Thailand's insurance regulator, the Office of the Insurance Commission (OIC) organised the 1/2025 Consumer Protection and Insurance Participation Committee meeting to clarify the criteria of copayment on the terms and conditions for renewing insurance contracts in the case of policy renewals, chaired by OIC secretary-general Chuchat Pramulpol.
In the meeting, it was established that in the case of policy renewals, the copayment will be effective only in the following year if the insured meets the following criteria:
Case 1: Claims for inpatients with common minor illnesses and no medical indication for inpatient treatment, where there are more than, or equal to, three claims and the total compensation claim rate is 200% or more.
Case 2: Inpatient claims, excluding serious illnesses and major surgeries, with more than, or equal to, three claims and a total claim rate of 400%. Iin each case, the maximum copayment ratio shall not exceed 30%.
If both Case 1 and Case 2 are included, the maximum copayment ratio shall not exceed 50% of the covered treatment costs in the following year. The determination of the ratio in each case will depend on the consideration of each company. The OIC will oversee the calculation of health insurance premiums and ensure fair copayment conditions.
At the meeting, it was also agreed that insurers can add conditions for participation in three cases to control inappropriate medical expenses claim behaviour, which will help prevent and reduce the abuse of rights to claim medical expenses.