# Co-payment in Thai health insurance: what it is, and how hospitals, insurers and HR should respond

> Since 20 March 2025, Thailand’s standard health insurance includes a co-payment of 30% or 50% at renewal when claims meet set criteria. The three cases, who is affected, a calculator, and what hospitals, insurers and HR should prepare.

Updated 22 October 2026 · Web page: https://hdmall.co.th/work-with-us/en/resources/copayment-health-insurance/

**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.

> **Summary**
> - Co-payment is not applied from day one; it is assessed at renewal from the past year’s in-patient claims.
> - There are three cases: frequent simple-disease claims, high general claims, or both, giving 30%, 30% and 50% respectively.
> - It is reviewed every year; a year without qualifying claims returns the policy to no co-payment.
> - Policies that started before 20 March 2025 and were renewed continuously are not affected.
> - Hospitals should give clear prices before admission; insurers and HR should steer members to appropriate care before costs arise.

## 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.

## 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?

1. **Give clear prices before admission:** estimates, inclusions and what the patient may pay
2. **Offer fixed-price packages for self-pay patients** in services where they now weigh claiming against paying
3. **Help patients check cover before booking,** asking for policy details at first contact
4. **Offer alternatives to admission where appropriate,** such as outpatient care or day surgery
5. **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](/work-with-us/en/resources/medical-inflation-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](/work-with-us/en/resources/employee-health-benefits/) and the [HR guide to annual health checks](/work-with-us/en/resources/employee-annual-health-check/).

*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](https://www.oic.or.th/web-upload/1xff0d34e409a13ef56eea54c52a291126/202412/m_news/217/68875/file_download/0f38082b2174b0fdbb3d26693e395c46.pdf) (in Thai)
- InfoQuest, [Thai Life Assurance Association sets out 3 co-payment conditions](https://www.infoquest.co.th/?p=467657) (in Thai)
- Thairath, [10 questions on co-payment](https://www.thairath.co.th/money/personal_finance/insurance/2840568) (in Thai)
- Thai PBS, [What co-payment is and why](https://www.thaipbs.or.th/news/content/348438) (in Thai)
- Tokio Marine, [co-payment FAQ](https://www.tokiomarine.com/th/th/life/about-us/media-centre/copayment-health-insurance-explained.html)
- ttb analytics, [Thai private hospitals at a structural turning point](https://thaipublica.org/2026/07/ttb-analytics-private-hospital-industry/) (ThaiPublica, 27 July 2026, in Thai)