Government Health Insurance

[Martian]

After an unsuccessful forum search for answers to my questions I want to ask those with knowledge about the government health coverage available through your employer.

I am a Farang and considering a teaching job at a government school in my Thai hometown and they say after 3 months I can have the "social security health coverage at ****** hospital". The designated hospital is the usual one I go to so I am ok with that but what I am asking is this:

As a member of the program, are all medical costs (IP & OP) covered without any deductibles, co-pays or maximums? What are the terms of the program? Dental and/or vision included?

Thank you,

Martian

Edited August 13, 2008 by Martian

[ThaivisaInsurance]

After an unsuccessful forum search for answers to my questions I want to ask those with knowledge about the government health coverage available through your employer.

I am a Farang and considering a teaching job at a government school in my Thai hometown and they say after 3 months I can have the "social security health coverage at ****** hospital". The designated hospital is the usual one I go to so I am ok with that but what I am asking is this:

As a member of the program, are all medical costs (IP & OP) covered without any deductibles, co-pays or maximums? What are the terms of the program? Dental and/or vision included?

Thank you,

Martian

Suggest you look here for the information :

http://www.sso.go.th/english/faq.php?menu_...;content_id=350

Please note however this is very low coverage and should not be relied on – certainly not if one wants to use the better private/international hospitals

[Martian]

After an unsuccessful forum search for answers to my questions I want to ask those with knowledge about the government health coverage available through your employer.

I am a Farang and considering a teaching job at a government school in my Thai hometown and they say after 3 months I can have the "social security health coverage at ****** hospital". The designated hospital is the usual one I go to so I am ok with that but what I am asking is this:

As a member of the program, are all medical costs (IP & OP) covered without any deductibles, co-pays or maximums? What are the terms of the program? Dental and/or vision included?

Thank you,

Martian

Suggest you look here for the information :

http://www.sso.go.th/english/faq.php?menu_...;content_id=350

Please note however this is very low coverage and should not be relied on – certainly not if one wants to use the better private/international hospitals

Thank you for the reply and link. As I mentioned in my post, I am quite happy with the designated hospital in my possible program. Otherwise, I have funds to cover the additional costs should something happen and I need a better hospital not completely allowed for in the plan. If something changes or I change my perspective, I will certainly give Thaivisa Insurance an opportunity to bid on my business.

Regards,

Martian

[TerryLH]

"Please note however this is very low coverage and should not be relied on – certainly not if one wants to use the better private/international hospitals"

That's a pretty self serving statement from a competing ins broker/salesperson.

In case I'm wrong, can you give an explanation of what you mean by low coverage and why it shouldn't be relied on?

Thanks

Terry

[ThaivisaInsurance]

"Please note however this is very low coverage and should not be relied on – certainly not if one wants to use the better private/international hospitals"

That's a pretty self serving statement from a competing ins broker/salesperson.

In case I'm wrong, can you give an explanation of what you mean by low coverage and why it shouldn't be relied on?

Thanks

Terry

Very simple, the amount payable under this scheme will not be sufficient to pay for the treatment in the private/international hospitals

[TerryLH]

Soc Sec does provide full coverage at some private hospitals.

The ones that wouldn't be covered haven't joined the soc sec scheme anyway.

[Martian]

Sorry, I think my original question was a little vague. I appreciate Thaivisainsurance pointing out the non-coverage or low coverage limits regarding hospitals NOT a part of the Social Security System and TerryLH proposing counterpoints.

What I really should have asked was: Given that I am satisfied with the local hospital named in my plan and if I utilized that hospital for all my medical needs, would everything be paid 100% or is there a complex myriad of ifs, and, buts and of course those things called exclusions, deductibles and co-pays?

At this point I am interested in the terms regarding only my program's designated hospital.

Thank you!

Regards,

Martian

Edited August 14, 2008 by Martian

[TerryLH]

At my chosen private hospital.

No co-payments.

