Most medical insurance plans sold in Thailand, including those packaged with life insurance policies, focus on providing basic hospital Inpatient (IPD) coverage.
With IPD coverage, a doctor has to admit you to the hospital to stay overnight. To get you admitted, the doctor has to certify that you have a medical problem that requires you to stay in the hospital at least one night. (While some insurance plans only require that you stay in hospital for 6 hours, the insurance company is still required to pay the hospital for full 24 hour occupancy of your room).
Packaged with many hospital IPD plans is Supplemental Major Medical coverage. It helps to enhance your medical coverage while keeping the premium more affordable.
The 5 most important areas of health insurance coverage that you should be aware of and be able to evaluate for your own needs when purchasing health insurance are: 1) the maximum amount of coverage provided by the plan: 2) The Daily Room and Board benefit, 3)) The Hospital General Expenses maximum coverage, 4) The maximum coverage for Surgery and 5) The maximum payment per day for Inpatient Doctor Visits.
1. The Maximum Amount of Treatment Coverage provided by a plan can sometimes be a little confusing. Is the maximum coverage per disability, per year or for life? The maximum coverage is "per year" with most plans; But for some plans it is per disability. If they say per disability/per year, it just means which ever comes first. But what can really be misleading, though, is when a plan covers low daily charges for a longer period of time than most insurers and puts a lower limit on the maximum coverage for the fast-building hospital costs. If you totaled up the amount that they would be willing to pay for low, fixed daily costs, the maximum amount of coverage could appear to be quite high. Unfortunately, you could go broke having to pay the more costly charges that the plan didn't adequately cover.
2. Hospital Daily Room and Board Coverage also includes the charge for daily nursing care and any hospital service charge for the room. Every Thai-based medical insurance plan has a fixed limit on the amount of Daily Room and Board coverage that plan provides. (International plans generally don't have a fixed limit, but tend to be more costly). If you look around for a hospital where the daily room and board charge matches your R & B coverage, make sure that this charge also includes the cost of daily nursing care and any service charge for the room. 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, maximum The majority of the hospitals in Thailand, though, charge less than 3 thousand baht per day.
3. Hospital General Expenses can be the most costly part of a hospital stay and can eat into the limits of your coverage very quickly. General expenses include the cost for diagnostic tests, special consultant fees, medications, bandages and dressings, emergency outpatient care, ambulance and much more, including post-hospitalization follow-up out patient care
4. Surgery can be another costly 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 plan maximum for surgery coverage. Surgery Schedule pays a percentage of the plan maximum, determined by a surgery schedule that is standard within the industry. It pays up to 100% of the coverage maximum for major surgeries and a lower percentage for less major ones.
5. Inpatient Doctor Visits covers payment to the doctor for visiting you once a day in your hospital room. The amount of coverage you should need is predicable depending on the hospital you choose to use.
The benefits shown above make up what is called Basic Hospital Inpatient coverage. They provide 100% coverage up to the limits in the plan you chose. When each limit has been exceed, that area of coverage stops. Your main areas of concern should be Hospital General Expenses coverage and Surgery coverage. Daily Room & Board and Inpatient Doctor Visits costs are predictable and 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 supplementary Major Medical coverage steps in, if your plan has it. The Major Medical coverage rides on top of the Basic Hospital Inpatient plan and acts as back up coverage. It pays 80% or 90% (and sometimes 100%) of any additional Hospital General Expenses costs and Surgery costs up to the plan's Major Medical Maximum..