Health insurance glossary

The words you will meet in a Thai health insurance policy, explained simply, with the Thai term used by hospitals and insurers.

• Admit (hospital admission)แอดมิท

  “Admit” (แอดมิท) means being formally admitted to hospital as an in-patient, which is what triggers in-patient (IPD) insurance cover.

• Annual limitวงเงินความคุ้มครองต่อปี

  The annual limit is the maximum amount the insurer pays in total during one policy year.

• Cashless / direct billingแฟกซ์เคลม (ไม่ต้องสำรองจ่าย)

  Cashless or direct billing means the hospital bills the insurer directly, so you do not pay the covered costs upfront.

• Claimเคลมประกัน

  A claim is a request to the insurer to pay for covered medical costs, either directly to the hospital (cashless) or as a reimbursement to you.

• Co-paymentการร่วมจ่าย (Co-payment)

  A co-payment is a percentage of each covered bill that you pay yourself, for example 20%, with the insurer paying the rest.

• Deductibleค่าเสียหายส่วนแรก

  A deductible is the amount you pay yourself on a claim (or per year) before the insurer starts paying.

• Exclusionsข้อยกเว้น

  Exclusions are the situations, treatments and conditions that a health insurance policy does not cover.

• Health declarationการแถลงสุขภาพ

  The health declaration is the questionnaire about your medical history that you complete when applying for health insurance.

• Insurance policyกรมธรรม์

  An insurance policy (กรมธรรม์) is the contract between you and the insurer that sets out what is covered, the limits, exclusions and premium.

• IPD and OPDผู้ป่วยใน (IPD) / ผู้ป่วยนอก (OPD)

  IPD (in-patient) is care received when admitted to hospital; OPD (out-patient) is care without admission, such as consultations and tests.

• Medical evacuationการเคลื่อนย้ายผู้ป่วยเพื่อการรักษา

  Medical evacuation covers the transport of a patient to the nearest hospital able to provide the required treatment, when local care is not adequate.

• OIC (Office of Insurance Commission)สำนักงาน คปภ.

  The OIC (คปภ.) is the Thai regulator that licenses insurers, agents and brokers and supervises insurance sold in Thailand.

• Pre-existing conditionโรคที่เป็นมาก่อนทำประกัน

  A pre-existing condition is an illness or injury you had, or had symptoms of, before the policy started; it is usually excluded or covered only under conditions.

• Premiumเบี้ยประกัน

  The premium is the price you pay for your insurance policy, usually yearly; for health insurance it depends mostly on age.

• Renewal age limitอายุต่ออายุสูงสุด

  The renewal age limit is the maximum age up to which an existing policy can be renewed; it is distinct from the maximum entry age.

• Room and boardค่าห้องและค่าอาหาร

  Room and board is the nightly hospital room and meals benefit; if your room costs more than the limit, you pay the difference.

• Underwritingการพิจารณารับประกัน

  Underwriting is the insurer's assessment of your application and health declaration to decide whether to accept you and on what terms.

• Waiting periodระยะเวลารอคอย

  The waiting period is the time after the policy starts during which some illnesses are not yet covered.