The $15 per month comprehensive health insurance coverage for living in Thailand.

One of the key aspects of laying the groundwork for living in Thailand is to make sure you’ve got sufficient health coverage. Horror stories of expats of being caught without health insurance abound, and for many, it means giving up on their dreams of living in Thailand on a permanent basis.

While there are some very decent private health insurance plans available for people moving to Thailand, it’s no secret that as you age, private health insurance options get more expensive, and the coverage becomes less generous as pre-existing conditions get excluded.

Then you as you hit 60 or 65 years of age, and your existing health provider might even decide to not renew your plan. For those providers that do, the coverage is limited and can be expensive. A 33 million (US$1 million) baht level of annual inpatient coverage (pre-existing conditions excluded) might run to 130,000 baht ($4000) per year for an otherwise healthy 65-year old (that’s if they are happy to insure you!).

But what if there was a cheap health insurance option to ensure that you had lifelong comprehensive coverage while you stayed in Thailand and would only set you back around US$15 per month?

Not working in Thailand? Stop reading here…(sorry!)

Now before reading on, if you haven’t worked in Thailand, or have no intention of working in Thailand, this article isn’t for you.

But if you are working in Thailand, even for as little as a year and have plans at some point in future to stay in Thailand longer term, then there will be plenty if critical info in this article for you.

Thai Social Security – the government insurance scheme (which you can keep for life)

When you work for a Thai company, in most instances (with a few exclusions for teachers, civil servants, university employees and company directors), your HR will be legally required under section 33 of the Social Security Act, to enroll you into Thai social security system.

In addition to 750 baht the employer pays, a small portion of your salary (max 750 baht per month) will be deducted to pay for contributions to a fairly wide-ranging social safety net including health care, maternity, pension and unemployment insurance.

   Thai Social Security card

In many cases, you probably don’t even know you had these entitlements.

More likely than not, your employer will also have enrolled you into a private health insurance program as well – in addition to your social security coverage. This is purely optional for employers, but it is standard that employers provide private health insurance as part of the overall employee employment package.

Thai Social Security Coverage

The system as a whole is administered by the Thai Social Security Office, commonly known as the ‘SSO’.

There are a range of things that are (and aren’t covered) when employed and covered under Thai Social Security, which is separate to other benefits your employer may also provide. We’ve put together a table of most of the things covered by the SSO while you are employed.

Source: CLC Asia research

There is an extensive network of mainly public (but some private) hospitals registered with the Thai social security system. The list (Thai only sorry) of hospitals in the Thai Social Security network can be found here.

You’ll have the option of choosing the main hospital in your area to be the site of your primary care and you have the option of updating your preferences annually at the start of each year.

It is important to remember too that you’ll need to seek primary care through your main registered hospital if you don’t wish to pay out of pocket expenses. If in an emergency, you need to go to another SSO registered hospital, you can, but you’ll need to pay up front first and then get reimbursed later.

Life-long health insurance coverage?

Yes – if you set in place a few things.

But first, the important, but boring stuff. The Thai Social Security Act says:

Section 39 “Any person who is an insured person under section 33, has paid contribution for a period of not less than twelve months and, subsequently ceases to be insured person in pursuance of section 38(2), if such person wishes to continually be insured person, he or she shall, within six months from the date of his or her termination to be insured person, notify his or her statement to the Office according to the regulations prescribed by the Secretary– General”

So why is Section 39 important?

In plain English, when you leave your job – and this can be at any age and on any visa status – you can walk into any Social Security office and elect to continue the health insurance coverage provided under the scheme.

You’ll nominate a Thai bank account from which the SSO insurance premium can be taken from, after which 432 baht per month will be deducted automatically and your SSO insurance coverage will continue.

Basically, under Social Security legislation, once you have contributed 12 months of social security payments, you are entitled to Social Security provided health insurance – FOR LIFE, subject to two VERY important caveats which I outline below.

1) Enroll within 6 months of finishing work

Assuming you never go back to work again for a Thai company, you have one chance to keep your Social Security health coverage and you MUST enroll to maintain your health insurance within six months of leaving work. At 6 months and one day, you lose that right forever.

2) You need to maintain payments

Once you are signed up, you’ll need to pay the 432 baht per month ‘premium’ to continue the health coverage. If these payments lapse for more than a few months, you will lose coverage and you won’t be eligible to re-instate it unless you return to work for a Thai company.

