New government health insurance for foreigners - info for TV members in Issan

[Sheryl]

The Thai government has initiated a new system which allows foreigners living in Thailand to enroll in the UC (AKA “30 baht”) scheme on a fee basis. The directive issued thus far, which involves a premium of only 2,200 baht a year plus another 600 for initial medical screening, was aimed at migrant workers, but the directive failed to specify this clearly, rather stating only “foreigner”. As a result many up-country hospitals are issuing the cards to resident expats. We have confirmed that this was not the original intent of the MoPH, and that they plan on introducing something for resident expats subsequently which would have a different premium, as yet to be established (it will be based on analyses of age, expected utilization etc). It will surely be more than 2,000 baht a year but also almost certainly still be much less than private insurance. Meanwhile, many resident expats are getting the cards at the 2,000 baht rate. So far there are no reports of any hospital in the Bangkok area doing this, but up-country it seems more common than not.

In Issan, so far have had reports of cards being issued by:

Udon Thani Hospital

Pakchong Nana Hospital in Pakchong and Maharat Hospital in Korat

Kuchinarai, Crown Prince Hospital in Kalasin

Kanthawichia Hospital (ampur) MahaSarakam Province.

However, Nang Rong Hospital in Buriram is reported to have refused saying the cards are only for migrants.

Given the uncertainties of the situation just described (with some risk that cards issued might later be revoked, or people run into difficulties if they have to be referred up to a higher level of care, especially in Bangkok), we do not recommend discontinuing private insurance coverage if you have it. However, those who are unable to get private insurance have nothing to lose by enrolling in the system and will certainly be better off with it than remaining uninsured. Self-insured people would also benefit from it as a means of minimizing the need to dip into their savings. The system does not exclude pre-existing conditions nor have an age limit, and the required medical exam focuses on a few infectious diseases of Public Health importance only (TB, leprosy, syphilis etc – again, aimed at migrant worker issues). People with significant known chronic diseases have been issued cards.

The terms of use are identical to those for Thais covered under the UC (AKA “30 baht” scheme) – you cannot chose the hospital but must register at the government hospital responsible for the area where you live (if in doubt ask a Thai neighbor), and can only get free care at that hospital, or at a higher level facility that the hospital you are registered at refers you to. Care will be that Thais get in government hospitals, i.e. long waits, cannot chose your doctor, but usually consistent with accepted standards of care. In-patient care would be in a ward, though you might be able to pay extra out of pocket for a semi-private or private room, if available. Military hospitals are not included, though you can certainly continue to use them (or private hospitals) on a fee basis if and when you like. Similarly, private after hours arrangements at government hospitals (e.g. Suan Dok, Chula, Ramatibhodi) will not be covered, only use of the regular public channel, but again nothing to stop you from availing from it on a fee basis if desired. The coverage includes some provision for dental care as well as a pretty comprehensive range of medical services.

To register you will need to show your passport and most (but not all) hospitals are requesting some type of proof of residence, i.e. yellow tabieen baan or rental agreement. Some TV members have managed with just their wife’s tabien baan even though they are not listed in it, but with the wife going along to attest that he lives there. As is common with new government initiatives there is a lack of consistency in how requirements are interpreted in different locations. This thread in the Health Forum details experiences people have had at various hospitals http://www.thaivisa.com/forum/topic/671391-affordable-health-insurance/

Edited October 15, 2013 by Sheryl
corrected amount - 2,200 baht not 2,000

[soi41]

Bravo Sheryl!!

You are doing a very good, often unnoticed, job for the expatcommunity.

[riepan963]

I am in Nakhon Phanom and nobody I know has tried to enrol in this scheme so we don't know if it exists over here..

I would like to visit our local hospital to check it out but the missus doesn't believe the Thai Government would ever do such a thing.

Can anyone post or send me any documents/cards etc (preferably in Thai) which I can take to the hospital and use as a reference point.

Thanks ....

[Sheryl]

1. Add to the list if places that have now been reported as having issued cards: Khao Wong Hospital in Kalasin

2. riepan963, the health forum topic (link in OP) includes the actual MoPH directive, in Thai.

