Sleep Test under Social Security: Rights and Procedures according to the new criteria in 2026.

If you are insured and suspect you have sleep apnea, you may be covered by a sleep study or sleep test once your doctor determines you meet the criteria. The easiest way to check is to start by contacting the healthcare facility you are covered by.

The current announcement from the Social Security Office (SSO) is dated... July 13, 2026 And it is effective from that date. July 30, 2026 The actual cost of Type 1 testing is capped at 7,000 baht, and for Type 2 testing, it is capped at 6,000 baht. Clearer guidelines for pre-test assessment are also being established.¹

Things to do first: Contact your designated healthcare facility, report your symptoms, and have a doctor assess your condition before your next appointment. If you are unsure of your designated healthcare facility or have specific questions, please check with the Social Security Office or call the 1506 hotline.⁵

Is a sleep test reimbursable under social security?

The easiest way to check is to contact your healthcare provider and have a doctor assess whether there is a medical reason to order the test.

For insured persons under Sections 33 and 39, the benefits page of the Social Security Office states that when receiving treatment at a medical facility under their entitlement, insured persons do not have to pay any expenses.³

If treatment is not received at a hospital covered by insurance, other medical facilities may be used, but these facilities must meet the following conditions: 1) They must be able to diagnose and treat sleep apnea; 2) They must be certified by a relevant professional college or association; and 3) They must be registered with the Social Security Office for this type of service and be the one to submit the reimbursement request to the Social Security Office. In this case, if the service fee exceeds the specified rate, the insured person will only be responsible for the excess amount.¹

However, the term "reimbursable" does not mean:

• ❌ All insured persons can request a check immediately.
• ❌ You can choose to get tested at any hospital or clinic.
• ❌ You can always pay upfront and then claim reimbursement with the receipt.
• ❌ If you pass the test, you will receive a PAP device immediately.
• ❌ There are no extra charges in any situation.

Therefore, before receiving the service, you should clearly ask whether the test is covered by social security benefits and whether there are any additional services or extras that you have to pay for yourself.

Who is eligible to claim reimbursement?

The terms used to refer to insured persons under each section refer to different groups:

• Article 33: Employees who are still employed by the employer and contribute through the establishment.⁶
• Article 39: Individuals who were previously insured under Section 33 and have left their jobs, but have applied to continue contributing to the social security fund on their own.⁶
• Article 40: Self-employed individuals who register for social security themselves.⁷ Under this system, healthcare rights use the universal healthcare card or the original healthcare scheme; they are not the same as those under Articles 33 and 39.⁴

For Articles 33 and 39, the general condition for illness benefits is that contributions must have been made for at least 3 months within the 15 months prior to the month of receiving the service.³ Before your appointment, check your insured status and which hospital you are entitled to. If you are unsure, call the hotline 1506.

Check for initial symptoms yourself.

You should consult a doctor if you have symptoms or information that suggests sleep apnea, such as:

• I snore loudly regularly.
• Some people have reported that they stop breathing or gasp for breath during sleep.
• Feeling unusually sleepy during the day.
• Woke up feeling unrested.
• There are any diseases or health factors that the doctor deems should be evaluated together.²

This information is provided to help prepare you for a conversation with your doctor. It is not a diagnostic criterion and does not guarantee that you will qualify for a Sleep Test.²

Pre-examination criteria according to the new announcement.

The announcement, effective July 30, 2026, outlines pre-test guidelines stating that physicians must take a medical history, perform a physical examination, and assess risk using a risk assessment score. STOP-Bang: 5 points or more It is one of the important criteria.¹

If the score falls below the required threshold, a sleep physician may still consider ordering further tests if deemed medically necessary.¹

You can take the STOP-Bang test yourself, but it is only a preliminary assessment and cannot replace a doctor's diagnosis.² Therefore, do not use this online test to determine your eligibility or conclude that "my score is below 5, so I definitely can't get tested."“

Things to prepare for your doctor's visit.

• Details of the symptoms and their duration.
• Information from close friends or family members who observed your symptoms while you slept.
• List of pre-existing medical conditions and medications currently being used.
• Previous test results or medical records, if available.
• Questions regarding hospital procedures, waiting lists, and costs.

How much is reimbursable for a sleep test?

The announcement outlines the inspection schedule as follows:¹

• Sleep Test Type 1: There are officers monitoring throughout the night during the inspection. Payment is based on actual expenses, not exceeding the limit. 7,000 baht
• Sleep Test Type 2: The measurements are the same as for type 1, but there is no officer monitoring during the inspection. Payment is based on actual costs, not exceeding the limit. 6,000 baht

The term "reimbursement based on actual expenses" refers to the rate set by the Social Security Office for services as per the announcement, and does not refer to cash or personal funds that insured persons can use to purchase services from anywhere.

