Mild, asymptomatic COVID-19 cases not entitled to claim under new insurance rules

[webfact]

 

Thailand’s Office of the Insurance Commission (OIC) has issued new rules, which take effect on February 15th, limiting compensation claims by people infected with COVID-19. Patients who are symptomatic or who have mild symptoms being treated in hospital or in home isolation and are without doctor’s certificate stating the need for treatment in such facilities will not be covered by the medical care or compensation scheme.

 

Assistant OIC Secretary-General Apakorn Panlerd said that the new rule is in line with the Public Health Ministry’s guidelines for the care of people infected with COVID-19, as revised on January 4th, which has resulted in a change to the conditions covering claims.

 

Under the previous guidelines, all COVID-19 patients were considered in-patients and were entitled to claim medical expenses and compensation for the loss of income during the period of treatment.

 

Full story: https://www.thaipbsworld.com/mild-asymptomatic-covid-19-cases-not-entitled-to-claim-under-new-insurance-rules/

 

-- © Copyright Thai PBS 2022-02-08

 

- Aetna offers a range of visa-compliant plans that meet the minimum requirement of medical treatment, including COVID-19, up to THB 3m. For more information on all expat health insurance plans click here.

 

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[bobbin]

A bone thrown to the struggling Thai Insurance companies?

 

If I'm in a hospital through no choice of my own, I expect the insurance I paid for to "cough" up the agreed compensation...

[Boomer6969]

"Under the new guidelines, however, the patients must meet specific requirements to be able to claim. For instance, he or she must have a fever of over 39 °C for more than 24 hours or their breathing rate is more than 25 times per minute or the oxygen content of their blood is lower than 94%."

 

The have lost faith in vaccines, it seems; IMHO it should say "The vaccinated patients must meet... unvaccinated patients will not be compensated."

[4MyEgo]

24 minutes ago, bobbin said:

A bone thrown to the struggling Thai Insurance companies?

 

If I'm in a hospital through no choice of my own, I expect the insurance I paid for to "cough" up the agreed compensation...

That is why you don't insure with a Thai company.

[MadMac]

Quarantine was never covered. Now they just admit it.

[TallGuyJohninBKK]

This is an interesting development, because....

 

I've always been told by my insurance broker here in TH that any change an insurer might want to make in the terms of their coverage can only take effect at a person's next policy renewal -- not somewhere mid-term during a prior policy issued under different terms.

 

If that's true, how's that going to work in this instance?

 

Of course, this is TH, where the government and companies break or ignore rules all the time with impunity.

 

Edited February 8, 2022 by TallGuyJohninBKK

[feasantplukka]

So if your insurance company don't cover a quarantine in Hospital if asymptomatic why stipulate the need to have it?

If you are positive that's should be cause enough, it's like saying car insurance doesn't cover you for a minor bump only a write off????

Madness the whole process 

[DezLez]

1 hour ago, webfact said:

mild symptoms being treated in hospital or in home isolation and are without doctor’s certificate

Edited February 8, 2022 by DezLez
so it is just a mild flue

[tlcwaterfall]

Another nail in the tourism coffin.

[stigar]

51 minutes ago, 4MyEgo said:

That is why you don't insure with a Thai company.

Ur rigth.I have a insurance from my country that cover everything.

[JonnyF]

1 hour ago, 4MyEgo said:

That is why you don't insure with a Thai company.

Good advice. 

 

The Thai company I insured with never sent my documents through and then went bust about 3 months after I took cover out with them. I won't mention the expat forum I found this insurance company on but it used to rhyme with Vie Teaser????. 

[John Drake]

1 hour ago, TallGuyJohninBKK said:

This is an interesting development, because....

 

I've always been told by my insurance broker here in TH that any change an insurer might want to make in the terms of their coverage can only take effect at a person's next policy renewal -- not somewhere mid-term during a prior policy issued under different terms.

 

If that's true, how's that going to work in this instance?

 

Of course, this is TH, where the government and companies break or ignore rules all the time with impunity.

 

And now we know what can happen with some sort of health insurance requirement for extensions authorities might dream up. A Thai insurance policy, it seems, is not worth the paper it is written on. Literally.

[Misab]

WOW

 

[Etaoin Shrdlu]

1 hour ago, TallGuyJohninBKK said:

This is an interesting development, because....

 

I've always been told by my insurance broker here in TH that any change an insurer might want to make in the terms of their coverage can only take effect at a person's next policy renewal -- not somewhere mid-term during a prior policy issued under different terms.

 

If that's true, how's that going to work in this instance?

 

Of course, this is TH, where the government and companies break or ignore rules all the time with impunity.

