In case of dental treatment (extracting, filling, removing dental plaque and fitting of denture)

The insured is entitled to receive medical treatment service at any hospital in the case of extraction of teeth, filling teeth, removal of dental plaque the cost of which the insured can advance the expense and can later apply for the reimbursement at the rate of not exceeding 250 Baht per each dental service or not more than 500 Baht per year; and shall further be entitled to be fitted with an acrylic-based overdenture from 1 to 5 teeth at the cost of not exceeding 1,200 Baht; and an overdenture for more than 5 teeth, at the cost of not more than 1,400 Baht within a period of 5 years with effect from the date of fitting the acrylic-based overdenture.

Evidence required for applying for dental service cost reimbursement

• Application Form for Compensation Payment in Case of Dental Service (2-16).
• A medical certificate and a receipt.
• A copy of the Citizenship ID Card and a copy of the Certified Entitlements Card.
• In case of collection of payment through the Bank, a copy of the first page of the Bank Savings Account book showing the Name of Account and Account Number of either Bank of Ayudhya Plc or Krung Thai Bank Plc.
  
  

Medical expense in case of kidney dialysis

The insured that has been afflicted with chronic kidney disease of final stage and has been granted approval as a person entitled to medical care cover in the case of kidney therapy shall be subject to the terms and conditions and the rate of medical treatment service as prescribed by the Zone Office of Social Security as follows:

1. The cost of hemodialysis payable to the hospital under agreement, which provides hemodialysis service to the insured at the rate of not exceeding 1,500 Baht per each kidney hemodialysis and not exceeding 3,000 Baht per week.
2. The cost of Chronic Peritoneal Dialysis (CPD) payable to the hospital under agreement and that provides service to the insured as actually incurred not exceeding 15,000 Baht per month. In the course of the first month of approval, the cost will not exceed 500 Baht per day with effect from the date of entitlement to the end of the month.
3. The cost of kidney transplantation operation procedure is payable to the hospital under agreement that provides service to the insured as follows:
   • Pre-transplantation cost as actually incurred at the rate of not exceeding 30,000 Baht per each insured.
   • Expense in the course of kidney transplant shall be payable in a lump sum amount at the rate not exceeding 230,000 Baht to cover both the insured and the donor of the kidney for a duration of 60 days with effect from the date of kidney transplant including the treatment of the acute condition of kidney rejection of the insured for a duration of 2 years with effect from the date of kidney transplant.
   • The cost of post-kidney transplant operation for the hospital performing the kidney transplant operation on the entitling insured also to cover medical inspection and treatment; immunity suppression medication; laboratory test, urine test; inspection of the level of immunity suppression medication payable in lump sum amount as follows:
     • The 1st year; 1st to 6th month: at 30,000 Baht per month.
     • From the 7th to 12th month: at 20,000 Baht per month.
     • The 2nd year; 1st to 6th month: at 15,000 Baht per month.
     • The 3rd year onward: at 10,000 Baht per month.
       
       

Post-kidney transplantation entitlements and benefits with effect from the 1st day of the following month in the following case:

1. Return for kidney hemodialysis with the use of dialyzer or the Chronic Peritoneal Dialysis (CPD)
2. Termination of the status of being the insured.
3. Death.
   
   

Evidence to be presented on applying for kidney hemodialysis service

• The Application Form for Reimbursement of the Cost of Kidney Dialysis (Form SorPorSor. 2-18) (for Hemodialysis or Chronic Peritoneal Dialysis (CPD).
• The Application Form for Reimbursement of the Cost of Kidney Transplantation (Form SorPorSor 2-18/2).
• A copy of Medical Records of the relevant treatment.
• The result of the kidney examination according to the terms and conditions annexed to the Notification of the Medical Board Re: The Criteria and Rates of Compensation in Case of Injuries or Sickness Not Related to Work Performance in the Case of Hemodialysis.
• The Medical Certificate issued by the kidney disease specialist.
• A copy of the Citizenship Identity Card
• Two photographs of 1 or 2 in size ( of 6 months currency).
  
  

Procedure on applying for compensation benefits

• The insured shall be required to complete and sign the Application Form for Reimbursement of the Cost of Kidney Dialysis (Form SorPorSor. 2-18) to be submitted to the Zone Office of the Social Security /provincial office countrywide or submit the application form for compensation benefits by post or by telephone.
• Members of the staff make sure that the documents are complete and correct before submitting them to the Medical Board.
• The Zone Office of the Social Security sends a letter informing the insured of the result of the consideration.
  
  

For critical sickness which necessitates prompt medical attention or others in which the life of the insured may be put at risk; the insured shall be able to be admitted to the nearest hospital; the insured or next-of-kin of the afflicted insured must report to the hospital immediately according to the Certified Entitlements Card so that the medical expense shall be responsible for properly. As for the pre-admission expense incurred prior to notifying the hospital according to the Certified Entitlements Card, the Zone Office of the Social Security shall be responsible for the pre-admission expense within 3 days (72 hours) according to the category and the announced rates. As for the medical expense in excess of the medical bill which is to be responsible for by the hospital according to the Certified Entitlements Card shall have effect from the date on which the hospital according to the Certified Entitlements Card is notified.

