Health insurance or Health insurance is insurance that occurs from illness or injury from an accident, such as falling, spraining or breaking an arm or leg, or being sick with a fever, etc. The insurance company (that we have) must make a contract to compensate the insured (which is us).
If we talk about the definition from the Office of Insurance Commission (or abbreviated as
OIC ), it says that “
Health insurance is insurance in which the insurance company agrees to compensate the insured for the medical expenses incurred from the insured’s treatment, whether the medical expenses are caused by illness or injury from an accident to the insured.”
The Office of the Insurance Commission (OIC) has stated that health insurance is divided into 2 types.
These include group accident and health insurance and individual accident and health insurance. Both types provide the same coverage.
The benefits or protections that we will receive are as follows: for example, hospitalization, expenses from accidents, expenses from surgery, expenses from treatment at hospital clinics, expenses for childbirth, expenses for dental work, compensation for expenses, etc.
How many types of health insurance are there? What are they?
1.
Health insurance for outpatients (OPD – Out Patient Department)
“If you are sick or unwell, go for treatment but do not have to stay in the hospital.”
The meaning of outpatient is a patient who is admitted to the hospital but can go home immediately without having to stay in a hospital. For outpatient health insurance, it will provide coverage in cases where the insured is treated in the hospital for less than 6 hours or does not need to stay in the hospital. Just see a doctor, get diagnosed, and get medicine, then you can go home. Or in cases of minor injuries, such as minor accidents, falls, sprained ankles, knife wounds, colds, headaches, fevers, sore throats, coughs, allergies, etc.
2.
Health insurance for inpatients (IPD – In Patient Department)
“I’m sick, not well, I went for treatment but had to stay in the hospital.”
The meaning of inpatient is a patient who is admitted to the hospital but must stay in the hospital for more than 6 hours. For inpatient health insurance, it is a health insurance plan that requires the insured to register for treatment in a hospital or medical facility for no less than 6 hours continuously, and must receive a diagnosis and advice from a doctor first, including being admitted as an inpatient but dying before 6 hours.
3.
Health insurance for critical illnesses (ECIR – Enhanced Critical Illness Rider)
“Serious diseases such as heart disease, cancer, and stroke are diseases that require long-term treatment and have high treatment costs.”
The existing health insurance may not be sufficient, so there is a health insurance for critical illnesses to provide coverage for critical illnesses that require treatment by a specialist and must be treated continuously. This type of insurance will specify in the policy what diseases will be paid? When it is detected or at what level of disease, how? etc.
4.
Health insurance for accidents (PA – Personal Accident Insurance)
“Accidents or death are covered.”
It is insurance that provides coverage in the event of an accident and injury, whether it is a minor injury to the point of disability or death. The insurance company will be responsible for compensating us for the expenses incurred from our treatment. And if it is serious enough to cause loss of organs, disability or death from an accident, the insurance company will have to pay us compensation.
5.
Health insurance for income replacement
“If you have an accident or get sick and need to stay in the hospital, you will also receive income compensation.”
This is insurance that provides income protection during hospitalization. The insurance company will compensate you daily. This amount is to compensate for your income when you are unable to work due to hospitalization. The details will vary depending on each policy, such as 300, 500, or 1,000 baht per day. The amount of income compensation depends on the insurance premiums you pay each year (the more you pay, the more compensation you get per day). However, if you have a regular job and a regular salary, you may not need to choose an insurance plan that requires you to pay an annual premium in order to get a high compensation amount.
So what kind of health insurance should we buy and how is it suitable?
Most health insurances that are available in the market are mixed, i.e. IPD, OPD, PA, or income compensation. The type of health insurance depends on the risks, the coverage that we want, and the price that we can afford. Because each working person may have different decision-making factors.
In this article, the admin would like to present a simple guideline to use as a criterion for considering the purchase of health insurance as follows:
- How much do our lifestyles, our eating, living, traveling and our careers have risks that affect our health or increase the risk of accidents? Because this affects the cost of medical treatment that follows.
- Check the existing health insurance (from the company) to see what it covers. This will help you know how to plan for the future if you consider the risks in the first point.
- Estimate from the assessment in the first point, if we get sick in the case of IPD, how much will the medical expenses per time or room cost be? Do we need income compensation? If we get sick in the case of OPD, how much should the medical expenses per time be (or how much more should we buy from what the company already provides), etc. All of this is to ensure that the health insurance is sufficient to cover the expenses incurred.
- Once you have the conditions and requirements, you need to consider the insurance premiums. Can you afford to pay them every year? If you can, then you need to compare 3-4 companies to see which insurance premiums are the cheapest and most worthwhile. And if you can pay in installments, that’s good because you pay in installments but get coverage right from the start.
Insurance premiums: Why are some cheap and some expensive? What do they consider?
Some people have to pay expensive premiums, to the point where they don’t want to do it. Some people have the opportunity to buy insurance with cheap premiums, but they don’t. So why are there differences in premiums? What are the principles behind their calculations? Let’s find the answer to this question. Referring to information from the Office of the Insurance Commission,
insurance premium rates depend on the following factors:
- Age : Different ages of the insured can indicate different chances of the body being injured or sick, including being affected by different complications. Because when people get older, they are more likely to have health problems. And if injured or sick, the body’s ability to repair worn out parts will decrease. There is a chance of being severely affected and needing to take longer to recover than a younger person.
- Gender : At present, the risk of women is not much different from that of men. However, the strength of physical health is still different. Normally, women take longer to recover from illness or physical injury than men. Therefore, insurers may accept insurance by setting a higher premium rate than men.
- Health : This includes the health and medical history, as well as the physical condition of the insured. A person who is in good health and has never had a history of serious illness has a lower chance of being seriously injured or sick, or being permanently disabled in the future, than a person who is unusually weak or has a history of serious illness. In addition, some physical or mental abnormalities will cause a high tendency or possibility of an accident, such as epilepsy, hallucinations, or being easily startled.
- Occupation : Occupation represents the activities that occur in an individual’s daily life, which lead to different risks or tendencies to get injured or sick.
- Lifestyle : Demonstrates behaviors that affect the health or accidents of different individuals, such as drinking alcohol, playing risky sports, etc.
For group insurance, the number of people to be insured must be considered because if there are more people, the risk distribution will be greater, which will result in lower premium rates.
The company’s consideration of accepting insurance depends mainly on the health and age of the insured. In providing coverage to the insured, the company will not cover “pre-existing diseases” such as if the insured has diabetes before taking out the insurance, the company will not cover if the insured has to be treated for diabetes, but will cover if the insured later develops heart disease.
Therefore, if the insured person is not in good health or has multiple chronic diseases, the chance of getting sick in the future is higher than those who are healthy. The company may consider insuring that insured person with a higher premium than a normal person or may not insure at all.
In cases where the insured person suffers from a serious illness such as AIDS or cancer, the company usually does not accept the insurance.
Conclusion
When it comes to health insurance, if you ask if it is necessary, the answer is yes, because it is a way to manage the risks of expenses that arise from our own health problems or those of our family members.
And it also helps to cut down on our financial burdens. Don’t forget that medical expenses are getting more expensive every year. We are also getting older every year, so we are more likely to get sick easily or get sick often.
Therefore, buying health insurance is like our helper when we are sick.