No exclusions for pre-existing conditions.

Full coverage for in patient and out patient services. I'm sure there are some exclusions, but I haven't come across them yet.

Full coverage for all medicines. (They don't cover condoms or Viagra.)

Dental is limited, but I'm not sure how little they offer.

Vision- they don't have an eye doctor on staff so gave me a referral to a hospital that does.

They offered several choices, and all was covered under soc sec.

I recently had surgery to my knee. The only thing I paid was a couple hundred baht per night to get an upgrade from the shared room soc sec covers to a private room. That was my choice.

Once you're in the system you can stay in it even after stopping working. You would have to enroll yourself and pay 432 baht per month. A simple process.

If you quit working / paying in to soc sec, you are covered for another 6 months without any more payments.

Social Security medical coverage suits my needs, which, unfortunately, are considerably more than anyone else I know.

I have nothing to gain by anyone using or not using soc sec coverage. I just think it's a benefit that most expats don't know enough about and tend to think it's not worth much.

I hope that helps to answer your questions a little bit.

Terry

[withnail]

I've used the social security for a while now, at a decent private hospital and have been very happy with the cover. In fact most of what it has provided me for free would not have been covered on a much more expensive plan.

I had a mole/wart taken off of my elbow, which being purely cosmetic they had to check it was covered. They called me back and I went in for the surgery which was all free. At one point I had a throat infection and visited the hospital for out-patient treatment a number of times receiving free medication, both of which would have added up to a lot more if I had so called "better" insurance which didn't cover out-patient visits.

The only thing I hear is that they won't give you imported medication with the plan, but otherwise I think it's great. It should be noted that the scheme has obviously changed a bit recently. I'm now paying less for it than I was, but the new guy at work was told that he could no longer join the scheme.

[TerryLH]

They do provide some imported medicines. Probably only if no generic or locally made version is available.

Withnail, do you work at a private school? In January there was a change in the SS Act that takes all employees at private schools out of the system.

Are you now paying 432 baht? That's what I now pay to stay in the system.

If the new employee at your school was in the system before, they can enroll themselves as long as their last payment was no longer than 6 months ago.

Terry

[Martian]

Thanks for the replies and clarifications. so, if I understand you correctly TerryLH: If I work for a year at my proposed job, which offers entry into the social security system, then decide not to work but live in Thailand.... lets say on a retirement visa thereafter...I can continue the same level of coverage at the same hospital by enrolling myself and paying a 432 Baht monthly premium??????????

What about if I decide to move back to my home country for a year or two? If I enroll myself before departing Thailand and continue to pay my monthly premiums while away, can I return for medical treatment under the plan or have continuing coverage if I decide to then stay a long time upon any return?

Not something I am planning but would like to know different scenarios because one never knows what will happen in the future and if possible, I would like to remain in the SS system because I know that one day (hopefully soon) I will come to LOS for good.

Thank you,

Martian

[withnail]

TerryLH, yes I do work at a private school, and yes I believe I'm paying 432 Baht now. The new guy wasn't in the system before so couldn't join.

[TerryLH]

Martian

As far as I know, yes to all your latest questions.

I know a Thai (a relative) who paid a year in advance, but they wouldn't let me do that.

They will let you pay at a bank so you could set it up to have the bank deduct the money from your account and pay SS every month.

Withnail

I believe the private schools have to provide an alternative to SS. I assume that would be with a private ins plan.

[toptuan]

Can someone tell me what they call the above "system" in Thai?

My (government) university says I can join, but they want to charge me 5% of my monthly salary--considerably more than the 432 baht quoted above. I'm wondering if they are talking about a "retirement" system like Soc. Sec. in the USA where you get a monthly check after retirement. All I want is the medical coverage, currently.

[withnail]

The system is called ประกันสังคม pragan sangkhom Literally "social security" It is medical coverage and a retirement system amongst other things, the same as in the US.

It shouldn't be any different to the 432 Baht and it may be that you can't enter the scheme anyway.

