Is Health Insurance affordable for young Thais?

[rockyysdt]

Hi All.

 

I was hoping for some advice.

 

Recently a young Thai I know who is in his early twenties was involved in a motorcycle accident.

 

He attended a Regional Hospital in Thabo where he was hospitilized for the initial emergency assistance and subsequent in patient care.

 

He then returned for a second period of a week to determine the extent of the damage.

 

Following this an operation was undertaken on the knee.

 

As he wasn't insured the bills came to 8,000 baht for each of the 2 hospital stays, including services, and 38,000 for an operation which took place.

 

I advised his family that having health insurance is essential in Thailand.

 

 

Is private health cover affordable for young working Thais?

 

thanks

 

[Sheryl]

Thailand has universal health cover. ALL Thais are covered.

 

If he is employed in the formal sector he is covered under Social Security. There is also a separate SS system for Civil Sevrants. Everyone else, without exception, is covered under the "universal" or "30 baht" scheme.

 

So there is no need for private insurance.

 

People do have to attend one hospital where they are registered (under SS they chose it; under universal it is based on residence). Exception in the case of emergency where it is nto possible to get treatment in the registered hospital and treatment cannot safely be delayed. In that case any government hospital must treat for free, but it is nto unusual for them to try to charge. A call to the NHSO or SS head office will put a stop to that fairly quickly.

 

A new law passed a year or two ago also requires even private hospitals to provide emergency care for up to 72 hours free to everyone covered by the Thai system but enforcement and compliance are weak. However from the prices you mention this may have been a government hospital.

 

Motor vehicle accidents are in a sort of special category because of compulsory insurance plus a fund for victims of accidents where the driver was uninsured. Will generally cover up to 30,000 or 80,000 in medical costs depending on whether the insured person was at fault.

 

not only is private insurance unnecessary for Thai citizens, it is very poor value for money here do to the very small pool of insured persons and general lack of development of local health insurance sector.

 

No reason to advise Thais to get private insurance. Rather help them understand their rights under the cover they already have and also know where to call/complain when hospitals try to wrongly charge.

 

 

 

 

 

[rockyysdt]

Thanks Cheryl.

 

I'm out of the country and don't really know the details of what happened, but I believe the rider just came off the vehicle which is probably not registered nor insured.

 

Also, the riders mother lacks confidence in the public system and may have engaged a private hospital.

 

Does she have a valid point regarding the quality of service?

 

I'll have to find out more information.

 

You mentioned "free" for 72 hours?

What about charges beyond?

 

Also, what about charges for corrective surgery beyond the patients emergency situation?

 

Once the patient has stabilised and will live, who pays for corrective action such as knee surgery to etc?

 

cheers

 

R

Edited December 28, 2019 by rockyysdt

[uhuh]

1 hour ago, rockyysdt said:

Thanks Cheryl.

 

I'm out of the country and don't really know the details of what happened, but I believe the rider just came off the vehicle which is probably not registered nor insured.

 

Also, the riders mother lacks confidence in the public system and may have engaged a private hospital.

 

Does she have a valid point regarding the quality of service?

 

I'll have to find out more information.

 

You mentioned "free" for 72 hours?

What about charges beyond?

 

Also, what about charges for corrective surgery beyond the patients emergency situation?

 

Once the patient has stabilised and will live, who pays for corrective action such as knee surgery to etc?

 

cheers

 

R

Does he have Thai ID card?

If yes,  see Sheryl's post.

 

He was in a district hospital, there is no private hospital in Thabo.

The hospital in Thabo is not bad.  Difficult cases are referred to Nongkhai (not so good) or Udon (good) government hospitals. 

But doctors and nurses in government hospitals do rarely consider their work as a "service", so you can't talk of "quality of service".

 

In private hospitals, after 72 hours he would have to pay. 

 

Necessary corrective surgery and follow ups are covered by the 30 baht scheme.  What is deemed necessary for a village boy at the Lao border may not be the same as for an American in Beverly Hills.

 

 

[BritManToo]

4 hours ago, rockyysdt said:

I advised his family that having health insurance is essential in Thailand.

This was wrong advice.

The correct advice would have been for him to use the hospital near the accident for free emergency health care

..... then use the hospital near his registered address for the free ongoing healthcare (or move his registered address).