[selftaopath]

Thank you for this very valuable information. I personally have been using BUPA but options are greatly appreciated. Hope some X pats can benefit.

[Michael Hare]

Last week a friend of mine informed me that his neighbour a retired German living in village outside of Ubon Ratchathani, recently had a hernia operation at the main Government hospital in Ubon Ratchathani. His wife had arranged for his "30 baht insurance scheme" using her house registration. Total cost of the operation came to 1200 baht which was for some take-home medicine.

[John 1]

Last week a friend of mine informed me that his neighbour a retired German living in village outside of Ubon Ratchathani, recently had a hernia operation at the main Government hospital in Ubon Ratchathani. His wife had arranged for his "30 baht insurance scheme" using her house registration. Total cost of the operation came to 1200 baht which was for some take-home medicine.

I'm totally against this scheme for expat foreigners as we would be using a Thai health care system that the Thai's have been paying to through there tax. As for migrant worker's yes this system should be used for them as they are now in the tax payment system. As for the use of the government hospital's there fee's are very reasonable.

[harrry]

Last week a friend of mine informed me that his neighbour a retired German living in village outside of Ubon Ratchathani, recently had a hernia operation at the main Government hospital in Ubon Ratchathani. His wife had arranged for his "30 baht insurance scheme" using her house registration. Total cost of the operation came to 1200 baht which was for some take-home medicine.

I'm totally against this scheme for expat foreigners as we would be using a Thai health care system that the Thai's have been paying to through there tax. As for migrant worker's yes this system should be used for them as they are now in the tax payment system. As for the use of the government hospital's there fee's are very reasonable.

Acttually the 30 baht scheme is wholy funded for thais by a payment of 2000 baht a year per person in it to the hospital by the Government. This ensures the hospital recieves the same without the Government contributing anything in tax or other.

[John 1]

Last week a friend of mine informed me that his neighbour a retired German living in village outside of Ubon Ratchathani, recently had a hernia operation at the main Government hospital in Ubon Ratchathani. His wife had arranged for his "30 baht insurance scheme" using her house registration. Total cost of the operation came to 1200 baht which was for some take-home medicine.

I'm totally against this scheme for expat foreigners as we would be using a Thai health care system that the Thai's have been paying to through there tax. As for migrant worker's yes this system should be used for them as they are now in the tax payment system. As for the use of the government hospital's there fee's are very reasonable.

Acttually the 30 baht scheme is wholy funded for thais by a payment of 2000 baht a year per person in it to the hospital by the Government. This ensures the hospital recieves the same without the Government contributing anything in tax or other.

Where do you think the money from the government come's from. Thai paying there tax is part of this.

[harrry]

Last week a friend of mine informed me that his neighbour a retired German living in village outside of Ubon Ratchathani, recently had a hernia operation at the main Government hospital in Ubon Ratchathani. His wife had arranged for his "30 baht insurance scheme" using her house registration. Total cost of the operation came to 1200 baht which was for some take-home medicine.

I'm totally against this scheme for expat foreigners as we would be using a Thai health care system that the Thai's have been paying to through there tax. As for migrant worker's yes this system should be used for them as they are now in the tax payment system. As for the use of the government hospital's there fee's are very reasonable.

Acttually the 30 baht scheme is wholy funded for thais by a payment of 2000 baht a year per person in it to the hospital by the Government. This ensures the hospital recieves the same without the Government contributing anything in tax or other.

Where do you think the money from the government come's from. Thai paying there tax is part of this.

I say again.....The Government does not pay one Baht for this scheme. THe Hospital receives the 2200 baht from the user. THe Government pays the hospital 2000 baht for tThais that are not in another plan like SS or Government Employee. The plan is cost neutral for the Government. Not one cent of tax goes to it.

[JoePai]

The plan is cost neutral for the Government. Not one cent of tax goes to it.

and you think the total cost of (say) a stent is 2,000 Baht or less ....................... ?