Edited August 17, 2008 by withnail

[Martian]

Can someone tell me what they call the above "system" in Thai?

My (government) university says I can join, but they want to charge me 5% of my monthly salary--considerably more than the 432 baht quoted above. I'm wondering if they are talking about a "retirement" system like Soc. Sec. in the USA where you get a monthly check after retirement. All I want is the medical coverage, currently.

TerryLH: Thanks for replies and info!

toptuan,

I am still investigating the details of all of this myself but the government school which has "informally" (no contract yet) offered me a position quoted me an amount I would have to pay each month based upon the anticipated salary and it was exactly 2.5% of my monthly salary and they did make the comment that the school would pay the same amount on my behalf. So, 5% does sound like the correct overall deduction amount but, as in the USA (which overall is 13%), maybe most employers pay half and the employee pays half. I would question your employer about this if they aren't offering such, especially being a government institution. The 432 Baht amount was the monthly premium for someone who was in the program and stops working (no income to base premium on) but wants to continue the coverage by enrolling themselves as individuals as TerryLH says needs to be done if you stop working and want to stay in the system.

And by the way: IMHO any Farang who thinks this program (as we understand it) isn't worthwhile, probably hasn't checked out the cost of health insurance coverage, even in Thailand, not to mention the exclusion-heavy coverage most of the Thai private insurance companies provide. If the program is what we think it is, I consider it a godsend for affordable health coverage and maybe might put me over the edge in deciding to come to Thailand to work and retire there even sooner! Even if I am in the states and need some non-emergent surgery, it is probably cheaper to buy the two-way ticket to Thailand, have the procedure performed and then return home (after a long holiday of course) than to have the procedure done here in the states with no insurance coverage. There are businesses springing up offering this kind of referral service to foreigners wanting affordable health care.

I wonder, is there an age limit in the program? Due to the nature of the program you wouldn't think so but TIT!

If anyone becomes more enlightened on all this, please do share!

Regards,

Martian

Edited August 17, 2008 by Martian

[TerryLH]

As noted, the 'system' is Social Security.

Take a look at Post #2 (by Thaivisainsuranc...). He put in the link to Soc Sec. It's a site with lots of info on what SS offers, which is much more than than just health insurance.

The cost, if working, is 5% of your salary, up to a maximum of 750 baht per month. The employer also coughs up 5%, again up to a max of 750. If you make at least 15,000 per month you'll be paying the maximum amount each month, as will your employer.

If you are enrolled but not working, you pay 432 baht per month.

I don't remember ever seeing an age limit, but I might have missed it if there is. I think once you're in they wouldn't kick you out for being too old. Follow the above link and you should get an answer.

[Martian]

Thanks TerryLH

Here's one statement I found about age, but it is in context with "starting work":

Who is the insured person ?

The insured person is the employee who starts working at the age of not under fifteen and not over sixty years old in the enterprise with 1 or more employees.

Statement about coverage in hospital outside of system:

Can the insured persons seek medical care outside registered hospital ?

The insured persons can seek medical care outside registered hospital in case of emergency and accident only

1. For emergency case, it should be fatal diseases that the insured persons need help urgently or the diseases that need urgent operation.

2. For accident case, it should happen suddenly without expectation.

Here are exclusions:

DISORDERS AND SERVICES WHICH SHALL NOT BE ENTITLED TO MEDICAL SERVICE ENTITLEMENT BENEFITS

Diseases and services which shall not be entitled to medical service (a group of 15 diseases being excepted):

1. Psychosis except in case of acute psychosis which requires immediate treatment and for a period of not more than 15 days.

2. Disorders or injury due to the use of narcotic substance under the law government narcotic drugs.

3. The same disease which requires hospitalization period of more than 180 days in one year.

4. Hemodialysis except:

A) In the case of acute kidney failure which requires hospitalization period of not more than 60 days shall be entitled to medical service benefits.