 

Why would you be advising him to pay for something which his government will provide free of charge?

[uhuh]

4 hours ago, Sheryl said:

 

No reason to advise Thais to get private insurance. Rather help them understand their rights under the cover they already have and also know where to call/complain when hospitals try to wrongly charge.

Correct. 

Many Thais don't like the public system,  though. Sometimes for good reasons (the public hospital at their location may be really bad - but better check if there is a private hospital available and if the private hospital is any better).

But the health insurance policies available to Thais are usually completely useless.

[singasong]

10 minutes ago, uhuh said:

Correct. 

Many Thais don't like the public system,  though. Sometimes for good reasons (the public hospital at their location may be really bad - but better check if there is a private hospital available and if the private hospital is any better).

But the health insurance policies available to Thais are usually completely useless.

Can you elaborate on that as my Thai step daughter has Health ins with Pacific Cross.

[uhuh]

Like Sheryl said: very poor value for money. 

Young Thais will buy an insurance who might pay for a nice room or some outpatient health check ups.

Really important is: the insurer cannot terminate the policy (no yearly extensions,  no end when you are 70) and the coverage is as high as possible. Should be unlimited. 

People need health insurance when they are over 60 and the really costly diseases start. So if the insurance can kick you out as soon as you get expensive - forget it. 

If you buy insurance now,  when you are 25, the coverage usually will not increase. But you will need it in 40 years, not now.  Look at the development of health care prices in Thailand in the least 40 years - they have increased maybe 100fold. Don't think a coverage of 20 million baht will be worth much in 40 years. 

Premiums, of course, must be accordingly high. Don't expect a good lifelong health insurance for much less than 10000 baht per month. 

 

Krung Thai Axa used to offer pretty much the only insurance with good value for money. That was 2 years ago, I didn't follow up on it.

 

If you want health insurance for just this year or just five years, i refer once again to Sheryl, no good value for money. The premium is much too high for the risks covered. Better buy accident insurance or use a credit card.

[singasong]

18 minutes ago, uhuh said:

Like Sheryl said: very poor value for money. 

Young Thais will buy an insurance who might pay for a nice room or some outpatient health check ups.

Really important is: the insurer cannot terminate the policy (no yearly extensions,  no end when you are 70) and the coverage is as high as possible. Should be unlimited. 

People need health insurance when they are over 60 and the really costly diseases start. So if the insurance can kick you out as soon as you get expensive - forget it. 

If you buy insurance now,  when you are 25, the coverage usually will not increase. But you will need it in 40 years, not now.  Look at the development of health care prices in Thailand in the least 40 years - they have increased maybe 100fold. Don't think a coverage of 20 million baht will be worth much in 40 years. 

Premiums, of course, must be accordingly high. Don't expect a good lifelong health insurance for much less than 10000 baht per month. 

 

Krung Thai Axa used to offer pretty much the only insurance with good value for money. That was 2 years ago, I didn't follow up on it.

 

If you want health insurance for just this year or just five years, i refer once again to Sheryl, no good value for money. The premium is much too high for the risks covered. Better buy accident insurance or use a credit card.

 

But you still haven't explained why Health insurance policies available to Thais are usually pretty useless ? for your info my daughter is covered for 5m bht, so surely she would get more than a nice room or are you saying that she wouldn't ?

[lopburi3]

7 minutes ago, singasong said:

 

But you still haven't explained why Health insurance policies available to Thais are usually pretty useless ? for your info my daughter is covered for 5m bht, so surely she would get more than a nice room or are you saying that she wouldn't ?

Everything within the power of insurance company will likely be used to declare any expensive hospital stay a pre-existing condition and therefore not valid.  Insurance in Thailand, of any type, tends to only pay out when family status requires - most holders will never get paid.  As there are very few Thai with such insurance there is just no money to pay any claims and still keep owners happy.

[Sheryl]

It is not useless, especially if obtained at a young age and then maintained. . But it is comparatively poor value for money (as compared to international policies)  and there are significsnt disadvantages due to the regulatory environment here. Chief among these is that, unlike in most Western countries, the insurer is allowed to raise premiums on an individual basis if you have a large claim. Which rather undermines the whole concept of insurance (risk pooling). 

