slice-of-thai.com → Thai Health Insurance Tips

By Chris Pirazzi

Last updated 10 OCT 2023.

Tips for Long-Term (>2yr) Thai Health Insurance

Here's a public service announcement for long-term expats who want to get health insurance that works in Thailand. I just went through the process and here's some info to save you a lot of time. It's not as hard or costly as I thought, but there are some pitfalls.

AGENTS: If you want someone to help you, there are several agents that represent multiple insurance companies and make it easy, and as far as I can tell the prices are the same as each other and as retail. One company is AA Insure and I found their website FAQ and Bonnie's help very useful: https://www.aainsure.net/index-quote-health-insurance.html Another company with a useful online policy price search feature is Mister Prakan: https://misterprakan.com/th/health/main?lg=en I do not make money from either of these links.

AVOID SHORT-TERM COMPANIES: First, in farang social circles you'll often hear about travel insurance companies like Safetywing, Heymondo, Caremed, Genko, etc. These companies are not suitable for long-term expats, because at the end of the maximum term for which you can purchase a policy (1 year, or rarely 2 years) you have to re-apply from scratch and any conditions you had during that period become "pre-existing conditions" and not covered! If you are in Thailand for more than 2 years, you need a plan with continuity. Some of these plans also cancel your policy if you return to your home country.

LONG-TERM COMPANIES: I will focus on long-term plans below, which means companies like AXA (a French multinational), Allianz Ayudhaya (Thai company), Luma (Thai company), April Group (another French multinational), Pacific Cross (multiple owners over last 10 years: beware), LMG (from Liberty Mutual in the USA: beware), and Bupa Thailand (now owned by Aetna from the USA: major beware).

AGE: Most of the long-term providers will let people up to roughly age 65-70 apply (varies by company) and once you are on board they "guarantee" coverage for you typically until age 99, at which point you might be wishing for death anyway. Your yearly premium cost depends hugely on your age (example with one plan: age 25 is 15,750B, age 55 is 32,775B).

PRE-EXISTING CONDITIONS: Because Thailand has no law against it, pretty much all of the providers refuse to cover any condition you had before applying for the policy, and you are required to declare pre-existing conditions on the application. Different companies demand different levels of detail and number of years back that a cured pre-existing condition may count against you, and a handful of policies require you to get an exam to try to find pre-existing conditions. Companies can refuse to insure you from the start based on your pre-existing conditions. While you can try to hide your pre-existing conditions from them, be aware that the companies frequently request your health records from any hospital you ever visited in Thailand at the time you make a claim, and deny you coverage based on that. So you'd have to switch hospitals to hide your history too, and that might not work either the more computerized things get. Since the companies have you by the balls (because if you cancel or lose your plan, you will have to re-apply at an older age to another company and you may be denied due to your age or, again, pre-existing conditions), it is probably not worth it to lie. So you have to assume that you will never get coverage for any condition you have now, which is both depressing and inhumane, but nothing you can do about it in Thailand.

AVOID "INDIVIDUALLY-RATED" PLANS: Another thing that should be illegal is that some of the plans, especially those from Thai companies like Pacific Cross, are "individually-rated," which means the company is free to increase your yearly premium charge by any amount they want next year based on the medical claims you make this year. If this seems completely insane to you and totally defeats the purpose of, or really the very meaning of, "insurance," you're right. Avoid those companies like the plague. You want "community-rated" plans where the companies are legally obligated to charge everyone with the same age the same premium. They can and do still raise premiums of course, but equally for everyone of your age. Fortunately most companies seem to offer community-related plans (especially the non-Thai companies, but you must check the fine print to be sure). Some community-rated plans offer you a small premium rebate in a given year if you have no claims in the past year, but that is not the same (it is small and legally bounded in amount).

YOU DECIDE: WHICH COUNTRIES? A major difference between plans is which countries you can be covered in if you have medical issues. This is a major component of the price too. The cheapest plans are Thailand-only (and some of those offer coverage of emergencies in other countries). The next more expensive plans include other SE Asia countries other than Singapore. The next level include Singapore and maybe Canada, and so on. Pretty much no plan includes US coverage, where health care and its price is dysfunctional beyond belief. Beware that some plans which claim to be multi-country in their marketing actually only cover emergencies in those other countries, and you must get all regular care in Thailand only. Be sure to read the fine print.

YOU DECIDE: CATASTROPHIC OR FULL PLANS? Each policy choice has three main characteristics:

• a certain per-year or per-disease or per-confinement (depends on policy) coverage limit beyond which the company will not pay another baht (ranging from 500,000B - 10,000,000B)

• a certain yearly deductible (the amount you must pay before the insurance company starts paying anything) that can range from 0B to 300,000B.