In the case of chronic kidney failure of final stage for which medical service benefits shall be granted by means of hemodialysis with the use of dialyzer; by means of the Chronic Peritoneal Dialysis (CPD) and by kidney transplant according to the criteria, the terms and conditions and rates prescribed in the Notification of the Zone Office of Social Security.

5. Any action taken for beautifying purpose with absence of medical indications.

6. Treatment in the course of doing researches and experiments.

7. Infertility.

8. Examination of mucus membrane for organ transplant except bone stem cell transplant.

9. Any examination that is exceeding the needs for curing such disease.

10. Organ transplant operation except the bone stem cell transplant according to the established criteria.

11. The sex change.

12. Artificial insemination

13. Service provided in the course of recuperation.

14. Dental service except in the case of tooth extraction, filling and removal of dental plaque.

15. Spectacles.

Here is overall coverage statement:

THE CRITERIA AND RIGHTS AND BENEFITS

In the event of the insured sustaining an injury or is taken ill , the insured shall be entitled to hospitalization in the selected hospital according to the Certified Entitlements Card or is to be admitted to affiliated hospital without paying any cost; and the insured shall be entitled to compensation up to half of the receiving wage according to actual number of days of leave; but not exceeding 90 days and 180 days in one year for loss of income in the course of being admitted for medical treatment at the recommendations of the attending physician. In case of chronic sickness, compensation for loss of income shall be entitled to not exceeding 365 days. The evidence to be presented on applying for medical treatment from the hospital is Certified Entitlements Card and Citizenship Identity Card. The evidence required to apply for compensation payment for loss of income is the Application for Compensation Benefit Form (SorPorSor. 2-01 Form); the medical certificate, a certificate from the employer and a copy of the bank account, particularly, the copy of the first page on which the Name of the Bank Account and Bank Account Number are shown (in the case of receiving compensation payment benefit through the Bank).

Martian

[tonydabbs]

I have just skimmed the replies - so I may be repeating some of them.

1. SSI coverage is very good, depending on the hospital you get. Some facilities are very poor and way over extended.

2. They will also pay for treatment at other hospitals, but the amount they will pay is very small compared to what they will pay at your designated hospital.

3. As a rule, imported medicines are not covered, nor are expensive procedures that can be handled in a less costly way, such as Hormone Replacement Thereapy.

4. The cost of the insurance is determined by your salary. Most expats end up paying 750 baht per month, the maximum.

5. If your employer is enrolled in the system you must pay for the coverage, whether you want it or not. Some expats just accept it as a cut in pay and then go out and get their own coverage. But...many expats are quite happy with the program.

6. You can't take the coverage with you if you leave your participating employer.

[TerryLH]

"You can't take the coverage with you if you leave your participating employer."

I'll politely disagree with that part of your otherwise right-on post.

If, for whatever reason, you are no longer in the system through work you can enroll yourself. You have 6 months to re-sign up, during which time you can still take advantage of the coverage.

I recently did this and now pay 432 baht per month. I did this at my local SS office. It was a routine task for them.

I was asked if I wanted the same hospital provider, or if I wanted to choose a different one.

I think if you do this in a differnt province there may be a several month waiting period while the paperwork gets processed and a new card issued, but I'm not positive about that part of it.

Same benefits as before, so far.

[Martian]

I have just skimmed the replies - so I may be repeating some of them.

1. SSI coverage is very good, depending on the hospital you get. Some facilities are very poor and way over extended.

2. They will also pay for treatment at other hospitals, but the amount they will pay is very small compared to what they will pay at your designated hospital.

3. As a rule, imported medicines are not covered, nor are expensive procedures that can be handled in a less costly way, such as Hormone Replacement Thereapy.

4. The cost of the insurance is determined by your salary. Most expats end up paying 750 baht per month, the maximum.

5. If your employer is enrolled in the system you must pay for the coverage, whether you want it or not. Some expats just accept it as a cut in pay and then go out and get their own coverage. But...many expats are quite happy with the program.

