The OIC secretary signs the registrar’s order. Order a life insurance company to pay for treatment. Home isolation- Community isolation ‘with income compensation’ up to 14 days.
On July 30, 2021, Mr. Sutthiphon Thaweechaikarn, Secretary-General of the Office of Insurance Commission (OIC), signed an announcement of the registrar’s order on July 29, 21, regarding payment of medical expenses. A nurse under an insurance policy for COVID-19 infection and received nursing care in the form of Home Isolation or Community Isolation for life insurance companies and non-life insurance companies.
by Home Isolation care means that if the patient is diagnosed as a patient with coronavirus and the care physician of the service unit considered Deems appropriate that the patient is appropriately and safely quarantined in the accommodation. with the consent of the patient and the facility owner and including cases where patients are treated in service units and came back to isolate in the accommodation until the due date This is in accordance with the rules and guidelines set by the Ministry of Public Health.
Community Isolation care means that if a patient is diagnosed with a COVID-19 patient. and the care physician of the service unit considered deems appropriate to allow that patient to be isolated in the community both patients who are undergoing treatment as inpatients in the hospital or return for further care from the hospital until the due date by providing an isolated area in the community for isolation from the infected person with the consent of the patient and the owner of the place in preparing the site for proper care and treatment This is in accordance with the rules and guidelines set by the Ministry of Public Health.
In essence, life insurance companies and non-life insurance companies who have agreements in the insurance policy against COVID-19 Let the company pay for medical treatment for patients infected with COVID which is maintained in the form of Home isolation. The method of taking care of community isolation is as follows:
1. In the case that the policy provides coverage for medical expenses In the case of receiving outpatient treatment according to medical necessity and actual payment but not exceeding the amount of benefits for expenses which arises from medical expenses As stated in the table of benefits of the insurance policy
2.In the case that the policy provides coverage for medical expenses In the case of inpatient treatment granting permission to pay medical expenses Outpatient treatment form according to medical necessity and actual payment but not exceeding the amount of benefits for expenses which arises from medical expenses As stated in the table of benefits of the insurance policy
3. In the case that the policy provides coverage for medical expenses In the case of outpatient and inpatient treatment Grant permission to pay for medical expenses in the form of outpatient treatment according to medical necessity and actual payment but not exceeding the amount of benefits for expenses which arises from medical expenses As stated in the table of benefits of the insurance policy
by the cost of treatment for outpatient treatment in the first paragraph to include expenses according to the rules and guidelines and the price is not lower than the Ministry of Health or other government agencies If there is a limited cost only related to medical treatment only
In addition, the company pays daily compensation or income compensation. For the insured infected with COVID under the coverage that pays daily compensation or income compensation. with the following conditions
1. There is a document showing that the insured is a patient. who were diagnosed with coronavirus by the attending physician and
2. There is a medical need for treatment. being a patient in the hospital But there is no hospital to support the insured infected with the covid. Although initially it may look like to be treated in a home isolation or community isolation that follows the rules Guidelines prescribed by the Ministry of Public Health, for example, aged 60 years and over, obese means having a body weight of more than 90 kg and having the following congenital diseases: Chronic Obstructive Pulmonary Disease (COPD) Chronic Kidney Disease (CKD Stage 3,4) Cardiovascular Disease cerebrovascular disease Uncontrolled diabetes, other diseases at the discretion of the physician
In this regard, the daily compensation or the first paragraph of income compensation shall be paid for no more than 14 days from the date of the incident. However, in addition to the expenses as specified by the Company as it considers appropriate
‘Insurance’ allows RT-PCR test results to submit a claim for COVID-19
Mr. Anon Wangvasu, President of the Thai General Insurance Association, said that due to the current situation of the COVID-19 epidemic, which has continuously escalated and widened As a result, the government has to increase the channel to bring people infected with COVID-19 into the care system in the form of home isolation and community isolation. ) increased from the original set to be hospitalized in a hospital Field hospital or Hospital only
The association had discussions with the OIC and member companies. In considering the adjustment of the compensation payment criteria to be more suitable for the model of patient care. To increase benefits and facilitate the insured as follows
1. Insurance policy which provides coverage in case of sickness or detection of COVID-19 (Found, Pay, End) because in the find, pay and finish insurance policy, it is required that the insured who is infected with COVID-19 must present evidence of a medical certificate supporting the claim. However, the Home Isolation and Community Isolation care system prevents the insured from obtaining a medical certificate from a medical facility. and may make the claim process inconvenient in the current situation.
The association therefore asks for cooperation from the member companies to allow the need to request a medical certificate from the insured during this period. By requesting only the insured’s RT-PCR form of COVID-19 detection document From the COVID-19 testing agency that has standards and has been certified by the Department of Medical Sciences To be able to verify the identity of the person being tested and the test results are reliable.
Sick in a coma-death outside the hospital. Allows to pay compensation.
2. Insurance policy which provides coverage for terminal illness and/or coma and/or brain death and nervous system failure caused by COVID-19 causing death.
Because in the insurance policy that provides such protection Requires the insured to be diagnosed by a physician of terminal illness and/or coma and/or brain death and nervous system failure. causing death But in case of death from COVID-19 outside of a medical facility such as at home or other places Which has not been diagnosed by a doctor that the deceased was in the condition before his death. The non-life insurance company will allow to pay compensation according to the coverage of the insurance policy.
3. Insurance policy which provides coverage for medical expenses from COVID-19 because in the insurance policy that covers medical expenses It provides coverage only for inpatient treatment in a hospital setting. Field hospital or Hospital only, the non-life insurance company has extended the coverage to medical expenses during treatment in the form of Home Isolation and Community Isolation, whereby the non-life insurance company will allow the insured to pay medical expenses to the insured according to the actual medical necessity that has been paid. in the scope of outpatient medical care but not exceeding the coverage limit specified in the insurance policy schedule
4. Insurance policy which provides coverage for daily compensation or income compensation from COVID-19 due to insurance policy that provides coverage for daily compensation or income compensation. It provides coverage for inpatient treatment in a hospital setting. Field hospital or Hospital only
The non-life insurance company has agreed to pay daily compensation or income compensation to the insured who is a patient with COVID-19 who has a medical need to be admitted as an inpatient. but could not find a hospital Field hospitals or Hospitals can support them, so they need to be treated in the form of Home Isolation or Community Isolation.
Compensation for high-risk sick income – no more than 14 days
Non-life insurance companies will pay compensation only to high-risk COVID-19 patients according to the Ministry of Public Health’s announcement, such as those aged 60 years and over, those who are obese. (Body mass index greater than 30 or body weight greater than 90 kg) or people with underlying diseases such as chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD Stage 3,4), cardiovascular disease cerebrovascular disease Uncontrolled diabetes or other diseases at the discretion of the physician
The non-life insurance company will pay compensation for not more than 14 days from the date of emergence of evidence of COVID-19 infection.
“The Thai General Insurance Association and the non-life insurance business sector sincerely hope that Relaxation measures and benefits that has been prescribed additionally will assist and facilitate the insured, who is our customer, more suitable for the situation To enable the non-life insurance business to truly act as a professional risk manager for the people and society. and participate in leading the country through this crisis,” said the President of the Insurance Association.