The Benefits of Social Security Insurance in Thailand

When it comes to your healthcare as a digital professional in Thailand, you want to ensure that if and when problems do arise, you are covered. Otherwise, the high costs of having no insurance can do serious damage to your personal finances.

So what are your healthcare options as a foreigner in Thailand?

Private insurance is great, especially for accidents and emergencies. Even before the pandemic, many travelers would choose to buy a plan in their home country before coming to Thailand, enough to cover the first few months of their stay. And for the foreseeable future, private health insurance will be one of the basic requirements to enter the country (who’s to say until when?).

However, if you already plan to work in Thailand long term, then paying for a private insurance plan each month can put an unnecessary strain on your budget. This is one of the many reasons it is beneficial to work with an Employer of Record (EOR) in Thailand, such as Shelter.

Not only does an EOR provide you with a Business Visa and Work Permit to live and work in Thailand legally – you will also receive a Thailand Social Security card which gives you thorough coverage for illnesses, regular doctor visits, and preventative treatments, among other things.

In this article, we take a closer look at the benefits of being enrolled in Social Security in Thailand.

Overview of Thailand Social Security

When you join Shelter (or any Thai company that follows the tax and employment laws in Thailand), you will automatically be enrolled in Thailand’s Social Security program and receive a card that looks like this:

Comprehensive personal health insurance is included in the program, and for most expats living and working in Thailand, the coverage is more than sufficient for their needs. (See “What’s Covered Under Thailand Social Security” below to determine if additional coverage will be needed in your case.)

Since Shelter is a Chiang Mai-based company, our employees are assigned to a local hospital – usually Lanna Hospital about a mile north of the city center – to be their primary care provider.

Having an assigned hospital does not mean that you cannot use other hospitals, for example if you are based in Bangkok or traveling. However, if you do visit another hospital, you will need to pay out of pocket first and be reimbursed later. The same is true for Thai citizens on Social Security as well.

In addition to being assigned a local hospital, you will also receive a Social Security number. While we recommend taking your Social Security card to the hospital with you, sometimes this is not possible during an emergency, in which case you can simply provide your passport and Social Security number.

For any non-emergency health matters, you should bring your physical Social Security card and passport. After checking in, you will be redirected to a specific ward that handles Social Security patients.

Normally you will see a general practitioner first, who will diagnose the problem and prescribe medication, send you to the lab for tests, or refer you to a specialist if necessary. If you wish to see an outside specialist at another hospital or clinic, you will need a recommendation from a doctor at your assigned hospital in order for the care to be covered by Social Security.

In most cases, you are in and out of the hospital in a couple of hours (especially if you arrive early) without having to pay any money out of pocket. Medications, X-Rays, MRIs, blood tests, and most other procedures are completely covered.

Dental care, on the other hand, is somewhat limited. You get 900 THB per year – basically enough to cover teeth cleaning and a check-up. So if Social Security is your only form of health insurance in Thailand, you will need to pay cash for other dental treatments.

The upside is that Thais in general are quite fastidious about dental care, so there are many dental clinics all around the country with good and reasonably-priced services – just a fraction of what you would pay at a clinic in western countries.

The Pros and Cons of Thailand Social Security

Pros

• If employed in Thailand, you will already be paying into it, so there is no additional cost.
• For treatments and prescriptions at your assigned hospital you don’t need to make any payment (with a few exceptions).
• Coverage includes a “sickness cash benefit” equal to 50% of wages if you must take sick leave beyond the initial 30 days covered by your employer. The cash benefit is limited to 90 days at a time and 180 days maximum per year. However it can be awarded for 365 days in the case of chronic illness such as cancer.
• It’s easy to use—just show up at the hospital with your passport and Social Security number.

Cons

• You must go to your assigned hospital, which may not be your first choice.
• Social Security hospitals can often be crowded, with long wait times.
• There are many patients each day, especially if you go at the wrong time, so you may feel rushed with just a few minutes to assess your condition.
• Dental coverage is limited.

What It’s Like Going to the Hospital in Thailand

In this section, we will look at what it’s actually like using your Social Security card at a Thai hospital. In my case, I was assigned to Lanna Hospital which is conveniently located close to the city center in Chiang Mai, right off the Superhighway.

Lanna Hospital is a large hospital with multiple wards, one of which is dedicated specifically to Thailand Social Security participants – not to say it is a VIP wing or anything. I have received treatment there several times for various illnesses over the past few years.

