Health Insurance in Thailand: Policy wording and benefits

There are many companies in Thailand offering health insurance, and each company has many policies, all of which offer different plans and benefits.

In this article we take a deeper look at the policy wording and benefits, so that you can make a more informed decision when purchasing insurance in Thailand.

Some people consider insurance in Thailand cheap compared to other countries, but it’s good to know that this can be at the expense of excluding certain benefits.

After you read through this article I hope that you’ll be able to understand the policy language and benefits, and identify when a policy excludes the benefits that you need.

In a different article, I’ve ranked understanding policy wording and benefits as the first step to finding the best health insurance in Thailand.

If you’d like to learn more about the other important steps, you can check out that article here.

Insurance policy

An insurance policy is a contract that details the benefits and conditions that the policy holder receives when they purchase it.

The types of health-related insurance policies are health insurance, life insurance, critical illness cover, and accident cover.

In Thailand you may find insurance policies translated into English, but only the Thai insurance policy is considered legally binding.

Policy Premium

The policy premium is the cost of the policy that you need to pay in order to receive the benefits. It’s the amount you pay whether it be monthly, quarterly, bi-annually, or annually.

Before you pay the policy premium remember to ask your agent about ways you can get a premium discount, and about how the premium increases on contract renewal. 

How to get a premium discount

Most people choose the premium payment frequency they’re most comfortable with. However, just know that you will receive a discount the more you pay in advance.

In the west it is quite common to pay monthly, but in Thailand most people pay annually to receive the discount. People do the same for car insurance.

Some insurance companies also have reward programs that you can take part in, which may reduce your premium. For example, AIA has its Vitality program.

Other companies will straight up give you a discount for every year you renew your policy, or if a family member signs up.

Any discount is always welcome, but when you are looking for the best health insurance as an expat, you should prioritize the benefits you need over small discounts.

When does the premium increase?

Before you purchase an insurance policy, make sure you know when the premium increases.

Health insurance companies all approach premium increases differently.

To check how a policy increases its premiums, study the pricing tables of the policy that you’re interested in.

Pricing tables will differ between insurance companies, but here are a few examples of how a premium can increase;

• annually with age, by a small amount.
• depending on your gender.
• by reaching a different age bracket every 5 or 6 years, by a small amount.
• by reaching a different age bracket every 5 or 6 years, by a large amount.

Not all insurance companies increase their premiums by a large amount, but be on the lookout for those that do. If you buy a policy you don’t want to be unsatisfied with it later.

Try to find a health insurance policy with forever in mind.

While there is nothing wrong with changing your health insurance, it’s just that you could experience fewer problems if you have had the same policy for a long time.

Children between 1 and 10 and people aged 65 and older generally need to pay more for their premium. However, the exact amount will differ between policies and companies.

Please note that an insurance company may also adjust your policy premium if they consider the applicant to be a high-risk customer.

This can happen in two situations;

• When someone applies for an insurance policy, the insurer will consider the application information, medical history, and current health. If the applicant is considered high risk, the insurer will either reject the application or approve it but at a higher premium.
• If someone already has an existing health insurance policy and during the contract period claims what the insurer deems as excessive, then the insurer could adjust the policy premium when the customer tries to renew the policy.

Plans and plan coverage

In Thailand, it is common to find an insurance policy that includes a few different plans. Each plan will offer different amounts of coverage.

The plan coverage is the upper limit, or available policy amount, to meet your medical liabilities. It is also renewed annually, not per incident.

In the diagram above, the policy is called Health Happy. There are 4 plans, with a plan coverage ranging from 1 million baht to 25 million baht.

I’ll discuss the types of benefits in the next section.

How much plan coverage should you get?

This will depend on many factors, but for a short answer, I would say get a plan coverage that is around your recommended health insurance budget.

When you are working out your budget, you’ll also need to consider the reason why you are getting health insurance in the first place.

