Mandatory Health Insurance for Long-Stay Foreigners, aged 50 Years or older

In May 2019, rather suddenly, reports started to get published in English-language newspapers in Thailand, stating that health insurance would become mandatory for 50+ years old foreigners, staying long-term in the country. This would apply for expats on the long-stay non-immigrant O-A visa, that is valid for one year.

Insurance coverage should be for at least 400,000 baht in inpatient expenses, and 40,000 baht in outpatient expenses.

Additionally, a website of a (we think) newly established association, the Thai General Insurance Association, was put online, with links to local insurance companies that have apparently especially created new health insurance policies for the government initiated insurance schemes. More about this later.

The reasoning is simple : Some foreigners do not pay their bills after using medical services in Thailand. As reported in the Nation Newspaper dd. May 2019, a representative of the International Health Division (Health Service Support Department), stated that foreigners incurred non-paid medical bills amounting to 349 million baht and 305 million baht respectively in 2017 and 2018. Nowhere is it clear however how much of these unpaid bills were incurred by long-stay foreigners and how much by 'regular' tourists, which are more numerous. Personally, we were quite surprised to notice that up to a fifth of foreign visitors using medical services, did not pay for them. (565,000 out of 3.3 million visits in 2017 ; 680,000 out of 3.42 million visits in 2018).

Some easy mathematics : If one compares the number of unpaid visits, with the money amount of unpaid medical bills, we are talking about around 500 baht (!!!) per visit. We would not be surprised if some errors had slipped into the numbers provided by the Health Ministry.

In any case, if the non-paid medical bills amounted to 349 million baht and 305 million baht for the years 2017 and 2018, we are clearly talking about rather small amounts of money, maybe not quite necessitating a drastic scheme as will be outlined below.

Bumrungrad Hospital Entrance, Bangkok, Thailand

Entrance to Bumrungrad Hospital. Very popular with foreigners. Make sure to check your wallet before checking in, even with the 'mandatory' health insurance.

 

longstay.tgis.org

This is the website were you will find insurance policies, as provided by (at present) 6 different insurance companies operating in Thailand.

The insurance companies participating are :
AXA Insurance Public Co. Ltd.
Thaivivat Insurance Public Co. Ltd.
Bangkok Insurance Public Co. Ltd.
Pacific Cross Health Insurance Public Co. Ltd.
Navakij Insurance Public Co. Ltd.
Viriyah Insurance Public Co. Ltd.

Interestingly, all these companies are publicly traded in Thailand (except Pacific Cross which is listed outside the country)

Overall Review

The website of AXA Insurance has not yet been updated for this service, so we will exclude it from further evaluation.

1) All companies have insurance schemes that follow the government's guidelines, with inpatient coverage up to 400,000 baht, and outpatient coverage up to 40,000 baht. Some companies provide also slightly higher coverage(s) for higher premiums.

2) Age limit : This insurance scheme is especially created for foreign long-stay visitors to Thailand above the age of 50.

At present, Thaivivat Insurance and Pacific Cross Health Insurance will only start initial coverage (first year insurance) up to the age of 74 years (younger than 75). Bangkok Insurance and Navakij Insurance will provide initial coverage up to the age of 79 years (younger than 80). Only Viriyah Insurance will initiate insurance up to age 99 years (at 249,900 baht premium rate).

Renewal of policies though is usually up to around 99 years old (not always explicitly mentioned though). Not mentioned by Navakij Insurance.

3) Insurance Premiums

1) for 61-65 years old insured persons (caution : insurance policies may differ somewhat between companies)

Viriyah Insurance : 59,150 baht
Navakij Insurance : 60,060 baht
Pacific Cross : 51,074 baht
Bangkok Insurance : 63,366 baht
Thaivivat Insurance : 59,000 baht

2) for 81-85 years old insured persons (mostly renewal only, but remember MANDATORY)

Viriyah Insurance : 145,500 baht
Navakij Insurance : N/A
Pacific Cross : available, but rates not published
Bangkok Insurance : 155,972 baht
Thaivivat Insurance : 120,000 baht

So, premiums are rather high, even for 61-65 years old persons, and rise with advancing age. If you need insurance in your 90's, the premiums rather approach the maximum coverage that can be obtained.

