Healthcare in Thailand: there is no treaty route, and that is the real risk
Within the EU you slot into the local system with an S1. To Thailand that route doesn't exist: your basic insurance stops on deregistration and you buy a policy yourself. Thai private healthcare is good and cheap — but the premium hangs on your age, existing conditions are excluded, and above a certain age nobody will take you on as a new customer any more.
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Written and checked by Auke on , against the sources at the bottom. Is something no longer right? Report it below and I'll fix it.
No, there is no S1 or treaty route to Thailand, as you have within the EU. That means:
- your Dutch basic insurance stops on deregistration;
- you buy a policy yourself;
- for the O-A visa that policy must cover at least 3 million baht (US$ 100,000).
Of all the steps in the Thai journey, this is the one people misjudge later. Not because the care is bad: Thai private healthcare is excellent and much cheaper than Dutch. It is because the safety-net construction you are used to in Europe is entirely absent here.
What falls away?
Your Dutch basic insurance ends on the day you deregister. That is not a choice and not a notice period. To be insured under the Zvw (the Dutch Health Insurance Act, the basic insurance) you have to be insured under the Wlz (the Dutch Long-term Care Act). You no longer are as soon as you live outside the Netherlands.
With an EU destination something takes its place. With an S1 form from the CAK, the Dutch agency for healthcare abroad, you register with the local health fund. You then pay the Netherlands a treaty contribution. That is the route to Spain, Italy, Greece and every other EU country.
To Thailand that route doesn't exist. There is no treaty that places you in the Thai system, and there is no treaty contribution. From the day of deregistration your cover is entirely your own purchase.
What does the visa require as a minimum, and why is that too little?
For the O-A visa health insurance is compulsory. Since 1 October 2021 the requirement is far higher than the figures that keep circulating. Your policy has to cover all medical costs up to at least US$ 100,000, that is 3 million baht.
- The old requirement of 400,000 baht for inpatient and 40,000 for outpatient care belongs to the 2019 scheme and no longer applies.
- Since September 2022 the same three million is asked at the annual extension of an O-A as well.
- A foreign policy is allowed, provided the insurer fills in the official certificate form.
- For the O-X it is stricter: there a Thai policy is required.
Pay close attention to what that figure is: a minimum requirement of the government, not sensible cover. A serious admission with surgery and intensive care in a good private hospital in Bangkok can still go beyond it. Whoever insures at exactly the minimum has a visa, but not security.
So insure yourself for what you would actually need, and use the visa requirement only as the floor for the paperwork.
| Requirement or amount | What applies |
|---|---|
| Cover for the O-A visa | at least US$ 100,000 (3 million baht), since 1 October 2021 |
| Old requirement (2019 scheme) | 400,000 baht inpatient and 40,000 baht outpatient; lapsed |
| At the annual extension of an O-A | the same 3 million baht, since September 2022 |
| Foreign policy | allowed for O-A, with the insurer's official certificate form; for O-X a Thai policy |
| O-A visa | from age 50; 800,000 baht balance or 65,000 baht income a month; 5,000 baht for multiple entries |
Which three things determine the premium?
Age, and it weighs more than anything. Around fifty an international policy is a modest amount. Above seventy it is a multiple of that, and the rise is not linear. So ask for quotes for now, for ten years from now and for twenty years from now, not just for your current age.
Existing conditions. With new policies these are often excluded or covered at a hefty surcharge. What you got reimbursed in the Netherlands without questions can fall outside your cover here.
The acceptance limit. Above a certain age many insurers simply no longer take you on as a new customer. Whoever has a policy at sixty-five can usually continue it. Whoever wants to take something out for the first time at seventy-five runs into closed doors.
That last point is the reason the order matters. Arrange the medical acceptance while you still live in the Netherlands, and only cancel your Dutch policy once the new one actually starts.
Which question do you ask before departure?
Not "what does a policy cost now", but: what do we do if this policy is cancelled or becomes unaffordable in fifteen years?
There are three honest answers, and you have to choose one of them:
- We keep capital in reserve that can carry a serious treatment without insurance.
- We go back to the Netherlands if it comes to that. Then you need to know that you have to register again and that the basic insurance is then open to you again.
- We accept the risk.
What doesn't work is not asking the question. This is the item that determines whether Thailand is sustainable in the long term. It therefore belongs in the orientation phase and not at the point of signing up.
What a policy costs roughly for your situation is in the cost indication for Thailand.
In Vertrekklaar this is phase 3 of 5 of the journey: the same steps, but applied to your situation — in your order, tickable, and with the deadlines monitored. See the whole journey to Thailand.
What this rests on
The facts in this article come from these official pages. Rules change. When in doubt, go by the source, not this article.
- CAK — treaty countries (Thailand is not on the list) — hetcak.nl
- SVB — consequences of emigration for your health insurance — svb.nl
- Belastingdienst — your national insurance schemes when you emigrate — belastingdienst.nl
- Ministry of Foreign Affairs Thailand — insurance requirement for the O-A visa — image.mfa.go.th
- Ministry of Foreign Affairs Thailand — foreign insurer's certificate — image.mfa.go.th
- Ministry of Foreign Affairs Thailand — Non-Immigrant Visa O-A — mfa.go.th
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