For example, if one of the main reasons you are buying insurance is to cover for critical illnesses such as cancer, then the plan coverage should be larger.

Plan coverage special benefits and marketing traps

Higher coverage makes the plan more expensive, but in general they will also include better benefits.

However, higher plans can also include special benefits, so there might be a genuine reason why someone would choose a more expensive plan.

Some insurance policies, for example, include the additional benefit of;

• Worldwide coverage
• Dental
• Vaccination
• Tax deduction
• Additional OPD
• International specialist network
• Maternity benefits

However, please note that these benefits can increase the price of the policy a lot, possibly even putting it out of your price range.

Some insurance companies use these benefits as marketing traps to get people to request a quote, only for the customer to find out that the benefits apply only to the higher plans.

These benefits are definitely nice to have, but just check whether paying the higher premium is worth it.

For example, a policy with maternity benefits might be much more expensive while not offering such a high coverage. Buying a maternity policy directly from the hospital could provide more extensive support with fewer conditions.

Here is another example. Paying a lot extra to have medical coverage in other countries might not be worth it. International medical coverage doesn’t usually include other travel insurance related benefits such as lost baggage, flight delays etc. Furthermore, these days annual travel insurance is now available only for a few thousand baht.

In summary, sometimes choosing a lower plan together with some add-on policies or external policies, you can build a better and more affordable health portfolio.

Be careful not to fall victim to marketing traps, and not-so-special policy benefits.

Types of insurance benefits

Every insurance policy has two main types of insurance benefits called OPD benefits (Out-Patient Department) and IPD benefits (In-Patient Department).

In the diagram above, you can see an extract from a AIA Health Happy policy.

Under both IPD and OPD you’ll find different groups, or sections, which categorizes the benefits. Unfortunately, the way an insurance company groups its benefits will change from company to company.

Besides IPD and OPD benefits, you might also find an “additional benefits” section. This section could include benefits that would normally be in a separate policy, such as life insurance (death benefit), or critical illness cover.

In-Patient Department benefits

IPD insurance is short for In-Patient Department treatment. In this situation, the patient’s condition is serious enough for a doctor to book the patient a room and admit them to the hospital for at least one night.

It is also considered IPD treatment if you book yourself into a hospital where you stay at least one night. For example, you may require an operation or surgery that is not necessarily an emergency.

IPD pays for medical expenses such as surgery, operating room fees, physician fees (including anaesthesiologist fees), medical supplies, and equipment.

IPD cover generally provides financial protection against the largest expenses you might encounter at a hospital.

For example, if you need to use an ICU (intensive care unit) room it can cost anything from 5,000 baht to 25,000 baht per day. If you are in a serious accident, a month or two in the ICU can set you back a small fortune.

Out-Patient Department benefits

OPD insurance is short for Out-Patient Department treatment. This is when a patient is not necessarily in a critical condition but requires consultation or treatment at a hospital.

The patient is not admitted to the hospital.

For example, you are not feeling well and you’re unsure of what is wrong. You might need to consult a normal doctor or a specialist doctor. Your condition is diagnosed and you’re sent home.

OPD covers medical expenses such as diagnostic charges and doctor consultation fees.

Some health insurance policies might not include general OPD coverage, but they might cover OPD for an accident. This is a benefit you should look out for when researching policies.

In general, OPD expenses are not as high as IPD expenses, but if you are someone who regularly needs to visit a hospital, OPD cover can definitely help.

When OPD becomes an IPD treatment

It is also good to know that an OPD consultation can become an IPD treatment.

For example, imagine someone with a pain in their arm. The pain is not that bad, but he is concerned about it, so he decides to get it checked out at a hospital. This would be considered OPD treatment.

During the consultation, the doctor finds something very serious and admits the patient into the hospital, either immediately or a few days later. The treatment would then change to IPD.

Always check the wording in your policy. If you have a good policy, in this situation the policy will cover the original OPD treatment if the treatment changes to IPD.