Taking the insurance will affect your pension pay out…

While you are working, part of your SSO contribution goes towards the equivalent of a Thai State Pension which is available to all members of the SSO, Thai or foreign. When finishing work you’ll have the option of either taking a lump sum amount or – if you’ve made 180 months’ of contributions – getting a modest monthly pension of around five thousand baht from age 55 onwards for the rest of your life.

If you do decide to take the medical insurance, the SSO will use a different income base to calculate your pension payment, effectively lowering it by a few hundred baht per month, assuming you’ve made 180 months’ worth of contributions.

So is Thai Social Security insurance worth it?

Everyone will have different opinions on this, but to my mind it is.

It will be different for everyone, but if your employer is also providing you with private health insurance then most people are going to take advantage of it, particularly if you get access at the big private hospitals.

But what happens after you stop working and don’t have access (or can’t afford) private health insurance? At that point, the value of having Social Security insurance really comes to the fore.

A typical Thai public hospital ward

Thailand has an excellent public health system. While they aren’t the flashy luxury private hospitals, many of the doctors who work at the big private hospitals often split their time working in the public system.

Some hospitals are better than others, lesser equipped hospitals will usually refer patients to larger hospitals where they’ll a good standard of treatment. Like most public health systems, getting ‘into’ the system usually is the most bureaucratic part of the process, often with waits for certain non-life threatening procedures. But once ‘in’, things tend to run a lot more predictably and smoothly.

For the 432 baht a month you are paying, you are essentially getting as close as a comprehensive and universal form of health care that many other countries provide, but without the need to be a Thai citizen or Permanent Resident. Indeed, you can be in Thailand on a tourist visa and still receive treatment if you are insured.

Using Social Security as part of a long-term Thai residency strategy

For those being a little bit strategic about their plans for Thailand, having the Thai social security insurance as an option is really a clever and indispensable part of setting yourself up for stress free extended stay. There are a number of ways to lay out this strategy, so that when you need it, you have it.

a) Setting up SSO coverage, even if you don’t need it (yet)

For those who aren’t near retirement yet, but who but may be working in Thailand and then planning come back at some point in the future to retire, keeping your SSO insurance ‘active’ could also be a wise strategy.

Given that the Social Security premiums can be set up to be automatically deducted from any Thai bank account, loading up a bank account with many years of premium payments on a ‘set and forget’ basis so you can spend your time not having to worry about what happens if you get sick or injured in Thailand.

This would allow you, for instance, to work in Thailand for a few years, go elsewhere while maintaining your access to this insurance for when you decide to return to Thailand to retire. Paying what essentially amounts to $15 per month (or $180 per year) for the option of ensuring you have cheap comprehensive health insurance coverage in Thailand is really an excellent deal.

b) Private health insurance + SSO coverage in your back pocket

Those who are comfortably well-off may opt to pay for private insurance premiums. However, as discussed earlier, these premiums will increase substantially as you age and, in many cases, the insurance company may reduce, or totally kick you off, their coverage, particularly as you approach the age of 65 or 70.

Knowing you have the safety net of Thai Social Security health insurance means you aren’t left high and dry coverage wise in your older age if your insurance provider refuses to renew their coverage.

c) Self-insurance + SSO Coverage

Many people choose to ‘self-insure’ for health care expenses, either out of necessity (i.e. can’t get or afford private insurance) or by deliberate choice.

Putting aside what you would pay in premiums into a special kitty and building up your own health fund buffer – or just putting a lump sum aside for health care expenses – is known as ‘self-insurance’.

There are a number of approaches to using these ‘self insurance’ funds, but the most common involves relying on Social Security major events such as major surgeries in public hospitals, or for long-term therapies such as cancer treatments.

Alongside this, you may use your own private monies to pay for ‘out of pocket’ expenses associated with those procedures (i.e. private rooms, better food and non-covered SS drugs and medicines). Those private monies might also be used for routine outpatient treatments hospitals or specialists for more mundane and predicable medical care needs for which there might be a wait under the public system.

For those who want to be treated in private hospitals for more serious procedures, institutions like Bangkok Hospital, publish extensive price lists for major procedures and can be used as a good comparison tool of how much in private savings you might want to keep aside should you want to be treated as a private patient for ‘big ticket’ procedures. (It should be noted too that public hospitals often do perform many procedures for people who want to pay privately too, often at a fraction of what bigger private hospitals charge, so it is worth asking).

Whatever the case, the Thai social security insurance will be a very good to excellent safety net for your health insurance needs while in Thailand, particularly if private insurance isn’t an option or doesn’t provide significant value. With a bit of forward planning, establishing your access to the scheme by enrolling while eligible is critical, but once it is set up, it will mean most, if not all major, your medical needs in Thailand will be covered.