Questions regarding Thai SSO and pregnancy

[vi2004]

Hello all,
 

I have a couple of questions regarding the Thai SSO system. Trying to get the grasp of it.
 

1. A Thai woman who has been an employee but missed to pay voluntarily into SSO after the termination of the contract, will be eligible to SSO under section 40 only?

2. If that person is paying into SSO voluntarily 300 THB per month can she get assigned a government hospital in Bangkok and what is the criteria for what hospital gets assigned? Can a hospital be chosen by herself?

3. If that woman gets pregant what services (monthly examinations, giving birth, ...) are covered by the SSO? If any this is only true for the assigned government hospital I guess?

4. If there a complications during birth or after birth (preterm delivery, need for NICU for the baby, .. ) what of these costs are covered by SSO?

Guess, I have more questions, but these are the most important ones for now.

Thanks a lot

[Sheryl]

1. If her employment was terminated, she needs to continue paying on self pay basis within 6 months to continue the medical benefit. If she failed to do so then no way to continue SS. HOWEVER, as a Thai she automatically then comes under the universal (AKA "30 baht" system) which will also pay all pregnancy related costs. For which reason, most Thais do not bother to continue SS through self pay.

 

2. Whether self-pay or still employed, people can choose their SS Hospital, it is not automatically assigned (unless one leaves it to one's HR department to decide, usually a very bad idea). However in Bangkok there is a real limit to the selection as most hospitals are full in terms of SS and no longer accepting new enrollments. If previously employed, she would have had an SS hospital assigned and that would remain her hospital until such a time as she elected to change it (such changes can only be done at certain times).

 

3. All antenatal checks, delivery, post natal care, vaccines for baby etc are fully covered under both SS and the Universal care system. Yes, assigned hospital must be used unless an emergency occurs in which it is nto feasible to reach it. 

 

While SS hospital can be selected, under the Universal system it is based on residence. Must use the hospital which covers the district lived in. Normally this is based on listing in a tabian ban, but I believe Bangkok and possibly Pattaya -- both locations where many people move for work - will accept registration based on a rental contract.

 

4. All complications, care of baby etc are fully covered under both SS and the Universal scheme.

[vi2004]

Thank you very much Sheryl for your quick answer.
 

5. And Universal Care System ("30 THB") is not the same as section 40 where one can pay 70, 100 or 300 THB per month? So in terms of the hospital services that you described and that are covered under the Universal scheme it doesn't actually really matter if you pay voluntarily into the system or not? Like I said, I am just trying to understand the local system.

6. In terms of getting assigned a hospital I guess the best course of action would be to make a short wishlist of government hospitals and then go to the next SSO office and see what they say? My girlfriend is not on any house book in Bangkok but in her home province. We could probably put her on the rental contract in Bangkok though.
In our extended area the first government hospital that comes to mind would be Ramathibodi Hospital. That extended area would probably be everything around Rama 9 and to Victory Monument and Petchaburi Road.
Any hospital recommendations?

7. My main thoughts behind my initial questions are these:
If my girlfriend gets pregnant there would be no problem to pay for monthly checkups and a birth delivery package in a decent private hospital. That is all good.
My concerns are only regarding the case - which hopefully never happens - where the mother or the baby (!) need an extended stay at (N)ICU or something like that (which can in some cases be financially extremely tough).
Is it even feasible to go to private hospital during pregnancy and birth and only switch to the assigned government hospital in case of the mentioned complications?
Or does it make more sense to do it all at the government hospital and maybe pay extra for a Special Clinic that government hospitals seem to have inside?
The market for insurances that cover this case seems to be very thin in Thailand.

Again, thanks a lot for your help!

[DrJoy]

15 minutes ago, vi2004 said:

We could probably put her on the rental contract in Bangkok though.

Rental contracts are not considered. She has to move her Blue House book to Bangkok (incase of 30 baht scheme)

[DrJoy]

3 hours ago, vi2004 said:

2. If that person is paying into SSO voluntarily 300 THB per month can she get assigned a government hospital in Bangkok and what is the criteria for what hospital gets assigned? Can a hospital be chosen by herself?