 

Most Thai medical insurance policies already stipulated prior to the advent of Covid-19 that only medically-necessary treatment would be covered. It was the OIC that required insurers to cover the medically-unnecessary costs of mild and asymptomatic cases that caused these expenses to be covered, not the actual policy wording. This is just reversion to the status quo ante. It also brings Thai medical insurance cover back to the same level as most foreign medical insurance policies. No change in policy wording is needed in most cases.

Edited February 8, 2022 by Etaoin Shrdlu
Clarity

[damascase]

1 hour ago, feasantplukka said:

So if your insurance company don't cover a quarantine in Hospital if asymptomatic why stipulate the need to have it?

If you are positive that's should be cause enough, it's like saying car insurance doesn't cover you for a minor bump only a write off????

Madness the whole process 

Health insurance would - and should - never cover medically absolutely unnecessary ‘treatment’. Your car insurer wouldn’t cover you if you don’t have any damage to your car, but still the body shop wants you to park the car at their premises for 10 days, at 10.000 baht a day……..

[Tropicalevo]

1 hour ago, feasantplukka said:

So if your insurance company don't cover a quarantine in Hospital if asymptomatic why stipulate the need to have it?

For some time now, our guests have been allowed to quarantine in the private villa that they booked to stay in.

The last 6 or 7 Covid positive guest have not had to go to hospital or hospitel. They were all asymptomatic or mild symptoms.

[Bkk Brian]

11 minutes ago, damascase said:

Health insurance would - and should - never cover medically absolutely unnecessary ‘treatment’. Your car insurer wouldn’t cover you if you don’t have any damage to your car, but still the body shop wants you to park the car at their premises for 10 days, at 10.000 baht a day……..

Exactly, the insurance needed here in addition to normal health insurance for Thailand is quarantine insurance, nothing more, nothing less however Thailand will not admit to this as being the necessity as its so hard to get that cover from anyone.

[UKPaul67]

Then this forced insurance should be removed, most symptoms are mild to none. Yet another reason to make a tourist pay for a service which is useless as all positive are forced into paying for hotels.

Getting crazy on the rip off the very people they want back to save the economy ????????.

 

[daveAustin]

If that is the case, then these Thai hospitals that obligatory take in covid positive people should NOT be treating asymptomatic cases or SHOULD make said treatment free, or Thai gov SHOULD pick up the bill. STOP behaving like a banana republic!!

[TallGuyJohninBKK]

20 hours ago, Etaoin Shrdlu said:

Most Thai medical insurance policies already stipulated prior to the advent of Covid-19 that only medically-necessary treatment would be covered. It was the OIC that required insurers to cover the medically-unnecessary costs of mild and asymptomatic cases that caused these expenses to be covered, not the actual policy wording. This is just reversion to the status quo ante. It also brings Thai medical insurance cover back to the same level as most foreign medical insurance policies. No change in policy wording is needed in most cases.

 

I would simply make the counter argument:

 

IF someone is FORCED to stay in an actual hospital facility for a week or two due to the Thai government's COVID policy, then to me, that by definition becomes medically necessary.

 

Because if it wasn't medically necessary, then...

1. The hospital shouldn't have admitted/accepted them if the first place, and

2. The government shouldn't have been confining people in actual hospitals if it wasn't medically necessary.

 

Recall, one of the supposed reasons they were doing that was in the cases of asymptomatic people who they considered to have risk factors for serious/bad outcomes. If that's the case, that too begins to sound pretty much like a government determination, right or wrong, of medically necessary.

 

Otherwise, those folks should have instead been in "hospitels" -- which would be a whole different insurance quagmire -- or home or community quarantine.

 

One could argue, the government's policy decision to confine those certain COVID cases to hospitals, by definition, made it medically necessary, as determined by the national government.

 

 

 

Edited February 8, 2022 by TallGuyJohninBKK

[Etaoin Shrdlu]

1 minute ago, TallGuyJohninBKK said:

 

I would simply make the counter argument:

 

IF someone is FORCED to stay in an actual hospital facility for a week or two due to the Thai government's COVID policy, then to me, that by definition becomes medically necessary.

 

Because if it wasn't medically necessary, then...

1. The hospital shouldn't have admitted/accepted them if the first place, and

2. The government shouldn't have been confining people in actual hospitals if it wasn't medically necessary.

 

Recall, one of the supposed reasons they were doing that was in the cases of asymptomatic people who they considered to have risk factors for serious/bad outcomes. If that's the case, that too begins to sound pretty much like a government determination, right or wrong, of medically necessary.

