Health Insurance in Thailand

Add-on note : As from mid-2019, health insurance is mandatory for long-stay foreigners in Thailand, aged 50 years or older. The Covic-19 pandemic caused an update on the mandatory insurance requirements, and a 'Covid' insurance with at least 100,000 U.S. Dollar coverage seems now required.

This original review of health insurance dates from many years ago. The basic facts still hold true. For private health insurance in Thailand, it is a case of 'you can't always get what you want, but you may get some of what you need', to paraphrase the famous song. The way I see it, private health insurance companies in Thailand, are in the business of providing health insurance as well as in the business of 'not-insuring'.

We need to mention we come from one of the smaller European countries, where basically health care is socialized. As a result we are somewhat accustomed to good health care at a reasonable price (often close to free). Health insurance is obligatory and not for profit and covers basically the whole lot.
When moving abroad, even when keeping the same insurance company as before, the rules change. Insurance becomes more expensive and complicated (and not complete), even when you move to a country where health services are cheaper (as in Thailand). Increases in health insurance premiums, way above general and medical inflation, are common. There is almost complete coverage but prices eventually become unpayable.

So, when getting older, and /or with limited resources, there may come a time to settle for somewhat (or more than somewhat) limited coverage, but at a price you may still be able to afford.

Previously, we have compared different insurance policies in Thailand. However, now we want to point out the possibilities of getting health insurance overall.

What has changed in recent years? There is more online information. Maybe there is more competition, both between internationally operating insurance companies, and local providers. There are now several online websites, where one can (superficially) compare policies of various insurance providers.

For mostly internationally operating insurance providers, you can check-out pacificprime.com . You can find quotes from famed companies like Cigna, Aetna, Allianze, Axa, and lots of other companies I never heard off before. Do not despair, as said before, you may not get what you want, but still some of what you need. For example, we found very reaonable premium quotations at least from one famed company, but with very high deductibles (16,000 U.S. Dollar). If you are in a position, where you are able to pay that amount, without running out of resources, it is a possibility. At least, you are covered, when major expenses are concerned.

For comparisons of policies issued by more locally operating companies (Thailand, Asean region) you may find Mister Prakan useful.

Both sites you reasonable initial information about various policies. We recommend comparing policies offered by the same company. Play around and see how much your premium may change when not only including inpatient treatments, but also outpatient, dental coverage. What is the effect of deductibles (the part you pay yourself, before your insurance kicks in)?

There are many excellent health facilities in Thailand. But can you afford treatment, and does your health insurance cover all treatments? Picture : Entrance to Samitivej hospital

Information gained from online comparison sites, provides a good starting point. Personally, we would not recommend booking a policy that way. There may be a lot of information available, but you will get more when contacting the insurance provider directly. We recommend make a choice online (or a few choices) and then head to the address of the insurance company, instead of using the online broker, and any other intermediate. Insurance companies will have someone available (broker or not) to discuss various options of insurance. You can ask relevant questions, and you may find out some more even on an initial contact. For example, on one occasion, we noticed an insurance company offered no-claim discounts, not mentioned earlier.

We are old fashioned, and learned by experience, and find it may be advisable to have your insurance provider at a place where you can physically reach him. (the same provision holds for banks by the way).

The Insurance Process

1) You discuss your possible insurance policy with the company or a broker provided by the company. We suggest to do this at least two times. The first time for initial information, and finetuning your decision, after asking some relevant questions. The second time to ask some more questions, and finalize the applications.

Things of particular interest :

a. The amount of coverage per disease/ per year. Most of the time there will be a limit here. The amount of coverage, whether total of per disease, seems to be the most relevant factor determining the premium paid.

b. When omitting outpatient coverage, you will get a substantial premium deduction. However, be aware that nowadays, a lot of procedures, are done during daytime-admissions. We recall that many insurance companies will consider this as in-patient treatments, some may not. Be sure about this, because of course costs can include various X-rays, MRI's, blood work, etc.

c. Are you covered when leaving the country and for how long?

d. Ask to see the premium rates for all age brackets. These are not binding, and later on the effect of medical inflation (always faster than general inflation) may be substantial. However, it may tell you what to expect during your 'senior' years. By the way, ask up to what age you are covered!

e. What is the effect of deductibles? You can save a lot of premium here. The one disadvantage is that you may want to save money for yourself, by avoiding to go see a doctor, or postponing seeing one.

f. Is there a no-claim discount?

g. Besides a glossy brochure, ask to see a copy of a standard insurance policy. This will look less glossy, have many pages, and makes for a boring though revealing read. Not sure of all companies you ask, will be willing to provide a copy.

h. Ask if you can change policy later on. The policy you desire now, may become somewhat expensive in the future, and you may want to 'grade down', let's say reduce coverage per disease/per year, from 10 million to 5 million baht, or something similar.

i. Discuss the effect of pre-existing conditions. The premium you pay will be different from the one advertised for your age and gender, depending on pre-existing conditions.

