Health InsuranceThailand

• Jaimy Shah(PA-7)• Viraj Mahida(QA-18)• Jaimin Patel(PC-8)• Dhaval Patel(PC-5)• Mitul Thekadi(QA-10)• Ankit Bhatt(PA-2)

Few facts about Thailand

• Health and medical care is overseen by ministry of public health along with private agency

• In2009 4.3% of GDP was spend on helthcare• Serious issues were HIV TB maleria• 99.5 % population has health coverage as per

world bank• Avg spending is $345 per person

Government policies • The Universal Coverage Scheme (UCS) is only one public health protection scheme, which provides health care coverage to all Thai citizens who are not covered by any other public health protection scheme.

• This scheme was a result of the reform of the Medical Welfare Scheme (MWS), a medical welfare scheme for indigent people, and the Health Card Scheme (HCS), a government subsidized voluntary health insurance for self employed people.

• This scheme is administered by the National Health Security Office (NHSO) which has 13 regional offices nationwide.

• There are about 47 million people were registered under the scheme in 2006.

Private policies

Bangkok Insurance

Cancer insurance policy-General terms and conditions - Insured must be between 10 and 60 years old. Renewal

allowed until insured reaches 65 years old.Exclusions: In cases where there is pathological evidence to

indicate that cancer is diagnosed prior to an applicant taking up the policy or during 90 days of the first year on which the policy is taken up.

Exclusions: In cases where cancer is effected by other illnesses or is tumor-related, such as resulting from AIDS, HIV and skin cancer.

Personal accident and health insurance

The insurance provides medical and accident cover as an in-patient of a hospital, cover includes:

• Room, food and general service fees• Hospital service fee• Operation room, X-ray, biochemical lab fees• Surgeon’s fee• Specialized consultation fee• Emergency fee for first 24 hours of admission

BUPA Blue Cross-Health Insurance Co.

• Comprehensive health insurance• Platinum Plan

Comprehensive health insurance for individuals who want the best medical care with full-coverage benefit up to 5 million baht

• Benefits• Personal care

Personal Care provides you long-term protection for you and your family.

• Crystal PlanValuable and affordable health insurance with lump sum benefit, Offering full coverage for medical expenses

• Personal accident insurance• AccidentplusBupa Accident Plus is a 24 hours and worldwidepersonal accident insurance covering forindividuals and families.• Supplemental health insurance Extra Value (Cancer insurance) Cancer Insurance

that helps protect you and your loved one against high medical expenses of cancer treatment

Health Insurance Service In Thailand

Health Insurance Service In Thailand

• Delivered by the public sector

• Universal healthcare system since 2002 i.e. health care and financial protection to all its citizens.

• Provided through three programs: (1) The civil service welfare system for civil servants and their families, (2)Social Security for private employees, (3) The Universal Coverage scheme available to all other Thai nationals.

Universal Coverage Scheme

• First lower-middle income countries to do so.

• People joining the scheme receive a gold card which allows them to access services in their health district, and, if necessary, be referred for specialist treatment elsewhere.

• Financed by patient self-payment and private insurance.

• According to the WHO, 65% of Thailand's health care expenditure in 2004 came from the government, while 35% was from private sources.

Challenges

• Thailand achieved universal coverage with relatively low levels of spending on health but it faces significant challenges:

(1) Rising costs, (2) Inequalities, and (3) Duplication of resources.

Insurance as Contract• A contract between an insurance provider (e.g. an insurance company or a

government) and an individual or his/her sponsor (e.g. an employer or a community organization).

• The contract can be renewable (e.g. annually, monthly) or lifelong in the case of private insurance.

General Parts of Contract• premium is a valuable consideration for starting an insurance contract.• The fact is that without payment of premium (consideration) the insurance contract

cannot be start.

For Insured: Payment of first premium plus an

agreement to abide by the conditions specified

in the policy

For insurer: Promise to do certain things as

specified in the contract. For e.g.:

paying for a loss from the insured peril

American International Assurance Co., Ltd. Paiboon Insurance Co., Ltd.Apex Health Insuance Co., Ltd. Phatra Insurance Public Co., Ltd.Aviva Insurance (Thai) Co., Ltd Pornpat Life Assurance Co., Ltd.Ayudhya Allianz C.P. Life Assurance PCL. Prudencial TSLife Assurance Public Co., Ltd.Bangkok Health Insurance Co., Ltd. QBE Insurance (Thailand) Co., LtdBangkok Life Assurance Ltd. Road Accident Victims Protection Co., Ltd.BUPA Blue Cross Safety Insurance Public Co., Ltd.Dhipaya Insurance Public Co., Ltd. Siam City Insurance Co., Ltd.Health Benefit Consultants Co., Ltd. Siam Commercial New York LifeING Life Limited Siam Samsung Life Insurance Co., Ltd.Interlife John Hancock Assurance PLC. Syn Mun Kong Insurance Public Co., Ltd.Kamol Sukosol Insurance Co., Ltd. Thai Development Insurance Co., Ltd.Krungthai AXA Life Insurance Co., Ltd. Thai Life Insurance Co., Ltd.Liberty Insurance Co., Ltd. Thai Thanakit Insurance Co., Ltd.Max Life Assurance Co., Ltd. Thai Zurich Insurance Co., Ltd.Millea Life Insurance (Thailand) Public Co., Ltd. The Ayudhya Insurance Public Co., Ltd.Mittare Insurance Co., Ltd. The Deves Insurance Public Co., Ltd.Muang Thai Life Assurance Co., Ltd. The Navakij Insurance Public Co., Ltd.Nam Seng Insurance Public Co., Ltd. The South East Insurance Co., Ltd.Nationwide Life Assurance Co., Ltd. The Viriyah Insurance Co., Ltd.New Hampshire Insurance Company Pacific International Insurance Co., Ltd.

