OIC allows insurance to not have to pay for COVID-19 claims for treatment at home
Date 26 Feb 2022 time 22:26
Urgent discussion. The OIC agrees that insurance companies don’t have to pay for Covid-19 claims and treat it at home.
Quick discussion of 4 parties “OIC – Ministry of Public Health – Insurance Business Sector – Private Hospital Association” in case of criteria for receiving insured infected with covids, concluded 2 hot issues, requiring insurance companies to pay claims in all cases If admin is an inpatient, in a hospital or Hospital according to medical standards
In the case of Home Isolation (HI), to alleviate the suffering of the insured people The insurance company shall consider paying the claim on a case-by-case basis, mutatis mutandis according to the specified conditions. which will be discussed in detail soon
Dr. Suthiphon Thaweechaikarn, Secretary General of the OIC revealed that from the case that the Thai Life Assurance Association has issued a circular notifying member companies regarding the guidelines for providing coverage under health insurance contracts For the insured infected with the Coronavirus Disease 2019 (COVID-19), referring to the Ministry of Public Health’s Notification Re: Guidelines for Medical Personnel in Advising Patients and Providing Home Isolation Services for COVID-19 Patients. Effective from February 15, 2022 onwards
After the Thai Life Assurance Association communicated the guidelines, it appeared that it was widely interpreted and controversial. as well as private hospitals have refused to accept patients infected with COVID If it does not meet the aforementioned criteria due to fear that the insurance company will refuse to pay the compensation As a result, patients infected with COVID-19 The insurance companies are affected a lot.
Therefore, in order to solve the situation and find a solution together, the Secretary-General of the OIC held several meetings with the executive committee of the OIC as well as meetings with the insurance business sector. until getting to know the facts and relevant laws Then, as the registrar, he assigned Mr. Chuchat Pralumphol, Deputy Secretary-General for supervision, and Mr. Chaiyut Mangsri, Deputy Secretary-General for legal matters, litigation and protection of privileges. The meeting was held on February 25, 2022 via online system with the Department of Health Service Support, Department of Medicine, Department of Disease Control, National Health Security Office (NHSO), Legal Division, Ministry of Public Health. Private Hospital Association Thai Life Assurance Association and the Thai General Insurance Association in order to get a solution on the aforementioned issues
from this meeting came to the preliminary conclusions together on 2 issues, namely the first point, if the guideline provides coverage under the health insurance contract of the Thai Life Assurance Association with messages that are inconsistent with the guidelines set by the Ministry of Public Health The meeting concluded that if admitting as an inpatient in a hospital or hospital, the insurance company would have to cover it because it was considered medically necessary and met medical standards. And it is the case that it is in accordance with the conditions of the insurance policy, which the OIC will expedite the issuance of guidelines for insurance companies to follow.
The second issue is the case of the new guidelines of the Ministry of Public Health. Prescribing care for COVID-19 patients During the transmission period it is necessary to keep the patient separate from others. “In a medical facility at the patient’s residence” (Home Isolation (HI), which is considered a patient of a medical facility.
The meeting saw that The Ministry of Health’s opinion that HI, CI and Hotel Isolation treatments are excluded from the Healthcare Facility Act. In this segment, the insurance sector is undisputed. But since the comments were made only after the health insurance and covid insurance policies were created, at the time the terms were defined in the insurance policies, there were no cases of HI, CI and Hotel Isolation.
Determining whether such patients are considered inpatients in a hospital or not Therefore, it is necessary to consider mainly according to the conditions of the policy. This is a matter that the parties agreed upon during the insurance contract. as well as having to consider medical necessity and medical standards, including
However, according to the insurance policy, there are conditions for coverage. The exceptions are clearly stated. Therefore, considering the coverage under the insurance policy conditions Therefore, the components of the treatment style must be considered as an inpatient treatment. or outpatient as well as to consider the definition of a nursing facility Providing coverage that does not meet the requirements of the insurance policy affects the calculation of the premium rate and also affects the reinsurance contract. that Thai insurance companies have done with reinsurance companies both in the country and abroad.
However, to alleviate the suffering of the insured Therefore, it is deemed necessary to agree to pay medical expenses and daily compensation to the insured who undergoes HI or CI treatment if necessary, which the OIC will discuss with the Ministry of Public Health, business sector and relevant agencies. as soon as possible to jointly define the guidelines to be in the same direction
“The organization of this meeting gives relevant parties the opportunity to exchange opinions and views. This results in a certain level of mutual understanding. which need to be integrated together to find a solution and reduce the impact on the people As for the guidelines that the OIC will continue to do is expedite the issue of guidelines for insurance companies to pay for claims in the event of hospital admissions or hospitals, and the issue of daily compensation in the case of HI. , CI and hotel isolation, which were recently agreed by the Ministry of Health to expand the definition of inpatients. therefore does not match the conditions in the policy This section has resolved that the grant is permitted to be paid in case of necessity. which will expedite the discussion in details asap,” said the OIC secretary-general.