Doctors and medical facilities should select types of tests based on medical reasons and hospital procedures, not solely on price.

Caution: The phrase "no staff member will be present during the examination" does not mean that all insured individuals have the right to take the equipment home for testing. If the hospital schedules an examination outside the sleep study room or allows you to take the equipment home, you should ask directly what type of social security coverage is used for the examination and whether there are any out-of-pocket costs involved.¹

Steps to claim your Social Security Sleep Test benefit.

1. Check the healthcare facility covered by your insurance.

Start with the medical facility you've chosen through your social security insurance. If you're unsure, check with the Social Security Office or call 1506.

2. Schedule an appointment with a doctor and describe your symptoms truthfully.

Describe the symptoms, their frequency, duration, pre-existing conditions, and any information observed by close contacts. Your doctor may use the STOP-Bang method in conjunction with your medical history and physical examination.¹

3. Have a doctor assess whether further testing is necessary.

If the criteria are met or a sleep medicine physician deems it necessary, the physician will consider referring the patient for testing according to the medical facility's procedures.¹

4. Inquire about the type of test and the testing location.

I want to know what type of test it is, what preparations are needed, whether the test will be done at a healthcare facility covered by my insurance or if I will be referred elsewhere, and whether there are any costs I have to pay myself.

5. Undergo check-ups and follow-up with your doctor.

After the test, you should schedule a follow-up appointment with your doctor to discuss the results. Diagnosis requires a comprehensive sleep assessment combined with test results and appropriate follow-up. You should not rely on screening tools or interpreting a single number to self-diagnose the condition.²

If I already have a sleep test result from a private clinic, can I use it?

It's not yet possible to say definitively that it works everywhere or in every case.

Take the full report and documents from your previous healthcare provider to the doctor at your designated healthcare facility for evaluation. Then, ask the hospital directly about their criteria for considering your previous results, what documents are required, and whether a new test is necessary, as the announcement doesn't provide a single answer for all cases.

Things you shouldn't do: Paying for the test yourself with the expectation that you'll definitely be able to claim reimbursement later, the safest approach is to inquire with the healthcare facility you are covered by insurance first.

If the test results meet the criteria, will I receive a PAP device immediately?

Not immediately, because the eligibility for a Sleep Test and the eligibility for a PAP device are separate processes.

After the doctor interprets the results, a separate evaluation of the criteria for receiving a PAP machine is still required.¹ Read more details about AHI and the device pickup process here. CPAP/PAP Machine Reimbursement Guide for Social Security

Those who were approved for PAP devices and/or masks under the previous announcement before the new criteria came into effect will continue to receive those entitlements until they have fully eligible.¹ In this case, please provide the approval document to the healthcare facility for verification. For further details, please refer to the PAP manual above or contact the hotline 1506.

Costs should be inquired about at the hospital before the test.

Costs and reimbursement procedures vary depending on the route taken. Please check the specific case before confirming your appointment.

case	Who coordinates or submits the disbursement request?	Expenses as indicated in the evidence.	Things to ask before an appointment.
Use your benefits through the hospital according to your insurance plan.	Hospitals covered by insurance	The Social Security Office's benefits page states that insured persons under Sections 33 and 39 do not have to pay any fees.3	It's important to ask clearly whether all appointments and services offered by the hospital are included in your insurance coverage, and whether there are any additional services or items not covered by the insurance.
The hospital, as per your insurance coverage, will refer you to another medical facility.	The hospital designated under the insurance plan will coordinate and pay the referral fee to the receiving medical facility and claim reimbursement from the Social Security Office (SSO) according to the established criteria.	The announcement did not specify whether insured individuals would have to pay extra.1	You should check with the hospital according to your insurance coverage before confirming your appointment.
They went to another medical facility instead of receiving treatment at the hospital they were entitled to.	The healthcare facility is the one that submits the reimbursement request to the Social Security Office.	If the service fee exceeds the specified rate, the insured person is only responsible for the amount exceeding that rate.1	The medical facility must meet the following conditions: Sleep apnea can be diagnosed and treated. Certified by a relevant royal college or professional association. My name is registered with the Social Security Office for this service. Having a Sleep Test service available alone does not mean the medical facility accepts social security insurance, nor does it mean that insured individuals pay for everything and then claim reimbursement later.1

What questions should I ask before confirming an appointment?

• Is this test covered by social security?
• Is this a Type 1 or Type 2 Sleep Test?
• Get tested at a healthcare facility under your insurance coverage or be referred.
• Are there any services outside of the coverage or as additional options?
• If there is an surplus, how much is it and from which item?
• Do I need to pay in advance? And if so, what documents are required?
• If I have test results from another institution, will the hospital consider them?
• What are the current queues for examinations and results?

FAQ

Does social security provide free sleep tests?

