Data as of 20 October 2026 · compiled by Prakanthai.com
Last year you caught the flu, had diarrhoea and dizzy spells, made several trips to hospital, and every health insurance claim was paid. Then, as renewal approached, the renewal notice arrived with a new condition: next year you must pay part of your treatment costs yourself.
This condition is called copayment. Who does it apply to, which claims trigger it, and if you are about to buy health insurance now, how should you choose?
What is copayment in health insurance?
Short answer: Copayment is a condition under which the insured pays a share of treatment costs themselves, for example 30% of every bill. The version most talked about is the one that arises at renewal. It applies to new health policies that started cover on or after 20 March 2025 and have this condition written in: if you made 3 or more claims in the past year and the claim total exceeded the threshold, you must co-pay 30% or 50% the following year, then go back to normal once you no longer meet the conditions. Whether a copayment applies depends on the conditions of each plan's policy, so new buyers should check before deciding.
The Office of Insurance Commission (OIC) explains that there are 2 kinds of copayment
| Type | When it applies | Effect on the premium |
|---|---|---|
| Copayment from the start of the contract | The insured chooses it when buying | A lower premium |
| Copayment at renewal | When the past year's claims meet the criteria | Not chosen by you; it results from your claims history |
Which claims mean you co-pay the following year?
The criteria used by the insurance industry, as explained by the Thai Life Assurance Association, look at claims in the previous policy year.
| Case | Which claims | Copayment next year |
|---|---|---|
| 1 | Minor illnesses (Simple Diseases): 3 or more claims, and a claim total of 200% or more of the premium | 30% of all treatment costs |
| 2 | General illnesses: 3 or more claims, and a claim total of 400% or more of the premium (not counting major surgery and serious illnesses) | 30% of all treatment costs |
| 3 | Meets both case 1 and case 2 | 50% of all treatment costs |
Minor illnesses (Simple Diseases) are conditions that can be treated as an outpatient if there are no complications, such as influenza, upper respiratory tract infections, fever of unknown cause, headache, dizziness, diarrhoea, gastritis, acid reflux, allergies and muscle inflammation.
This condition is assessed year by year. If claims fall in the following year to below the criteria, the policy goes back to normal terms the year after.
A worked example to illustrate
Example: a health insurance premium of THB 20,000 per year. During the year you claim for influenza, diarrhoea and acid reflux, 3 claims in all, totalling THB 40,000.
- The claim total is 40,000 ÷ 20,000 = 200% of the premium, and there were 3 claims, so case 1 applies.
- The following year, if treatment costs THB 10,000, the insured pays 30% = THB 3,000 and the insurer pays THB 7,000.
If the plan also has a deductible, the deductible is subtracted from the treatment cost first, and the copayment is then calculated on what remains.
How does copayment differ from a deductible?
| Copayment | Deductible | |
|---|---|---|
| How it is calculated | A percentage of the treatment cost | A fixed first amount, for example THB 20,000 or 200,000 |
| Does the insured know in advance? | The renewal type depends on your claims history | Known from the day you buy, because you choose it |
| Who it suits | – | People whose group insurance or other insurance already pays the first amount |
A simple rule: a deductible is a figure you choose yourself to lower the premium, while a renewal copayment is the result of claims. Read more in Excess vs Deductible: what is the difference?
How can you avoid co-paying at renewal?
- Read the renewal notice every year. The insurer states the copayment condition in the renewal notice.
- Treat minor symptoms as an outpatient when the doctor sees no need for a hospital stay.
- Keep a separate OPD limit for general doctor visits instead of claiming from the inpatient limit.
- Check the plan's renewal conditions before you buy to see whether it has copayment terms, and how they work.
Is there health insurance without copayment?
Yes, because copayment depends on the conditions of each plan's policy. One example is AXA SmartCare Essential from AXA Insurance, which has no copayment condition, either at purchase or at renewal.
- Many categories of inpatient treatment are paid at actual cost, within a limit of THB 1–10 million per illness
- Choose a deductible of THB 20,000–200,000 to lower the premium
- OPD can be added at THB 3,000 per visit or THB 50,000 per year
- Inpatient-plan premiums start at THB 16,310 per year (data as at 20 Oct 2026). The actual premium depends on age, plan and the deductible chosen.
See the cover, premiums by age and who this plan does not accept at AXA SmartCare Essential health insurance, or enter the ages of your whole household in the AXA SmartCare Essential premium calculator.
A plan with no copayment condition still has waiting periods, exclusions for pre-existing conditions and the usual underwriting criteria. Read the section "Who should not buy this plan yet?" before deciding.
Frequently asked questions
Do policies bought before 20 March 2025 have to co-pay?
The announced criteria apply to new policies that started cover on or after 20 March 2025. For an older policy, check the conditions in the insurer's renewal notice.
Do major surgery or treatment of serious illnesses count towards the criteria?
Case 2 does not count major surgery and serious illnesses, so they do not make you meet the copayment criteria under this case.
Do you have to co-pay in the first year you buy?
No. The renewal copayment condition looks at claims in the past year, so it can only take effect from the renewal year, unless you choose to buy a plan with copayment from the start of the contract.
What should you do if you want to compare plans with and without a copayment condition?
Send your date of birth and say whether you already have group insurance or other health insurance. Our team will send back a premium quote with a summary of the renewal conditions within a business day. LINE Official: @prakanthai · Tel. +66 2 459 2223
Notes
The information on copayment conditions is based on statements by the OIC and the Thai Life Assurance Association published in the media. The information on AXA SmartCare Essential is based on the product presentation and information from AXA Insurance Public Company Limited, checked on 20 October 2026. It is general information and not part of the insurance contract. The conditions of each policy may differ. Underwriting and claim payments are decided by the insurer. Prakanthai.com is a non-life insurance broker, not an insurer, licence no. 5104000004. Please read the policy and the renewal notice in full before deciding.
