Choose Your Mutual Health

Choosing a mutual health insurance starts with knowing your needs. Indeed, a mutual health insurance is “individual” and falls into the category of “personal insurance”; so many parameters that concern you directly.

Between the rates that are reported up, the decreases in social security reimbursements, offers that are available on the net and elsewhere, how to navigate? We will bring you some clues to help you choose your mutual.

Compare to choose the best complementary health

To be able to choose the right mutual Thailand-plans, it is necessary to compare all the services offered by each proposed contract, according to your needs. It will be useful to compare each item by item.

If you want a high level of reimbursement in the event of hospitalization, it will be necessary to know the services supported by your mutual Thailand-plans and to compare with the offers of the market.

In most cases, a broker can also help you compare.

Online comparators are often the ideal solution because in the blink of an eye, you can have a comparative table of market offers, or even a table with the advantages and disadvantages of each contract.

How is the reimbursement calculated by your mutual Thailand-plans?

This is to deduct expenses that you have actually paid, the reimbursement of social security and mandatory lump sum participation (within the limits of the benefits provided for in your contract).

On certain health expenditure items, the excess fees, that is to say the costs that may be borne by you, are relatively small.

For example:

For a general practitioner’s consultation, the minimum reimbursement of your social security and mutual insurance (apart from the options provided by your contract) will be ฿ 24, for ฿ 25 paid (฿ 1 obligatory participation fee always remains your responsibility).

If you consult a general practitioner of sector 2, he is allowed to apply a free fee, but with “tact and measurement”. It is not uncommon to see consultations of this type of practitioner up to 30 or 35 ฿.

If your mutual does not provide for the reimbursement of excess fees, you will be refunded 24 ฿, 1 ฿ compulsory participation mandatory always remaining your responsibility. The difference between the price paid (35 ฿) and the reimbursement of 24 ฿ of your social security and mutual Thailand-plans will remain at your expense, or 11 ฿ in this example.

Health insurance or mutual health?

In reality, the purpose of health insurance and mutual health Thailand-plans is the same: Reimburse all or part of medical expenses not reimbursed by social security. The difference is simply in their statutes.

A health supplement is an insurance contract. That is, the insurance company (the intermediary) that sold the contract is governed by the insurance code. They are private, for-profit companies.

Unlike mutuals (or mutual insurance company) which are non-profit and governed by the code of mutuality. Their operation is based on the solidarity of contributions, that is to say that it is the members, by their contributions, who finance the complementary cover.

Mutual health guarantees and their levels

Mutuals generally offer a first level of guarantees, which corresponds to the support of user fees. The co-payment is the amount corresponding to the social security reimbursement base, after deduction of the social security reimbursement.

This notion is rather complicated to understand because all the data allowing the calculation are indicated by the social security itself. But for simplicity, we can say that all the overruns of fees will remain at your expense.

The second level of guarantees will, in general, provide for lower level benefits, to which are added packages for optical and dental services.

The higher the guarantee level, the higher the repayments will be. In addition, the highest guarantee formulas will also include reimbursements for health costs not covered by social security (such as natural medicines, for example).

Each level of collateral offers repayment items categorized by category:

Hospitalization:

Includes the cost of the stay, the hospital package and medical procedures performed in the hospital or maternity.

Medical procedures:

These are consultations, medical imaging, surgical procedures performed in medical offices, medical auxiliaries, and laboratory medical analysis services.

The equipment:

Which concerns in general hearing aids and orthopedics

The dental:

Care, prosthesis and orthodontics

Optics:

Frames, lenses and lenses

Each reimbursement item is affiliated with a repayment rate, which will be the amount you will receive after reimbursement of Social Security.

The most superior guarantees offer, in addition to the lower levels, additional services:

Post prevention: taking care for example some vaccines, smoking cessation etc …

Post hospitalization: reimbursement of the particular room for example

Dental post:

Implantology or periodontology

Optical station:

Refractive surgery

Post “wellbeing”:

Dietician, pedicure, osteopath, sophrologist …. Whose consultations are not usually reimbursed by Social Security?

It is therefore necessary to understand the guarantees of mutual health , and to know its needs to compare reimbursement items that will be useful and necessary.

For this also, insurers have changed their offers. Some now offer “optional modules”. That is to say that you can subscribe to a minimum guarantee for example but choose a single optical and dental module to strengthen your repayments. So you only pay the option for the benefits you really need.

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