Listed questions and answers about Health Insurance Thailand
Choosing a Health Insurance plan can be quite challenging. The best choice of plan depends entirely on your personal circumstances such as age, family composition, overall health and budget. AA Insurance Brokers is more than happy to guide you through the maze of different Health Insurance plans, their benefits, advantages and disadvantages so that you and your family can rest assured you have the best option available.
In Thailand two types of insurance are available:
1. Insurance policies that cover almost everything for 100% and
2. the so-called limited insurance policies.
The limited plans are generally lower cost however they do have limits to almost everything. For example: room and board may have a max. 4,000 Thai Baht/day. These types of policies carry the risk that you may end up paying a (substantial) part of the hospital bill yourself.
Inpatient (hospitalization only) is a term used in the case that you are hospitalized, i.e., admitted to the hospital for a certain amount of time. Outpatient is the care you receive when you visit a hospital and consult a general practitioner, receive the prescribed medication and then return home. Please note that the definition of Inpatient care might differ amongst insurance companies e.g., it does not always mean an overnight stay. Sometimes being assigned to a hospital bed for a certain amount of time during the day will qualify as Inpatient care.
It is always best to add Outpatient cover however in general people living in Thailand insure for Inpatient only. This because Outpatient treatment is not expensive in Thailand and by adding Outpatient coverage can be quite costly. However, by not insuring yourself for Outpatient you do take a risk. It is not expensive if you visit the Doctor once a Year for something minor, but it can become quite costly should you develop a chronic condition where you need to take medication for the rest of your life. Always check the coverage for Outpatient Cancer Treatment as this can be very expensive. With many plans this is covered under the Inpatient plan but if not then it is better to add Outpatient coverage.
Where it is possible to insure yourself for Inpatient only it is not possible to insure for Outpatient only. The basis of your insurance plan is an Inpatient plan. You can add extra modules to the Inpatient Plan such as Outpatient, Dental, Vision, Maternity etc.
A period defined under the insurance policy before a select list of medical conditions and/or ailments start to be covered under your intended Health Insurance policy. Once the defined waiting period is over the insurance company can no longer deny a claim based on the waiting period.
This is the amount you will need to pay by yourself before the insurance kicks in. For example: you have a USD 2,000 deductible and your hospital bill is USD 10,000. You will have to pay the first USD 2,000 and your insurer will cover the remaining USD 8,000. If it is an annual Deductible, you will only have to pay the Deductible amount 1 time per Policy Year. Another possibility is a deductible per illness/accident. If you have a Policy like this, it is possible you need to pay a deductible multiple times a year. Although this system looks less attractive, it can also be positive if treatment continues when you go into a new policy year. In that case you will not have to pay it again whereas with an annual deductible you will need to pay it again.
Yes, every year when the policy is up for renewal you can change your deductible level as the insurance companies consider it to be a downgrade if you increase your deductible amount. Downgrading your plan will not result in filling out a new medical questionnaire and/or undergo a medical examination. Lowering your deductible amount is seen as an upgrade. When you upgrade an insurance plan it is usual for the companies to ask for a new medical questionnaire. Should you develop a new medical condition before your upgrade, there is a chance this will result in an exclusion in your new upgraded plan.
A co-payment or cost share is a fixed out-of-pocket amount, or a percentage, paid by an insured for covered services. Insurance companies offer this option to lower the premium. It can be a fixed amount per treatment or a fixed percentage of the Bill. Usually, you will need to pay this at the time of service.
Any health condition that a doctor has previously diagnosed you with prior to your health plan taking effect can be labelled as a pre-existing condition. Please be aware that if you decide to switch insurers the new insurance company may exclude any medical conditions you have had treated whilst insured with the previous insurer. Pre-existing conditions result in a higher risk for the insurer and therefore might lead to either an exclusion or loading of the Premium.
Pre-existing conditions are often excluded but sometimes can be covered. This is depending on multiple factors such as:
1) What kind of pre-existing condition is it?
