Aetna Health Insurance Thailand

Claims Procedure

Cashless Claims(No advance payment)

You do not need to pay anything when it comes to cashless claims. Usually, if you have a medical card and you are in one of the insurance company's hospital network list you just have to show your card. If your card is not accepted or the company requires further investigation, then you would have to pay first and get reimbursed.

Reimbursement Claims

Reimbursement claims can happen when the insurance companies need to investigate further in your claims. To be able to claim for reimbursement, please do the followings :

1. Gather all important documents, Insurance companies are very strict and they do need original documents and not photo copies.
   • Original Medical Certificate (Translated in English or Thai) - must contain chief complaint, diagnosis and treatment.
   • Original receipts.
   • Thai Bank Account Information - Photocopy of the first page of your bank book. If you do not have a Thai Bank Account, you can authorize a transfer to a trusted person or receive payment by cheque.
   • You can send your files directly to the insurance company or you can send them to your broker they will handle the the process and follow up for your claim.
   • Wait a few business days, usually takes 15 business days or less to settle depending on what insurance company.
   • Insurance company will send you an email or notification regarding your claim and the details of the bank transfer.

   In the end, it would be better to go to the hospitals that are in the insurance company's network list, as the hospital will start the cashless claiming procedure right away and you will not need to pay anything in advance.

Coverage of Health Insurance

There are many options to Health Insurance, most individuals would just get insurance for emergencies so they only require Inpatient option. Cover for doctor’s visits and procedures done that don’t require you to be admitted would be considered Outpatient. There are also things you add and remove like coverage for Dental and Vision. If you wish to lower the cost of your Health Premium, other’s put on a deductible or excess.

IPD / Inpatient Cover

Coverage for hospitalization purposes, meaning that you are admitted and required to stay overnight or a couple of days due to doctor’s recommendation.

OPD / Outpatient Cover

Coverage for doctor’s visits and outpatient procedures that do not require you to stay in the hospital for observation. This includes prescribed medications and lab exams that doctors prescribe.

Vision Cover

Coverage for Vision related concerns, this coverage includes prescribed eyeglasses or contacts or any exam or checkup related to your vision.

Dental Cover

Coverage for Dental related concerns, this coverage includes normal procedures, cleaning, fillings etc. This however does not cover anything related to cosmetic procedures. If you are looking for only dental insurance, please check the coverage and price here : Dental Insurance Thailand

Deductible / Excess

Helps lower the cost of your premium, a specified amount of money that the insured must pay before the insurance company will pay a claim.

Maternity Cover

Other insurance policies include Maternity cover, plans in Thailand do not have the option to take this out, it usually comes with the plan as a bonus or the plan is a much higher plan so it includes maternity coverage.

*Maternity coverage usually has a 10-month waiting period or 1 year, depending on what insurance company you decide to go with.

No claim bonus

Most but not all insurance companies offer a no claim bonus, should you have no claims for the year, some insurance companies give a 10% reward discount to clients so their premiums will be less.

To find the best plans for yourself, you must always compare between available plans and options and also take a look at the terms and conditions from both of the insurance companies and the OIC thoroughly.

Who is Health Insurance For?

Health insurance is essential for expatriates, long-term residents, and anyone living in Thailand who wants financial protection against unexpected medical expenses. Whether you are a retiree, working professional, or digital nomad, having comprehensive health coverage ensures peace of mind and access to quality healthcare without the burden of hefty medical bills.

Quick Comparison Checklist

• Compare coverage limits (600k to 32M baht range)
• Check if OPD coverage fits your needs and budget
• Review network hospitals in your area
• Understand waiting periods (typically 30 days for illness)
• Verify age limits and renewal conditions
• Consider deductible options to lower premiums
• Ask about no-claim bonus discounts
• Confirm maternity coverage if planning a family

Steps in Applying for health Insurance

Buying health insurance in Thailand is simple & easy

To apply for health insurance, we will need the documents from you as below (This applies to every insurance companies) :

1. Apply via our website or contact our Customer Service Representative for Application form.
2. Submit Copy of Passport with Verified Signature.
3. Wait for Offer Letter.
4. Accept Offer Letter.
5. Pay the Invoice Premium
6. You’re Covered.
7. Original Policy and Card will be delivered to your specified address in 7-10 business days by Registered EMS.

*Some insurance companies require Work Permit and Visa Stamp. Others only require Application form and Passport Copy with Verified Signature.

You can send addtional documents to us by LINE Chat with us or by Email [email protected]

FAQs

Who can apply?

This all depends on the Insurance companies, with some insurance companies you can apply until 70 years old, but most insurance companies only accept new entries until the age of 64 or 60.

Why do I need Health Insurance?

Health Insurance is for your peace of mind, there are a lot of horror stories in Thailand about people who have moved to Thailand with no Health Insurance and they end up in a very difficult situation with no money to pay their hospital bills because of unforeseen circumstances. Health Insurance will give you coverage for health issues and accidents that may occur.

How much insurance coverage do I need?

