The Thai Life Assurance Association 'clarifies' health insurance practices: "Copayment in the renewal conditions in the case of insurance policy anniversary (Renewal)"

Mrs. Nusara (Assakul) Banyattipiyaphon, President of the Thai Life Assurance Association, revealed that in 2024, Thailand had a medical inflation rate as high as 15% (referring to WTW), which is significantly higher than the general consumer inflation rate. The main factors that caused medical expenses to increase include entering an aging society, emerging diseases, air pollution, medical advancements, and the structure of medical expenses. The increase in health care expenses has resulted in a continuous increase in health insurance claim rates. Therefore, it is a major challenge that the insurance industry must plan carefully to cope with, especially from the current situation where health insurance claim rates are continuously increasing due to common minor illnesses.

In addition, under the new health insurance standard or "New Health Standard" that was enforced in 2021, life insurance companies are ready to continuously take care of the insured, helping to build confidence in the insured, which resulted in the previously calculated insurance premiums being insufficient to cover the medical expenses incurred, which may directly affect the health insurance system. This leads to the adjustment of insurance premiums for the entire portfolio, which means that people cannot access health insurance, affecting the overall public health system of the country. Therefore, the insurance sector must plan to deal with this challenge carefully so that health insurance can truly help reduce risk and ease the burden of medical expenses for the people.

The insurance sector has therefore introduced copayments under the new health insurance standard or "New Health Standard" as a condition for renewal of insurance policy anniversary (Renewal) to reduce claims from hospitalization that exceed medical necessity, which will affect the adjustment of insurance premiums for the entire portfolio. Copayments help create sustainability for the insured under management that complies with medical standards and medical necessity, excluding major surgery or serious illnesses.

The criteria for entering the copayment health insurance guidelines in the conditions for renewal of insurance policy anniversary (Renewal) are divided into 3 cases: Case 1 Claims for non-serious illnesses or symptoms that do not require hospitalization Minor illnesses (Simple diseases) or symptoms without complications, do not require hospitalization By claiming more than or equal to 3 times per policy year and the claim rate is more than or equal to 200% of the health insurance premium, you must co-pay 30% of all treatment costs in the following year.

Case 2: Claims for general diseases, excluding major surgery and critical illnesses, by claiming more than or equal to 3 times per policy year and the claim rate is more than or equal to 400% of the health insurance premium, you must co-pay 30% of all treatment costs in the following year. Case 3: If the conditions in both Case 1 and Case 2 are met, you must co-pay 50% of all treatment costs in the following year.

When the insured meets the copayment conditions in the next renewal year, the insured must co-pay 30% or 50% according to the proportion specified in the medical expenses. However, if the claim has decreased and does not meet the copayment conditions, the insurance company will consider canceling the copayment. The said policy will return to its normal status in the following year.

However, the Thai Life Assurance Association recommends that the public study more details about these measures for the maximum benefit of the insured. Health insurance remains a good tool for managing the risk of medical expenses because in practice, copayments in renewal conditions on the policy anniversary date (Renewal) are not easy to occur because such conditions have sequences, steps, counting, and consideration, which are multi-layered filters. The company will inform the details in the health insurance contract renewal notification letter.

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