Ajarn group health insurance

On the 15th of October the Ajarn.com Teachers Group is renewing for another year. Anyone wanting to join or renew, should do so now. There is a choice of 3 plans.

Plan 1, is for 4,000 baht hospital Room and Board. The premium is 12,966 baht. Plan 2, provides 4,000 baht Room and Board plus 3,000 baht per doctor visit out patient (OPD) care and 30,000 baht per year x-ray & lab tests. The premium is 33,061 baht. Plan 3 provides 6,000 baht Room and Board. The premium is 19,123 baht.

More information about these plans and how to apply can be found elsewhere on this website. The purpose of this article is to provide you with some insight about the coverage and help you decide whether this is for you, or not.

The main advantage of purchasing group insurance is the cost. The premium is normally much lower than the premium would be if you bought your own personal policy with the exact same coverage. For many people, the low cost of group insurance allows them to purchase a much higher level of "peace of mind" than they could otherwise afford.

With group insurance, though, you don't own the policy and you are sharing the same "money jar" with a large number of people. If some of the other people in the group draw too much money out of the "money jar" (have high claims) your premium next year could increase dramatically, even if you have never used the insurance. Fortunately, this hasn't happened, so far. By the same token, though, if you are one of those with high claims, your premium would probably increase much less than if you were insured under your own personal policy.

The Ajarn.com Group offers two choices of Daily Room and Board (including nursing care): 4,000 baht per day and 6,000 baht per day. 4,000 baht per day is adequate for most hospitals in Thailand. But it is not enough to cover the full cost of a room at some of the more popular "expat hospitals"; in particular, the Bangkok Group of hospitals. It can get you into a 2 bed or 4 bed room at Bumrungrad, though. On the other hand, 6,000 baht per day should be adequate room and board coverage for most of the top rated hospitals that are popular with expats.

The room and board limit in your insurance coverage includes the cost of room, food, nursing care and any service fee for the room. If you check with a hospital to determine whether your coverage is adequate enough to cover the full cost of their room, make certain that the room charge they quote includes all of the things that I just mentioned. One very well known hospital in Bangkok likes to quote only the basic room charge (4,000 baht) , without mentioning that there is in an additional 2,000 baht charge for food, nursing care and service. If the Room and Board maximum in your coverage is not adequate, you have to pay the difference yourself.

Actually, Room and Board is not the major expense in a hospital stay, unless you have to stay for a very long time and require constant medical supervision.

For most patients, the General Hospital Expenses (GHE) can easily be the most costly part of a hospital stay. That's because they include the cost of nearly everything needed to treat you and get you well, including the cost of an ambulance to get you to the hospital. Plans 1 & 2 provide 40,000 baht coverage and Plan 3 provides 60,000 baht GHE coverage. When the GHE maximum is exceeded, the Major Medical in your plan takes over and starts paying 90% of your additional GHE costs until the Major Medical maximum is reached.

Major Medical also takes over and starts paying 90% when the maximum coverage for Surgery has been exceeded. The Surgery maximum in Plans 1 & 2 is 60,000 baht.
The Surgery maximum in Plan 3 is 90,000 baht.

The Major Medical maximum in Plans 1 & 2 is 400,000 baht. In Plan 3, the Major Medical maximum is 600,000 baht. Major Medical only covers your hospital inpatient (IPD expenses. It doesn't cover any outpatient (OPD) expenses.

I mention this because your General Hospital Expense coverage also pays some costs for Emergency Accident Outpatient (OPD) care (Plan 1 & 2 up to 8,000 baht and Plan 3 up to 12,000 baht). And GHE also pays for the 30 Day Outpatient Follow-up care after release from the hospital. If your GHE gets used up in the hospital, there might not be enough to cover your Outpatient follow up care.

The Ajarn.com Group plans provide very good value for the money. The coverage is good, but don't expect it to be perfect. We represent all of the health insurance companies in Thailand and a few International ones - none are perfect. But, Thai Health Insurance (THI) is among the best when it comes to quick settlement of claims.

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