybe has an occasional beer or wine. During these years, he's not had to visit the doctor or hospital very often, and BPJS is not something that's shown up on his radar. In all those years, he classified doctors into three groups. The first group are doctors who simply don't know what they're doing, and probably shouldn't be doctors at all. He really wondered how they ever got certified, and certain that some level of cheating or worse took place. The other two groups are doctors who are truly professionals and are quite skillful in what they do. In this skilled set of doctors, one group is dedicated to the profession, and have an altruistic motive towards their patients. The other set of doctors in the skilled group are primarily motivated by money. He finally noted to me, that as a bule (i.e. expat) that he's sometimes been treated differently than the average Indonesian. He's had to deal with hospital and doctor politics, and that's been primarily about money related issues. He speaks perfect Indonesian, and is quite in tune with the Central Javanese nuances to know what was happening. So he smiled, and said "you'll learn over time..."

 

[scouser59]

As I remember when I started the process for bpjs there is a list of conditions covered on the wall in the office , it seemed quite extensive to my inexpert eye , If you have deep pockets of course you can do better ie quality of service, staff qualification etc ,or travel outside for treatments .

 

[Anglian]

My wife is telling me about her visit to the BPJS clinic, she arrived at 9am was number 150 to see the Doctor, I’m afraid not very impressed, she suffers arthritis in her hands, didn’t think the doctor was a doctor, he wrote out a prescription, but she checked up as too what is was and didn’t bother to collect, I’m afraid first impression not too good

 

[Daniel50]

Yes......some Indonesians have tough decisions to make when a loved one needs medical care. Family usually chips in or if one is rich they may pay. And sometimes people just suffer and die due to lack of care. There are sometimes difficult decisions to make for families.....use our meager life savings to keep an elder alive or use the money for our younger family, for survival etc..

I went to a hospital for minor treatment and some physio in BSD and used cash. I went to the front of the line while there were some waiting for treatment. I did not really feel good about that but I still went.

 

[Chiron]

My wife is telling me about her visit to the BPJS clinic, she arrived at 9am was number 150 to see the Doctor, I’m afraid not very impressed, she suffers arthritis in her hands, didn’t think the doctor was a doctor, he wrote out a prescription, but she checked up as too what is was and didn’t bother to collect, I’m afraid first impression not too good

Hi Anglian,

Since first posting this thread, I'm now getting a better understanding of the options one has with regards to health insurance in Indonesia. The pat answer is: yes health insurance exists, but it should probably be viewed with lowered expectations. For myself, coming from a western country, specifically the USA, I need to basically rearrange my thinking when it comes to the topic of healthcare and health insurance after taking up residence and retiring in Indonesia.

I recently spoke with an Indonesian friend, living in Jakarta I've known for quite some time. As it turns out, he, his wife, and two children have recently been signed up for BPJS. He's a very patient person who's not quick to criticize, but said that BPJS is lacking in some areas. The experience you describe above, is consistent with his description of the insurance. BPJS is not a comprehensive national health insurance, but is more of an outpatient clinic approach to medicine for the masses. He believes that BPJS has a focus on preventative medicine and wellness. He claims: "someone takes your blood pressure readings, asks how your feeling and what may be troubling you. From there you get things ranging from eating and exercise advice, to a prescription for something (e.g. pain or blood pressure meds)." I'm not sure what would prompt a hospital admission, or how much BPJS would cover if that were to occur.

Thus the typical BPJS experience is waiting in long queues for issues that are not life threatening or emergency in nature. If you have a heart attack, cancer, or severe trauma, probably more important to know the best hospital in your area, and go there quickly. Once there, and under these serious conditions, BPJS doesn't seem to play a role, but guaranteed payment by cash or insurance (that you've probably overpaid for) does.

For me, this means I should really plan to have a medical based savings account - especially as I start to put on more years of life. My Dutch friend's advice of staying healthy, and avoiding accidents is probably the best. I'm guessing that's why he advised strongly to join the swimming pool group, and not using a motor scooter for transportation.

 

[scouser59]

The bpjs experience , bad or good, depends on where you live , south bali reasonably on time appointments , decent hospitals ie siloam etc , ya its not up to european / american standards but we live in a developing country , the high population areas in java long ques , patchy service . I also carry a fairly inexpensive private policy to hopefully fill in the gaps .

 

[Smallworld]

...
No matter how great this international health insurance is, I believe I'd be better off with BPJS and using the 1.3 billion IDR savings for filling in the gaps when needed. ..

I think you are right. I just got a letter from my medical insurance company informing me that my monthly premium went up 70% even when I did not use them. I compared the letter with the letter from my wife and the in-laws and it is only in my letter stated that the price when up. No one had any medical emergency or reimbursed the cost with the insurance, the same medical plan but now I have been quoted different price. So I asked the agent why my premium went up so much? She said: "...maybe because I am a bule and I am higher risk"?!

So yes ... now I am thinking that maybe only basic critical illness insurance would be sufficient with extra cash flowing into some nice saving account. Do you really need med evac to Singapore? Do you really need full world cover all the time?
BPJS - well yes you can buy it, after all it only cost peanuts vs what you get in return, once you have to use it, just give it a try and decide how was the overall experience. You can always patch all medical needs eg. You need CT scan but it is not emergency so you try to get it on BPJS rather than your own private insurance. You may need to wait a bit few days but eventually you save yourself some extra money. If you have cataract in the eye and need simple surgery but BPJS is full and you cannot wait... use private insurance (if it is covered) or pay cash. I heard some dreadful stories about BPJS, I also heard stories where whole families took mortgage for someone terminally ill in the family.