• most policies give you a choice of IPD-only (inpatient only: covers only stuff so serious that you are confined to the hospital) or IPD+OPD (covers both inpatient and outpatient care).

These three factors together have the biggest impact on the yearly premium charge you must pay.

I recommend you think about 4 cases when deciding what coverage you need:

• a) major, complex IPD emergency issues where you are immediately in a hospital bed and cannot fly home: e.g. vehicle accident with major injury, heart attack with complex followup, stroke or brain aneurysm with long care, weird virus that makes you bedridden for a long time, ... these things can easily run you up bills of 3,000,000B-5,000,000B or more, especially at better hospitals.

• b) major, complex IPD issues where you could fly home: e.g. cancer, most back problems, complex surgeries, brain replacement ... These could run you bills of 5,000,000B or more if you do them in Thailand.

• c) more minor IPD issues: minor surgeries, elective surgeries, say more in the range of 10,000B-60,000B per visit.

• d) more minor OPD issues: e.g. weird flus, broken bones, vaccinations, blood tests, ... these are more typically in the range 3,000B-25,000B per visit.

For your Thai insurance, you will definitely need coverage of case (a) no matter what, so I would recommend getting a policy with at least 3,000,000B coverage per year/disease, maybe better 5,000,000B. If you have insurance in your home country, you might prefer to do case (b) at home if you trust home medical care technology more and/or can get a better price (or you are from a civilized country with socialized medical care, unlike me). Or if you never want to go back to your home country, you need coverage for case (b) in Thailand too. For case (c) and especially case (d) you might decide that you don't need insurance at all, because they really aren't that expensive compared to case (a) and (b). Based on your choices of case (a)-(d) this will help you decide what coverage level, deductible and what IPD/IPD+OPD you want.

Your choice of deductible also depends on your cash flow situation. It makes sense to choose a deductible which is the amount of cash you have on hand, or can rely on a family member to lend you, at short notice. A higher deductible massively reduces your premium payment.

Here is one random example of a decision process. I have crappy Obamacare insurance in the US and despite the utter US health system dysfunction and not wanting to go back there, I do trust US doctor skills/technology more, so I would choose to do (b) in the US for my own safety. I can pay for (c) and (d) myself. So I chose a catastrophic-only plan with 5,000,000B coverage, a very high 100,000B deductible and IPD-only and that cost me about 16,000B per year in premium (my age is 51).

As a comparison to show you the influence of the factors on price, if my same plan had no deductible it would cost 45,000B per year instead. If my plan had no deductible and IPD+OPD it would cost 65,000B per year. If I chose a different company with more countries covered with all other factors the same, then my 16,000B/yr plan goes up to 34,000B-45,000B/yr depending on company.

MOTORBIKE/CAR ACCIDENTS: Be warned that many plans will refuse to cover your vehicle accident if you do not have a valid Thai driver license. Check the fine print. Also, the "universal" Thai accident coverage that comes with vehicle reg (so-called PRB paw-raw-baw พ.ร.บ.) is more or less useless because the coverage amounts are too small.

CANCER AND HIV: Be careful that some plans specifically exclude all cancer coverage, especially cheaper plans marketed as "visa insurance." Check the fine print. An insane number of plans still exclude all HIV treatment, which seems barbaric to me and perhaps is a remnant of old prejudices.

YOU MUST CHECK THE FINE PRINT. REALLY: This is something you definitely have to do even if you are using an agent. When you are down to your final few choices, request the "policy wording" documents for the plans you are considering (what they call "Evidence of Coverage" in the US). These are long (~30-50-page) documents with often shocking and important exclusions that are not revealed in any of the friendly 2-page brochures. Read it all. I know it's a drag. I know you'd rather be drinking. Read it. It could literally save your life, because it will be the difference between you getting a surgery/treatment you need and not getting it. Don't become another desperate Gofundme case. Read it.

WAITING PERIODS: be aware most policies will not cover anything at all except emergencies for a certain period after you are accepted (often around a month) and then will not cover a certain list of typical surgeries for a longer waiting period (say 6 months or so). Read the fine print to see which is which.

VISA CONNECTION: Some people who have O-A visas (and in the future probably also non-O visas) must hold a certain kind of insurance to get and keep the visa. Fortunately most of the policies mentioned here qualify, but again, check the fine print.

Well that's what I learned. Hope you find it helpful!