Ricky Batten

Understanding medical insurance

What does the small print all mean?

Most medical insurance sold in Thailand, including medical insurance riders found on life insurance, is formed around Basic Hospital Inpatient Coverage, which is broken down into four areas of coverage: 

  1. Daily Room and Board
  2. Hospital General Expenses
  3. Surgery
  4. Inpatient Doctor Visits

1. Every Thai-based medical insurance plan has a fixed limit on the amount of Daily Room and Board coverage that plan will provide. This daily limit also includes the cost of nursing care and any hospital service charge. If you shop for a hospital whose daily room and board charge matches your coverage, make sure that their daily room and board charge also includes the cost of daily nursing care and any service charge for the room so that you avoid any unexpected charges.

Insurance companies will normally pay up to double the daily room and board coverage for a stay in the ICU (Intensive Care Unit).

If you want to stay at one of the hospitals popular with medical tourists and local expats, expect the cost to be about 6 to 8 thousand baht per day. The majority of the hospitals in Thailand, though, charge less than 3 thousand baht per day.

2. Hospital General Expenses can be the most costly part of a hospital stay and can eat into the limits of your coverage very quickly. These include diagnostic tests, special consultant fees, medications, bandages and dressings, emergency outpatient care, ambulance and much more.

3. The cost of Surgery can be another expensive drain on your coverage. So make sure that your coverage for surgery is adequate to cover the cost of most common operations. You also need to be aware that there are two types of surgery coverage, Actual Cost and Surgery Schedule. Actual Cost pays 100% of the actual cost of the surgery up to the limit of the Maximum Coverage. Surgery Schedule pays a percentage of the Maximum Coverage determined by a surgery schedule that is standard within the industry. It pays 100% of the coverage maximum for major surgeries and less for more minor ones.

4. Inpatient Doctor Visits covers payment to the doctor for visiting you once a day in your hospital room. The amount of coverage is determined by the plan you choose.

The benefits shown above make up what is called Basic Hospital Inpatient coverage. They provide 100% coverage up to limit in the plan you chose. When each limit has been exceed that area of coverage stops. The main problem is with Hospital General Expenses and Surgery. Daily Room & Board and Inpatient Doctor Visits can only used up over a long period of time. Coverage for General Hospital Expenses and Surgery, though, can be wiped out almost immediately if you don't have adequate coverage.

This is where Major Medical coverage steps in, if your plan has it. The Major Medical coverage rides on top of the Basic Hospital Inpatient plan and pays 80% or 90% of any additional Hospital General Expenses costs and Surgery costs up to the plan's Major Medical Maximum. You pay the other 10% or 20% yourself

Under the Ajarn.com coverage the Major Medical pays 90% .

For more information on medical insurance in Thailand, please feel free to reach out to Pacific Prime Thailand Insurance Brokers, or email Walter directly at walter@pacificprime.com


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