New Thai Health Insurance Co-Pay Rule Going Into Effect March 20th

A new co-payment rule for health insurance in Thailand is set to take effect on March 20, 2025. This updated policy will reshape how insurance providers cover medical expenses in the country by shifting more financial responsibility to policyholders in certain situations.

What is the New Health Insurance Co-Pay Rule in Thailand?

Most health insurance plans in Thailand cover all medical expenses within the coverage limits. However, with the introduction of the new co-payment rule, a system will be put in place where policyholders will be responsible for a portion of their medical costs, even if the full amount would normally be covered. 

Fortunately for policyholders in Thailand, this rule will apply in particular circumstances. Policyholders will be required to provide a co-pay only if they meet one of the following criteria:

1. If a policyholder files three or more claims for “common medical conditions” and the total cost amounts to 200% of their annual insurance premium, they will be subject to a 30% co-payment the following year. These conditions include, but are not limited to, headaches, influenza, muscle inflammation, diarrhea, stomach acid issues, and gastroesophageal reflux.
   
2. If a policyholder files three claims for general diseases and the total cost amounts to 400% of their annual insurance premium, they will be subject to a 30% co-payment the following year. 

However, if the policyholder meets both criteria above, the required co-payment will rise to 50%. Despite this, it is important to note that the co-payment rule will not apply to cases involving major surgeries or critical illnesses.

Why is this rule being implemented?

The health insurance co-payment rule was created to address concerns regarding medical cost inflation and the overall sustainability of health insurance in Thailand:

• Medical Cost Inflation: The average rate of medical cost inflation in Thailand reached as high as 15% in 2024 alone, which is an alarming difference from the global and regional average rate of 10%. Contributing factors include an aging population, air pollution, emerging diseases, medical advancements, and the structures of current healthcare systems in the country. Without measures like the co-payment rule to control rising costs, the healthcare system could become unaffordable for most, increasing insurance premiums.
  
• Frequent Insurance Claims: Data shows that a small number of policyholders file multiple claims for minor illnesses every year, increasing the financial burden on insurance providers. By introducing the co-payment rule in Thailand, insurance providers hope to encourage responsible healthcare consumption among policyholders. This will reduce medical expenses on unnecessary claims and help ensure long-term sustainability for private health insurance.

How will the New Co-Pay Rule affect policyholders in Thailand?

The co-payment rule aims to control the rising costs of medical treatment in Thailand and stabilize (or potentially lower) the price of insurance premiums. Thus, private health insurance may become more accessible and affordable to the public. By reducing the number of minor medical claims each year, insurance companies can reduce costs and won’t be compelled to raise premiums on everyone to compensate.

Though this is expected to increase the number of health insurance applications, policyholders will need to be more responsible and careful when seeking medical attention for minor ailments, as they may be required to co-pay 30% or 50% of their medical expenses (excluding for major surgeries and critical illnesses) if they exceed the specified thresholds mentioned above. 

However, this will only affect those renewing their policies or entering one from March 20, 2025, onward, as the co-payment clause will only be added after this date. Policyholders with coverage lasting beyond the implementation of the co-payment rule will not need to be concerned about exceeding the thresholds, as their original policy will still apply until its renewal.

For this reason, policyholders who are unsure about their coverage and the complexities of the new system are urged to secure new health insurance policies before the co-payment rule takes effect.

Category: Thailand Law