This document discusses healthcare options in Thailand. It provides an overview of the three main government healthcare schemes: Universal Healthcare Scheme (UHS), Civil Servant Medical Benefits Scheme (CSMBS), and Social Security Scheme (SSS). UHS covers nearly 49 million people but has limited facilities and long wait times. CSMBS covers government employees and dependents through public hospitals. SSS covers 14 million private sector employees through contributions from employers and employees. Many Thais also opt for private health insurance for quality care at private hospitals without long wait times. The document outlines types of private insurance like life, non-life, critical illness, and cancer policies that provide supplemental coverage. It advises readers to assess coverage from their government

1. Publication 101
KNOWLEDGE INSIGHT
Quarterly newsletter
Thailand Healthcare
How to navigate it
By Ben Assanasen
Sang Lee
Tommy Pichet

2. Publication 101
KNOWLEDGE
INSIGHT
Quarterly newsletter
In this issue
03 Thailand overview
07 Insurance healthcare
09 How to navigate it

3. Thailand overview
Thailand has always been known as the
“Land of Smiles”, bustling with tourism and
business development, increasingly
becoming a medical tourism hub. Yet, for
people who live in Thailand, healthcare is
becoming an increasing concern. Many
view critical illnesses like cancer and heart
disease as one of their top concerns from
prevention of these ailments to managing
the medical costs for treatment. With
multiple public care and private insurance
options layered over one another, it can be
confusing to the individual consumer to
know what is covered under their policies
and what options or combinations will
provide the best care for their family.
In examining Thailand’s demographics, it’s a
society that is rapidly aging with nearly
one-third of the Kingdom's population
expected be over 60 years old by 2031,
according to the Office of National
Economic and Social Development Board
(NESDB). So from a government’s
perspective, this potentially has significant
implications on providing comprehensive,
universal and affordable healthcare services
to the consumers going forward.
In this article we outline the core
elements to healthcare coverage in
Thailand and address key concerns of
consumers.
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4. Civil Servant Medical Benefit Scheme
(CSMBS) 5 million ppl
*Disadvantaged Scheme were folded into UHS
Social Security Scheme
(SSS) 14 million ppl Universal Healthcare Scheme
(UHS) 49 million ppl
POPULATION COVERED THROUGH
HEALTHCARE SCHEMES IN THAILAND
There are three main basic health care
coverages managed by the government
covering all Thai citizens: Universal
Healthcare Scheme (UHS); Civil Servant
Medical Benefits Scheme (CSMBS); Social
Security Scheme (SSS). The most basic of
healthcare is the Universal Healthcare
Scheme which we estimate covers nearly
49 million Thais. First launched back in
2001, the scheme allows patients to seek
medical care at designated public
hospitals and participating private
hospitals. While UHS is universal in
covering all socioeconomic classes, the
benefits provided by the scheme namely
the quality of the facilities and care varies
considerably.
As the name suggest, CSMBS covers
employees of government and their
dependents (parents, spouse and
children) with care provided at
designated public hospitals. In general,
all treatments costs are settled directly
between the program and the hospital
including prescription drugs. We
estimate there are about 5.0 million
Thai’s covered under the care of CSMBS.
Prior schemes like the Health Card
Scheme and Health Welfare for the Poor
and Disadvantaged Scheme were folded
into UHS.
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5. A summary of the health schemes are presented next page, along
with key pros and cons of each plan
Social Security Scheme (SSS) is estimated
to cover about 14 million Thais. This
scheme is divided into two completely
separate funds, Social Security fund (SSF)
and The Workmen’s Compensation Fund
(WCF). The SSF provides participants with
benefits classified into 7 categories: illness
and injury; childbirth; disability; loss of life;
children funding support; elderliness
pension; unemployment. As required by
law, employers subscribe to this scheme
and the contributions are made equally
between the employees and employers as
a percentage of monthly salary with small
subsidy made by the government.
Currently, cost to an employee is 5% of
monthly salary that ranges from 1,650
baht to a max of 15,000 baht. See detail of
benefits in appendix.
