The Office of the Insurance Commission (OIC), Thailand's insurance regulator and the Consumer Council (council) have jointly reviewed the copayment measures to ensure fairness in health insurance, emphasising that it must not affect consumers. It also accelerated the dissemination of correct information and will take legal action against those who provide inaccurate information.
During the meeting, the OIC was represented by deputy secretary-general for insurance business supervision Aphakorn Panlert, assistant secretary-general for benefit protection Khananusorn Thiangtrakul and assistant secretary-general insurance product supervision Paiboon Piemmetta.
In the meeting, the criteria for copayment expenses in the terms of contract renewal upon the renewal of the insurance policy was proposed. In the discussion, the council expressed its concern about the possible burden of expenses for the public, especially vulnerable groups, low-income earners, the elderly and chronically ill patients who may be affected by the enforcement of the regulation.
The council requested the OIC review and delay the enforcement of the regulation.
According to Mr Panlert, the adjustment of the criteria for collecting co-payments has been considered thoroughly and comprehensively. The criterion are not only to control expenses, but also to take into account the impact on the quality of life of the public as a whole, to prevent and solve the problem of being rejected for health insurance renewals by policyholders with high claims and to control insurance costs from:
- Case 1: Reimbursement for inpatient treatment for minor diseases (simple disease) without the need for hospitalisation more than three times and with claims for more than 200% of the annual premium, or
- Case 2: Reimbursement for medical expenses from hospitalisation as an inpatient for more than three times and with claims for more than 400% of the annual premium. In this case, insurance companies can set the co-payment in each case not exceeding 30% of the covered medical expenses.
If both cases are met, the co-payment can be set to not exceed 50% of the covered medical expenses, to promote appropriate use of health insurance rights and control overall costs.
The OIC also stated that it is ready to listen to opinions and suggestions from all sectors in order to find a solution that is appropriate for all parties.
In addition, it explained that some problems with the copayment measure are due to consumers’ misunderstanding from the information and sales pitches of insurance agents. It was emphasised that the copayment in the terms and conditions of contract renewal was not applicable to all policies, but is only one option for purchasing health insurance.
Additionally, the original insurance products that were previously available will not be cancelled. In order to prevent misunderstandings about information that appears on various online media, the OIC will publicise correct information and undertake strict punishments against insurance agents who provide inaccurate information or mislead consumers.
“The OIC places importance on publicising accurate information about the copayment measure and other health insurance products to provide consumers with clear information and reduce misunderstandings,” said Mr Panlert.
“In addition, there are strict measures to inspect and control the sale of health insurance, especially the provision of information by insurance agents, to prevent miscommunication and pressure on consumers in making decisions.”
Mr Panlert added, “The OIC and the Consumer Council will jointly discuss the control of medical treatment prices, medicines and medical supplies to prevent overpricing and reduce the burden on the public. The OIC would like to thank all parties involved in the discussion and will consider all suggestions to create cooperation in developing laws and policies that will benefit consumers in the future.”