Clients ask this question, usually when they are new to Thailand. Most clients just like insurance for emergencies so usually they go for the Basic Coverage for 600,000 baht to 1,200,000. Others want a more extensive cover for severe cases so coverage can go as high as 32,000,000.

Do I need outpatient coverage?

If a client is looking for insurance for emergencies only, we suggest that clients forgo Outpatient coverage, doctor’s visits can be cheap, especially if you go to the normal hospitals that are not known to be international. Outpatient can be easily explained as visits to the hospital, doctor consultation and prescribed medicine, or any medical procedure that does not require you to stay overnight.

What is the difference between Outpatient and Inpatient coverage?

Inpatient coverage is for hospitalization purposes, meaning that you are admitted and required to stay overnight or a couple of days due to doctor’s recommendation. Outpatient coverage is for doctor’s visits and outpatient procedures that do not require you to stay in the hospital for observation. This includes prescribed medications and lab exams that doctors prescribe or order.

What is Social Security Insurance and isn’t that enough?

All those working are eligible for medical cover under Social Security, if they have a work permit. Contributions are compulsory this is 5% of your income – but not less than 83 baht per month and not exceeding 750 baht per month. Your social security can be used in a registered Public Hospital near your workplace or where you live. The problem with Social Security is that Public Hospitals in Thailand has limited resources compared to Private medical care that Private insurance covers.

If I apply today when will I be covered?

Most insurance companies have a 30 day waiting period when it comes to illnesses for emergent accidents, companies usually cover immediately. When buying Health insurance clear this up with your agent.

I'm pregnant, can I apply for Health insurance?

You can apply for Health Insurance but you will not be covered for maternity. Waiting period for Maternity is 10 months after signing you Health Insurance policy.

Are there waiting periods I should be aware of?

Insurance companies have different policies on waiting period. The most common type of waiting period is 30 days waiting period for Local Insurance companies like Bupa, Pacific Cross and LMG. For International companies like MSH and AXA there is no waiting period unless stated in the agreed upon offer letter. Feel free to ask your agent about the waiting periods for each company.

Do I need a Medical Examination?

If you are 60 years old and below, you won’t need a Medical Examination. Sometimes underwriters request tests and medical records so it's best to have them handy as well. If you are over 64, you will be required to have a medical examination or submit your medical records to the insurance company.

Will I be able to renew until I die?

Insurance companies usually have an age restriction, they will only cover you until you're 80 or 90. Depending on the insurance company, so be sure to ask your agent until what age you are able to renew your health insurance.

I’m over 70 can I still buy Health Insurance?

The entry age for most insurance companies is 60 years old and below. Some offer entry until 64. The one’s that take clients over 65 are the international insurance companies and their premiums can be really expensive. We sometimes suggest our clients who are over 65 to see Personal Accident insurance as an option.

I have a kid or newborn, can I apply insurance for her/him only?

No. Most insurance companies require at least one parent to sign in with their minor. There are companies that allow kids to sign alone but the rates would be different. (Higher than applying with a parent)

Does Health Insurance coverage, cover me for accidents or riding as a passenger at the back of a bike?

Health Insurance companies will cover your accidents as long as you are not under the influence or negligent.

What is the condition of residence?

Clients applying for health insurance must be residents of Thailand.

Am I covered when I travel outside Thailand?

Clients are usually covered when traveling outside Thailand, although you would have to pay first and get reimbursed when you get back to Thailand. Be sure to keep all original medical certificates and receipts for reimbursement. 

Can I visit a hospital of my choosing?

Yes, you are free to choose any medical provider you are comfortable with. However, each insurance company has a network list, if you go to a hospital or clinic that is not on their list you would have to pay first and get reimbursed.

Are people with pre-existing condition covered?

Everyone is welcome to apply, you will get coverage but unfortunately pre-existing conditions will be excluded from the coverage.

Can an insurance company deny my claim?

Accidents and sudden illnesses like dengue are hard to deny as these cannot be linked to pre-exisiting conditions. Although insurance companies reserve the right to investigate further. Insurance companies are quite cautious for claims that occur in the first months/year because it may be related to a pre-existing condition. Some clients decide to have a full check up before applying for health insurance, although this is not required. 

Does being healthy affect my coverage?

There are benefits to a healthy lifestyle, insurance companies tend to put a risk loading fee for clients who are Obese. If you have a healthy lifestyle your policy will have no exclusions and no risk loading fees.

What are the general exclusions?

The policy usually states general exclusions but the most common exclusions are:

1. Drug and Alcohol Abuse
2. Self-inflicted injuries
3. Infertility
4. Cosmetic surgery
5. Preventative Treatment

Feel free to ask your agent a copy of the policy wording before you purchase the plan.

If I apply now, when will I get my documents?

Application process is different for everyone, the process can take longer if you have pre-existing conditions. Application process is 3-4 days and once you sign the offer letter the Card and Policy will be sent to your specified address within 7-10 business days.

How to contact you ?

You can always call us at our Hotline : 02-985-9000 or Chat with us LINE@ @checkdi or Email us : [email protected]

Office hours Mon-Fri : 08:00 - 17:30

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