The Workmen’s Compensation Fund
(WCF) was set up according to the
Workmen’s Compensation Act under
SSS in parallel with SSF to lessen
employer’s liability and to give prompt
and equitable protection against work
related injury, disease, disability or
death. The participants of this program
must be an active member in SSS. An
annual contribution is directly paid by
the employer for each employee at 0.2-
1% of his or her yearly income with
income cap of 240,000 per year. See
appendix for detail of benefits.
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6. Healthcare Coverage Schemes
Schemetype Population
Covered
Pros Cons
Universal Health
Care (UHC)
Not covered by
SSS or CSMBS
(49 million)
30 baht fee waived Healthcare with limited facilities, only
public hospitals and few private
hospitals are in the scheme. There is
long waiting time before seeing
doctors. Some medical benefits are
capped. Consult general practitioner
before being referred to specialist.
Civil Service Medical
Benefit Scheme
(CSMBS)
Government
employees &
dependents
(5 million)
Fully paid by the government Only public hospitals. Long waiting time
to receive treatment. Facilities are only
in fair conditions.
Social Security
Scheme (SSS)
Private Sector
Employees
(14 million)
Receive free subsidy by employers and
Govt. Several types of benefits are
given to participants. The contributed
fund is returned to the employees at
the end of employment in term of
gratuity or life monthly annuities
Employees are deducted 5% from with
a cap on monthly income. Only public
hospitals or limited private hospital
with limited facilities are chosen. There
is long waiting time before seeing a
doctor. Some medical benefits are
capped.
Private Health
Insurance
Voluntary/Optio
nal
Full Access to quality private hospitals.
No waiting queues. Coverage on many
new types of treatments and surgeries
not covered in public care. Tailored
coverage to your needs
Multiple options and complex in
nature. Cost prohibitive for some
consumers.
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7. Many consumers are continually opting for private healthcare insurance due to the
quality and convenience of healthcare at private hospitals and clinics. In Thailand,
supplemental health care insurance ranges from life to non-life policies, from per
benefit inner limits to annual and per event maximums, from indemnity to cash,
from use of any provider to preferred provider organization or designated
provider, and from co-insurance to deductible. The main categories are detailed
below including benefits and range of coverage amounts:
Life
Insurance Healthcare01
a. Basic Death Benefit Coverage - Compulsory with sum assured ranging from
low to high.
b. Indemnity - Coverage is comprehensive and each benefit has an inner limit
especially room and board on a daily maximum. Annual or event maximums
apply for certain products after applying co-insurance or deductible. Max
issue ages range from 60 - 70 years and max coverage age ranges from 80 to
90 years. Health care benefits are clearly stated as yearly renewable but in
practice only policies that are deemed fraudulent would not be renewed or
cancelled. This is usually referred to as a Hospital & Surgical (H&S) rider
c. Cash - Benefit provided for all hospitalizations with a daily cap and max event
coverage. This is usually referred to as Hospital Cash Rider.
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8. Non Life
Insurance Healthcare02
a. Basic Death Benefit not required and therefore healthcare benefits are
standalone basis.
b. Indemnity - Similar to benefits in life insurance products. Policy benefits are
clearly stated yearly renewable.
c. Cash - Benefit provided for all hospitalizations with a daily cap and max event
coverage.
Additional Supplementary
Insurance03
These are policies that generally provide for your healthcare post hospitalization
or for common diseases that have significant and long-term care costs. (i.e.
Cancer, Heart Attacks, Strokes ). These policies act as supplemental insurance
for healthcare for key things that are generally not covered on basic health
policies provided by the government. With supplementary insurance, patients
may have access to new innovative advanced technological treatments since
policies provided by the government may only cover general healthcare.
The effectiveness of treatment of Critical illness such as diabetes, cancer, heart
diseases depends on expertise of the doctor, quality of the medical facilities,
quality of the medicine and especially waiting time before being treated. With
supplementary insurance, those cumbersome problems could be mitigated.
