Top 6 health insurance exclusions to watch out for

Before securing a health insurance plan, there will be a number of things you will need to look out for to determine whether it’s the best fitting plan for your needs; chief among them being the policy exclusions. For those of you who don’t know what it means, a health insurance exclusion refers to anything that your plan won’t cover. If you’re unsure about what exclusions you’ll need to look out for, read on to learn about the top six most common health insurance exclusions.

Natural disasters, extreme sports, etc.

Virtually every health insurance plan in Thailand will have a number of specific scenarios or events listed under its policy exclusions. Commonly excluded scenarios include:

• Injuries or illness sustained as a direct result of a natural disaster (e.g. floods, tsunami, earthquake, etc.)
• Injuries or illness caused by participation in illegal activities (e.g. drug misuse)
• Injuries sustained from participating in extreme sports – some plans exclude this completely, while plans that do cover extreme sports often exclude injuries sustained from more dangerous forms of extreme sport (e.g. skydiving and off-piste skiing)
• Self-inflicted injuries/ hazardous activities
• Treatment arising from war or terrorist acts

Dental and optical services

General health insurance plans typically exclude cover for dental and optical services. That said, more comprehensive plans do offer the option of including dental and optical cover as an add-on benefit.

Please note that often times these add-on benefits will impose a waiting period. This means that you’ll need to wait a certain period of time from the inception of your dental and/or optical plan before you’ll be eligible for reimbursement pertaining to these particular add-on benefits.

Maternity care

Costs related to maternity treatment are in most cases listed as an exclusion in general health insurance plans. However, like dental and optical insurance, maternity insurance is also available as an add-on benefit. Again, this will be subject to a waiting period. As maternity insurance waiting periods last at least 10 to 12 months, and sometimes even as long as two years, it is therefore essential to take out the maternity benefit well ahead of conception.

With maternity insurance in place, you’ll be able to offset the extensive costs associated with private maternity care (e.g. prenatal ultrasound, tests, delivery).

Fertility treatment

Fertility treatment such as In Vitro Fertilization (IVF; a process that involves fertilizing an egg outside of the body) can be very expensive. As such, most plans exclude IVF and other assisted reproductive technology (ART) treatments due to its high cost. That being said, select plans do cover fertility treatment, although often times a number of caveats will apply. For example, the insurer may impose a long waiting period of 18 months or more before you’re covered for that benefit. Some insurers may also require both partners to obtain the plan before the mother can receive coverage for IVF and other ART procedures.

Cosmetic surgery

This is quite an obvious exclusion, as virtually all health insurance plans will only cover medically necessary care. As such, elective surgeries aimed at improving one’s aesthetic appearance (e.g. rhinoplasty, facelift, tummy tuck) likely won’t be covered by your health insurance.

On the other hand, if the surgery is cosmetic in nature but is deemed medically necessary (e.g. breast reconstruction surgery after a mastectomy), then it will usually be covered.

Health insurance coverage outside of Thailand

If you have a local Thailand health insurance plan, then you’ll only have healthcare coverage in the country and likely won’t have any coverage benefits outside of Thailand. If you would like to have international health coverage, you may want to think about securing an international health insurance plan instead. Designed specifically to meet the needs of expats and frequent travellers, with an international medical insurance plan you will get to enjoy healthcare coverage in virtually any hospital, anywhere in the world.

If international health insurance is not the right option for you, travel insurance may also be a good alternative if you would like to protect yourself from travel-related mishaps and medical emergencies when going overseas for a short period of time.

Please note here that travel insurance policies tend to have much lower coverage limits than international health plans, as they’re designed to provide enough cover to see you well enough to send you home in the event of a medical emergency.

There’s no such thing as a one-size-fits-all plan, so before purchasing a health insurance plan it can pay to seek advice from an experienced broker like Pacific Prime for impartial insurance advice.

If you have any questions, be sure to get in touch with our friendly team at Pacific Prime Thailand today.

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Jess

Content Strategist at Pacific Prime Thailand

Jessica Lindeman is a Content Strategist at Pacific Prime. She comes to work every day living and breathing the motto of "simplifying insurance", and injects her unbridled enthusiasm for health and insurance related topics into every article and piece of content she creates for Pacific Prime. When she's not typing away on her keyboard, she's reading poetry, fueling her insatiable wanderlust, getting her coffee fix, and perpetually browsing animal Instagram accounts.

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