 

I am aware of only one Thai based policy that does not do this and that is April Thailand....though even they have language in their policy that would allow them to do so as the Thai Insurance Commission requires that (incredibly).

 

Another feature of the regulatory environment here is that insurers are free to not guarantee renewal at all, or guarantee it only up to a comparatively early age.  So must check policy terms very carefully. There are some that do guarantee lifetime renewal if the policy is taken out before a certain age. Pacific Cross guarantees to age 99.

 

Many but not all  Thai insurers fail to do full medical underwriting when a policy is issued, and instead wait until there is a claim to decide if it is eligible or considered due to a pre-existing condition and some of the grounds I've seen used to claim something is "pre-existing" are tenuous indeed. This is mainly an issue for hospitalizations due to chronic diseases as opposed to accidents or infectious disease, and especially likely to occur when such hospitalizations occur in the first year or two of taking out a policy. Occurring after a policy has been held for some years is less likely to be a problem. Pacific Cross does full medical underwriting.

 

Thai underwriters seem not to consult medically trained people and the intake forms are often poorly designed leading to frequent misinterpretations of an applicants health status and odd decisions e.g. exclusions of conditions the applicant does not have, and never had, or denial of cover for perfectly healthy people.  These are especially  issues for older people.

 

Many, but again not all, Thai health insurance policies are issued by companies for whom health insurance is just a small sideline (i.e. companies who do mostly life and motor vehicle insurance, or banks) and they do not really understand health insurance. The policies offered ate often bizarre in structure (ridiculously low levels of cover, or limited to certain diseases etc). And some -- a minority - do indeed engage in dodgy attempts to avoid pay outs. 

 

Not an issue for your daughter but majority of Thai companies will not issue a new policy to anyone over age 60 or 65.

 

Final issue is that for the few Thai companies that guarantee lifetime renewal,  premium rates really go through the roof past  70. Any private policy anywhere in the world will cost more as you age, but the extent of the rise is disproportional in Thailand. There is actually a company charging a premium equal to the maximum cover once people are over 85. Don't ask me to explain that.

[uhuh]

Response to singasong:

 

Yes she gets coverage for 5MB, so it's not completely useless. 

But a young person rarely will be ill, so the premiums are too high relative to the covered risk. 

That's bad value for money,  Sheryl already explained the reasons. 

 

My "useless" refers to another point:

You really need insurance for a catastrophic event that can destroy you economically, socially and can kill you (meaning you can die from it), and that you and your family cannot shoulder under any circumstances.  (Even 5MB many Thai families can shoulder.) Events like expensive chronic diseases like SLE or diabetes,  AIDS or cancer. Are these things covered (many Thai insurances don't cover cancer which is one of the most common diseases) ? Can the insurance kick you out if you have a disease like this  (manny Thai insurances can)?

 

These events happen mostly when you get old.  A typical Thai insurance gets your premiums as long as you are young and more or less healthy (you don't cost them much). Once you are old (often at the age of 70) coverage ends. Good business for the insurance because almost all of the medical cost that you cause in a lifetime, are incurred in the last couple of years of your life. Not good business for you, because when you are old you can hardly get a new insurance anymore (too many preexisting conditions,  too).

 

So the most important question is: will the insurance last all your life (most Thai insurances don't)? Or can they kick you out when you are not profitable any more?

And related to this: what will the coverage be in 20, 30, 40 years? 5MB in 20 years in health care is maybe the same as 500000 now, not much. But the coverage of most Thai insurances is fixed,  will not go up. 

 

Edited December 28, 2019 by uhuh

[WayWokeWhiteGuy]

9 hours ago, Sheryl said:

Thailand has universal health cover. ALL Thais are covered.

 

If he is employed in the formal sector he is covered under Social Security. There is also a separate SS system for Civil Sevrants. Everyone else, without exception, is covered under the "universal" or "30 baht" scheme.

 

So there is no need for private insurance.

 

People do have to attend one hospital where they are registered (under SS they chose it; under universal it is based on residence). Exception in the case of emergency where it is nto possible to get treatment in the registered hospital and treatment cannot safely be delayed. In that case any government hospital must treat for free, but it is nto unusual for them to try to charge. A call to the NHSO or SS head office will put a stop to that fairly quickly.