[John 1]

I say again.....The Government does not pay one Baht for this scheme. THe Hospital receives the 2200 baht from the user. THe Government pays the hospital 2000 baht for tThais that are not in another plan like SS or Government Employee. The plan is cost neutral for the Government. Not one cent of tax goes to it.

Ok you are correct on the new scheme which should apply to migrant worker's. I'm talking about the general health care system I assume that is government funded through tax. Anyway the main think I object to is expat foreigners being able to use this system.

[Sheryl]

Actually the intent is to help the hospitals address the problem of financial losses due to care provided to foreigners (migrants and, to a lesser extent resident expats and sometimes even tourists) who cannot pay their bills. Government hospitals are losing a very significant amount per year on this, and they were cash-strapped to begin with because the funds they receive from the government for Thais (which are actually more than just the 2,000 baht/person in operating costs, they are other inputs as well) is less than the costs of delivering services.

The scheme is meant to be cost neutral for the hospitals i.e. the premium they collect is expected to be sufficient for the costs of the services provided; they will not get any budget supplement from government for the foreigners enrolled. However the 2,200 baht premium was established based on the expected utilization pattern of migrant workers. It does not reflect that of resident expats which is why this is going to boomerang and be a money loser for the hospitals (most noticeable in places with many expats enrolled). The MoPH had planned to develop a premium suitable for expats, hopefully they will do that soon so that people already issued the cards can keep them and just transition to the higher premium, whatever that proves to be (it will still be less than private insurance, and unlike private insurance have no age limit of exclusions).

[SlyAnimal]

So, as I'm employed and have a work permit, I could definitely register for this? At any hospital, not just the ones listed, as I'm technically a "migrant worker".

Or was it more the government's intention to provide the service for Burmese/Cambodian/Laotian workers, rather than western workers?

[harrry]

So, as I'm employed and have a work permit, I could definitely register for this? At any hospital, not just the ones listed, as I'm technically a "migrant worker".

Or was it more the government's intention to provide the service for Burmese/Cambodian/Laotian workers, rather than western workers?

You could and should enrol in Social Security if you are working with a work permit.

[Jasun]

So, as I'm employed and have a work permit, I could definitely register for this? At any hospital, not just the ones listed, as I'm technically a "migrant worker".

Or was it more the government's intention to provide the service for Burmese/Cambodian/Laotian workers, rather than western workers?

If you're an employee of a Thai company you've always been eligible. Your company should have issued you with the card.

[boloa]

I've been told by my local Hospital that the system is for 'migrant workers' and not for Ex-pats living here in Thailand and that anybody that has been allowed to sign up has be allowed because the Hospital that are doing so don't know the rules.But at the same time my friend has a Gold Medical Card and gets all his Diabetic meds for free!

I remember years when I got my Yellow house book the Amphur Office try to give me a Thai ID card.......until my wife told them I was British, so how could I have a Thai ID card.? After a few phone calls they realised they were making a mistake!!

[Michael Hare]

From my own observations the Thai people who are entitled to the government 30 baht programme have never paid any income tax in their lives. They do, however, pay taxes in the form of sales taxes and VAT as foreigners living in Thailand also do. I believe that less than 20% of the general Thai population pay income tax. I may be wrong and stand to be corrected on this figure.

[Sheryl]

This is a very important topic so please let's stay on it and not go off into debates about which Thais do and do not pay taxes. Taxes have nothing whatsoever to do with this new insurance scheme which is premium based.

Update: Bua Yai Hospital is also issuing the cards. That makes 3 places so far in Korat.

@Boloa: which hospital was this?

@SlyAnimal: you are definitely eligible for Thai Soc Security if you have been employed for 13 months, make sure they give you a card. They will deduct a small amount from your salary monthly to cover it. Unlike the 30 baht scheme, you will have a choice of hospitals and can also get a semi-private room if hospitalized. So better than this new insurance scheme plus, unlike it, of long standing and secure system. You an also maintain it after you stop working as long as you keep up the payments which are very reasonable.

[boloa]

@Boloa: which hospital was this?