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a. Critical Illness - These policies provide significant payments and lump sums to
the consumer in case of major diseases like Cancer, Heart Attack, and Strokes
to allow the consumer to pay for extended care and potential loss of income.
b. Cancer - These policies focus on Cancer and typically provide benefits for a
range of different cancers to allow the consumer to pay for treatment and post
healthcare for serious cancer diseases.

9. Navigate it
How to
?Basic or comprehensive coverage derived from whichever scheme generally
provides sufficient comprehensive coverages, yet with some out of pocket expense
ranging from low to high depending on sicknesses. Ideally each individual with
their respective schemes would claim benefits and then use supplemental
insurances benefits. More frequently though, the use of supplemental insurance
occurs because of the limitations of each comprehensive scheme or the need for
much higher coverage sums and better and timely care services. Some of these are:
CSMBS is strictly limited to public hospitals for fully coverage and few participating
private hospitals for partial coverage, SSF have limits providers that have mediocre
facilities, UHS has its issue of long queues and the impression of lower quality care,
and WCF is limited to work related injuries and illnesses.
But in healthcare treatment, it is often that more immediate and higher sums are
required to attend to the specific emergency or illness. Adding supplemental
insurance provides that additional security. Each individual should assess their basic
coverages provided by their entitled schemes and, depending on one's income level
and needs, add supplemental health care insurance.
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10. For supplemental health care insurance, consumers should
consider a combination of or all of the following
● Low or no deductible or coinsurance
● Claimable at any provider
● Direct settlement between insurer and provider
● Guaranteed renewable until maximum age of 90 years or lifetime
● High comprehensive annual or per sickness limit
● Return of premium or no-claim bonus
● Level premium or limited pay premium
● Agents - Insurance agents offer service and convenience to consumers who
are looking to purchase complex policies or would want to have assistance
to match their needs with specific product packages.
● Banks - Bank branches generally offer different types of health policies but
tend to be more standardized coverages.
● Direct - Many supplemental health policies are now offered through the
internet or TV purchase. This will allow you to purchase directly from the
company.
● Brokers - They offer a range of life and non-life insurance policies, but
mainly cater to businesses.
For consumers interested in purchasing supplemental
healthcare coverage, there are a number of options
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11. Understanding and navigating through Thailand’s healthcare schemes can be
daunting to some consumers let alone make the most out of scheme benefits. This
article has provided some clarity to the consumer for better understanding of the
benefits of each scheme. Yet, inevitably whichever healthcare scheme that one as
a consumer is using, to get the best and timely care possible, there will be a need to
seek care outside of the range of listed scheme benefits, therefore requiring “out of
pocket” funds or if prepared in advance, supplemental health insurance. As a
consumer, it is up to you to decide what level of overall protection you desire for you
and your family, preparing for potential additional expenses through insurance
premiums or other private sources.
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12. Appendix
Universal Healthcare Scheme(UHS)
The benefits are comprehensive at a nominal and waivable charge of 30 baht per
visit. Eligible participants are assigned to a public hospital that is nearest to their to
registered address and the participant may request for change of public hospital at
their convenience. There are several services under the scheme that are advisory and
preventive, general vaccination, diagnostic, ante-netal care, curative care,
medication, medical supplies, organ substitutes, newborn child care, child delivery,
basic dental services, physical and mental rehabilitation. In the case of emergency
and confirmed by receiving doctor, patients are fully covered in first 72 hours at
public or private hospitals similar to SSS and CSMBS schemes. Each medication
distributed to patients is under the National Essential Drug list again similar to SSS
and CSMBS schemes. Chronical disease treatments such cancers, kidney, diabetes,
high blood pressure, AIDS are fully covered by UHS subject the schemes rules and
regulations. Scheme members requesting services beyond the programs will need to
seek care with out of pockets expenses and/or with private hospitals.