Voluntary SSO payments currently is @  THB 432/-

 

Can be assigned a hospital in Bangkok only if she in the blue book , her ID card must show BKK address.

 

Yes can choose hospital

[DrJoy]

Here is the Government Hospitals List -

Government Medical Facilities, Bangkok

Hospital	Network Clinic
1. Faculty of Medicine, Vajira Nursing	Network Clinic
2. Central Hospital	Network Clinic
3. Chulalongkorn Hospital
4. Charoen Krung Pracharak Hospital	Network Clinic
5. Taksin Hospital	Network Clinic
6. Police Hospital
7. Correctional Hospital Correctional Institution
8. Nopparat Ratchathani Hospital (THO)	Network Clinic
9. Phra Mongkutklao Hospital
10. Bhumibol Adulyadej Hospital
11. Rajavithi Hospital
12. Ramathibodi Hospital
13. Ratchapipat Hospital	Network Clinic
14. Lerdsin Hospital	Network Clinic
15.Vejkarun Rasmi Hospital	Network Clinic
16.Siriraj Hospital	Network Clinic
17. Somdej Phra Pinklao Hospital	Network Clinic
18.Sirindhorn Hospital	Network Clinic
19.Luang Por Taweesak Hospital Chutintharo Uthit	Network Clinic
20. Ladkrabang Hospital, Bangkok

[Sheryl]

1 hour ago, DrJoy said:

Here is the Government Hospitals List -

Government Medical Facilities, Bangkok

Hospital	Network Clinic
1. Faculty of Medicine, Vajira Nursing	Network Clinic
2. Central Hospital	Network Clinic
3. Chulalongkorn Hospital
4. Charoen Krung Pracharak Hospital	Network Clinic
5. Taksin Hospital	Network Clinic
6. Police Hospital
7. Correctional Hospital Correctional Institution
8. Nopparat Ratchathani Hospital (THO)	Network Clinic
9. Phra Mongkutklao Hospital
10. Bhumibol Adulyadej Hospital
11. Rajavithi Hospital
12. Ramathibodi Hospital
13. Ratchapipat Hospital	Network Clinic
14. Lerdsin Hospital	Network Clinic
15.Vejkarun Rasmi Hospital	Network Clinic
16.Siriraj Hospital	Network Clinic
17. Somdej Phra Pinklao Hospital	Network Clinic
18.Sirindhorn Hospital	Network Clinic
19.Luang Por Taweesak Hospital Chutintharo Uthit	Network Clinic
20. Ladkrabang Hospital, Bangkok

Vast majority of these are no longer taking new SS enrollment.  Some have wait lists extending to decades.

 

 

[Sheryl]

1 hour ago, vi2004 said:

Thank you very much Sheryl for your quick answer.
 

5. And Universal Care System ("30 THB") is not the same as section 40 where one can pay 70, 100 or 300 THB per month? So in terms of the hospital services that you described and that are covered under the Universal scheme it doesn't actually really matter if you pay voluntarily into the system or not? Like I said, I am just trying to understand the local system.

6. In terms of getting assigned a hospital I guess the best course of action would be to make a short wishlist of government hospitals and then go to the next SSO office and see what they say? My girlfriend is not on any house book in Bangkok but in her home province. We could probably put her on the rental contract in Bangkok though.
In our extended area the first government hospital that comes to mind would be Ramathibodi Hospital. That extended area would probably be everything around Rama 9 and to Victory Monument and Petchaburi Road.
Any hospital recommendations?

7. My main thoughts behind my initial questions are these:
If my girlfriend gets pregnant there would be no problem to pay for monthly checkups and a birth delivery package in a decent private hospital. That is all good.
My concerns are only regarding the case - which hopefully never happens - where the mother or the baby (!) need an extended stay at (N)ICU or something like that (which can in some cases be financially extremely tough).
Is it even feasible to go to private hospital during pregnancy and birth and only switch to the assigned government hospital in case of the mentioned complications?
Or does it make more sense to do it all at the government hospital and maybe pay extra for a Special Clinic that government hospitals seem to have inside?
The market for insurances that cover this case seems to be very thin in Thailand.