When IPD becomes an OPD treatment

It is also possible for an IPD consultation to become an OPD treatment.

Imagine that you were hospitalized for a surgery. After the surgery, you are released but told to return to the hospital for a few follow-up consultations to make sure everything is still alright. These follow-up treatments would be considered OPD.

Again, it’s very important to check what an insurance policy says regarding the change in the type of treatment needed.

A good health insurance policy will cover OPD fees before, or after, IPD treatment.

Should I buy a policy that covers IPD, OPD, or both?

This is a very difficult question to answer because there are many factors to consider.

Sure, if you have the money to buy the best policy available, you’ll find that both IPD and OPD are covered.

But for the majority of health insurance policies out there, you’ll find that either IPD or OPD provides more coverage and benefits.

Buy a policy that favours OPD if;

• You consult a doctor at a hospital regularly.
• You need to have regular health check-ups.
• You regularly need to have tests done, such as blood tests or x-rays.
• You need to regular take home prescription medicine.

Buy a policy that favours IPD if;

• You want coverage in the event of a large medical expense.
• You want cover for emergency medical treatment or specialists.
• You don’t have a large savings in case of an accident.
• You prefer to use a hospital with better facilities.

The main purpose of health insurance is to reduce your medical expenditure when you need it, and also to protect your future financial freedom.

A large unexpected medical expense can negatively impact the rest of your life and can even affect your retirement goals.

Therefore, I suggest that when financially possible, make sure that you have as-charged IPD benefit coverage. This will reduce your risk the most.

Types of benefit coverage

The benefit coverage is how a policy covers, or pays for, the benefit mentioned.

The benefits you receive in a health insurance policy usually never has unlimited benefit coverage. Most of the time, a benefit will be covered either as a “limited” benefit or an “as-charged” benefit.

If there is a number next to the benefit, then generally the benefit is limited, otherwise the benefit is as-charged. The benefit coverage can also just state “no coverage”.

The types of benefit coverage found in a policy will greatly influence the value the policy provides. It will also influence the premium a lot.

In the diagram above, you’ll notice that the limited benefit sometimes increases as the plan coverage increases.

You’ll also notice that a limited benefit can become an as-charged benefit as the plan coverage increases.

Benefit coverage as a limited benefit

A limited benefit is a benefit that covers a medical expense but only to a certain amount. Once this limit is reached, the policy holder needs to pay the excess.

For example, the policy in the diagram above (5-million-baht plan) offers a limited benefit of 3,000 baht a day for a hospital room. Depending on which hospital you go to, the cost of the room might be more or less. If the actual expense is below 3,000 baht a day the policy will pay in full, but if it is more the policy holder will have to pay the excess.

There are actually quite a few different types of limited benefits you should look out for. Let’s learn a few;

• Per day limited benefit. For example, a hospital room has a limited benefit of 1500 baht which pays the amount for every day hospitalized. The benefit limit can also be specified per month, every 3 month, every 3 years, twice a year etc.
• Lumpsum limited benefit. For example, a policy might include an 8,000 baht compassionate death benefit, which is a once off payment upon death.
• Lifetime limited benefit. This is an amount you can receive as a benefit throughout the whole lifetime of the policy. Once you’ve used it, it’s finished.
• Combined limited benefit. This is when more than one benefit deducts from a single limited benefit amount. For example, you have a general OPD annual benefit, but other benefits such as physical therapy and acupuncture also deduct from that same amount.
• Per admission limited benefit. For example, you need to take home medicine, but the policy limits the cost to 10,000 baht each time you are admitted.

Remember, the benefit type can also change as the policy plan changes.

Some policies can also have a single type of benefit coverage. For example, a policy that covers for critical illness might only have a lumpsum benefit.

Benefit coverage as an as-charged benefit

Other policies have benefits which have their expenses fully covered.

These benefits are only limited to the policy’s plan coverage which, in most cases, should cover the full expense. These benefits are called as-charged benefits.

