Coverage and Benefit
| Benefit Details | Maximum Coverage (Baht) | |||
|---|---|---|---|---|
| Plan 1 | Plan 2 | Plan 3 | Plan 4 | |
| Deductible per confinement (A) (For total benefit of the section 2 - 5) |
20,000 | 30,000 | 40,000 | 40,000 |
| Maximum Benefit per confinement (exceeding from (A)) (For total benefit of the section 2 - 5) |
200,000 | 300,000 | 400,000 | 400,000 |
| 1. Inpatient Benefits | ||||
| Section 1: Hospital Daily Room and Board, daily nursing and other hospital service charge coverage per confinement | ||||
| 1.1 Room and Board (not exceeding 150 days per confinement) | 2,000 | 4,000 | 6,000 | 8,000 |
| 1.2 Intensive Care Unit (I.C.U.) per day (not exceeding 15 days per confinement, in aggregate with Room and Board shall not exceed 150 days (in total of benefit under Section 1.) |
4,000 | 8,000 | 12,000 | 16,000 |
| Section 2: Hospital medical expenses for diagnosis or treatment, blood transfusion services, blood components and nursing services fees, medicine, parenteral nutrition, and medical supplies per confinement | ||||
| 2.1 Medical expenses for diagnosis | As charged | As charged | As charged | As charged |
| 2.2 Medical expenses for treatment, blood transfusion services, blood components and nursing services fees | ||||
| 2.3 Medicine, parenteral nutrition, and medical supplies | ||||
| 2.4 Home medication and medical supplies 1 | ||||
| Section 3: Fee for medical professional service (physician), examination, physical services per confinement | As charged | As charged | As charged | As charged |
| Section 4: Surgeon & Medical procedure expenses per confinement | ||||
| 4.1 Operating room or medical procedure room | As charged | As charged | As charged | As charged |
| 4.2 Medicine & Parenteral nutrition medical supplies & surgical devices | ||||
| 4.3 Medical professional service, Physician (and assistant) fee – Surgery & Procedure (Doctor fee) | ||||
| 4.4 Physician Anesthesiology Services (Doctor fee) | ||||
| 4.5 Medical expenses for organ transplantation | ||||
| Section 5: Day Surgery | As charged | As charged | As charged | As charged |
| 2. Outpatient Benefits | ||||
| Section 6: Hospital medical expenses for diagnosis tests directly related to inpatient treatment within 30 days before and after inpatient treatment or outpatient treatment after inpatient treatment (follow-up treatment) within 30 days after inpatient treatment per confinement | ||||
| 6.1 Hospital medical expenses for diagnosis are directly related and incurred within 30 days before and after inpatient treatment | - | - | - | - |
| 6.2 Outpatient treatment after inpatient treatment (follow-up treatment) within 30 days after inpatient treatment (Excluded hospital medical expenses for diagnosis) |
||||
| Section 7: Hospital medical expenses due to accident for outpatient within 24 hours of each accident | 10,000 | 20,000 | 30,000 | 40,000 |
| Section 8: Post-treatment rehabilitation per policy year | - | - | - | - |
| Section 9: Fee for physician performing treatment of chronic kidney failure by hemodialysis per policy year | - | - | - | - |
| Section 10: Fee for physician performing treatment of tumor or cancer by radiation therapy, interventional radiology and nuclear medicine (also including brachytherapy) per policy year | - | - | - | - |
| Section 11: Fee for physician performing treatment of cancer by chemotherapy including Targeted Therapy per policy year | - | - | - | - |
| Section 12: Emergency Ambulance service fee | - | - | - | - |
| Section 13: Hospital medical expenses for Minor Surgery | - | - | - | - |
| Benefit No. 1 and No. 2, the company will pay actual amount but not exceeding the benefits specified above, and not exceeding the maximum benefit per confinement. | ||||
1 year / 1 year
(1) Any illnesses which exist within 30 days counting from the effective date or the latest date of reinstatement of the rider, whichever is the latest; or
(2) Illnesses due to the following diseases which exist within 120 days counting from the effective date or the latest date of reinstatement of the rider, whichever is the latest.