However, Thaivivat Insurance offers renewal of annual premium up to the age of 100 years at 120,000 baht (fixed rates between ages 76 and 100).

We can only say that the premiums are very high, for the limited coverage that is being provided.

Man in a wheelchair, Bangkok

Using a wheelchair in Bangkok is hard enough. But does your insurance company cover equipment like this? Check your policy

4) Room rates

While there is coverage provided up to 400,000 baht, that does not mean that all expenses up to 400,000 will be reimbursed. Most insurance companies mentioned here, have ceilings for costs incurred during hospitalization or outpatient treatment. We will just list the ceiling for room and board, as covered by different companies.

Viriyah Insurance : 2,500 baht
Navakij Insurance : 3,000 baht
Pacific Cross : 3,000 baht
Bangkok Insurance : see below
Thaivivat Insurance : 4,000 baht

What this means is that the room & board costs above the insured amount, will have to be covered by the patient himself. You may want to check the room rates at your preferred hospital to see what this means.

Now Bangkok Insurance is the only company here that uses the 400,000 baht maximum limit differently (correctly?). Room and board is included in the total costs of treatment, and might thus be totally covered.

5) Surgical fees

Same comments as at 4)

Viriyah Insurance : 100,000 baht
Navakij Insurance : 40,000 baht (!!!???) per disability
Pacific Cross : 100,000 baht
Bangkok Insurance : see comment at 4) Surgical fees are included in the maximum limit per policy year of 400,000 baht.
Thaivivat Insurance : Actual Costs (!), of course up to maximal limit of coverage only.

6) Outpatient visits

Every little bit helps insurance companies to increase their profits, and this is most visible with the coverage here for outpatient visits. There are limits per visit !!!

Viriyah Insurance : 1,400 baht
Navakij Insurance : 3,000 baht
Pacific Cross : 1,500 baht
Bangkok Insurance : maximum limit per policy year of 40,000 baht (no limit per visit mentioned)
Thaivivat Insurance : 2,000 baht

Just recently we went to an ENT specialist at a well known hospital in Bangkok. We ended up paying around 4,000 baht, which included a doctor's exam and medication. So from the above you can estimate what your additional expensed will be, with different insurance schemes.

Simvastatin generic drug

Generic drugs can be obtained at a fraction of the cost of 'brand name' drugs. However, only in pharmacies outside major hospitals.

7) Miscellaneous

a) Information provided by visiting the websites is preliminary. There will certainly be exclusions of certain diseases, exclusions of pre-existing conditions, waiting period after the policy has started for certain conditions etc. Your insurance premium and the conditions excluded in your particular case, will be individually determined.

b) At least one company insures only citizens from certain nationalities (Navakij Insurance)

c) Navakij Insurance and Pacific Cross mention they provide coverage up to 400,000 baht per year per DISABILITY. The other insurance companies (Viriyah Insurance, Bangkok Insurance, Thaivivat Insurance) seem to state that the maximum total limit per year is 400,000 baht. This can make a HUGE difference.

 

Conclusions :

Overall, we find these recent developments unsatisfactory.

1) We are in favor of everybody having health insurance, though not necessarily the way it is being suggested here.

2) The amounts lost by medical service providers, seem to rather modest, not necessitating making health insurance mandatory. We however suspect that there are some errors in the data provided by health authorities.

3) The premiums are high, and the coverage is low. Some restrictions are rather pathetic (like the limit covered per outpatient visit). Even when paying the high premiums, you can be expected to pay additional costs for any substantial surgical intervention.

4) Above age 75 and especially above age 80, it will be difficult to apply for a new health insurance, and then only when paying rather exorbitant premiums, in the end approaching the maximum coverage you can get. So, we can assume, that some really old persons, are going to be forced out of the country eventually.

4) There is no insurance company that really stands out as being the best value. All offer somewhat different policies, at least we can say that there is no significant collusion here.

5) We actually have a health insurance with one of the companies reviewed here. The interesting thing here is that we pay just about 20 % more for our age group as mentioned in this particular insurance scheme, while potentially getting much higher benefits. But we have room and board coverage up to 10,000 baht, and a maximum coverage per disability of 10,000,000. So this is a huge difference, and we do not quite know what is going on here with this government initiated insurance scheme.

In any case, you may want to look into trying to get a 'regular' health insurance, with any of the insurance companies that provide such. You may make a better deal.