1. Admission for medical treatment to the State-run hospital regardless of critical injury or sickness, the medical expense can be reimbursed as follows:
   1. For an out-patient case, reimbursement on medical bill can be made as actually incurred as necessary
   2. For an in-patient case, reimbursement on medical bill can be made as actually incurred as necessary within the duration of 72 hours.

   Except cost of ward room and food expense, this can be reimbursed at the rate of NOT more 700 Baht per day.

   • In the case of injury, the insured can also apply for a reimbursement of the medical bill without limitation to the number of admissions.
   • In case of injury, the insured can also apply for medical service in the category of either as an out-patient or as an in-patient for not more than 2 subsequent admissions for each category of patient.
2. Admission to private hospital for medical treatment:
   1. In case of an out-patient:
      • The insured is able to apply for reimbursement of medical bill as actually incurred above per each admission.
      • The insured is able to apply for reimbursement of medical bill as actually incurred at not more above than 1,000 Baht per each admission provided medical treatment service as listed in the Announcement are given as follows: Provision of blood transfusion or blood composition; tetanus anti-toxin injection in case suffering from tetanus; vaccination against rabies or provision of serum, exclusively for the first injection; ultra-sound examination in the case of critical condition in the abdominal regions; scanning with CT-SCAN or MRI; the medical bill is payable upon the specified terms and conditions: the uterine treatment (scraping of the lining of the uterus); in the event of post-natal or post-abortion bleedings; revival expense; and in case of over 3-hour vigilant watch.
   2. In case of in-patient:
      • Cost of hospitalization for non-ICU treatment, reimbursement shall not exceed 2,000 Baht per day.
      • Board and lodging not exceeding 700 per day.
      • Board and lodging, medical treatment cost in the case of being treated in the ICU-unit, reimbursement shall not exceed 4,500 Baht per day.
      • In case of the need to undergo a major surgery or operation, reimbursement shall not exceed 8,000 - 16,000 Baht per each operation according to the amount of time it takes for the operation.
      • Cost of Revival including the cost of medicine and equipment not exceeding 4,000 Baht.
      • For laboratory examination and or X-ray, reimbursement can be obtained not exceeding 1,000 Baht per case.
      • In the event of special diagnosis, i.e., Electrocardiogram (EKG); brainwave test; ultrasound tests; revascularization operation and X-ray; color-injection (litmus) test; CT-SCAN or MRI test; reimbursement shall be paid according to the established terms and conditions.
3. In the event of critical sickness, two applications for reimbursement per year shall be permitted. In the event of accident, unlimited number of applications for reimbursement may be permitted. Furthermore, it is necessary that the patient may be taken to other hospital for continuing diagnosis or treatment; reimbursement for further medical treatment may be allowed.

In the case of being in the same provincial area, if a motor car or an ambulance is use, additional reimbursement for actual expense may be reimbursed; but not exceeding 500 Baht/per reimbursement. If a hired vehicle or a private transport or other vehicle is used, a lump sum reimbursement at the rate of 300 Baht/per reimbursement may be paid. If it is in other province, the Zone Office of Social Security may pay an extra at 6 Baht per kilometer.

Services to be provided by affiliated hospitals. The fact that the insured has been issued the Certified Entitlements Card on which the name of the hospital is specified and such specified hospital has also had affiliated hospitals and the insured will be able to be admitted for medical treatment without paying any expense whatever.

OBSERVATIONS

In the case of the Certified Entitlements Card is not available, the insured after having made full contributions on the part of coverage for injury and sickness can also be admitted to the hospital for medical treatment if the insured has sustained injuries or has been taken ill; and the insured can be entitled to apply for reimbursement of medical service cost at the same rate as is the case with injury or sickness due to accident. Sickness due to other diseases, the cost of medical service can also be reimbursed at the same rate as in the emergency case.

In case in which the insured has to be admitted for treatment as an in-patient, the insured or related person is to notify the Zone Office of Social Security for information immediately to enable the Zone Office of the Social Security to determine the hospital for the insured to be admitted for medical treatment.

The cost of medical service in the case of bone stem cell transplant shall be reimbursed according to the criteria and the rates as follows:

1. The cost of medical service with effect from the date of commencing the treatment in the hospital to undergo the bone marrow (stem cell) transplant operation until the day the insured receives the bone stem cell, shall be payable on a lump sum basis of 500,000 (Five Hundred Thousand) Baht.
2. The cost of medical service from the time the insured receives the stem cell until the day of the insured being discharged from the hospital shall be payable on a lump sum basis of 250,000 (Two Hundred and Fifty Thousand) Baht.
   
   

The cost of medical services in the case of mucus membrane examination for the bone stem cell transplant for the insured who is unable to be transplanted with the bone stem cell according to the criteria and the rates as follows:

1. The insured must be approved by the Zone Office of the Social Security to be admitted to receive the bone stem cell transplant prior to receiving the mucus membrane examination test.
2. The cost of medical service in the case of mucus membrane examination test conducted between the siblings of the same parents; and the results of examination are not compatible shall be payable as actually incurred not exceeding 7,000 (Seven Thousand) per person including the insured.