- Are pre-existing conditions covered or not? Are they not covered now, but will they be covered in the future?

- Will there be 'a loading factor'. Depending on your pre-existing conditions, you may still be covered, but will have to pay more.

j. Ask whether the insurance starts on the requested date (after you paid), or whether there is a waiting period, even after you paid already. Sometimes there is a waiting period, sometimes there is a waiting period, but accidents may already be covered.

Using a wheelchair in Bangkok is hard enough. And does your insurance company cover equipment like this? Check your policy!

2) Fill out the applications forms completely. Applications forms in Thailand, will ask for all relevant medical information you can provide. For the most part, there will be interest in what happened the last 10-20 years of your life. It is important here to not make up things, or blatantly lie. It may catch up with you later when this is discovered. On the other hand, we suggest you do not volunteer all kinds of undiagnosed complaints you may have. In that case, no 'disease' has really been diagnosed.

As an aside : if you have been careful regarding your health in the past, you may be rewarded here with a higher insurance premium. For example, if you are known to have high blood pressure, or a high cholesterol, you will likely be charged a higher premium, and you may not be covered for treatment of these conditions. Someone who never could be bothered to have his/her (high) blood pressure measured, or his (high) blood cholesterol checked, will get away with a lower premium, and will be likely covered in the future when these conditions are 'discovered'.

You may not notice it, but somewhere in the multipage application form, there will be a paragraph, noting that your medical records may be requested from hospitals and health care providers, and if you please will sign for this. This is allowed by law in Thailand. This may be one additional good reason to be forthcoming in revealing your past medical history.

Motorcycle taxis are popular in Bangkok. But do you know some insurance companies offer only limited coverage for you when involved in an accident with a motorcycle? Our advice : Never use them. Do walk down the sois, or use other public transport.

3) After a few days or weeks, you will get a reply from the insurance company. You will final information, regarding your policy. Depending on your pre-existing conditions.

- There may be a loading factor. You pay more than the standard premium rate.
- It will be stated which conditions, diseases are not covered.
- It will be stated which conditions, are not covered now, but may be covered in the future. For example, if you do not need treatment for a certain pre-existing conditions for a few years, you may be covered for it later on.
- There may be a waiting period (even if you did not have a related pre-existing condition) for certain diseases. For example, you may not be covered for prostate cancer for 2 years. (often there is no coverage for cataract for a few years, and some medical procedures like colonoscopy etc.)

4) If you are agreeable with the premium and its conditions as presented, you will be asked to pay for your insurance.

5) After some days of weeks, you will get a copy of your insurance policy, a card from the insurance company (for presenting at hospitals and clinics), and further information regarding your insurance. The latter may be very revealing, and it would be useful to get this information at an earlier stage (see above). A lot of exclusions may be listed, not related to any previous medical conditions, and not related to anything 'medical'. For example, you may not be covered after you committed a crime, or have spent time in jail. Maybe no coverage for a pacemaker or a joint prosthesis. Actually, quite a few diseases may be listed that are not covered for a few months or years. It would be quite impossible to imagine it all, or ask for it all beforehand.

Some insurance companies provide your with your insurance card. You just present it when being admitted at the hospital, or going for an outpatient visit. Others may provide you with a card, but you still will have to send a 'claim form' to the company, and go through the paper work.

6) The final waiting period : Even though you paid for your policy, there may still be a waiting period of one month a so, before you are entitled to health insurance.

In conclusion :

In our opinion, welfare care systems like in Western Europe are much preferred, when it comes to health care. When moving to Thailand, things can change a lot for expatriates. Your insurance company in Europe may still cover you, but you will have to pay substantially more, even though health care costs in Thailand are less.

Therefore, eventually, you may want to look around locally for your health insurance. Things are a bit better now than let's say 10-20 years ago. There are some more choices than before and more relevant information is there.

Nevertheless, the problem of the 'pre-existing conditions' remains. As a result, you will not be covered, and will have additional costs, when you present with some diseases or accidents in your medical history. You may ruminate about the injustice of it all (when you come from Europe), but eventually maybe you should accept a 'partial health insurance', where still unforeseen diseases and accidents are covered, but you will not be covered for your already revealed weak bodily issues.

We suggest you offer yourself health insurance, but at the same time, put a reasonable amount of money into a dedicated bank account, for use for uncovered health issues.

We suggest you also read : Difference between local and international health insurance . Anyway, extracted for there :

What about disputes?

Other than Accidents, claims that occur in the first year of insurance are always suspect (for health insurers). All Health Insurance companies are very cautious in paying for claims that occur in the first year because of the risk of being related to a pre-existing condition.
Therefore, it is in your best interests to have a Full Medical Checkup at a reputable hospital just before starting your health insurance policy. This Medical Checkup provides you with documented proof of your medical condition at the start of the Insurance Policy. It is the most important document that will help you dispute an insurance company's decision to deny paying a claim because it is related to a pre-existing condition.