Again, thanks a lot for your help!

 

Thailand's universal health coverage consists of 3 schemes. ALL Thai citizens are covered under one of them.

 

1 - Civil Servant SS. Covers civil servants and their spouses, children and dependent parents.

 

2 - Regular SS. Covers non-civil servants employed in the formal sector, but not their spouses or dependents. Can be continued after leaving employment on a contributory basis but little to no reason for a Thai citizen to do that, see below

 

3 - Universal (AKA "30 baht") scheme covers all Thais not enrolled in #1 or #2. No contribution required, it is tax funded.

 

From what you say, makes little sense to bother with SS (especially since the better SS hosptals in Bkk have huge waiting lists for enrollment).  She is covered under the universal scheme. But, should try to change her tabian ban listing to where she actually lives. (Can be done in a rental but needs landlord's assistance). Could also try registering under the scheme at whatever hospital covers the area where you live (Ask neighbors about that) if she is in a rental contract as despite what @DrJoy said, I have had reports of people being able to do this. Possibly it varies by hospital.

 

You (or preferrably she as English may not be spoken) can also call the NHSO for more information on this.

https://eng.nhso.go.th/view/1/Home/EN-US

tel 02-141-4000

[vi2004]

Thanks again for the answers. This is very helpful. I am starting to get the idea.

- How is that house book requirement even working in Bangkok? I can only image that there is a 7-figure number of Thais living in Bangkok Metro who are registered in other provinces and are not in the Bangkok landlord's tabian ban. Do they travel to their home province for treatment or when they are pregnant? Do they all pay themselves in Bangkok? 

- Just to clarify if I understand it correctly: Being registered at a government hospital in Bangkok has the advantage that one can go there if any health problem arises. Without registered hospital these exams would not be covered. But: Emergency visits can be done at any government hospital and will always be covered? Does that include complications from pregnancy?

- And lastly because I think this question got somehow lost here:
If my girlfriend gets pregnant there would be no problem to pay for monthly checkups and a birth delivery package in a decent private hospital. That is all good.
My concerns are only regarding the case - which hopefully never happens - where the mother or the baby (!) need an extended stay at (N)ICU or something like that (which can in some cases be financially extremely tough).
Is it even feasible to go to private hospital during pregnancy and birth and only switch to the assigned government hospital (or any government hospital if that qualifies as emergency) in case of the mentioned complications?
Or does it make more sense to do it all at the government hospital from the beginning and maybe pay extra for a Special Clinic that government hospitals seem to have inside?

Thanks again all

[digbeth]

18 hours ago, vi2004 said:

Thanks again for the answers. This is very helpful. I am starting to get the idea.

- How is that house book requirement even working in Bangkok? I can only image that there is a 7-figure number of Thais living in Bangkok Metro who are registered in other provinces and are not in the Bangkok landlord's tabian ban. Do they travel to their home province for treatment or when they are pregnant? Do they all pay themselves in Bangkok? 

- Just to clarify if I understand it correctly: Being registered at a government hospital in Bangkok has the advantage that one can go there if any health problem arises. Without registered hospital these exams would not be covered. But: Emergency visits can be done at any government hospital and will always be covered? Does that include complications from pregnancy?

- And lastly because I think this question got somehow lost here:
If my girlfriend gets pregnant there would be no problem to pay for monthly checkups and a birth delivery package in a decent private hospital. That is all good.
My concerns are only regarding the case - which hopefully never happens - where the mother or the baby (!) need an extended stay at (N)ICU or something like that (which can in some cases be financially extremely tough).
Is it even feasible to go to private hospital during pregnancy and birth and only switch to the assigned government hospital (or any government hospital if that qualifies as emergency) in case of the mentioned complications?
Or does it make more sense to do it all at the government hospital from the beginning and maybe pay extra for a Special Clinic that government hospitals seem to have inside?