For example, have a look at the policy in the diagram mentioned earlier. There are 1, 5, 15 and 25 million baht coverage plans. If you look at benefit 2.1, Medical services fee for diagnoses, the benefit coverage is as-charged no matter the plan.

When you have an expense with a benefit coverage of as-charged, the expense is deducted from the plan coverage.

This can be done for all as-charged benefits, as long as the plan coverage has not been depleted for that year.

Which benefits should my insurance policy include?

Naturally, as-charged benefits are always better, but if some benefits are limited it’s not always so bad.

For example, some hospitals in Thailand charge very high room rates, so insurance companies limit what policy holders can claim per day.

By limiting certain benefits, the insurance company can reduce the policy premium a lot.

As I mentioned before as well, some policies will lean more towards IPD benefits, or OPD benefits. The policies that lean more towards IPD benefits will generally include more as-charged benefits.

It’s always better to determine how much you can spend on health insurance first, and then buy a policy in that price class.

This will increase the chance that important benefits aren’t excluded or limited.

Policy structures

In Thailand there are two types of policy structures;

• Standalone policy = Which only has a main policy
• Long term insurance = Main policy + rider(s) policy combination

You are probably most familiar with a standalone policy, which acts only as a main policy. They are simple and straightforward and every insurance company offers them.

However, some insurance companies offer policies that have a main and a rider policy structure.

The main policy basically acts as an additional benefit, such as life insurance, while the rider can be health insurance, critical illness cover, accident cover etc.

If you wanted to add on extra benefits, you’d just add on extra riders.

I’ve actually written more in-depth about this topic. If you’d like to read more about it you can check out Standalone policies vs Main and rider policies in Thailand.

But for a quick overview, I can mention some benefits of a main + rider policy structure;

• The main policy can have a contract term of 15-20 years. After the term, the insurance is free and you receive the full benefit until the age of 99.
• The main policy can be cancelled at any time. Depending on how long you’ve held the policy, you can get back a portion of the contributions made.
• People consider the main policy to be a savings policy, so even if you don’t file a claim, you can receive some money back.
• The main is not renewed annually like standalone main policies.

At first you might think it’s strange to buy health insurance with a 20-year main policy contract, but in Thailand it definitely has its benefits.

Imagine this. You have a health insurance contract and one day you become very sick.

After many large claims, your insurance company categorizes you as a high-risk customer, and refuses to renew your contract.

You now have a poor medical history and no other insurance company will take you, or they’ll take you but exclude your current condition. This happens!

This is one of the reasons why Thais prefer to have a long-term main policy tied to their health insurance contract.

Different price classes of insurance

In the previously mentioned article, Best Health Insurance for Expats in Thailand, I discuss how health insurance can be loosely categorized into three different price classes.

The price classes are low, medium, and high, and insurance companies offer policies in each to target customers with different budgets.

While not 100% clear cut, understanding which class your insurance policy falls into will give you a rough guideline on the benefits you’ll receive.

For example, low price class policies might only have limited benefits, while medium price class policies have mostly IPD cover with as-charged benefits.

High price class policies have exceptionally high plan coverage, and may provide special benefits without an additional cost.

While the higher classes offer better benefits, the cost-to-benefit ratio might not always be best for you.

I don’t believe that one policy, no matter the cost, can provide you with all the benefits necessary to be completely covered.

People only have so much to spend on their insurance, so it’s sometimes better to buy insurance in a price class you’re comfortable paying for, and picking up a few extra policies to fill in the gaps.

In conclusion

In Thailand there are many insurance companies, and even more insurance policies to choose from.

However, with some understanding of policy wording and benefits, you can make a better decision when choosing the insurance that is right for you.

The policy premium, plan, benefit type, benefit coverage, structure, and price class can all help you to find the best insurance for your budget.

More importantly, they will help you identify when important benefits are excluded from a policy.

If you have any additional questions about policy wording and benefits, feel free to send me a message.