In this article
Co-payment in Thai health insurance is a renewal condition that makes the insured pay 30% or 50% of treatment costs in the next policy year when the previous year’s in-patient claims meet set criteria. It applies to standard health insurance policies starting on or after 20 March 2025.
The condition changes more than how people claim; it changes how they use care. People who know they may have to share costs think twice before a hospital admission, ask the price first and compare more. This guide sets out the conditions, includes a calculator, and explains what hospitals, insurers and brokers, and HR teams should prepare.
The three co-payment cases
| Case | Criteria in the past policy year | Co-payment next year |
|---|---|---|
| 1. Frequent minor illness | 3 or more simple-disease claims, totalling 200% or more of the premium | 30% of every bill |
| 2. High general claims | 3 or more general illness claims excluding major surgery and critical illness, totalling 400% or more of the premium | 30% of every bill |
| 3. Both | Meets cases 1 and 2 in the same year | 50% of every bill |
Once triggered, the share applies to every treatment in the next policy year, including critical illness and major surgery. The condition is reviewed each year.
Simple diseases, as clarified by the Thai Life Assurance Association, include upper respiratory infections, influenza, diarrhoea, dizziness, fever of unknown cause, headache, muscle inflammation, allergies, and gastritis including acid reflux.
Try the calculation
Enter the annual premium and last year’s in-patient claims. The calculator shows which case applies, the co-payment share next year, and what one example bill would cost the insured. The starting figures are a made-up example of someone admitted three times for simple diseases in a year.
Co-payment at renewal calculator
- Case 1: simple diseases ≥ 3 claims and ≥ 200% of premium
- Case 2: general illness ≥ 3 claims and ≥ 400% of premium
- Co-payment share next policy year
- Paid by the insured on the example bill
- THB
Calculated on the renewal conditions of Thailand’s standard in-patient health insurance for policies starting from 20 March 2025. Actual results depend on the policy wording and the insurer’s assessment; check each policy.
Who is affected
- Affected: standard health insurance policies starting on or after 20 March 2025, current and future products
- Not affected: policies that started before 20 March 2025 and have been renewed continuously without lapsing
- Group insurance: the three cases come from the standard individual product; check each organisation’s group policy with its insurer
Co-payment differs from a deductible, which the policyholder chooses at purchase and pays as a fixed amount before the insurer pays. Renewal co-payment applies only when claims history meets the criteria, and is a share of each bill.
What it means for hospitals
ttb analytics (July 2026) expects co-payment to cut unnecessary claims in the short term; in the longer term, lower premiums and wider access to insurance could become new demand for private hospitals. In the meantime, insured patients ask the same questions more often: how much will it cost, and how much will insurance pay?
- Give clear prices before admission: estimates, inclusions and what the patient may pay
- Offer fixed-price packages for self-pay patients in services where they now weigh claiming against paying
- Help patients check cover before booking, asking for policy details at first contact
- Offer alternatives to admission where appropriate, such as outpatient care or day surgery
- Communicate neutrally: explain the rules accurately and do not use co-payment as an advertising hook
What it means for insurers and brokers
Co-payment reduces unnecessary claims but does not help members choose the right care. Members facing co-payment want prices first, want advice on where to go, and may delay care they need.
- Explain the condition at sale to avoid complaints at renewal
- Guide members to appropriate care before costs arise, which is care navigation, unlike claims management after the fact
- Show members prices before they decide, especially for non-urgent care such as health checks, vaccines and planned surgery
- Watch for rising simple-disease claims and offer better options such as online doctor consultations
See also medical inflation and insurer cost containment.
What HR should know
Many employees have both company group insurance and a personal policy. Those who bought a personal policy after 20 March 2025 may face co-payment next year if they claim often, so company benefits matter more for minor illness.
- Check whether the group policy has co-payment conditions and explain them to employees
- Add benefits that handle minor illness without admission, such as online consultations and outpatient cover
- Focus on prevention, such as annual health checks and vaccines
Read next: employee health benefits and the HR guide to annual health checks.
A general explanation, not financial or legal advice. Actual conditions follow each insurer’s policy wording.
Frequently asked questions
What is co-payment in Thai health insurance?
It is a renewal condition in Thailand’s standard health insurance that makes the insured pay 30% or 50% of treatment costs in the next policy year when the previous year’s in-patient claims meet set criteria. It applies to policies starting on or after 20 March 2025.
Do policies bought before 20 March 2025 have co-payment?
No. Policies that started before 20 March 2025 and have been renewed continuously have no co-payment condition. If a policy lapses and a new one is bought, the new policy has it.
What are simple diseases?
As clarified by the Thai Life Assurance Association: upper respiratory infections, influenza, diarrhoea, dizziness, fever of unknown cause, headache, muscle inflammation, allergies, and gastritis including acid reflux.
Is co-payment permanent once triggered?
No. It is reviewed every policy year; if claims in the co-payment year do not meet the criteria, the next year has no co-payment.
How is co-payment different from a deductible?
A deductible is chosen at purchase and paid as a fixed amount before the insurer pays. Renewal co-payment applies only when claims history meets the criteria, and is a share of each bill in the following year.
Does group insurance have co-payment?
The three cases come from the standard individual product. Group policies may differ, so HR should check with the insurer directly.
How should hospitals respond?
Give clear estimates before admission, offer fixed-price packages for self-pay patients, help patients check cover before booking, and offer alternatives to admission where medically appropriate.
Sources
- Office of Insurance Commission (OIC), co-payment explanatory document (in Thai)
- InfoQuest, Thai Life Assurance Association sets out 3 co-payment conditions (in Thai)
- Thairath, 10 questions on co-payment (in Thai)
- Thai PBS, What co-payment is and why (in Thai)
- Tokio Marine, co-payment FAQ
- ttb analytics, Thai private hospitals at a structural turning point (ThaiPublica, 27 July 2026, in Thai)
