Sunday, March 5, 2017

UPDATED: The Question of Medical Insurance for Expats in Sri Lanka

The question of medical or health insurance for expats is one of those critical things that needs some proper attention. To be honest, a decade ago, I didn't think too much on it because of my personal circumstances, which was essentially that I was young, healthy and not 100% sure about my plans for living in Sri Lanka. I had some travel insurance to cover me for the initial period, but after that I considered Sri Lanka's free public health system as "good enough" should anything happen. Plus, at that time I thought myself low risk in medical terms. Of course these things change over time and you learn through experience about the health system in Sri Lanka, both public and private, and that helps with making better informed decisions about medical cover and healthcare options.

I also recognize that not all expats are the same and therefore each person's circumstances and requirements may be quite different. For instance, a foreign assignee (and family) might have medical insurance built into their expat deal. But a young expat adventurer may weigh their options and decide not to take medical insurance based on personal circumstances and low risk factors. Or the expat entrepreneur who runs a business in Sri Lanka and has a young family that wants good medical insurance cover has a preference for private healthcare as that's what is the norm back in their native country. Or the expat retiree who has come over on the "My Dream Home" visa programme which requires a valid medical insurance policy applicable in Sri Lanka will make a choice based on their age and medical needs.

Sri Lanka offers free access to public health services as well as private paid health services. The quality of the Sri Lankan public health system is actually considered to be quite good in terms of equity, high system efficiency, good health outcomes and low costs for the government and households. But it is true there are challenges to free public health services in Sri Lanka that include under-funding, variable medical standards, limited access, long waiting times for specialist treatment and advanced procedures, and the continuing growth of the private paid health services. I previously wrote about this in my post on " Sri Lanka as a Viable Retirement Haven - Part 2, which covered Medical Insurance and Healthcare Services in Sri Lanka.

Please note, I don't work in the insurance industry so I am in no way qualified to recommend (nor do I wish to recommend) insurance policies or coverage for expats or foreigners living in Sri Lanka. The only thing I am seeking to do is to give an overview of what I know from my own personal experience and that of some of my colleagues and friends.

When you examine the overall insurance industry in Sri Lanka, it's not all that surprising to find that there is a relatively low uptake of life and health insurance in the country. The majority of the population relies predominantly on free public health services - western medicine and Ayurveda (and also private Ayurveda health services). Up until recently incomes had not grown significantly, but as the island is developing and incomes have slowly seen increases, there has been a positive correlation to the uptake of life insurance protection.

Generally speaking, I find that expats fall into three categories when it comes to the question of medical insurance in Sri Lanka:
  1. Expats who don't purchase medical insurance - they consider themselves low risk and/or they are happy to use the free public health service
  2. Expats with international medical insurance - it was offered as part of their work assignment or expat package, or they are only here short term and have taken expat health coverage from their native country through one of the global insurance providers as the easiest option
  3. Expats with local medical insurance - it's a visa requirement, or limited health coverage is offered through their local employer and they opt for additional cover, or they require (or expect to require) specialist private medical treatment, or they have long-term plans in Sri Lanka

I have expat friends who fall into each of these categories. The expat friends that came over on an international assignment generally have some form of life and health insurance included in their work contracts. It varies in that some employers may provide hospitalization cover only, while others have an agreement with private clinics and hospitals for their employees. Other expat friends who followed their Sri Lankan partners generally haven't taken out medical insurance unless they are pregnant, have a young family, have health issues, or are retired. Other expats who have come to Sri Lanka seeking out opportunities are a mixed bag - some have taken out some form of expat health insurance before coming to Sri Lanka from their home country, while others have waited till they've gotten established over here and then taken some kind of local medical insurance to meet their requirements. As you can see, it's a mixed bag.

The questions to consider when deciding on private health insurance include things like:
  • Are you considering a long-term healthcare solution to meet your needs?
  • Do you want insurance cover for hospitalization, surgery and critical illness? 
  • Do you want to extend insurance cover for your spouse and children?
  • How do you want to pay the premiums - monthly, quarterly,half yearly, or annually?

For the most part, if you decide that you want to take out medical cover then the choice of what type of medical cover depends on your personal circumstances - age, eligibility, health, family, work, lifestyle, healthcare service preferences and so on. And your insurance premiums will be calculated based on whether you take out individual or family cover and assessed on your age, health, risk indicators, the quantum of cover, no claim bonus, optional benefits, limits on benefits and policy term. If you are over 40 years of age, most if not all insurance companies will require a medical examination to help them determine insurance terms.

There are plenty of local insurers to choose from, such as Sri Lanka Insurance, Ceylinco Insurance, Janashakthi, Union Assurance, AIA Insurance Lanka, Amana Takaful, and Orient Insurance, to name a few. Most offer a wide variety of insurance ranging from motor, personal, travel, home, life and more. All insurance companies are regulated by the Insurance Board of Sri Lanka. On the regulator's website you can find the latest press notice informing the public of the current list of licensed insurance companies and registered insurance brokering companies in Sri Lanka.