On my most recent visit, I was in and out in a little over an hour and a half. The process went like this:

1. I entered the hospital through the main (front) entrance, showed my Social Security card and passport at the check-in counter, and informed them of the reason for my visit. They directed me to the Social Security ward on the 5th floor.
2. I took a lift to the Social Security ward, checked in, and waited at the nurse station to get weighed and have my blood pressure taken.
3. I waited around 15 minutes to meet with the doctor, a general practitioner. He asked me some questions about my symptoms, examined me, and finally decided that I should get an X-Ray.
4. At this point I was directed to Radiology on the 1st floor, where I waited about 10 minutes. They took images from several different angles and I was out of the X-Ray room in less than 2 minutes.
5. I was directed to a waiting room in a different area of the 1st floor, where I waited for around 20 minutes.
6. I was called into the doctor’s room – this time a specialist. We examined my X-Rays together and he informed me that my issue was not serious, but he prescribed a medication.
7. I sat in the waiting area for a few more minutes to wait for my prescriptions, and had them within minutes.
8. I was out the door and on my way without spending a single baht.

On my previous visits to Lanna Hospital, I have had blood tests and even an MRI. The nurses and doctors have always been nice to me and I felt like I was in good hands. Lanna Hospital is a good option in Chiang Mai because they have so many departments and can provide a wide variety of treatments.

As described above, when you need to see a specialist not found in the Social Security wing, they will direct you to a different area of the hospital. If you require a treatment that is not offered at Lanna Hospital, you will receive a recommendation to another hospital which will be covered under your Social Security insurance.

What’s Covered Under Social Security

14 Illnesses NOT covered by Social Security

1. Diseases or illness from drug usage (according to drug laws)
2. Diseases or illness that require staying in a hospital for more than 180 days in a year
3. Kidney diseases therapy except _the last stage of chronic kidney disease; the insured person shall be eligible for medical services by hemodialysis that uses the peritoneal dialysis, permanent chemical solution and kidney transplant methods. _
4. Any beauty treatment without doctor order
5. Treatment which is still under research development
6. Treatment of infertility condition
7. Tissue examination for organ surgery (except tissue examination for bone marrow transplantation of the insured person, the Social Security will reimburse for cost incurred but not exceeding 7,000 THB per case according to the rules and conditions prescribed by the medical committee)
8. Any extra examination/treatment that is more than necessary
9. Organ surgery (except the bone marrow transplant)
10. The cornea transplant surgery – the Social Security will pay the medical service fee as capital payment at the rate of 20,000 baht to the certified hospital and 5,000 to the Thai Red Cross Eye Bank in accordance with the rules and conditions.
11. Gender reassignment surgery
12. Artificial insemination
13. Dental services (except fillings, scale and polish and tooth/wisdom tooth removal); the insured person is entitled to receive medical fees as actually incurred as necessary but not exceeding 900 baht per year. In case of wearing removable dentures or false teeth, the insured person is entitled to receive medical service fees as actually incurred as necessary but not exceeding 1,500 baht within a five-year period.
14. Glasses/lenses

Maternity

• You must pay contributions to the SSO for not less than 5 months within 15 months before the due month
• Able to claim for childbirth costs of 13,000 baht per one time (unlimited time)
• Maternity allowance paid by SSO
• Employees receive 50% of wages for 90 days of leave (applied only with the 1st and 2nd child)
• Maternity allowance paid by employer
• Employees are entitled to 90 or 98 days maternity leave including leave for antenatal appointments.
• Employees receive 50% of wages for 45 days of leave. If employees take leave for 98 days, employers may decide whether or not to pay for the additional 8 days which, however, depends on the agreement between both parties.
• In the event that the husband and wife are both insured, rights can be exercised only by one party.
• Antenatal care; the insured person with gestational age 1 to 2 weeks can receive an allowance of 500 baht, gestational age more than 12 weeks but not more than 20 weeks can receive an allowance of 300 baht and gestational age more than 20 weeks but not more than 28 weeks can receive an allowance of 200 baht. Note that insurers must pay in advance and bring receipts with them to reimburse at the Social Security Office all over the country.