6. You can't take the coverage with you if you leave your participating employer.

I greatly appreciate the honest and "non-sales" oriented reply from someone who has a stake in trying to sell insurance. Very classy indeed and if I ever need insurance in Thailand, you (I've reviewed your "teacher's" policy on another website already) and Thaivisa insurance will be given the opportunity for my business should Thai social Security coverage not be available to me.

Regards,

Martian

[Lancashirelad]

Sorry, taking the thread a little off course, but still on the same topic. Anybody know how a self-employed Thai (very small, non registered business)[as yet] would go about joining the government scheme?

[desertrat]

having had in and out patient treatment in private and government hospitals (gov insurance scheme), my opinion is that the in EVERY respect the government hospitals are better. Even the waiting arrangements are VIP (Queen Sirikit Satthahip)

But don't choose a private hospital which is part of the govenment scheme, it seem's they don't want you.

I was given skin cream for skin cancer and I have had a history of skin cancer, and my GP's request for a biopsy was ignored, and told to come back when I had symptons from my glaucoma after being refused the pressure test. The only symptom is blindness.

[rockyysdt]

Hi TVI.

How can a Thai National obtain "social security health cover", if they don't have formal employment?

[ThaivisaInsurance]

Hi TVI.

How can a Thai National obtain "social security health cover", if they don't have formal employment?

May we suggest you start your search here :

http://www.sso.go.th/english/faq.php?menu_...;content_id=350

[rockyysdt]

Hi TVI.

How can a Thai National obtain "social security health cover", if they don't have formal employment?

May we suggest you start your search here :

http://www.sso.go.th/english/faq.php?menu_...;content_id=350

Keen to read your reference, but the link seems to be faulty!

[torrenova]

Try here

http://www.sso.go.th/english/index.php

http://www.sso.go.th/english/faq.php?menu_...;content_id=350

[sprq]

Try here

http://www.sso.go.th/english/index.php

http://www.sso.go.th/english/faq.php?menu_...;content_id=350

These pages no longer exist -- "page not found" comes up.

Is there anything current thay anyone knows?

Thanks in advance?

[pakorn8000]

What you need to understand is how the "Social Security system" work?

Once you are a member of this program, a small portion of money is deducted from your monthly salary -together with some from your employer. The Government will assign you to a hospital in the program where the Gov will pay Max 35,000 Baht (actual number is much less, depends on category of illness), and Max 200,000 Baht for operation. Thus, the pro is "cost" for sure, but the con are as follows:

1. Gov hospital problems:

- crowded

- exhausted personal to due to traffic daily

- control of infection is still not very good (you might end up infected worse than what you went in for in the first place)

2. Private hospital problems:

- must be one in the program, and must be one you are assigned to.

- if you encountered serious illness in a place far away. For instance, you need an immediate brain/heart operation. This will be a problem. Because the hospital close by is not the one got paid. So, why treat you at best? !!

- private hospital runs a business. Hence, new/inexperience/careless doctor or low grade medical possible (and seen in many cases) due to budget constrain.

- Serious or High cost operation/treatment ... forget it!!

- Remember poor or careless treatment usually cost your health. Maybe even more serious llness might follow

It is your health that counts, make your own decision. Maybe the welfare is adequate - maybe not.

[TerryLH]

"The Government will assign you to a hospital in the program where the Gov will pay Max 35,000 Baht (actual number is much less, depends on category of illness), and Max 200,000 Baht for operation."

Can you explain these numbers, please?

Are they for each event, yearly, or what?

If you don't like the hospital you are assigned to, you can change, assuming there is a hospital to change to. Check with the soc sec office for times during the year you can make changes.

If you are at a hospital that doesn't have a specialist that you need, you can get a referral to another hospital that has the treatment/doctor you need. The referral basically gives the referred to hospital permission to collect money for the work from soc sec.