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13. Appendix
Civil Servant Medical Benefit Scheme(CSMBS)
This comprehensive scheme covers civil service employees and their dependents and
is funded by general tax revenue and is administered by the Comptroller’s General
Department. Based on diagnosis related groups(DRGs) both inpatient and outpatient
benefits are provided at both public and private providers subject to rules and
regulations as stated in the program. Similar to other schemes, the processes of
treatment are under rules and regulations and follows the National Essential Drug list
managed by the Ministry of Public Health. There are exemptions in case of cancer
treatment where costly medications are provided out of the list such as Imatinib,
Rituximab, Trastuzumab, Bevacizumab, Erlotinib, Gefitinib. Regular Room and board
is capped at 400 baht per day with unlimited number of days. Superior Room benefit
is capped at 1,000 baht per day for not more than 13 days per each admission. I.C.U.
admission is capped with 600 baht per day. Unlike other schemes, eligible patients
can register with any public hospital after fingerprint verification which directly links
hospitals to the Comptroller’s General Department for expense settlement.
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14. Appendix
Social Security Scheme(SSS)
The benefits are comprehensive with maximum caps for each type of benefits. In case
of illness or injury, claim benefits per certain medical events vary between
participating private and public hospitals. Basically the cost of treatment can be fully
reimbursed if the kinds of disease or illness are listed. The disease includes common
cancers, high blood pressure, heart disease, diabetes, aids, CVA, chronic hepatitis.
While staying at a hospital or home to recover, participants are eligible for daily
compensation of half of their income for 90 days per event with max of 180 days in a
year. In case of emergency, for first 72 hours, OPD patients are fully covered at public
or private hospitals but there is a 1,000 baht cap per visit at private hospitals. IPD at
public hospital is fully covered but room and board is limited at 700 baht per day.
Besides these medical benefits, participants are also eligible for funeral cash of
40,000 baht and for childbirth for 13,000 baht per child. Moreover, in case of
disability, participants can be eligible for monthly compensation for a few months to
the whole life. Monthly subsidy of 400 baht is paid to participants for each child they
have up to age of 6. Participants can claim unemployment benefits of 50% of salary
up to 180 days in case of layoff and 30% of salary up to 90 days in case of resignation.
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15. Appendix
The contribution fund is returned to participants at the end of employment in term of
lump sum money or life pension monthly income if participants have been active for
15 years and their ages are over 55, they are eligible for pension income starting from
20% of their latest salary if their employments end.
Workmen's Compensation Fund
The employees are eligible to receive benefits consisting of medical services, monthly
indemnity, rehabilitation, and funeral grants. Certain maximums apply per event
ranging from cap on medical expense, 60% of monthly salary but not exceed 12,000
baht in the case of loss of workdays from day 3 not exceeding 1 year, and not
exceeding 10 years for loss organ and 15 years for permanent total disability.
Essentially all employees other than government entities and street peddlers or stall
shop owners and fishermen are entitled to receive coverage under WCF. Employees
who are not receiving this benefit may notify WCF who in turn will issue ordinance to
employers to enforce adherence to the Workmen’s Compensation Act.
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16. Frequently Asked Questions
1) Where can I locate scheme benefits?
UHS participants go to the NHSO website at www.nhso.go.th or call 1330
CSMBS participants go to the CGD website at www.cgd.go.th or call 02-127-7000.
The user at
https://home.kku.ac.th/praudit/law/07_medical_fee/22_Medical_guide_governme
nt%20officer_CGD_2553.pdf
SSS participants go to the SSO website at http://www.sso.go.th or call 1506
2) Are foreigner workers with proper visa/work permit entitled to UHS benefits?
No, Only Thai citizens are eligible, foreigner workers are eligible under SSS.
3) For private health insurance. Which website compares the premiums and insurance
benefits?
Can visit
www.prakanguru.com or
www.prakunrod.com/HealthInsurance.aspx?Label=health
4) For reviewing my current scheme benefits and private insurance who could provide
professional advice?
The scheme representatives can provide information along with advice by phone
call or personal visit
Office of Insurance Commission (OIC)
Insurance Agents of each insurance company
Website of each insurance company
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