- Tumors, cysts, or all types of malignancy/cancer
- All types of hernia
- Tonsillectomy or adenoidectomy
- Varicose vein
- Hemorrhoid
- Pterygium or cataract
- All types of stone
- Endometriosis
The rider shall not cover medical expenses or damages from injury or illness (including complications), conditions, or abnormality that arise from:
1. Result from congenital abnormalities or incomplete organ system of the body at birth or genetic disease or abnormalities in physical development, unless this Rider is effective for at least one year and symptoms appear after the insured attains the age of 16.
2. Cosmetic surgery or any other treatments for skin beauty purposes such as treatment for pimple, blemish, freckles, dandruff hair fall, weight control, elective surgeries, unless it is a wound dressing from accident being covered.
3. Pregnancy, miscarriage, abortion, childbirth, or any causes related to pregnancy, sterilization or investigation of sterilization except choriocarcinoma.
4. AIDS or venereal disease or sexually transmitted diseases. AIDS includes Acquired Immune Deficiency Syndrome caused by AIDS virus infection, and includes opportunistic infection, infection, or any illness in which a blood test detects the Human Immunodeficiency Virus, or HIV. Opportunistic infection includes, but not limited to, Pneumocystis carinii pneumonia, Organism causes chronic enteritis, Disseminated virus and/ or Fungi infection; malignant neoplasm which includes but not limited to Kaposi’s sarcoma, central nervous system lymphoma, and/or other critical illnesses that are currently known as a symptoms of Acquired immune deficiency syndrome, or which causes sudden death, illness, or disability. AIDS shall include HIV (Human Immunodeficiency Virus) that causes Encephalopathy dementia.
5. Anti-aging examination, treatment or prevention by consuming drugs or substances, the use of hormone replacement therapy for menopause women, sexual deterioration, sexual disorder treatment, and gender affirmation surgery.
6. Medical examination, request for hospitalization or request for surgery, recuperation or rest for recovery or rest by dormant or hospitalization for the propose of recieving care by caregivers, examination or treatment that are not related to the disease which is the cause of admittance for hospitalization, diagnosis of injury or illness, treatment or investigation that are not medical necessity and medical standard.
7. Examination and treatment of vision abnormalities, LASIK , any expense of equipment to assist with vision or treat vision abnormalities.
8. Examination or treatment of teeth or gum, denture making, dental crowning, root canal treatment, teeth filling, orthodontics, teeth scaling, teeth extraction, dental implant excluding necessary cases from an accidental injury and expenses of denture, dental crowning, root canal treatment, and dental implant.
9. Treatment or therapy of addiction to narcotics, tobacco, alcohol, or psychoactive substances.
10. Examination and treatment of mental symptom, Psychopathy, Behavior disorders, Personality disorders, Attention deficit hyperactivity disorder, Autism, Stress, Eating disorders, or Anxiety.
11. Treatment under experiment, Examination or treatment of obstructive sleep apnea, Examination or treatment of sleep disorders and Snoring.
12. Inoculation or vaccination except rabies vaccination after an animal’s attack and tetanus vaccination after being injured.
13. Non-conventional medical examination and treatment including alternative medicine.
14. Any medical expense resulting from examination and treatment which is given by a physician who is oneself or the parent, spouse, or child of the insured.
15. Suicide or suicide attempt, self-injury or attempt of self-injury whether being their own action or allow others to perform while insane or not.The exclusion also includes the accident due to consuming, drinking or injection of toxic substances, or drug overdose.
16. Any injury occurring as a result of the insured’s action:
(1) while under the influence of addictive substances or narcotics and being unable to remain conscious; or
(2) while under the influence of alcohol with an alcohol level in the body reaching 150 milligram percent or above during testing; or
(3) while under the influence of alcohol and unable to remain conscious in the event of lack of test or test incapacity;
17. Any injury occurring while the insured is committing a felony, is under arrest or escapes the arrest of authorities.
18. Any injury occurring while the insured is in any kind of car or boat race, horse race, any kind of ski race including jet ski, skating, boxing , parachuting (except for parachuting for life saving), paramotor or glider, getting on or off ,or on boarding in a balloon, bungee jumping, diving with oxygen tank and breathing equipment underwater (scuba diving).