For insured persons under Sections 33 and 39 who receive services through hospitals according to their entitlements, the benefits page of the Social Security Office states that insured persons do not have to pay any fees.³ However, the hospital must confirm beforehand that the appointment is covered by insurance and does not include any out-of-private or supplementary services. If you seek services at another medical facility instead of the hospital designated for your insurance, the insured person must pay the amount higher than the announced rate.¹

The rates of 7,000 and 6,000 baht are the ceiling payments made by the Social Security Office (SSO), not a rule that insured persons must pay the difference in every case. The announcement clearly states that insured persons are responsible for any amount exceeding the rate only in cases where they undergo examinations at other medical facilities instead of receiving treatment at the hospital designated under their insurance plan.¹ For cases where you go for a check-up at another medical facility after being referred by your designated hospital, you should check with your designated hospital before confirming your appointment, as the announcement does not specify whether insured individuals will have to pay extra.

Can I take a sleep test without seeing a doctor?

No, sleep tests under the officially mandated insurance coverage require a prior medical history, physical examination, and evaluation by a physician.¹

Does STOP-Bang disqualify me if I don't spend at least 5 baht?

Don't assume you're out of luck. Sleep physicians may still recommend the test if they deem it medically necessary.¹

Which hospitals accept sleep tests under the social security scheme, and can I claim reimbursement retroactively?

Start by contacting your designated hospital and ask if they will conduct the examination themselves or refer you to another facility. Do not book and pay for the examination yourself with the expectation of claiming reimbursement later, as the regulations do not specify that insured individuals can self-submit receipts. If you are not receiving treatment at your designated hospital and wish to seek examination at another medical facility, that facility must meet the following criteria: 1) be able to diagnose and treat sleep apnea; 2) be accredited by a relevant professional college or association; and 3) be registered with the Social Security Office (SSO) for this type of service and be the one submitting the reimbursement request to the SSO. In this case, if the cost exceeds the specified rate, the insured individual is only responsible for the excess amount.¹

Can I choose either Sleep Test Type 1 or Type 2 myself?

Doctors and medical facilities should choose types of tests based on medical reasons, not solely on price, convenience, or advertising claims.

How long do I have to wait in line?

A fixed time cannot be specified. Queues depend on the medical facility, the availability of examination rooms, and referral routes. Please inquire with the hospital on the day of your appointment.

If I already have a test result, do I need to get tested again?

Depending on the assessment by the healthcare facility under your insurance coverage, you should have the full report reviewed by your doctor before drawing any conclusions about whether the original results are valid or invalid.

summarize

Under the new Social Security Sleep Test eligibility criteria, it doesn't mean you can simply choose a test package and submit the receipt for reimbursement. The easiest way to verify this is... Contact the healthcare facility under your insurance coverage and get an assessment from a doctor. If treatment is not received at a hospital designated under the insurance plan, the other medical facility used must be able to diagnose and treat sleep apnea, be certified by a relevant professional college or association, be registered with the Social Security Office (SSO) for this service, and be the one to submit the reimbursement request to the SSO. If the service fee exceeds the specified rate, the insured person is only responsible for the amount exceeding that rate. The specified rates are: Type 1, actual cost not exceeding 7,000 baht, and Type 2, actual cost not exceeding 6,000 baht. This is effective from July 30, 2026.¹

The safest approach is to prepare information about your symptoms, contact your designated healthcare facility, inquire about costs before receiving services, and avoid making upfront payments with the assumption that you will be able to claim reimbursement later. If there are specific cases or conflicting answers, verify the information with the Social Security Office or the 1506 hotline.

References

¹ Social Security Office. Announcement of guidelines and rates for insured persons with sleep apnea. Dated July 13, 2026, effective July 30, 2026 (accessed August 11, 2026).

² Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea. Journal of Clinical Sleep Medicine. 2017;13(3):479–504. American Academy of Sleep Medicine (accessed August 11, 2026).

³ Social Security Office. Benefits in case of injury or illness not related to work. Conditions for entitlement and receipt of services at healthcare facilities under the entitlement scheme (Accessed August 11, 2026).

⁴ Social Security Office. Benefits and conditions for eligibility to receive compensation under Section 40. Indicate whether the healthcare entitlement uses the universal health coverage scheme, the gold card scheme, or existing entitlements (accessed August 11, 2026).

⁵ Social Security Office. Contact information Contact number 1506 (Accessed August 11, 2026)

⁶ Ministry of Labour. Rights of insured persons under Sections 33 and 39. It states that Section 33 applies to employees, and those who have ceased to be employees may apply to be insured under Section 39 under certain conditions (Accessed August 11, 2026).

⁷ Ministry of Labour. Guidelines and conditions for insured persons under Section 40. It explains that Section 40 refers to independently insured persons who are not employees under Section 33 or insured persons under Section 39 (Accessed August 11, 2026).