Mr. Suthiphon Thaweechaikarn, Secretary-General of the Board of Supervision and Promotion of EntrepreneurshipbusinessguaranteePhai (Secretary-General of the OIC) revealed that according to the OIC held a meeting to discuss four parties, namely the Office of Insurance Commission, the Thai Life Assurance Association. Thai General Insurance Association Private Hospital Association on March 11, 2022 to find a solution to reduce disputes and alleviate the suffering of the insured suffering from COVID-19 who undergoes Home Isolation (HI), Community Isolation (CI) or Hotel Isolation, but cannot claim daily medical and/or compensation. Due to the policy conditions agreed upon at the time of the contract to claim medical expenses and/or daily compensation Must be in the case of patients receiving medical treatment in a hospital only This does not include sickness and HI, CI or Hotel Isolation treatment and no premium is charged for this type of coverage. The treatment model for HI, CI or Hotel Isolation occurs following the policy conditions have been defined. The Ministry of Public Health has agreed to expand the definition of a medical facility to include treatment in HI, CI or Hotel Isolation for specific reasons. for public health management But expanding that definition Does not have a legal effect to extend the coverage that the insurance company has issued under the existing insurance policy and that the parties agreed upon in the first place
In order to alleviate suffering and reduce the impact that occurs to the insured, the Office of Insurance Commission has discussed with the region.businessInsurance and related sectors which is aware of the aforementioned problem It is therefore agreed to allow to pay in some cases necessary for HI, CI stay, even if it is beyond what is specified in the policy and no additional insurance premiums are calculated. The insurance company agrees to pay medical expenses and daily compensation to the insured who undergoes HI or CI treatment according to the conditions agreed upon by the 4 parties according to the news of the meeting’s announcement to the public beforehand. this page
Therefore, in order for the above practice guidelines to be in the same direction and have concrete effect, the OIC has issued the Registrar Order No. 5/2565 regarding the payment of medical expenses and daily compensation or compensation. Insurance policy income For the insured or insured who is infected with Coronavirus 2019 (COVID-19) and has received medical care in a hospital at the patient’s residence under Home Isolation, Community Isolation, or Hotel Isolation for life insurance companies. and the Registrar’s Order No. 6/2565 regarding payment of medical expenses and daily compensation or income compensation under insurance policies. For the insured or insured who is infected with the Coronavirus 2019 (COVID-19) and has received medical care in a hospital at the patient’s residence under Home Isolation, Community Isolation, or Hotel Isolation for non-life insurance companies.
In this regard, the Office of Insurance Commission has issued a letter notifying the insurance company. non-life insurance company Thai Life Assurance Association and the Thai General Insurance Association to be implemented in the same direction. On March 16, 2022, Registrar Order No. 5/2565 and Registrar Order No. 6/2565 have the following key contents:
1. To be applicable to claims under insurance policies that the company has been approved by the registrar. which the company issues to the insured or the insured and the insurance policy is still effective for claiming From 1 November 2021 until 16 May 2022
2. In this order, “medical facility at the patient’s residence” means a place established for patients with dangerous communicable diseases under the law on communicable diseases. In the case of Coronavirus Disease 2019 (COVID-19) infection while waiting for treatment at a hospital or a patient whose condition is less or has improved following receiving treatment at a medical facility or a government facility provided for at least ten days or for a period of time prescribed by the Medical Department or relevant agency and disposed of for continued treatment at the patient’s residence which is considered as a patient of a hospital or according to the agency under the Ministry of Public Health as follows:
- 2.1 Home Isolation is a house or residence of a dangerous communicable disease patient under the law on communicable diseases. In the case of Coronavirus Disease 2019 (COVID-19)
- 2.2 Hotel Isolation is a hotel under the hotel law. Dormitory under the law on dormitory, apartment or other suitable place as prescribed by the Department of Medical Services, Department of Health Service Support or other relevant agencies.
- 2.3 Community Isolation: villages, temples, schools, construction workers’ accommodation or other suitable places as prescribed by the Medical Department. Department of Health Service Support or related agencies and “insurance policy” means an insurance policy. additional contract or record endorsement protection agreement or attachment that provides protection once morest the coronavirus disease 2019 (COVID-19) regardless of the name
3. Allow the insurance company to pay medical expenses for the insured or the person covered under the insurance policy. infected with the coronavirus 2019 (COVID-19) in a medical facility at the patient’s residence the following cases
- 3.1 In the case that the insurance policy only covers medical expenses in the case of being admitted as an outpatient Let the insurance company pay for the medical expenses. according to actual expenses but not exceeding the amount of benefits for expenses which arises from medical treatment as specified in the table of benefits of the insurance policy
- 3.2 In the case that the insurance policy only covers medical expenses in the event of being admitted as an inpatient Grant consent to pay according to actual expenses. but not exceeding the amount of benefits for expenses which arises from medical treatment as specified in the table of benefits of the insurance policy and not more than twelve thousand baht
- 3.3 In the event that the insurance policy covers medical expenses in the event of being admitted as an outpatient and an inpatient, in both cases, the company shall pay the medical expenses according to the actual expenses. but not exceeding the amount of benefits for expenses incurred from medical treatment as specified in the table of benefits of the insurance policy that covers medical expenses in the event of being admitted as an outpatient
If there are expenses that exceed the coverage for medical expenses in the event of being admitted as an outpatient The company shall allow the company to pay medical expenses according to the actual expenses but not more than the amount of benefits for the expenses. In the case of being treated as an inpatient as specified in the table of benefits of the insurance policy and not more than twelve thousand baht
4. Medical expenses in case of being admitted as an outpatient shall include other expenditure items in accordance with rules, guidelines, and prices that are not lower than those prescribed by the Ministry of Public Health or other government agencies, but are limited to expenses related to medical treatment only.
5. The Company shall pay daily compensation expenses or income compensation for the insured or the insured person.
Those infected with the Coronavirus 2019 (COVID-19) under an insurance policy that provides coverage for daily compensation or income compensation. and receive medical care in a hospital at the patient’s residence with the following conditions
- 5.1 There is a document of coronavirus disease 2019 (COVID-19) detection that can verify the identity of the person being tested.
The infection can be found from a laboratory certified by the Department of Medical Sciences by RT-PCR method. - 5.2 The insured or the person covered under the insurance policy infected with the Coronavirus Disease 2019 (COVID-19) has one of the risk factors. And there is no hospital to support the following: over sixty years old chronic obstructive pulmonary disease (COPD) and other chronic lung diseases, chronic kidney disease (CKD), cardiovascular disease and congenital heart disease cerebrovascular disease Uncontrolled diabetes, obesity (weight greater than 90 kg or BMI of 30 kg/m2), cirrhosis, hypothyroidism, and lymphocyte less than 1,000 cells/m3. days or compensation for the above income not more than fourteen days from the date of the foregoing event
In this regard, infirmary means a hospital, a hospital infirmary, a hospital and a field hospital. but does not include a medical facility at the patient’s residence
6. Open a channel for the company to consider paying more as it sees fit in addition to the payment as specified by this order.
“Issuing the said registrar’s order is a compromise because the terms of the agreed insurance policy do not include HI, CI or Hotel Isolation, in order to set clear guidelines for insurance companies to follow as one. This will help to reduce disputes and alleviate the suffering of the insured who are sick from covid infection and undergo treatment such as Home Isolation, Community Isolation or Hotel Isolation. with the insurance sector Therefore, the insurance company is requested to strictly comply with it,” said the OIC Secretary General at the end.