Invalidity

• You must pay contributions to the SSO for not less than 3 months
• The monthly compensation shall be paid at the rate of 50% of wage for the rest of the insured’s life for severe disability causing the loss of income. If the disability is not too severe, the insured shall receive the compensation according to the disability criteria and period of such disability. 
• If admitted to a public hospital, medical expenses will be covered by the SSO as much as actually incurred as necessary.
• If admitted to a private hospital, for outpatient care, the SSO will compensate no more than 2,000 baht per month, for inpatient care, no more than 4,000 baht per month, for cars and service fees, 500 baht per month.
• The insured person receiving invalidity benefits can establish a claim to old age benefits, where appropriate.  

Death

• You must pay contributions for not less than 1 month within 6 months before death
• The funeral director can request a funeral grant of 40,000 baht.  
• If the insured person having made contributions for 3 years onwards but less than 10 years shall be entitled to assistance benefits equal to 2 months of the average wages.
• If the insured person having made contributions for 10 years onwards shall be entitled to assistance benefit equal to 6 months of the average wages.

Child Allowance

• You must pay contributions for not less than 12 months.
• The insured shall receive a monthly child allowance of 600 baht per one legitimate child until their child turns six (6)
• No more than 3 children per one household

Annual Health Check-up

• Ear examination (Finger Rub Test); over 15 years old; once a year
• Breast examination;
  •   30-39 years old; every 3 years
•     40-54 years old; once a year
  •   55 years old and above; as needed
• Eye examination; 
  •    40-54 years old; single time
  •    55 years old and above; once every 1 to 2 years
• Visual acuity testing (Snellen Art Chart); 55 years old and above; once a year
• Complete blood count (CBC);
  •   18-54 years old; single time
  • 55-70 years old; once a year
• Urinalysis urine test (UA); 55 years and above; once a year
• Fasting blood sugar test (FBS); 
  • 35-54 years old; every 3 years
  • 55 years old and above; once a year
• Creatinine blood test (CR); 55 years old and above; once a year
• Cholesterol test (Total and HDL Cholesterol); over 20 years old; every 3 years
• Hepatitis B surface antigen (HBsAg); those born before 1992, single time
• Cervical cancer screening (Pap Smear Test);
  •    30-54 years old; every 3 years
  •    55 years old and above; as needed
• Cervical cancer screening (VIA: visual inspection with acetic acid)
  •    30-54 years old; every 5 years
  •    55 years old and above; Pap Smear Test recommended
• Fecal occult blood test (FOBT); 50 years old and above; once a year
• Chest X-ray; over 15 years old; single time

Covid-19 (Coronavirus)

1. Admitted to public hospitals:
   1. For outpatient care, the SSO will cover the medical expenses incurred as necessary but not exceeding 3,000 baht per time. The personal protective equipment (PPE) of healthcare workers shall be covered not exceeding 540 baht.
   2. For inpatient care, the coverage on:
      1. Room and food expenses shall not exceed 2,500 baht per day.
      2. Medical fees shall be calculated in accordance with the Diagnostic Related Group (DRG) at the rate of 12,000 baht per Adjusted Relative Weight (AdjRW).
      3. Medications shall not exceed 7,200 baht per case.
      4. The testing procedure shall not exceed 2,500 baht per time.
      5. The personal protective equipment (PPE) coverage varies depending on the severity of the illness.
         1. For mild to medium condition, the coverage shall not exceed 740 baht per equipment set with the allowance of 15 equipment sets per day.
         2. For severe conditions, the coverage shall not exceed 740 baht per equipment set with the allowance of 30 equipment sets per day.
2. Admitted to private hospitals; the medical expenses shall be covered by the SSO if the patient shows symptoms that may be the result of COVID-19.
3. Ambulance rides: In the case of being transferred within the same province, the coverage shall not exceed 500 baht per time. In the case of being transferred outside of one own province, an addition of 6 baht per kilometre will be covered. Plus, the costs of PPE of healthcare workers and the ambulance cleaning and disinfection will be covered not exceeding 3,700 baht per time.
4. If there are other necessary expenses that have not been mentioned above, the SSO shall cover according to the decision from the Medical Board.

It is advised that the insured that shows symptoms such as coughs, a fever, sore throat and other related symptoms should go to the hospital they are assigned to for the SSO program. If the insured is COVID-19 free, they can receive treatment from the registered hospital. If the insured cannot get treatment from their registered hospital for whatever reason, they can go to any hospital, both public or private, and if the insured turns out to have COVID-19 positive, they can receive treatment at that hospital other than their registered hospital, free of charge and without having to report to their registered hospital.