Naris Sakdapolrak, a retired engineer aged 72, had been diagnosed with mitral regurgitation, a heart problem whose remedy costs could reach millions of baht at private hospitals. So he decided to use his medical treatment rights under universal healthcare coverage, better known as the "gold card", and sought treatment at Bhumibol Adulyadej Hospital, according to information from the National Health Security Office (NHSO).
The patient was later referred to state-owned Siriraj Hospital for cardiac catheterisation, a procedure unavailable at Bhumibol Adulyadej Hospital. But a doctor at Siriraj Hospital found coronary artery disease and recommended vein bypass and mitral valve repair procedures that could be done at the same time.
The total medical bill was about 300,000 baht, but a mere 10,000 baht was out-of-pocket expense; the remainder was absorbed by the universal healthcare scheme.
Mr Naris's case is a great example of the necessity of planning for healthcare costs in retirement to avoid future economic hardship.
Most people understand the need to save a lot of money to retire comfortably. But the budget for healthcare is often underestimated or even overlooked when salaried employees estimate their retirement expenses, as healthcare coverage provided by employers and the social security fund (SSF) enables them to shift some responsibility for such expenses. And, of course, healthcare spending by the working-age population is always far lower than that of the elderly whose health has deteriorated.
SSF versus gold card
Employees after retirement have two basic alternatives for medical welfare: one is a termination of being an insured person under the SSF's Article 33 in return for a monthly pension and switching to the gold card scheme, and another is remaining an SSF member and shifting to status as a voluntarily insured person under Article 39, said Knong Sripiboolpanich, vice-president of K-Expert under Kasikornbank.
Insured persons under SSF's Article 33 who no longer want to be fund members after resignation or retirement will lose benefits for sickness, disability, maternity, unemployment, death and child allowance. If they want to maintain all benefits with the exception of unemployment, they must relinquish old-age pension benefits under the SSF's Article 33 and continue to contribute 432 baht a month to the fund.
Moreover, they must keep in mind that the old-age pension under the SSF's Article 39 is reduced significantly when compared with those insured under Article 33, as the former is computed based on the maximum salary base of 4,800 baht a month, while the latter is based on a 15,000-baht ceiling.
Only those who resign SSF membership can receive the old-age pension or gratuity, subject to contribution period.
Patients are waiting for filing a prescription at a hospital. CHINNAWAT SINGHA
According to the SSF, those paid contributions for less than 12 months will get a gratuity at the same amount as their contributions, and those paid 12 months but less than 180 months will get a gratuity equal to the amount contributed by both them and their employer, plus investment returns.
For those making contributions for 180 months or more, the old-age pension benefit is payable at the rate of 20% of the last 60 months of average monthly salary but not exceeding 15,000 baht. In the case of making contributions for over 180 months, the rate of old-age pension benefit will be increased at the rate of 1.5% per every 12 months.
Based on the average final 60-month salary at 15,000 baht or above, those who have made contributions since the FFS's establishment and retire at the end of this year will receive an old-age pension of 4,350 baht a month until death. The amount will increase to 4,575 baht per month in the event of retirement due at the end of next year and 4,800 at the end of 2021.
To qualify for being a voluntary insured person under the SSF's Article 39, they must pay contributions to the fund under Article 33 for at least 12 months and express intention to the SSF within six months after employment status has ended.
Mr Knong recommends that insured persons under Article 33 who are due to retire in the coming months opt for an old-age pension and become gold card holders if they have already taken out individual health insurance.
"They should take an old-age pension to pay the health insurance premium if that's the case," he said.
But Mr Knong said retirees need to cautiously weigh the worthiness of maintaining or ceasing SSF membership based on the medical treatment benefit available at large state-owned hospitals like Chulalongkorn Hospital, Siriraj Hospital and Ramathibodi Hospital, as these centres are capable of treating severe illnesses at friendly prices.
Moreover, there is a high risk that SSF-insured persons will lose their medical treatment benefit at these large hospitals if their membership is terminated, he said.
Medical benefits for common disorders on the gold card are on a par with the SSF, but coverage for some major illnesses, such as kidney disease, is different, Mr Knong said.
Regarding hospitals, each insured person under the SSF can choose a hospital from the fund's list. Gold card holders must pick from a participating hospital in the holder's registration area (normally based on household registration or living area).
Early purchase of coverage
Although healthcare coverage is one of the most common benefits companies provide to their employees, and medical benefit is also covered by the SSF, salaried workers should not shrug off taking out their own health insurance before retirement, as exorbitant medical bills could still arise, Mr Knong said.
"They should buy health insurance as early as possible because insurers typically do not cover pre-existing medical conditions," he said, referring to health problems that insured persons already have before the date their health coverage starts. "There's a higher risk of severe illness when getting old."
Critical-illness insurance should also be considered, as such treatment can cost millions of baht, Mr Knong said, adding that insured persons should have coverage of at least 2 million baht to ensure that they will live comfortably in retirement life.
