An “acute serious illness” shall be determined to exist only after review and agreement by both the attending physician and the Company’s medical consultant.
Overview
Health Insurance Definitions and Exclusions
CCW Global, and our Thailand Insurance Partners, recognize that health insurance jargon can often be overwhelming for anyone who isn’t a seasoned insurance expert. This is especially true with respect to the terminology used in policy documents.
To make things easier, and to help you better understand how your Thailand health insurance policy functions, we’ve created a straightforward glossary of frequently used health insurance terms along with their definitions. This resource is designed to clarify key concepts and support you in making informed decisions about your coverage.
Thailand Health Insurance Definitions
01
Acute serious illness
02
Anniversary date
The renewal of a health insurance plan
03
Applicant
A person named on the Application Form and the Medical Questionnaire.
04
Application
The Form and Medical Questionnaire you fill in when requesting insurance coverage.
05
Claim
The financial demand covered, in whole or in part, by the insurance.
06
Commencement date
The date at which the insurance starts providing coverage.
07
Deductible
The total amount of money noted in the policy schedule which each insured agrees to pay each policy year before being reimbursed by the Company.
08
Documents
Written information related to the insurance including original bills, policy schedules and the like.
09
Due date
Date on which a premium is to be paid.
10
Hospitalization
Surgery or medical treatment in a hospital or clinic as an in patient where an overnight stay is medically necessary.
11
Inpatient
Surgery or medical treatment in a hospital where an overnight stay is medically necessary.
12
Insurance
The Policy Conditions and policy schedule representing the insurance contract with the Company. Setting out the scope of the insurance terms, the premium payable, deductible and reimbursement rates.
13
Insured
The policyholder and/or all other insured persons as listed in the policy schedule.
14
Outpatient
Surgery or medical treatment in a hospital or clinic where an overnight stay is not medically necessary
15
Policy Conditions
The contract of the insurance purchased.
16
Policyholder
The person identified as the policyholder on the Application Form.
17
Policy schedule
Policy details showing the type of insurance purchased, deductible and any special terms.
18
Pre-existing condition
The medical history, including the illnesses and conditions listed in the Medical Questionnaire, which may affect the Company’s decision to insure or not to insure or to impose special terms.
19
Reimbursement rates
The maximum amount of money which will be paid by way of reimbursement of medical expenses in one year from the commencement date or from each anniversary date.
20
Region
The name of the region as stated on the policy schedule determining the area of cover.
21
Renewal
The renewal of the insurance as per the anniversary date.
22
Serious injury
A “serious injury” shall be determined to exist only after review and agreement by both the attending physician and the Company’s medical consultant.
23
Special terms
Restrictions, limitations or conditions applied to our standard terms as detailed in the policy schedule.
24
Standard terms
The Company’s standard insurance terms with no special restrictions, limitations or conditions.
25
Subrogation
The insurer’s right to enforce a remedy which the insured has against a third party, and the insurer’s right to require the insured to repay the insurer if the insurer has paid expenses recouped by the insured from a third party.
26
Surgery
A surgical treatment/intervention, which does not include endoscopies and scannings even though these examinations may require anesthesia.
27
Terminal phase
When the advent of death is highly probable and medical opinion has rejected active therapy in favor of the relief of symptoms and support of both patient and family. ,
28
Waiting period
A waiting period is the duration of time from the commencement date where the insurance provides no cover.
Insurance Exclusions
Thailand Health Insurance Exclusions
Outside of defining the specific terms which you will encounter on your Thailand or International Health Insurance policy, it is also important to understand what an international medical insurance plan will normally exclude from coverage. Common coverage exclusions with Thailand Health Insurance plans may include:
• Cosmetic surgery or treatment (unless previously approved by the insurer)
• Obesity surgery e.g. gastric bypass surgery
• AIDS or HIV related diseases. These will be covered however; if it is proven that the condition was contracted due to a blood transfusion after commencement of the insurance, or as a result of an accident during the course of your normal occupation.
• Conditions contracted due to the abuse of alcohol, drugs or medicines will not be covered in any case.
• Any intentionally self-inflicted bodily injuries.
• Conditions arising due to contraception, including sterilization.
• Induced abortion unless medically prescribed.
• Any fertility related treatment including fertility testing.
• Induced abortion unless medically prescribed.
• Any kind of fertility testing or treatment, including hormone treatment or examinations and any related procedures.
• Treatment of sexual dysfunction.
• Any kind of care which is experimental, not part of a medical or surgical treatment, including stays in nursing homes.
• Treatment by naturopaths or homeopaths and naturopathic or homeopathic medications and other alternative methods of treatment. Unless stated in the specific insurer’s list of reimbursements.
• Health certificates.
• Treatment of diseases during military service.
• Treatment for sickness or injuries directly or indirectly caused while actively engaging in: war, invasion, acts of a foreign enemy, hostilities (whether war has been declared or not), civil war, terrorist acts, rebellion, revolution, insurrection, civil commotion, military or usurped power, martial law, riots or the acts of any lawfully constituted authority, or army, naval or air services operations whether war has been declared or not.
• Nuclear reactions or radioactive fallout.
• Treatment performed by the insured, his/her spouse, parents or children or an enterprise owned by one of the aforementioned persons.
• Epidemics which have been placed under the direction of public authorities.
• Treatment by a psychologist
Please note that not all insurers will include the same exclusions under their plans. The exclusions applicable to your policy will vary dependent on the insurance company you choose to work with and the type of plan you have purchased. The above list of exclusions should be used for informational purposes only and should not be taken to construe a comprehensive list of coverage exclusions applied to all Thailand health insurance plans.
Consultation
Free Thailand Health Insurance Consultations
If you would like to learn more about a specific term which is included in your international health insurance plan, or if you would like to enquire about an exclusion which may affect your policy, please Contact a Global Insurance Advisor for more information today.
Alternatively, you may complete this short form to request a consultation now.
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