19. War, invasion, acts of foreign enemy, warlike operations (whether declared or not), civil war, uprising, terrorism, riot, strike, commotion, revolution, coup d'etat, proclamation of martial law, or any event resulting in the proclamation or maintenance of martial law.
20. Terrorism from the use of force or violence and/or threat by any person or group of people, whether alone or on behalf of others or in connection with any organization or government, that is performed for purposes of political, religious, ideological or similar purposes, including the intention to put any government and/or public, or any segment of the public, in fear.
21. Radiation or radioactive emission from any nuclear fuel or nuclear waste due to combustion of nuclear fuel and any self-sustaining nuclear fission process that can proceed by itself.
Remark: The English version is a translation of the original in Thai for information purpose only.In case of a discrepancy, the Thai original shall prevail
Q: สัญญาเพิ่มเติมคุ้มครองสุขภาพเฮลท์ พลัส (Health Plus) แบบมีความรับผิดส่วนแรก เหมาะกับใคร ?
A: เหมาะสำหรับผู้ที่มีสวัสดิการหรือความคุ้มครองสุขภาพอยู่แล้ว แต่ต้องการ Top-up ความคุ้มครองค่าห้อง และความคุ้มครองค่ารักษาพยาบาลเพิ่มเติมจากสวัสดิการที่มี
Q: ความรับผิดส่วนแรก คืออะไร ?
A: ความเสียหายส่วนแรกที่ผู้เอาประกันภัยต้องรับภาระตามข้อตกลงของสัญญาประกันภัย (โดยอาจใช้ผลประโยชน์จากสวัสดิการ หรือสิทธิค่ารักษาพยาบาลอื่น (ถ้ามี))
Q: สัญญาเพิ่มเติมคุ้มครองสุขภาพเฮลท์ พลัส (Health Plus) แบบมีความรับผิดส่วนแรก สามารถขอทำบันทึกสลักหลังค่ารักษาพยาบาลผู้ป่วยนอก (OPD) แนบท้ายได้หรือไม่ ?
A: สัญญาเพิ่มเติมคุ้มครองสุขภาพเฮลท์ พลัส (Health Plus) แบบมีความรับผิดส่วนแรก สามารถขอทำบันทึกสลักหลังค่ารักษาพยาบาลผู้ป่วยนอก (OPD) แนบท้ายได้สูงสุดแผน OPD2000
Q: เบี้ยประกันสุขภาพของสัญญาเพิ่มเติมคุ้มครองสุขภาพเฮลท์ พลัส (Health Plus) แบบมีความรับผิดส่วนแรก สามารถนำไปอ้างอิงลดหย่อนภาษีได้หรือไม่ ?
A: เบี้ยประกันสุขภาพสามารถนำไปอ้างอิงลดหย่อนภาษีเงินได้บุคคลธรรมดาได้ตามหลักเกณฑ์ที่กรมสรรพากรกำหนด ผู้เอาประกันภัยอาจนำเบี้ยประกันสุขภาพสูงสุดไม่เกิน 25,000 บาทต่อปี (ถ้ามี) รวมกับเบี้ยประกันชีวิต ไปใช้อ้างอิงการลดหย่อนภาษีเงินได้บุคคลธรรมดารวมกันไม่เกิน 100,000 บาทต่อปี
ข้อควรทราบ :
* For Plan 4 in case of hospitalization
** For Plan 3,4 in case of hospitalization
*** For Plan 4 Coverage for medical expenses in case of accident within 24 hours
- Deductible means the amount of money that the insured is responsible for paying before insurance company start to pay benefit.
- The coverage term of Rider is 1 year. Rider can be renewed according to its terms and conditions. Renewed premium rate for Rider might be changed or co-payment, depend on an insured's age, occupation, claim of the insured and the company's terms and conditions
- Underwriting is subject to the Company’s terms and conditions.
- Benefits and coverage are subject to the health insurance policy’s terms and conditions.
- Health check up and health declaration might be the factor of underwriting process if necessary.
- Tax Deduction according to the rules prescribed by the Revenue Department
- This is only basic information. An insured should read aware of coverage condition, benefits, and exclusions of an insurance policy.
