OIC sets rules for coverage of Covid-19 policyholders in isolation

The order was issued by the Office of Insurance Commission (OIC) earlier this week after OIC secretary-general Suttipol Taweechaikarn met with Thai Life Assurance Association, Thai General Insurance Association and the Private Hospital Association (Thailand).

The reason for the order is that most insurance policies only cover patients if they are hospitalised, not if they need to go into isolation at home, community centres or in a hotel.

The Public Health Ministry had previously tried to get insurance companies to cover policyholders in isolation but did not get too far, which is when the OIC had to step in and issue an order on March 16.

The order specified that insurance firms are required to cover all claims from November 1, 2021, to May 16, 2022.

For policyholders under home isolation, community isolation or hotel isolation, insurance companies are required to cover outpatient treatment fees up to the coverage limit.

For inpatients, the company is required to pay for treatment up to the coverage limit or a maximum of 12,000 baht.

For policyholders who have both inpatient and outpatient coverage, the insurance firms are required to pay the actual treatment fee up to the coverage limit.

If the fee exceeds outpatient coverage, the insurance firm is required to pay for treatment up to the inpatient coverage limit or a maximum of 12,000 baht.

In terms of daily/income compensation for policyholders under isolation, the insurance firm is required to pay compensation for each high-risk patient who needs an RT-PCR test and is unable to access hospital treatment.

Risk factors in this case are:

• Aged 60 and above
• Chronic obstructive pulmonary disease
• Other chronic lung diseases
• Chronic kidney disease
• Heart and artery diseases/congenital heart disease
• Stroke
• Out of control diabetes
• Obesity (weighing over 90kg or a BMI of above 30)
• Liver disease
• Weak immunity
• Lymphocyte levels lower than 1,000 cells/μL