 

A new law passed a year or two ago also requires even private hospitals to provide emergency care for up to 72 hours free to everyone covered by the Thai system but enforcement and compliance are weak. However from the prices you mention this may have been a government hospital.

 

Motor vehicle accidents are in a sort of special category because of compulsory insurance plus a fund for victims of accidents where the driver was uninsured. Will generally cover up to 30,000 or 80,000 in medical costs depending on whether the insured person was at fault.

 

not only is private insurance unnecessary for Thai citizens, it is very poor value for money here do to the very small pool of insured persons and general lack of development of local health insurance sector.

 

No reason to advise Thais to get private insurance. Rather help them understand their rights under the cover they already have and also know where to call/complain when hospitals try to wrongly charge.

 

 

 

 

 

 

Hello Sheryl,

 

I have a question about registering in a hospital outside my immediate area.

 

I'm retired and have Thai SS medical. My wife told me I had to register in our local hospital, as all the "good" hospitals are full, is this correct?

 

Our local hospital is not very good. I'd like to register at Siriraj, is this possible? If so, how do I go about it?

 

I am located in Lat Krabang

 

Thanks,

 

Dave

[Sheryl]

45 minutes ago, WayWokeWhiteGuy said:

 

Hello Sheryl,

 

I have a question about registering in a hospital outside my immediate area.

 

I'm retired and have Thai SS medical. My wife told me I had to register in our local hospital, as all the "good" hospitals are full, is this correct?

 

Our local hospital is not very good. I'd like to register at Siriraj, is this possible? If so, how do I go about it?

 

I am located in Lat Krabang

 

Thanks,

 

Dave

 

Siriraj and Chulalongkorn are indeed full and gave long waiting lists. True also of many of the other big teaching hospitals in Bkk.

 

That does not mean you have to settle for your local hospital thought. There will still be some options. Find out fro SS office which hospitals on Bangkok are still accepting new SS registrations.

 

 

[rockyysdt]

18 hours ago, Sheryl said:

 

Motor vehicle accidents are in a sort of special category because of compulsory insurance plus a fund for victims of accidents where the driver was uninsured. Will generally cover up to 30,000 or 80,000 in medical costs depending on whether the insured person was at fault.

 

Hi Sheryl.

 

If the motorcycle was unregistered and the accident did not involve another vehicle what are the implications in terms of the "30baht medical/hospital" services.

 

NB: The injured person is a Thai National with Thai ID

Edited December 28, 2019 by rockyysdt

[Sheryl]

3 hours ago, rockyysdt said:

Hi Sheryl.

 

If the motorcycle was unregistered and the accident did not involve another vehicle what are the implications in terms of the "30baht medical/hospital" services.

 

NB: The injured person is a Thai National with Thai ID

If the moto did not have registration it will not have had the compulsory insurance which all vehicles are required to have. It may be that what happened is that the hospital told him the costs had to come out of the vehicle insurance fund ("por rir bor") but due to lack of registration it could not. (Private insurance would also not pay in such a situation. Must have a valid license and be driving a registeted vehicle). As mentioned the compulsory  vehicle insurance covers only up to 30k. Beyond that the "30 baht" or SS scheme should take over

 

I am not sure if he is under the "30 baht" or SS scheme since you mentioned employment. You should ask him which he has, and at which hospital he is registered under whichever scheme it is.  Other possibility is that he went to a hospital other than where he is registered and they charged for that reason though if real emergency should not have.

 

 

[rockyysdt]

Thanks for your explanation Sheryl.

 

You mentioned the 30 baht scheme takes over beyond the 30k motor insurance cover.

 

Does that mean that the 30 baht national health scheme only kicks in beyond 30k regardless of whether a motoring accident occurs with or without the rider being insured?

 

thanks

Edited December 29, 2019 by rockyysdt

[Sheryl]

3 minutes ago, rockyysdt said:

Thanks for your explanation Sheryl.

 

You mentioned the 30 baht scheme takes over beyond the 30k motor insurance cover.

 

Does that mean that the 30 baht national health scheme only kicks in beyond 30k regardless of whether a motoring accident occurs with or without the rider being insured?