For health or medical insurance, Suwa Sampatha Health Scheme offered by Ceylinco Insurance and Health Insurance Plans offered by state-owned Sri Lanka Insurance seem to be the most popular.

Suwa Sampatha Ceylinco covers hospitalization expenses, out-patient treatment, laboratory tests, emergency transport to hospitals, and other specialized services.offering  because of its partnerships with reputable private hospitals (in Sri Lanka and abroad) and a variety of complimentary value-added benefits to membership cardholders. Interestingly, if you take a look at their website there are many other insurance plans on offer including, but not limited to, Ladies Insurance Protection Scheme (LIPS), Children's Health Policy and Mapiya Thillina for senior citizens aged between 60 to 80 years of age.

Sri Lanka Insurance is considered the largest insurance provider in Sri Lanka and offers a wide variety of insurance plans. The most popular appears to be the Comprehensive Plan that covers medical expenses ranging from laboratory tests, operation theatre charges, nursing charges, ICU charges and room charges to name a few. It must be taken out with  Life Insurance Policy, which appears to be a requirement for most their health insurance plans.

With all the insurance providers it's best to contact them directly and speak with one of their representatives. They can take your through their product offerings, policy conditions as well as providing information on their most popular and what may be suitable to your set of circumstances and any pre-existing medical conditions. Additionally, they can enter your details into the system and provide you with a quote that will help you with deciding on appropriate coverage. Alternatively, you can seek an insurance quote by completing the online form.

As I explained earlier, initially I didn't take any private health insurance. But now, I have a blended approach to my medical needs that isn't exactly like some of my expat friends. I have since taken out comprehensive health insurance (includes life insurance) that I pay in monthly installments. I consider it fairly low cost as I have no pre-existing medical conditions and the coverage I require is minimal - so essentially I have taken the minimum cover for hospital, surgery and critical illness. This may change as time passes.

In addition, I am open to Ayurvedic treatments as a preventative measure, so I have adapted my lifestyle to incorporate a more local diet (as opposed to a more western diet) and I consult with a range of Ayurvedic doctors and healers on a semi-regular basis to balance my internal system and remove blockages in the nervous system. I'd have to say this is probably one of the greatest perks of living in Sri Lanka, and something that expats and foreigners haven't really made the most of. It's hugely understandable given the language barriers and lack of access to finding suitably qualified and reputable Ayurvedic doctors and healers.And to think that Ayurveda, Sri Lanka's traditional medicine, has been around for over 3,000 years. Interestingly, Ayurveda means the "science of life",

When I was in Hong Kong last year, I was heartened to hear from one of my expat friends that many locals consult with their Traditional Chinese Medicine doctor (similar to an Ayurvedic doctor) in the first instance when they get sick or feel something is out-of-balance in their body. Only after seeking this route will they then see a western doctor if further help is needed. This has a comparable synergy to how many of the local Sri Lankans (though not in the case of more affluent and urban Sri Lankans) address their health issues. Having said that, as the island develops at a rapid rate, I can also see the rapid increase in access and prioritization of western clinics, hospitals and medicines.

At the end of the day, it is really down to personal circumstances, requirements preferences and how well informed you are about the health services in Sri Lanka. I don't think there's any easy answers to safeguard against accidents or emergencies, and the health decline that comes with aging. I guess that's why I'm more inclined to a holistic approach that includes preventative measures and lifestyle chances, and not simply a knee-jerk response when things go wrong.

Last updated 6 March 2017 at 10am


Unknown said...

Just a little piece of information that perhaps may disturb you. Did you know that more than 80% of nurses in private hospitals in Sri Lanka are not actually qualified. Most have done a six week course compared to Registered nurses who do 3 years training. There is absolutely NO control on who is nursing you, and if they are qualified to do so. My wife, who is a Sri Lankan registered nurse, has now been told that all Sri Lankan registered nurses are all to be enrolled in Batchelor of Nursing degree courses.Yet there is nothing being done about the thousands of unqualified nurses working in mainly private hospitals and clinics. Just because you have insurance that will pay for a private hospital, doesnt mean that you will get the best care.

Eva Stone said...

Hi Anonymous, Thanks for your comment.
No, the info on nurses in private hospitals does not actually come as a surprise, nor does it disturb me. I have good friends working in both government hospitals, private hospitals and who run their own medical clinics. Some have advised me to go to government hospitals as the quality of care is higher, though the external look of those hospitals gives a different impression.
I have accessed medical care in both public and private sectors and the experiences have definitely been mixed. Good and bad on both sides but for different reasons.
I hear your POV about qualifications and the lack there of in the paid private sector, and it's not a good thing. I hope that more steps are taken to better educate, train, remunerate and regulate the doctors and nurses in this country across all sectors, including Ayurveda.
I agree with you that medical insurance doesn't guarantee the best care, not just because of the quality of staff in either sector, but because we ourselves are not infallible no matter the medical treatment we select. Hence why I think prevention is much more important than medication and hospitalization when illness comes.
Best wishes

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