The Insurance contracts

• In many Thai insurance contracts, it is especially pointed out that the renewal of the contract is guaranteed up to 70 years old. There is of course, the danger that the contract will not be extended once you reach this age. However, there are now Thai insurance companies e.g. NSI, which offer an extensive insurance protection with a lifelong protection warranty which do, however, incur more expensive rates.

• The advantage of holding a Thai insurance policy is surely that the hospitals can account for all resulting costs very simply and directly with the insurer.

Hospitals in AIA HEALTH CARE

Insurance Market Structure

Thailand

Insurance regulation• 1. Regulator- The Office of Insurance Commission

(OIC), under the supervision of the Ministry of finance

• 2. FDI Restrictions- Insurance and Reinsurance companies: Up to 49 per cent with approval of the OIC Above 49 per cent with approval of the Minister of finance

(MoF) Brokers can be 100 per cent foreign owned

3. Portfolio transfer- No Regime

Insurance regulation4. Outsourcing- Insurer may not outsource “core” functions, which include: – risk underwriting & issue of policy and collecting premiums.

• An insurer may outsource non-core administrative functions,– accounting, it and back office functions.

• There is no formal approval process

5. Minimal Capital- Life insurer/reinsurer: thB500 million General insurer/reinsurer: thB300 million

Nature of Market• With the influx of foreign investment into the sector,

Thailand’s insurance industry has begun to mature with a wider range of products being offered

• General insurance sector- large number of small- to mid-size insurers with over half of the 77 general insurers holding less than 1 per cent market share, So intense competition in this sector

• DOI seeks to reduce the numbers of players in the industry by consolidation of small to mid-size general insurers

Barriers to Market Development• Much needed industry consolidation• Limited public awareness• Excessive dependence in general insurance sector, almost

40% of premiums come from motor vehicle insurance• Inadequate service level• Limited corporate governance, Risk management

particularly in smaller insurers• insufficient investment in IT system

The Department has recognized the need to address these issues and has developed a strategic plan aimed at strengthening the position of Thai insurers

Growing industry

Market Share

Auto mobile

Marine& Trans

Life Insurance Business

Personal acidentIndustrialGroupOrdinary

Non Life Insurance Business

Fire Marine & TrnaAutomobileOther

Thank You…

• Premium: The amount the policy-holder or his sponsor (e.g. an employer) pays to the health plan to purchase health coverage.• Deductible: The amount that the insured must pay out-of-pocket before the health insurer pays its share. For example, policy-holders

might have to pay a $500 deductible per year, before any of their health care is covered by the health insurer. It may take several doctor's visits or prescription refills before the insured person reaches the deductible and the insurance company starts to pay for care. Furthermore, most policies do not apply co-pays for doctor's visits or prescriptions against your deductible.

• Co-payment: The amount that the insured person must pay out of pocket before the health insurer pays for a particular visit or service. For example, an insured person might pay a $45 co-payment for a doctor's visit, or to obtain a prescription. A co-payment must be paid each time a particular service is obtained.

• Coinsurance: Instead of, or in addition to, paying a fixed amount up front (a co-payment), the co-insurance is a percentage of the total cost that insured person may also pay. For example, the member might have to pay 20% of the cost of a surgery over and above a co-payment, while the insurance company pays the other 80%. If there is an upper limit on coinsurance, the policy-holder could end up owing very little, or a great deal, depending on the actual costs of the services they obtain.

• Exclusions: Not all services are covered. The insured are generally expected to pay the full cost of non-covered services out of their own pockets.

• Coverage limits: Some health insurance policies only pay for health care up to a certain dollar amount. The insured person may be expected to pay any charges in excess of the health plan's maximum payment for a specific service. In addition, some insurance company schemes have annual or lifetime coverage maxima. In these cases, the health plan will stop payment when they reach the benefit maximum, and the policy-holder must pay all remaining costs.

• Out-of-pocket maxima: Similar to coverage limits, except that in this case, the insured person's payment obligation ends when they reach the out-of-pocket maximum, and health insurance pays all further covered costs. Out-of-pocket maxima can be limited to a specific benefit category (such as prescription drugs) or can apply to all coverage provided during a specific benefit year.

• Capitation: An amount paid by an insurer to a health care provider, for which the provider agrees to treat all members of the insurer.• Prior Authorization: A certification or authorization that an insurer provides prior to medical service occurring. Obtaining an

authorization means that the insurer is obligated to pay for the service, assuming it matches what was authorized. Many smaller, routine services do not require authorization.

• Explanation of Benefits: A document that may be sent by an insurer to a patient explaining what was covered for a medical service, and how payment amount and patient responsibility amount were determined