Thailand’s Health Insurance Industry Set for Transformation with Co-Payment Rule
Bangkok, Thailand – A new co-payment rule is poised to reshape the health insurance landscape in Thailand, addressing rising medical costs and unsustainable claims practices. The policy, slated to take effect on March 20, 2025, will introduce a cost-sharing mechanism for policyholders, marking a shift from the traditional all-inclusive plans that have been common in the country.
Under the new system, policyholders will share a portion of their medical expenses, a departure from the previous model where most costs within policy limits were fully covered. This move comes in response to several factors:
The new co-payment rule for the Thai health insurance policyholders is expected to transform the country’s health insurance industry which has been affected by rising medical costs, challenging economic conditions and unnecessary claims. The new rule is slated to take effect from 20 March 2025.
- Rising Healthcare Costs: The cost of medical care has been increasing significantly.
- Unnecessary Claims: Some policyholders have been making excessive claims for common illnesses.
A recent study by Willis Towers Watson found that Thailand has the highest average rate of medical inflation in the world. While the global and regional average was 10% last year, Thailand’s rate of medical inflation grew by 8-15%, driving up insurance costs.
The Thai Life Assurance Association (TLAA) announced in February 2025 that the co-payment clause would apply to policy renewals and new policies issued from March 20, 2025. The association estimates that only about 5% of health insurance policyholders will be affected.
According to the TLAA, co-payment will be triggered under specific conditions:
- Frequent Claims for Common Illnesses: If a policyholder makes three claims for common conditions, such as headaches, influenza, or gastroesophageal reflux, and the total amount claimed reaches 200% of the annual premium, they will be subject to co-payment the following year.
- Significant Claims for General Diseases: If a policyholder makes three claims for general diseases, reaching 400% of the annual premium, they will also be subject to co-payment the following year.
For those meeting either of these criteria, the policyholder will be responsible for a 30% co-pay for any medical costs incurred in the subsequent year, regardless of whether the condition is simple, general, or critical. If a policyholder meets both criteria, the co-pay will be 50%.
TLAA president Nusara Banyatpiyaphod clarified that the co-payment would not apply to major surgeries or critical illnesses.
Medical inflation, running at 15%, significantly exceeds the general consumer inflation rate. Several factors contribute to this rise, including an aging population, emerging diseases, air pollution, advancements in medical technology, and the structure of the healthcare system.
Office of Insurance Commission (OIC) secretary-general Mr. Chuchat Pramulpol noted that health insurance premiums have been steadily increasing, averaging 3-5% per year, due to inflation and higher costs. This trend has made it more difficult for people to access health insurance.
Mr. Pramulpol explained, “This copayment policy is not to benefit insurance companies, but rather to help slow down the increase in health insurance premiums from rising too quickly compared to the rising inflation rate, which truly benefits policyholders, promotes balance in the health insurance system, and reduces the impact on policyholders who exercise their rights as needed, as well as helps the sustainability of Thailand’s health insurance system in the long run.”
