Thailand has a two-tier health insurance system, comprised of both public and private cover. Most Thai citizens are covered under the UCS (Universal Coverage Scheme) and until recently this applied to expats as well. However, the system jas mpw changed with regard to some long term visa applications. We will look below at this revised approach to health insurance, and discuss some of your options.

The UCS is governed by the Department of Medical Services at the Ministry of Public Health. Employees have a monthly contribution deducted from their salary and will receive access to the public healthcare system, which is free at the point of delivery with the exception of Saturdays, when you will need to pay a charge.

Thai citizens are currently covered by three health insurance regimes. UHC is the primary insurer, also known as the 30-baht scheme, and covers 70% of the population, the underinsured or poor, at almost no cost.

The UHC costs account for 40% of all spending on public health care, which is generally considered to be excellent, with the USA’s CEOWORLD ranking Thailand in 6th place out of 89 nations. Its healthcare system is one of the best in Asia and it has a very high number of medical specialists: so high, in fact, that getting basic primary care treatment is said to be sometimes be more difficult than obtaining specialist advice.

Expats resident in the country used to be able to access public healthcare. However, the rules are changing both for visa applications and health insurance: some British and American expats applying for long term visas have recently been told that their respective embassies are no longer issuing confirmatory letters of their incomes, and it is necessary to prove your income in order to apply for a visa.

The Thai government has also insisted that compulsory private health insurance should be taken out if you are applying for the one-year Non-immigrant Visa "O-A" (Long Stay). They are particularly insistent that expats in a high risk category – those over 50 who are applying for Thai long-term non-immigrant visas – must have proof of health insurance. The country has been having to pay in the region of 500 million baht ($16.49 million) a year in medical bills for foreigners over 50, and it is increasingly reluctant to do so.

This should be a non-issue, since so many expats choose to take out private policies with international providers. However, the new rules initially stipulated that health insurance would only considered valid for visa purposes if it is obtained from a short list of three Thai-based and Thai-owned insurance companies. Hence, if you had private cover from one of the big international providers, it would no longer be any help in getting you a visa for Thailand.

Furthermore, some of the Thai cover is not only more expensive, but also covers a more limited range of treatment: a no-win situation which led to many expats threatening to leave the country. That has also been fuelled by the high charges in private hospitals.

After complaints from the country’s significant population of expats, the Thai government has stepped back some of these restrictions and now allows health insurance from international providers to count towards a long-stay visa application.

It has also now taken over partial regulation of private healthcare, imposing a colour-coded scheme on charges: termed green, red and yellow, with green being the least expensive and red being the costliest. Following the changes, 164 Thai hospitals are expected to come under this new government ruling in 2020 and be placed in the green category.

This is good news for the many expats resident in Thailand, but it is advisable to check with your local hospital and to keep a close eye on the forthcoming changes. The revisions to the healthcare system are not set in stone and may be changed again.

New regulations have been making health insurance more problematic for expats. If you are planning on working in Thailand, you need to discuss the issue of health cover with your new employer. Some employers may have group policies which will form part of your employment package.

The indication has been that if you are making contributory payments into Thai social security, which includes monthly contributions to the national health insurance, you should as an employee of a Thai-based company be able to access public healthcare. However, given the revisions to the system with regard to some expats, it is advisable at present not to continue to count on the possibility of being able to access public healthcare, unless you are prepared to pay out of pocket.

As an expat, you will not be able to join the state health insurance system although you should be able to access public healthcare if you are prepared to make out of pocket payments at a clinic or hospital.

The national scheme covers:

• primary care
• hospital treatment
• emergency treatment
• specialist consultations
• maternity care
• childhood illnesses

There have been increasing restrictions on people entering the country for retirement purposes and you will not be insured for public healthcare. You will therefore need to take out some form of private insurance.

As an international student you will not be able to access public health insurance and will need to take out private cover.

If you are obliged to take out private insurance, whether separately or as part of your employment package, then you will need to check that you have a policy which covers your dependents. Some local providers issue family policies.

As an expat you will not be eligible for public dental treatment unless you choose to pay out of pocket. However, costs are cheaper than in the USA and the kingdom is a destination for many forms of medical tourism, including dental care.

Local dental plans can cost in the region of 2,116.33 baht per year (US$68). A crown will cost in the region of US$600. A dental exam costs only around US$6. Tooth cleaning will cost about US$50.

The contribution rate is usually 5% on a basic salary capped at 15,000.00 baht (US$480). Employees and employers both have to contribute.

As above, you may be obliged to take out private cover due to the new restrictions and this may need to be with a local insurer. This does not prevent you from taking out insurance with an international insurer.

Private insurance will cover a range of primary and secondary care, including maternity and dental care, but if you take out insurance with a local provider you may find that it is hospital-specific, and may also have exemptions. It is also unlikely to cover you outside Thailand, and may impose an age limit.

However, hospital costs will be in the range of coverage from a local provider and local hospitals are accustomed to dealing with Thai insurance.

If you intend to take out cover with an international provider, it is worth considering a policy which has a medical evacuation clause.

Premiums from insurers such as Luma start at around 25,000 baht (US$800) per year. At Thai Health, premiums for 35-year-olds start from around 6000 baht (US$192) per year.

For a retirement visa application you will need a policy with coverage of at least 400,000 baht (US$13K) for hospital treatment and 40,000 baht (US$13K) for outpatient coverage.

Local and international health insurance provisions are available from providers such as:

• AETNA
• AXA
• Cigna
• Luma Health (local)
• LMG
• Pacific Cross

The three Thai providers referenced above are:

• Navakij Insurance
• Thaivivat Insurance
• Viriyah Insurance

UHC – Universal Health Coverage