Thanks again all

 

If they're working, they'll be on social security where they can select their own hospitals, most that'll accept new registration for social security in Bangkok are private, which will either have a 'social security/30 baht scheme' wing with longer wait for service 

 

For pregnancy, if you're registered at a government hospital, there's also a way to secure extra 'special' service of a doctor, where you pay the doctor and you either see him at his private clinic, but delivered at the government hospital where he has privilege, you'll get preferential treatment and the same doctor at every visit at the government hospital, whereas if you didn't pay for 'special' you get whatever doctor is on duty that day, plus you can arrange private rooms and cesarian in advance

 

Some view the special clinic as a bribe to the doctor as the hospital aren't billed for this 

[PPMMUU]

 

The concern about the high cost if the baby needs to stay a long time in the NICU is real. With this in mind, I suggest giving birth at a ‘private’ hospital with close ties to good government hospitals like Siriraj's SIPH or Ramathibodi's premium section.

[Sheryl]

On 6/11/2024 at 3:58 PM, vi2004 said:

Thanks again for the answers. This is very helpful. I am starting to get the idea.

- How is that house book requirement even working in Bangkok? I can only image that there is a 7-figure number of Thais living in Bangkok Metro who are registered in other provinces and are not in the Bangkok landlord's tabian ban. Do they travel to their home province for treatment or when they are pregnant? Do they all pay themselves in Bangkok? 

- Just to clarify if I understand it correctly: Being registered at a government hospital in Bangkok has the advantage that one can go there if any health problem arises. Without registered hospital these exams would not be covered. But: Emergency visits can be done at any government hospital and will always be covered? Does that include complications from pregnancy?

- And lastly because I think this question got somehow lost here:
If my girlfriend gets pregnant there would be no problem to pay for monthly checkups and a birth delivery package in a decent private hospital. That is all good.
My concerns are only regarding the case - which hopefully never happens - where the mother or the baby (!) need an extended stay at (N)ICU or something like that (which can in some cases be financially extremely tough).
Is it even feasible to go to private hospital during pregnancy and birth and only switch to the assigned government hospital (or any government hospital if that qualifies as emergency) in case of the mentioned complications?
Or does it make more sense to do it all at the government hospital from the beginning and maybe pay extra for a Special Clinic that government hospitals seem to have inside?

Thanks again all

Yes, many Thais from the provinces work in Bangkok.

 

Some are on Social Security which removes the tabian ban issue. (Employed in Bangkok will suffice to get registered in Bangkok or outskirts. The big problem is that all the better hospitals have long waiting lists for new SS enrollments.

 

Some arrange to change their tabian ban listing to a Bangkok one. (if landlord unwilling, may ask friends of family in Bangkok to add you to theirs).

 

Some do indeed travel back to their home provinces for medical care. Usually pay out of pocket for small thing then head upcountry for anything major.

 

From what I gather of your situation, and assuming you expect to be in Bangkok long term, best thing to do would be to get her listed on tabian ban in Bangkok. Start with your landlord, if he is unwilling then ask around among any friends, relations etc in the city.

 

It is no problem to transfer from a private hospital to a government hospital at any point in care, as far as the government hospital is concerned. But it can prove logistically difficult to effect a transfer of a critically ill patient, and private hospitals have been known to be uncooperative about it.  In an emergency NICU type situation, charges can skyrocket astronomically  in just the first few hours (I have seen 1 million baht charges just in the day of birth) and multiply thereafter ---  and they won't let you transfer the baby until they have been paid in full.  Offhand I can recall 2 cases in past 10 years on this board of people saddled with multi- million baht bills and unable to get their sick neonate transferred. 