2) How long ago when you contracted the condition?
3) Do you still receive treatment or has the medical treatment finished already?
It really depends on the severeness of the medical condition and the future risks for the Insurance Company as to how they will deal with it. Because this needs to be looked at on a case-by-case basis there is not a real standard answer. We recommend contacting one of our health insurance specialists, they will assist you with the options available.
In most cases this is a no but there are always exceptions. An exclusion or loading is given by the insurer if the insured forms a higher risk e.g., a high BMI can lead to a loading of the premium. If in future years the insured can prove that he/she does not have a high BMI the loading can be waived.
If you apply for a new plan based on Full Medical Underwriting, you will need to fill out an extensive medical questionnaire containing questions of your medical history and present status. The medical questionnaire can go back lifetime or for a certain number of years. An FMU application gives the Insurer a good insight into a client’s medical condition and based on this, the insurer decides the terms of coverage. You can be accepted with or without medical exclusions and with or without a loading of the Premium. With an FMU application you will know from the start what you are covered for.
If you apply for a new plan you can choose for a Moratorium application. This way of applying is usually done by people that have a medical history and want to avoid an exclusion. The application form contains no or only very few medical questions.
A typical example of a moratorium plan is no coverage for any medical conditions you have had in the last two years (usually five years for cardiac or cancer conditions) before the start of the policy. You will however be covered for these conditions if you did not experience symptoms, treatment, consultations, medication etc. after two years of continuous cover with an insurer (five years for cardiac or cancer conditions). This time is known as the ‘Moratorium waiting period’.
Personally, at AA we are not in favour of moratorium applications as each time you make a claim the insurer will look at your medical history first and may ask for information from your Hospital or GP. This slows down the process and as a result, you will have to wait with non-urgent surgeries until the insurer gives the okay.
Yes, health insurance premiums do go up because of age. Premiums go up when getting older as the risk for the insurer increases. Depending on the plan this can be a small percentage every Year or by a bigger jump in 5 yearly age brackets.
There is also the Increasing costs for medical care as the costs the Hospitals charge increase year by year. This cost increase is quite significant - within Thailand 8 to 9 % per Year is quite common. At one point, the insurers need to have this reflected in the premiums and an efficient insurer will perform cost containment to keep the premium increases as low as possible.
This depends on your selected plan. Some Health Insurance plans provide full coverage overseas, others only offer a limited amount of time or limited Financial Coverage whilst abroad. Please be aware that the so-called 'low-cost' plans, which might provide sufficient cover for Thailand do not always provide sufficient coverage for treatment abroad. If you know that you will frequently be travelling outside of Thailand, please inform us in advance so we can select a suitable option for you. We can also assist with Travel Insurances.
The Companies we work with will not cancel your Policy because of claims. The worst thing that can happen is a loading of the premium – for example 25% after a Year with a large claim. Thai Insurers tend to work with a Bonus/Malus system and thus the option to load premiums. The International Insurers do not do this and regardless of the number of claims you will always pay the same premium as anybody else of the same age and same plan.
This depends on the kind of policy you have. There are 2 types available.
1 Community rated plans:
With a community rated plan everybody from the same age and the same plan is paying the same premium regardless the claim history. The premium of an individual will never be loaded based on claims.
2 individually rated plans (also called experience rated plans):
With an individually rated insurance plan the premiums can change based on the claim history. You can also receive a No Claim Discount after a year with no claims. If you do claim however, the insurer might load your premium at the next renewal date. The maximum percentage with which the premium can be loaded depends on the Company. This is something to keep in mind as there are Companies that can load up to a 10% and can make your insurance unaffordable.
Both options have their pros and cons. It is not nice when your premium gets loaded because of a claim. On the other hand, it is also not nice to see your premium increasing every year – which happens at community rated plans - because of the medical inflation.
Not if you applied FMU (Full Medical Underwriting, so including a medical questionnaire). The application form you filled out at the start of the insurance is the starting point. Every medical condition you develop after the start of the insurance will stay covered and not result in a new exclusion.
