If you’re living in a country without a national healthcare service Covid 19 might have shifted your personal welfare to the forefront of recent priorities. Disclaimer…I am by no means a health insurance expert to advise on coronavirus cover! I can only suggest that you reach out to your individual insurance providers and relevant government health information.
Most expats make the leap abroad because of their job. It's also highly likely that your employer has provided you with health insurance so you don’t have to worry about your general health…right? It’s just like travel insurance, you’re covered by an amount so much more than you’ll ever need? You’re under 30, you have a perfect bill of health, so you just need to make sure you’re covered for emergency treatment like…being hit by a bus? So the minimum cover provided is fine? Right? Not necessarily.
Growing up as a Brit (with the wonderful NHS!) and thankfully never suffering any bad accidents during my travels, I have never previously been exposed to the true cost of healthcare. However, earlier this year I had my eyes fully opened to the private healthcare system in Singapore and there’s definitely a few takeaways that I’ve learnt from the experience.
Your cover starts and ends with your employment: I changed jobs and employer in April 2019 and I have never taken out any personal/supplementary health care cover above what work provided. Therefore any undisclosed medical condition, even if undiagnosed and unidentified, that existed prior to April 2019, would not be covered. In February 2020 I went for my routine PAP/smear test. FYI ladies, my health insurance didn’t cover the initial smear test (70$SGD) or the optional HPV screening (150$SGD). Due to abnormal results my doctor referred me to a gynaecologist who was on the insurance providers approved list. However, on arrival at my appointment and post emotional telephone call with said insurance provider, I was told that due to my cover only starting in April 2019 the colposcopy (1000$SGD) had to be covered personally and ‘potentially’ claimed back afterwards. This was because any abnormalities could have been pre-existing beyond April 2019 and diagnosis/identification date was not relevant. My colposcopy results identified level 3 cell changes that typically develop and progress over numerous years rather than months. Strike 1.
Read the exclusions and fine print: The date of my insurance cover was not the only issue. The colposcopy also identified traces of high risk type HPV. It’s medically recognised as a sexually transmitted virus even though most people will contract and clear it independently at some stage in their life. Sexually transmitted infections of any kind were not covered in my health plan. Strike 2.
Private medical care is expensive!: Due to identifying 2 areas of level 3 cell changes and a HPV type that promotes further cell change, my gynaecologist recommended a cone biopsy. Without further treatment there was a high chance of it progressing to level 4, otherwise known as cervical cancer. A cone biopsy is a small day surgery under general anaesthetic and you’re in and out of surgery within 30 minutes and they send what’s removed for further biopsy. This small operation and histology cost 10.1K$SGD. For every prior and post op consultation; 107$SGD. I was charged for every additional blood test, pregnancy test and all the subsequent medication provided. I’ve yet to add up the total costs but I believe it will be between 13-14K$SGD.
What is your co-payment obligation?: Even if your ARE covered by your insurance are you aware of the copayment (if any) you are liable to pay? An expat friend in Singapore has recently discovered that it can still amount to a considerable price. He is 27 and a competitive triathlete. With no prior respiratory issues he woke up one day with funny pains in his chest. 3 days later he was rushed to hospital with a collapsed lung, which required further lung surgery and a 2 week stay in hospital. Being so young fit and active, the last thing he was prioritising was paying extra to decrease any co-payment amount. His total financial liability included 20% co-payment plus GST for 100% of the final medical bill; he now owes between 40-50K$SGD.
Have a rainy day fund: Luckily both myself and my friend are in a position to be able to pay for our medical bills. However, if you don’t have savings and normally live pay check to pay check, what would you do in this situation? My immediate thought was to travel back home and try and receive treatment in the UK. However, less than 2 weeks later, borders across the world were closing up and the NHS was tackling its biggest challenge in recent history; Covid 19. Albeit expensive, the Singapore medical care I received was fantastic and could not have been more thorough or efficient. It was definitely the right decision for me at the time and I’m grateful to be in a position to afford such quality and immediate care.
Check the fine print: READ YOUR INSURANCE POLICY. Make sure you know what any exclusions are so you aren’t faced with any shock surprises or medical bills prior to any appointments. This is already an emotional and stressful experience without additional confrontations. I would recommend calling prior to the appointment just to double check you’re covered rather than ranting down the receptionist’s phone on the day and crying before you’ve even seen the consultant! (Guilty!)
What is your level of cover: During my time in Singapore I have had 2 employers with 2 different health insurance providers. However, with both they have given you options to pay more to decrease your co-payment obligation. After seeing the costs of private medical care first hand… I anticipate that emergency hospitalisation reason is going to be a lot more expensive than you might think!
Consider personal cover: As with all insurance, there are always exclusions for which insurance providers won’t pay out and you’ll never be 100% covered for all circumstances. However, if you’re planing on living overseas for a few more years without being tied to your employer then personal cover can be considered. For example, there are UK health insurance providers that provide expat cover and includes things like repatriation and will follow you around the world.
Be prepared to go home: Despite having a comfortable savings account I know that if I were unfortunate enough to be diagnosed with a serious condition I would go back to the UK. However, this would be for family and support reasons rather than just financial. If you do not have any savings for upcoming medical treatment, just always be prepared that you may have to abandon your life overseas until further notice. You may also risk receiving any medical attention less quickly than you would versus going private.
The above is by no means an exhaustive summary of the medical issues you may face whilst living overseas. However, hopefully the above will make you question your current cover and encourages you to make the necessary changes to better suit your individual situations and preferences. In the meantime I hope everyone is staying safe and well at this uncertain time and my final piece of advice would be to … always wait for the green man before crossing the road, else it might be the most expensive chance you’ve ever taken!