Thailand’s Office of Insurance Commission (OIC) reported on its discussions with the Consumer Council and civil society on the copayment criteria used in health insurance policy renewals, with a focus on fairness and consumer impact. The OIC also clarified that the copayment feature is not applied to all policies and said it will intensify public communication and pursue legal action and penalties against agents who provide inaccurate information or mislead consumers. The Consumer Council raised concerns that copayment could increase out-of-pocket costs, particularly for vulnerable groups such as low-income consumers, older people, and those with chronic illnesses, and asked the OIC to review and delay implementation. The OIC explained that the criteria are designed to address high-claim cases and manage costs linked to repeated inpatient claims, while also helping to prevent renewal refusals for policyholders with high claims. Under the criteria described, insurers may apply copayment at renewal where either (1) there are at least three inpatient claims for “simple diseases” where hospitalisation is not necessary and total claims are at least 200% of the annual premium, or (2) there are at least three inpatient hospitalisations and total claims are at least 400% of the annual premium; copayment is capped at 30% of covered medical expenses per case, or up to 50% if both cases apply. Existing health insurance products are not being discontinued. The OIC said it will continue to take feedback and, together with the Consumer Council, periodically monitor and review consumer impacts, especially for vulnerable groups. Further joint discussions will also cover measures related to controlling prices for medical treatment, medicines, and medical supplies, alongside consideration of clearer treatment standards to protect consumer rights.
Thailand Office of Insurance Commission 2025-03-24
Thailand Office of Insurance Commission reviews health insurance copayment renewal criteria with the Consumer Council and targets misleading agent communications
Thailand’s Office of Insurance Commission (OIC) discussed copayment criteria in health insurance renewals with the Consumer Council, focusing on fairness and consumer impact. The OIC clarified that copayment is not universal and will enhance public communication while penalizing misleading agents. The criteria aim to manage costs and prevent renewal refusals, with copayment capped at 30-50% of medical expenses, and existing products unchanged.