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Tony Dabbs

What are you getting?

Understanding health and accident insurance

1st June 2009

In order to help you understand "health and accident" insurance in Thailand a little better, I am going to tear down the Ajarn.com Group policy for you and then put it back together.

Keep in mind that health and accident insurance is tightly regulated by the Thai government and the structure of each policy sold here is quite similar. All "health" insurance plans sold here cover accidents also (including motorcycle accidents).
But we shorten the name to "health insurance" because many of us, me in particular, are too lazy to say, ‘health and accident insurance that also covers treatment for motorcycle accidents." All "health insurance" plans do that.

Bupa seems to be the daddy of health insurance companies in Thailand. All of the other health insurance companies operating here now came after Bupa was already established here. So the "new kids" came in and designed their benefit and price structure in an attempt to compete against the "big guy." But that's another story.

The Ajarn.com Group is underwritten by Thai Health Insurance. Under this group we can now offer you both the AH4000 and the AH6000. These 2 plans are exactly the same as THI's WH4000 and WH6000. The only difference is in the premium.

With group insurance the premium is calculated based on the number of participants in the group. If the claims for the group exceed the annual premium for the group, everyone in the group will receive a premium increase no matter whether they had a claim or not

With personal insurance the premium is calculated based on the insured's age. If the insured has high claims, exceeding the insured's annual premium, the insured's renewal premium will be increased. If no claims, the premium will just be increased when the insured moves up into a higher premium age band - every 5 years. (Or, when the insurance company increases the premium across the board for all insureds).

Beyond the differences in premium calculation and the fact that the group administrator is the owner of the group insurance policy, while personal insurance is owned by the insured, the coverage of the two is structured exactly the same.

As I stated earlier, the Ajarn Healthy (AH) group insurance plans are exactly the same as the Wealthy Healthy (WH) personal insurance plans. The fact is, though, Wealthy Healthy is really just a combination of Simply Healthy (SP) basic hospital inpatient coverage and Maxi Healthy (MP), major medical insurance that has a deductible (excess) that has to be satisfied first before the insurance starts paying. Once the deductible is satisfied it then pays 90% of the medical costs up to the plan maximum. Major medical provides a good low cost way to increase insurance coverage.

Next time I will break down and explain the actual structure of a health insurance policy.

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Tags: health issues health insurance coverage health insurance policies health insurance regulations health insurance companies health insurance