 

thanks

Not 100% sure but I think so. Note that the insurance is by law mandatory for all vehicles. Only costs around 500 baht and impossible to register a vehicle without it.

[rockyysdt]

Thanks Cheryl.

 

I think villagers don't register their vehicles.

Edited December 29, 2019 by rockyysdt

[rockyysdt]

On 12/29/2019 at 12:57 PM, Sheryl said:

Not 100% sure but I think so. Note that the insurance is by law mandatory for all vehicles. Only costs around 500 baht and impossible to register a vehicle without it.

Firstly, Happy New Year to you all the members.

 

Without laboring this topic I was hoping you could give me more clarity on Thai hospitalisation and fees involved.

 

An example which occurred.

 

A Thai male, with alcoholic tendencies went on an extensive binge and rendered himself unconscious and in a critical state.

He was hospitalised and after some intensive care was released about 10 days later.

He/his family were rendered a bill.

 

How would the 30 baht scheme operate?

 

Would his medical costs (room, procedures, and pharmaceuticals) be fully covered for 30 baht for a period of 72 hours and then after would further fees be billed?

 

Also, how does the Hospital recover fees from those who are without assets and without employment?

 

thanks

 

R

Edited December 31, 2019 by rockyysdt

[Sheryl]

4 hours ago, rockyysdt said:

Firstly, Happy New Year to you all the members.

 

Without laboring this topic I was hoping you could give me more clarity on Thai hospitalisation and fees involved.

 

An example which occurred.

 

A Thai male, with alcoholic tendencies went on an extensive binge and rendered himself unconscious and in a critical state.

He was hospitalised and after some intensive care was released about 10 days later.

He/his family were rendered a bill.

 

How would the 30 baht scheme operate?

 

Would his medical costs (room, procedures, and pharmaceuticals) be fully covered for 30 baht for a period of 72 hours and then after would further fees be billed?

 

Also, how does the Hospital recover fees from those who are without assets and without employment?

 

thanks

 

R

 

As has already been explained:

 

The 30 baht scheme covers all care in the hospital where the person is registered under the scheme.  If a person chooses to go elsewhere, they must pay full fee. Exception if it is a life and death emergency and impossible to transport the patient, in that case any government hospital can treat under 30 baht scheme but in practice will often try to charge people not registered there, often have to call the NHSO hotline to intervene to get care at a different hospital paid for.

 

Private hospitals are also by law supposed to provide emergency (emphasis: life and death emergency, patient cannot be transferred) for up to 72 hours (or less i.e. until the person can safely be transferred)  but this is poorly enforced.

 

Forget the "72 hours" which seems to have confused you. It is applicable only when someone had to be treated in a private hospital because it as a life and death emergency and they were too unstable to be transferred.

 

When at the registered government hospital there is no time limit and the 30 baht scheme pays for all. Rare exceptions for certain unusual drugs not on the essential drug list, which is unlikely in this case.

 

I suggest you find you in what hospital this person was treated and where they are registered in a tabian ban.

 

You may also need to consider the possibility you are being hit up for money on grounds that are not genuine. It happens a lot here.

[rockyysdt]

Thanks Sheryl.

 

Is it possible, for various reasons, that locals aren't registered at all?

Edited January 1, 2020 by rockyysdt

[Sheryl]

2 hours ago, rockyysdt said:

Thanks Sheryl.

 

Is it possible, for various reasons, that locals aren't registered at all?

 If they are Thai citizens they are listed in a tabian ban somewhere.

 

And for everyplace that has a tabian ban there is a government hospital responsible for that area.

 

Are you certain these people have Thai citizenship?

 

 

[rockyysdt]

21 hours ago, Sheryl said:

 If they are Thai citizens they are listed in a tabian ban somewhere.

 

And for everyplace that has a tabian ban there is a government hospital responsible for that area.

 

Are you certain these people have Thai citizenship?

 

 

Thanks Sheryl.

 

Yes, I've seen the Thai ID of the injured parties mother.

 

I'm just learning where I stand if requests are made to help out with medical bills.

 

R

[rockyysdt]

On 1/1/2020 at 11:58 PM, Sheryl said:

 If they are Thai citizens they are listed in a tabian ban somewhere.

