Health Insurance for Expats in Thailand
TL;DR: Private health insurance is primary option for expats. IPD (inpatient) vs OPD (outpatient) coverage determines benefits. Direct billing networks allow cashless treatment. SSO provides basic medical benefits for employed workers. Always verify insurers/brokers via OIC licensing before buying.
Before You Start
Your Coverage Options
- Private health insurance: Buy from OIC-licensed insurers/brokers
- Social Security Office (SSO): If employed with legal work permit + contributions
- Employer group plans: May offer better rates than individual policies
- International policies: Worldwide coverage including home country
Budget Planning
- Basic Thai coverage: 15,000-50,000 THB annually
- Comprehensive Thai: 50,000-150,000 THB annually
- International policies: 100,000-500,000 THB annually
- Deductibles: Higher deductibles = lower premiums
Coverage Basics: IPD vs OPD
Inpatient (IPD) Coverage
What it covers:
- Hospital room and board (private/semi-private/ward)
- Surgical procedures + specialist fees
- Emergency room + intensive care (24/7)
- Diagnostic tests (MRI, CT scans, lab work)
- Operating room costs
Key limits to check:
- Annual maximum per policy year
- Per-incident maximums
- Room rate limits (e.g., 3,000-10,000 THB/day)
Outpatient (OPD) Coverage
What it covers:
- Doctor consultations (GP + specialists)
- Diagnostic services (X-rays, blood tests)
- Prescription medications (usually with co-pay)
- Preventive care (annual check-ups, vaccinations)
- Physical therapy, alternative treatments
Common sub-limits:
- Annual OPD maximum (often 50,000-200,000 THB)
- Per-visit limits
- Medication co-payment percentages
Direct Billing Networks
How Direct Billing Works
- Present insurance card at network hospital reception
- Hospital verifies coverage with your insurer
- Pre-authorization obtained for major procedures
- You pay only: co-payments, deductibles, non-covered items
- Hospital bills insurer directly for covered treatments
Confirming Hospital Participation
- Check with insurer: Call customer service for current network list
- Hospital verification: Ask hospital billing if they accept your specific policy
- HAI accreditation: Verify hospital quality via Healthcare Accreditation Institute
- Emergency situations: Most insurers cover non-network emergencies (verify policy)
Network Quality Indicators
- JCI accreditation: International hospital quality standard
- Thai hospital accreditation: Verified through HAI database
- Specialist availability: Ensure network includes specialists you need
- Geographic coverage: Network hospitals in your area
Buying Channels & Verification
Licensed Sources Only
Before buying, verify via Office of Insurance Commission (OIC):
- Insurance companies: Check company licensing status
- Brokers: Verify broker license and authorization
- Online platforms: Ensure platform uses licensed insurers/brokers
Red flags:
- Unlicensed agents offering "special deals"
- Pressure to buy immediately without review time
- Policies without clear Thai regulatory approval
SSO Benefits for Employees
Eligibility: Legal employment + monthly SSO contributions
Coverage includes:
- Basic medical care at designated SSO hospitals
- Limited specialist services
- Emergency treatment
- Work-related injury coverage
Limitations:
- Network restrictions: Specific SSO-contracted hospitals only
- Service levels: Basic care; private insurance often needed for comprehensive coverage
- Verification: Check benefits via Social Security Office
Claims Process & Documentation
Pre-Authorization Requirements
When required:
- Non-emergency hospital admissions
- Surgical procedures
- Treatments exceeding certain amounts (varies by policy)
- Specialist consultations (some policies)
Process:
- Hospital/doctor submits pre-auth request to insurer
- Insurer reviews medical necessity
- Approval/denial communicated within 24-48 hours
- Treatment proceeds if approved
Reimbursement Claims
Required documents:
- Original medical receipts
- Doctor's reports/diagnosis
- Completed claim forms
- Prescription details
- Hospital discharge summaries (for IPD)
Submission:
- Deadline: Usually 30-90 days from treatment date
- Processing time: 7-21 business days typical
- Payment: Bank transfer or check
When Claims Are Denied
- Review denial letter for specific reasons
- Appeal process: Most insurers have formal appeal procedures
- OIC complaint: Use OIC hotline 1186 for unresolved disputes
- Documentation: Keep all medical records and correspondence
Pre-Existing Conditions & Exclusions
Disclosure Requirements
Must declare:
- All current medical conditions
- Previous surgeries/hospitalizations
- Ongoing medications
- Family medical history (for some policies)
Consequences of non-disclosure:
- Claim denials
- Policy cancellation
- Permanent exclusions
Waiting Periods
- General waiting: 30-90 days for basic coverage
- Pre-existing conditions: 1-2 years typical
- Maternity: 10-12 months
- Dental: 6-12 months
Common Exclusions
- High-risk activities: Extreme sports, motor racing
- Cosmetic procedures: Unless medically necessary
- Experimental treatments: Not yet proven effective
- War/terrorism: Check policy specifics
Where to Verify Information
Office of Insurance Commission (OIC):
- Website: oic.or.th
- Consumer hotline: 1186
- Services: License verification, complaints, consumer protection
Social Security Office (SSO):
- Website: sso.go.th
- Services: Benefit verification, contribution history, hospital network
Healthcare Accreditation Institute (HAI):
- Website: ha.or.th
- Services: Hospital accreditation verification, quality standards
Need Insurance Help? Our team connects you with licensed brokers who can compare plans from multiple insurers and explain direct billing networks. Contact us for personalized guidance.