When securing a health insurance plan in Thailand, be sure to confirm with your insurance broker what the exclusions are. You do not want to be caught in a situation where you make a claim only to be told by your insurer that owing to one or more exclusions your claim is invalid; for the insurer to inform you in this manner will come as a nasty surprise indeed.

So for those that are unaware of what it means, a health insurance exclusion refers to cases in which the company does not provide coverage. These are conditions that are excluded from the insured event to avoid losses to the insurance company. A very obvious reason.

Exclusions in Thailand can vary from insurer to insurer so it is important to check directly with an expert insurance broker to avoid any naive mistakes and misunderstandings.

In this article by Pacific Prime Thailand, we will look at 3 common health insurance exclusions that you should be aware of when securing a health insurance plan. In addition, we will provide sources to other exclusions that potential policyholders will need to be aware of.

However, to be completely clear, there are also a number of insurers in Thailand that will review case by case and offer options that would otherwise go against particular exclusions. Of course, there’s usually a catch, such as upgrading to an exclusive bespoke policy, paying an extra premium, or entering a moratorium. So without further or do, please see below for our view on exclusions.

Age

If you are 60 and planning to stay long-term as an expat, or you are a local native Thai seeking general health insurance,e warned that looking for suitable coverage may prove to be a real challenge in today’s market.

To be quite frank, insurance companies when considering potential customers will take into account your age when creating a quote. Also, many insurance plans will not accept new customers over a certain age – often 60 to 70 years old and above is the typical cut off range in Thailand. The logic is simple, you are more prone to an accident when you are older such as fall resulting in hospitalization, which therefore increases the chances of you claiming. Additionally, the older you are the more likely you’ll develop chronic conditions that require ongoing care, hence why insurance companies will tend to impose age limits of around 60 – 70 years old on policies.

On the bright side, what is worth noting is that a few of our partners actually support this demographic and offer plans for those above 70 too, the challenges and difficulties remain such as higher premiums, additional documentation, and further conditions to be met. Potential policyholders should take advantage of the limited companies around such as Axa Thailand and Pacific Cross Insurance. Such companies will fully review your medical conditions past and present, then consult on what would be the best policy for you to be on. We will explore more in the following paragraphs.

Pre-existing conditions

Generally, most private health insurers create policies to cover new medical conditions that arise after the insurance policy start date. Past medical conditions that policyholders have had prior to when the insurance policy starts is known as a ‘pre-existing condition’. Definitions vary depending on the insurer; a pre-existing condition can refer to any of the following:

• An undetermined existing condition, in which the person is unaware of, for example, a lump or tumor in the body.
• A past illness or form of injury regardless of when and where it occurred that the person has since recovered from, such as an arm fracture from competing in rugby at school.
• Ongoing treatments being received from a medical setting for current conditions such as therapies or blood transfusions.
• Symptoms that have yet to be diagnosed by a medical professional and thus require treatment such as, pains and bleeding.

In Thailand, there are 3 options that health insurers will choose when reviewing an application for \policyholders with pre-existing conditions: exclusions, loading, and moratorium. Additionally, there is a fourth option but this is limited to group health insurance, medically disregarded history.

The most common approach is to exclude the treatment for that condition and all related symptoms from coverage under the policy. What this means is that insurers will allow the recipient to take out the policy. This will cover new medical issues that arise for treatment but they will not be indemnified for medical issues related to their pre-existing condition(s).

The second option which insurers may opt to use is to apply a moratorium on the coverage of the condition. A moratorium is what we call a ‘waiting period’, normally 24 months, during which the condition cannot be covered under the policy. What this means is if during that period, the policyholder does not seek treatment or medication for that condition then the insurer may consider providing coverage for the condition under the policy. This gives policyholders a guarantee that their condition will be covered in the future, however, the catch is that they have to complete the payment terms fully in advance.

Next is loading, where insurers may only offer to cover the condition, on the basis that the policyholder pays higher premiums. Do take note that not all insurers will provide cover for pre-existing conditions simply by increasing the premium. Insurers will review case-by-case and extensively too, so get in contact with Pacific Prime Thailand’s team of advisors for more information.

Overall it is worth noting that the degree in which pre-existing conditions will be accepted will vary according to the insurer and health insurance plans. Check out our health insurance partners and speak to our team for support relating to your pre-existing condition(s) inquiries.

Cosmetic surgery

This exclusion is fairly obvious but is worth discussing. Across the board, all health insurance policies in Thailand – and elsewhere for that matter – will stipulate that cover is for new medical issues arising from accidents or from an undetermined event only. Virtually all cosmetic surgeries are categorized as elective.

Consequently, the policy will not cover the cost of elective surgery such as cosmetic procedures that aim to permanently change the aesthetics required at the person’s personal request. Common examples are nose jobs, face lifts, genioplasty, breast augmentation, and so forth. Thus any procedure that results in the change in image and function of a person’s physiology will not be covered in the policy.

However, there is one condition under which cosmetic surgery expenses are covered. This is when surgery is done to correct a facial distortion caused by an accident that may affect the person’s chances of survival, functionality, or standard of living.

Other important exclusions to check out

In addition to the above 3 exclusions, there are a number of other items that Thai insurers will exclude from their policies or scrutinize, namely:

• Natural disasters, extreme sports, etc.
• Maternity care
• Fertility treatment
• Health insurance coverage outside of Thailand
• Miscellaneous hospital charges
• Motorcycles and alcohol
• Dental and Optical Services

Of course, each one will be considered on an individual basis and insurers will offer options to appease potential policyholders without turning down the chance for them to attain health insurance. Check out our past article and blog for further information.

If you have any questions, be sure to get in touch with our friendly team at Pacific Prime where our experienced brokers can provide impartial health insurance advice.