Walter van der Wal

Health insurance exclusions

Addressing the elephant in the room


One of the most common mistakes I often see people make is skimming through their health insurance T&Cs without properly reading the exclusions section - which details what their plan won't cover. 

Virtually every health insurance policy on the planet will have scenarios, treatments, and conditions that they won't cover, so it pays to familiarize yourself with your plan's exclusions so that you're not caught off guard by any nasty surprises further down the line.

Insurance jargon can, however, often seem like a foreign language; hence why many people are put off by the prospect of reading their policy details properly. To help, I've taken the liberty of uncovering the below most common health exclusions to look out for. 

1. Pre-existing conditions

This term describes any ailments, conditions, or injuries that you currently/previously suffer(ed) from or received treatment for before joining your plan. Pre-existing conditions are, in most cases, automatically excluded from coverage. 

The most obvious reason why insurers automatically exclude pre-existing conditions is because there's a significantly higher chance that you, as a policyholder, will submit claims for care related to conditions that you already have and need ongoing care for. 

To be clear, there are a number of insurers who will cover your pre-existing conditions, but there's usually a catch (e.g. you'll have to pay an extra premium/loading). 

2. Cosmetic surgery

This might be an obvious one, but it's definitely worth mentioning. Many of the questions I get asked are related to health insurance coverage and cosmetic procedures like nose jobs, breast augmentation, face lifts, eyelid surgery, etc.

As a general rule, health insurance plans in Thailand - and everywhere else for that matter - won't cover elective surgery (i.e. procedures that are scheduled in advance, and are not deemed as medical emergencies). Virtually all cosmetic surgeries are classified as elective, and are consequently excluded from health insurance coverage.

Cases where this may not be true are where an accident causes a major physical deformity, and cosmetic surgery is deemed medically necessary for the benefit of the patient’s quality of life.

3. Assisted reproductive treatment

While comprehensive health insurance plans might cover infertility investigation, almost all health insurance plans will exclude assisted reproductive treatment like in-vitro fertilization. There are a small number of international health insurance plans, however, that do allow for fertility treatment coverage, but they will usually come with certain restrictions (e.g. a long waiting period of 18+ months or more). 

4. Miscellaneous hospital charges

If you've ever stayed overnight at a hospital before, you're likely aware that hospital bills will often list extra charges that are not classed as medical procedures or boarding fees. These include things like telephone calls, guest meals, etc. While these miscellaneous charges are typically excluded from cover, in most cases your health insurance plan will cover the main costs of hospital treatment, such as room and board fees, lab tests, surgery charges, etc. 

5. Certain scenarios and activities 

Virtually all health insurance plans will exclude injuries/illnesses arising from scenarios and activities like:

  • Intentional self-harm 
  • Hazardous use of alcohol/drugs
  • Participation in criminal acts
  • Professional sports
  • War and terrorist acts

6. Health insurance coverage outside of Thailand

Those with a local Thai health insurance plan will likely have no coverage outside of the Land of Smiles. If you travel frequently in Southeast Asia or further afield, I'd recommend buying an international or Southeast Asia health insurance plan, so that you have access to benefits without boundaries. 


If you any questions about health insurance in Thailand, get in touch with my team, or visit Pacific Prime Thailand's website, blog, and resources page today. 




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