There are some health insurance plans where No Claim Discount is offered. These plans are the so called individually rated plans. When you do not claim on the insurance you will receive a No Claim Discount. When you do have a claim you will not only lose your No Claim Discount but a chance also the premium will be loaded in the next year. The community rated plans (usually the international insurers) do not work with a Bonus/Malus system.
Yes, there are Insurers offering monthly payment options. Some do this without any surcharge and with others you will have to pay a small fee for this. If monthly payments are a must, please inform us upfront.
With Thai Insurers you can always cancel during the policy year. The company will refund you according to the pay back schedule. This is not pro-rated. At international insurers it depends on the Company. Some allow it and pay back pro-rated and others will only cancel during the policy year under certain conditions.
This depends on the coverage abroad of your Health Insurance policy. Most people living in Thailand take out an inpatient only insurance. Understandable since outpatient doctor visits are rather cheap in Thailand. Abroad the costs for outpatient treatment can be quite high. A travel insurance can solve this as it will cover for outpatient treatment (if not pre-existing).
Yes, in case of an admission (Inpatient) usually the insurer will pay the Hospital directly. For outpatient treatment it depends if the Company has a direct billing agreement with the Hospital. It is best not to go to Government / State Hospitals in Thailand as usually they do not deal with insurance companies. If you go to a State Hospital you will need to pay first and claim back later.
This depends on the Company. Thai Insurers usually work with contract hospitals. If you go to a contract hospital, the Company will pay the Hospital directly. Every Thai insurer has an extensive list with contract hospitals so there will always be 1 or more in your neighborhood. The international insurers usually do not work with contract hospitals; you are free to go where you want.
There are 2 possibilities when it comes to an admittance:
1/ An emergency admittance
In such a case you can give your insurance card to the Hospital Staff. The Hospital Staff will contact the insurance company exchange information and ask for direct payment. Please note that this process always takes time. While waiting for the approval of the insurer the Hospital might ask you for a deposit if they want to start treating you already.
2/ An admittance for not urgent conditions. It will almost always start with an outpatient Doctor visit because you have a complaint. If the Doctor suggests Surgery and it is not urgent give your insurance card to the Doctor and ask him to arrange a prior approval with the insurance company, this process might take a few days. Once the guarantee of payment is placed by the insurer the Hospital will call you to make the appointment.
Note: if it is not urgent, always ask the Doctor to arrange prior approval first. If this is not done, some Companies might deduct a percentage from the Bill to be paid by yourself.
Almost all plans know a maximum entry age. Until the age of 75 you will still have enough choice. After 75 only a few Companies will still accept you.
Yes, it is extremely important that you know what you buy.
Yes, as omitting things can give you big problem later if the Insurer finds out. The Insurer does have the right to cancel your Policy if the questions were not answered honestly. The insurer can even cancel if they find out a condition was not mentioned while you are admitted for a totally different condition. Therefore, it is best to be honest.
Basically, there are 3 kinds of insurance in Thailand for Thai Nationals:
-The insurance for Government workers.
-The insurance for employees in the private sector (Social Security)
-The Universal Health Scheme (a.k.a. 30 Baht insurance)
This means that all Thai Nationals can go to the Doctor/Hospital almost for free. It is limited to the designated government hospital (and other government hospitals in case of an emergency). The budget is 3,360 baht per head (2021). For this budget one should not expect luxury or the most advanced medication. If your Thai partner wishes to go to a private hospital, you should take out an insurance for him/her.
No, whether you go to the Insurance Company directly or obtain your insurance through us, the premiums are the same. In fact, because of our purchasing power it is even possible to obtain lower rates with us. Besides that if you go to an insurance company directly you will only have 1 choice. We can offer you a wide range of plans from all insurance companies and you will have the ability to compare options. Another major difference is that we are always working on your behalf and not on behalf of the insurance company plus you can fully count on our Claim Support!