 

[ChrisD]

My wife's family all believe BJPS is a waste of time (a few hours drive from Surabaya). Local doctors want cash as they (a) get little money from seeing a BJPS patient and (b) have to wait a very long time for the payment to come through.

Usually when a member of her extended family (out to second cousins) have an accident or illness and are hospitalised, those that can put the money up and then the family are repaid when the person can afford it. If they have assets, they then sell them (gold chain, goat, cow or even their motorbike).

None of them have any other private health insurance (rural farmers) and just hope everyone is OK and the cost doesn't hit them.

Half the hopitalisations seem to be bike accidents

 

[dafluff]

BPJS is a good last line of defense. For what it costs, it is hard to beat. When my daughter was born, there was another woman there scheduled for C-Section. She went first, my wife second. Same doctor, same hospital, same type room, we paid Rp 23jt, she paid about Rp 9jt (to upgrade to private room, which is not covered by BPJS). If you figure the about Rp 14jt in savings for her, and the top rate BPJS is Rp 80rb/person/mo, that C-Section alone is equal to 14.5 years of BPJS 1st class premium.

Overall as @scouser59 notes, the quality of service for BPJS in Bali seems to be good. I heard from relatives and also from people in my village that they have had fairly complicated surgeries performed and covered for BPJS. That said, as in any national health care system, the first line is always the primary care provider (FasKes 1) who rations out the care. So you can't really choose doctors, or which hospital you want to go to. You also have to content with long lines, etc. Welcome to public health care. But it is available from USD 2 per month, so there is that.

 

[Dianne]

For information....I'm now over 80 and when I was 75 I was rejected for medical insurance. There are some Companies that will insure the elderly but are limited, extremely expensive and don't offer coverage for everything.....so I set up my own savings account and put in what I would have paid the cheapest company. It grew to become my medical self-insurance plan.

Just under 2 years ago I was diagnosed with a colon tumour. I live in Bali and the hospital I had my colonoscopy has a cancer wing and one of the foremost cancer surgeons in the land.....so I elected to have my surgery done there.
I could have returned to Canada and used the Medical Services Plan there but I'd need to wait 90 days, after returning, to be eligible and I don't know how long to wait for a hospital bed. As we no longer own any property in Vancouver this would have entailed renting accommodation....and that's not cheap.

I tell the whole story on my forum blog so suffice to say I'm very happy with the hospital and the total cost is under US$30,000, which is less than what I'd saved in my self-insurance account, and the service was considerably more than what any insurance company would have paid for.

How did you establish a self insurance account, I am with BNI and staff were not very helpful. I am yet to ask my 'agent' if this is acceptanle for health insurance and terrified he may reject the idea

 

[Davita]

How did you establish a self insurance account, I am with BNI and staff were not very helpful. I am yet to ask my 'agent' if this is acceptanle for health insurance and terrified he may reject the idea

There is no such thing as an 'self-insurance account' as far as the bank is concerned...that's just what I called it.
I found the cheapest premium from the very few Health insurers that will insure the elderly and saved that in a monthly-rotating fixed deposit (FD) in IDR. I explained its purpose to my premium manager in the bank so she gave me the best Interest she could (then was 8% but not anymore). I simply called it my Self-Insurance Account to separate from my other FD's. I added the same amount every year and the fund soon accumulated.
I had in mind that I should take my own risk as, after a year, the premium with any Company is forfeited and an additional premium, usually considerably higher, must be paid. My way ensured the fund rolled over and I only added the same amount as previous.

As my bad-luck would have it I did face major surgeries but the account had sufficient funds to pay in Bali as the hospital rates are, imo, considerably cheaper than elsewhere.

I've written about that in my blog so I recommend, if finding difficulty sleeping anytime, give that a read....

With regard to Health Insurance for Immigration on a Retirement Kitas.....I had Insurance initially but my agent somehow must have fudged the application when applying for my Kitap...I believe he showed a copy of the FD's I had in RI. Agents have some sway with Immigration as they are the sponsors.....and why they charge the big bucks.

 

[Dianne]

There is no such thing as an 'self-insurance account' as far as the bank is concerned...that's just what I called it.
I found the cheapest premium from the very few Health insurers that will insure the elderly and saved that in a monthly-rotating fixed deposit (FD) in IDR. I explained its purpose to my premium manager in the bank so she gave me the best Interest she could (then was 8% but not anymore). I simply called it my Self-Insurance Account to separate from my other FD's. I added the same amount every year and the fund soon accumulated.
I had in mind that I should take my own risk as, after a year, the premium with any Company is forfeited and an additional premium, usually considerably higher, must be paid. My way ensured the fund rolled over and I only added the same amount as previous.

As my bad-luck would have it I did face major surgeries but the account had sufficient funds to pay in Bali as the hospital rates are, imo, considerably cheaper than elsewhere.

I've written about that in my blog so I recommend, if finding difficulty sleeping anytime, give that a read....

With regard to Health Insurance for Immigration on a Retirement Kitas.....I had Insurance initially but my agent somehow must have fudged the application when applying for my Kitap...I believe he showed a copy of the FD's I had in RI. Agents have some sway with Immigration as they are the sponsors.....and why they charge the big bucks.

Ah yes! I see it a bit better now! You are an inspiration! Will take a look at your blog soon too and sleep better! It so bothers me, insurance for my age in general has prohibitive costs! I am determined to stay here, and your info inspires confidence that it wont happen overnight, but it will happen. Thank you!