 

And for everyplace that has a tabian ban there is a government hospital responsible for that area.

 

Are you certain these people have Thai citizenship?

 

Hi Sheryl.

 

The latest information I've learned is that the 30baht hospital scheme is for those 60 and over.

 

The accident victims mother has indicated that this is the policy administered at the Ta Bo public hospital and all Public Hospital in her experience.

 

Is this correct and if not what can she do to recover her incorrectly billed accounts?

 

The bill so far has been 8,000b twice for inital accident and follow up treatment, and 39,000b for some kind of exploratory surgery on the knee as a result of the motorcycle accident.

 

Motorcycle was unregistered so road accident insurance is not accessible.

 

cheers

 

R

 

 

Edited January 22, 2020 by rockyysdt

[BritManToo]

1 hour ago, rockyysdt said:

The latest information I've learned is that the 30baht hospital scheme is for those 60 and over.

They are lying to you.

My entire family are treated free of charge at our local government hospital.

The woman I was married with, had a child delivered free of charge in our local government hospital.

Ask to see her house book, she will be entitled to free treatment in the nearest government hospital to her registered address (unless there is more than one locally, in which case she would have been given a choice).

 

If you are asked to help with medical bills, just say no.

Unless you want to throw your money away.

 

 

Edited January 22, 2020 by BritManToo

[offset]

On 12/28/2019 at 5:10 PM, uhuh said:

Response to singasong:

 

Yes she gets coverage for 5MB, so it's not completely useless. 

But a young person rarely will be ill, so the premiums are too high relative to the covered risk. 

That's bad value for money,  Sheryl already explained the reasons. 

 

My "useless" refers to another point:

You really need insurance for a catastrophic event that can destroy you economically, socially and can kill you (meaning you can die from it), and that you and your family cannot shoulder under any circumstances.  (Even 5MB many Thai families can shoulder.) Events like expensive chronic diseases like SLE or diabetes,  AIDS or cancer. Are these things covered (many Thai insurances don't cover cancer which is one of the most common diseases) ? Can the insurance kick you out if you have a disease like this  (manny Thai insurances can)?

 

These events happen mostly when you get old.  A typical Thai insurance gets your premiums as long as you are young and more or less healthy (you don't cost them much). Once you are old (often at the age of 70) coverage ends. Good business for the insurance because almost all of the medical cost that you cause in a lifetime, are incurred in the last couple of years of your life. Not good business for you, because when you are old you can hardly get a new insurance anymore (too many preexisting conditions,  too).

 

So the most important question is: will the insurance last all your life (most Thai insurances don't)? Or can they kick you out when you are not profitable any more?

And related to this: what will the coverage be in 20, 30, 40 years? 5MB in 20 years in health care is maybe the same as 500000 now, not much. But the coverage of most Thai insurances is fixed,  will not go up. 

 

My son is 10 years old his insurance cover cost me under 17000 baht for 5 million Baht cover which I think is not a lot of money for peace of mind and that I can use any hospital that I want

 

His first claim was for a 55000 baht when he swallowed a battery when he was young in total he has had claims of about 90000 baht in his life which I guess is less than I paid the insurance but he is a fit boy

 

I always wonder if insurance is worth the money but then I think what if anything big goes wrong so I pay it 

[Sheryl]

What you were told is absolutely untrue.

 

The 30 baht scheme covers all Thais who are not covered under one of the other employment based scheme. Nothing at all to do with age.

 

 

[rockyysdt]

14 hours ago, Sheryl said:

What you were told is absolutely untrue.

 

The 30 baht scheme covers all Thais who are not covered under one of the other employment based scheme. Nothing at all to do with age.

 

 

Thanks.

 

I was supplied a bill.

 

It was in Thai so I couldn't read it.

It's something I wouldn't post to a public forum, but maybe I can have it translated.

[PPMMUU]

"unconscious and in a critical state." from "extensive binge" is rarely a true emergency that need intensive care for 10 days

He may have been admitted and intubated in the nearest hospital and be transferred to government hospital immediately and the bill would have been covered by the "emergency scheme" (free for first 72 hr anywhere but only for life-threatening condition)

 

But if the families denied transfer, they have to pay in full. The critical condition is virtually gone after the patient was intubated.