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.
Under the new system the policyholders will share a portion of medical expenses, unlike the traditional all-inclusive plan in which all costs within the limits of the policy are fully covered.
After the pandemic increasing healthcare costs and incidences of policyholders making unreasonable claims for common illnesses led the insurance regulator and insurers to consider an appropriate solution to manage rising costs and ensure continued insurance options.
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) had announced in February 2025 that a co-payment clause will apply to policy renewals and new policies to be issued from 20 March 2025, though it is likely to affect only 5% of health insurance policyholders.
According to TLAA, co-payment will be triggered by specific conditions. If policyholders make three claims for common medical conditions such as a headache, influenza, diarrhoea, muscle inflammation, gastroesophageal reflux, amounting to 200% of the annual insurance premium, they will be subject to co-payment in the subsequent year.
Those who make three claims for general diseases with the total amount reaching 400% of the annual premium are also subject to co-payment in the subsequent year.
For those who match one of these two criteria, the policyholder is subject to a 30% co-pay for any medical cost in the subsequent year, whether it is related to simple, general or critical diseases. If the policyholder falls into both categories, the co-pay is 50% for any medical cost the subsequent year.
TLAA president Nusara Banyatpiyaphod said co-pay, however, will not apply to major surgery or critical illnesses.
Medical inflation of 15% is well above the general consumer inflation rate and is driven by an ageing population, emerging diseases, air pollution, medical advancements and healthcare system structures.
Office of Insurance Commission secretary general Mr Chuchat Pramulpol said the health insurance premiums have been increasing continuously, averaging around 3%-5% per year, due to many factors, such as inflation and higher insurance costs, which have caused people to have more difficulty accessing health insurance.
Mr Pramulpol said, “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.