 

Otherwise, those folks should have instead been in "hospitels" -- which would be a whole different insurance quagmire -- or home or community quarantine.

 

 

No, this does not negate the fact that the hospitalization is not medically necessary. The government is mandating it due to public health policy, not medical need. 

 

1) I don't think private hospitals would turn away a potential patient just because the government mandated that they be hospitalized. They'd be happy to take the patient's money in such cases. I could go on about the ethics of for-profit healthcare, but that's another subject.

 

2) You're right, but many of the private hospitals rely upon medical tourism, resident foreigners and tourists for a good portion of their revenues. Many of these hospitals are owned by the oligarchs that control the economy and who help prop up the current government. I can imagine that they lobbied the government for considerations when their revenues dropped as tourists dwindled and resident foreigners went home. Same like the hotels have been granted favors in the form of the Test and Go and Sandbox schemes.

 

But bottom line, a government mandate does not make hospitalization of asymptomatic or mildly symptomatic people medically necessary. Medical necessity would be determined by a qualified physician on a case-by-case basis, not by a blanket government diktat.

 

 

 

 

 

[ikke1959]

What is the need for an insurance than for travellers into Thailand?? Mild or a symptonic is not covered...

[hioctane]

"Patients who are symptomatic or who have mild symptoms being treated in hospital or in home isolation and are without doctor’s certificate stating the need for treatment in such facilities will not be covered by the medical care or compensation scheme."

 

This is common sense! I don't know if the wording is off but it sounds like it is saying that a doctor must consider it "medically necessary" in addition to testing positive. I don't know why people would want to but it sounds like there are overly paranoid people who want to be treated just because they are positive (even with no symptoms).

[alex8912]

6 hours ago, hioctane said:

"Patients who are symptomatic or who have mild symptoms being treated in hospital or in home isolation and are without doctor’s certificate stating the need for treatment in such facilities will not be covered by the medical care or compensation scheme."

 

This is common sense! I don't know if the wording is off but it sounds like it is saying that a doctor must consider it "medically necessary" in addition to testing positive. I don't know why people would want to but it sounds like there are overly paranoid people who want to be treated just because they are positive (even with no symptoms).

I doubt it.  What it says to most people is you better $$get$$ a doctors note while you are coughing in his office and then get compensated if you have to go to Corona jail. Even when you are not "really " feeling bad. But you are actually REALLY feeling bad about possibly  having to cough up $$ if you don't feel bad. 

[Dukeleto]

13 hours ago, John Drake said:

And now we know what can happen with some sort of health insurance requirement for extensions authorities might dream up. A Thai insurance policy, it seems, is not worth the paper it is written on. Literally.

I learned that 20 years ago and have not had one since…complete waste of money!

[cnx101]

Of course not it’s to make money not give it out.

[kimamey]

15 hours ago, DezLez said:

 

No it's not mild flu. The symptoms are generally less severe and may well not require hospital treatment but that's not all cases otherwise there wouldn't be so many people in hospital with Covid.

[alex8912]

Does anyone know an insurance company that a "tourist " can use to stay for 60 days or less that is cheaper or much better than let's say AXA which is about 3,100 baht per month for short term 50k covid insurance?  If Thai companies don't cover this do others?  Can ANYONE from most countries be accepted as well?  If not I guess most will just buy the Thai covid insurance that never really paid for asymptotic positive test result on day 1 or day 5 after arrival.  I have to buy insurance by tomorrow or next day to apply for Thailand Pass. I'm sure others have to soon as well. As a side note. I need to come to Thailand. Florida, Greece , Spain and Philippines as well as Mexico and others are NOT options????

[Puccini]

15 hours ago, tlcwaterfall said:

Another nail in the tourism coffin.

How many nails can fit in a coffin?

[bbOh]

That's what most (all?) Thai insurance companies state that are 'recommendedly forced on you'. (STV, O-A, etc.)

I have clicked my way through all the insurances on that longstay page. 

https://longstay.tgia.org/companiesstv

And here is the result:

aetna: to get a quote> can't put in my phone number because it allows only Thai numbers and all the regions are in Thailand
Muang Thai Insurance> 30 day waiting period --> not covered
Falcon insurance> will not pay for the first 30 days --> not covered
Dhipaya> page error
Axa>not covered for the first 30 days
Thai Setakij> not covered for the first 30 days
Bangkok Insurance> not covered for the first 30 days
Sompo> page is missing
Navakij> O-A visa
Viriyah> accident & health insurance, no Covid-plan
Pacific Cross> O-X and O-A, for people over 50
LMG> O-A visa
Thai Health Insurance> O-A visa
Southeast Company> page not found