Thailand Office of Insurance Commission held a meeting of its Consumer Protection and Insurance Participation Committee to set out how copayment clauses can be applied when renewing health insurance policies at the policy anniversary, including when cost sharing can be triggered and the maximum rates that can be charged. Copayment would apply only in the following policy year where an insured meets specified claim-pattern thresholds. For inpatient claims involving minor “simple diseases” without a medical indication for inpatient treatment, copayment can be applied where there are at least three claims and an aggregate claims ratio of at least 200%. For inpatient claims excluding serious diseases and major surgery, copayment can be applied where there are at least three claims and an aggregate claims ratio of at least 400%. In each scenario, the copayment rate is capped at 30%, rising to a maximum of 50% where both sets of criteria are met; insurers can set the specific rate up to these ceilings. The OIC will oversee health insurance premium calculations and monitor fairness of copayment terms, and it highlighted the need for ongoing public communications and accurate guidance for agents and brokers, warning that providing incorrect information could result in licence revocation. The OIC will incorporate feedback from the meeting into its ongoing work on controlling improper medical expense claims and implementing copayment arrangements.
Thailand Office of Insurance Commission 2025-03-17
Thailand Office of Insurance Commission clarifies copayment criteria for health insurance renewals and caps cost sharing at 30% to 50%
The Thailand Office of Insurance Commission issued guidelines for copayment clauses in health insurance renewals, detailing conditions and maximum rates. Copayment applies in the next policy year if claim-pattern thresholds are met, with rates capped at 30% or 50% under certain conditions. The OIC will oversee premium calculations and ensure fair copayment terms, emphasizing accurate public communication and guidance for agents and brokers.