OIC joins hands with partners to consider Copayment criteria, conditions for insurance contract renewal, in the case of the anniversary of the insurance policy of the health insurance contract. The copayment will be effective only in the following year.

Mr. Chuchat Pramulpol, Secretary-General of the Insurance Commission (OIC Secretary-General), revealed that the meeting of the Consumer Protection and Insurance Participation Committee for the year 2025 was to consider the criteria for copayment in the conditions for insurance contract renewal, in the case of the anniversary of the insurance policy of the health insurance contract.

There were representatives from agencies including the Thai Insurance Business Council, the Thai Life Assurance Association, the Thai Insurance Brokers Association, the Life Insurance Agents and Financial Advisors Association, the Office of the Consumer Protection Board, the Department of Empowerment of Persons with Disabilities, the Department of Rights and Liberties Protection, the Redemptorist Foundation for the Development of Persons with Disabilities, and related agencies.

For this meeting, they jointly considered the determination of criteria for copayment in the conditions for insurance policy renewal, in the case of the anniversary of the insurance policy. The copayment will be effective only in the following year if the insured meets the following criteria: Case 1: Claims are inpatients. With a group of common minor diseases (Simple Disease) and no medical indications for inpatient treatment and with more than or equal to 3 claims and a total claim rate of 200%

"Case 2: Claims as inpatients, excluding serious diseases and major surgeries, with more than or equal to 3 claims and a total claim rate of 400%, in each case, the maximum Copayment ratio shall be set at no more than 30%. If both Case 1 and Case 2 are included, the maximum Copayment ratio shall be set at no more than 50% of the covered medical expenses in the following year. The determination of such ratio is the maximum. The determination of the ratio in each case will depend on the consideration of each company," said Mr. Chuchat.

The OIC will oversee the calculation of health insurance premiums and oversee the co-payment conditions to ensure fairness. The meeting agreed that insurance companies can add co-payment conditions in 3 cases to control inappropriate medical expense claim behavior. This will help prevent and reduce the abuse of rights to claim medical expenses. In addition, the issue of communication, public relations, and education about Copayment has been raised as an important and necessary issue that must be continuously implemented. All relevant sectors must integrate together by using various social media channels to communicate public relations so that the public has correct and comprehensive knowledge and understanding about Copayment, along with adjusting the communication format to use easy-to-understand language.

In addition, it must be communicated to life insurance agents and brokers to ensure that they have correct knowledge and understanding and not present incorrect information to the public. If found to have done so, the licenses of life insurance agents and brokers may be revoked. The OIC will use the suggestions received from the meeting to adjust its operations in order to control medical expenses and participation in copayment as efficiently as possible and to benefit the public in the long term.

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