 

The other thing to be aware of is that private hospitals will push so strongly for c-section that it becomes virtually impossible to have a a natural birth in one. Of course many Thai women want c-section in which case may not matter, but if a natural birth is desired, be aware of this point,

 

So I would advise delivery in a government hospital. It is possible to use a semi-private channel in most government hospitals whereby you can see an OB-GYN after hours and arrange for them to deliver on a fee basis (thus being able to chose the doctor, and discuss in advance preferences). You can also arrange a private room for reasonable fee.

[vi2004]

On 6/13/2024 at 11:47 AM, Sheryl said:

In an emergency NICU type situation, charges can skyrocket astronomically  in just the first few hours (I have seen 1 million baht charges just in the day of birth) and multiply thereafter ---  and they won't let you transfer the baby until they have been paid in full.  Offhand I can recall 2 cases in past 10 years on this board of people saddled with multi- million baht bills and unable to get their sick neonate transferred. 

 

Oh my god! 1 million on the first day??? I mean I know why I am concentrating on finding a way to eliminate this kind of risk. But this amount is crazy. Bumrungrad is the only hospital I found online that is mentioning their NICU prices. It says 18.510 THB per day.

 

On 6/13/2024 at 11:47 AM, Sheryl said:

So I would advise delivery in a government hospital. It is possible to use a semi-private channel in most government hospitals whereby you can see an OB-GYN after hours and arrange for them to deliver on a fee basis (thus being able to chose the doctor, and discuss in advance preferences). You can also arrange a private room for reasonable fee.

This is a way I would be interested in. Government hospital with this semi-private channel. But if I understand correctly the costs in this government hospital that occurr from complications (NICU) would only be taken care of if that was the hospital my girlfriend is registered at. If she is not registered there we would have to pay for that ourselves. Is that correct? Any idea of NICU costs in a government hospital?

[Sheryl]

On 6/14/2024 at 11:30 PM, vi2004 said:

 

Oh my god! 1 million on the first day??? I mean I know why I am concentrating on finding a way to eliminate this kind of risk. But this amount is crazy. Bumrungrad is the only hospital I found online that is mentioning their NICU prices. It says 18.510 THB per day.

 

This is a way I would be interested in. Government hospital with this semi-private channel. But if I understand correctly the costs in this government hospital that occurr from complications (NICU) would only be taken care of if that was the hospital my girlfriend is registered at. If she is not registered there we would have to pay for that ourselves. Is that correct? Any idea of NICU costs in a government hospital?

Listed NICU prices refers just to the cost of the bed. Has nothing to do with the cost of medical care. This will vary widely  depending on what is needed.

 

Self pay costs at a government hospital  will usually be about 1/4 that in a private hospital but in cases of catastrophic illness NICU situation can still run quite high. 

 

As previously said, should get your GF registered under the universal health scheme at a government hospital and deliver there. 

[PPMMUU]

Sick baby can be very sick. One million Baht on first day is not a stretche.

[vi2004]

Thanks for all the answers. 

One more follow up question:
Once the girlfriend managed to register at a local government hospital how can you document that?
Is there a way to get a written confirmation that the registration is completed? Is it possible to get this from the hospital?

 

Thanks a lot

[Sheryl]

52 minutes ago, vi2004 said:

Thanks for all the answers. 

One more follow up question:
Once the girlfriend managed to register at a local government hospital how can you document that?
Is there a way to get a written confirmation that the registration is completed? Is it possible to get this from the hospital?

 

Thanks a lot

There is no documentation. Hospital just confirms verbally that it's in their system. And when she goes to the hospital for any reason, she pays either nothing or 30 baht .  (Some hospitals collect the 30 baht, some don't).

 

Note that registration at the hospital anyone can do, including those paying out of pocket. What you specifically want to ascertsin is that she is registered under the universal ("30 baht") system. 

[digbeth]

at some government hospital there's a machine that you insert the national ID card and it spits out slip of paper confirming your status, some make you do this before every visit or the staff print out manually and attaches this to your accompanying papers that you take to see various department from doctors, lab tests and pharmacy and cashier