My local Amphur Hospital in Surin province

[Sheryl]

@Boloa: which hospital was this?

My local Amphur Hospital in Surin province

Which Ampur? Do you mean Surin provincial hospital or other?

Thanks...

[jpinx]

What happens if a farang registers with a hospital and then has to move residence to an area covered by a hospital which has not been registering farangs? I would like to try my local hospital (Paknam, Samut Prakan) but there is a good chance I will move house within a year, but not sure exactly where to:

[Sheryl]

What happens if a farang registers with a hospital and then has to move residence to an area covered by a hospital which has not been registering farangs? I would like to try my local hospital (Paknam, Samut Prakan) but there is a good chance I will move house within a year, but not sure exactly where to:

Many Thais continue to use hospitals in a province they no longer live in but were registered in (more often, still are in a tabieen baan of). The local appliance repairman in my town has been away for almost a month for that reason, much to my frustration -- went from Prachinburi all the way to kalasin. Of course one would not bother to do that for something minor, but rather just pay out of pocket since outpatient care is pretty affordable anyhow.

If you move to a place that does provide coverage, there is a process through which you can change your registration but you'd have to ask what that is. It seems to be onerous enough that many people don't do it but I think that devolves back to the tabien baan issue since it is this which determines where you have to register.

[MJP]

I was given a Thai medical card on the 30 Baht programme around four years ago, on a Non-O visa, no charge. I still have the card.

Edited October 16, 2013 by MJP

[Sheryl]

I was given a Thai medical card on the 30 Baht programme around four years ago, on a Non-O visa, no charge. I still have the card.

Yes, some hospitals here and there did that. it was in error as only Thai citizens are eligible for free care under that system (the new insurance scheme under discussion is another matter). It gets caught out when/if you are referred to a higher level of care.

[MJP]

I was given a Thai medical card on the 30 Baht programme around four years ago, on a Non-O visa, no charge. I still have the card.

Yes, some hospitals here and there did that. it was in error as only Thai citizens are eligible for free care under that system (the new insurance scheme under discussion is another matter). It gets caught out when/if you are referred to a higher level of care.

I wondered at the time, it all seemed too easy. It was only for a diabetes check and metformin prescription.

[Sheryl]

Correction to original info -- the hospital in Korat town issuing the cards is Theparat.kok-kruad. (Maharot 2) not Maharot.

[meatboy]

this is a translation of the leaflet i was given.apart from their ability to speak english i could not fault the service.

arived at theparat hospital 8am.go to counter 1 to register.

weight and height taken.

then blood presure.

then x-ray,blood test,urine test.

then wait for the results[45mins]

see the doctor.

pay 600 for the medical.

then go and register.pay 2,200bht.

all along you will be told where to go for each test staff very afficient. out 10.45am.

the wife was handed what you can expect and what is not covered.

1-check up and treatment if needed.

2 dental,tooth extraction,cleaning and filling.

3 vacine for your children age 0-15yrs.

4 room and service plus basic food.

5 treatment exspences.

6 emergency in case of an accident.

7 if you need to be transfered to in my case maharat.

8 looking after you and check ups when pregnant.and during the birth.

9 birth control.

. not covered.

mental health problems.

drug problems.

car or bike accidents.

kidney dialysis.

organ change.

sex change or cosmetic surgery.

hope this gives you some idea what to expect.

[TerryLH]

"... you are definitely eligible for Thai Soc Security if you have been employed for 13 months, make sure they give you a card."

Not all employment is covered by Social Security.

If your employment is covered, you enroll in the system when you start work. After paying into the system for 3 months, you are eligible to use the coverage.

Not sure what the 13 months is, but after 12 months of payments, you can continue to pay on your own if you lose eligibility through employment.

Anything posted here about Social Security is for info only, and is not what this thread is about.

Because the government has three different health systems, all with different requirements, there is often confusion about them.

Terry

PS As others have said, thanks Sheryl. This is an issue that is very important.

Edited October 17, 2013 by TerryLH

[meatboy]

until someone has cause to test the scheme we have to play it by ear.