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WH 1500 |
WH 2000 |
WH 3000 |
WH 4000 |
WH 6000 |
WH 12000 |
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Health Insurance Coverage Maximum Payable per Disability/Time/Year |
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In-patient Hospitalization (IPD) Coverage
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- Room and Board, Including Nursing Care (Max. per disability/time) |
90,000 |
120,000 |
180,000 |
240,000 |
360,000 |
720,000 |
- Normal Room (Max. per day, limit 60 days) |
1,500 |
2,000 |
3,000 |
4,000 |
6,000 |
12,000 |
| - ICU Room (Max. per day, limit 15 days) |
3,000 |
4,000 |
6,000 |
8,000 |
12,000 |
24,000 |
| - General Expenses (Max. per disability/time) |
15,000 |
20,000 |
30,000 |
40,000 |
60,000 |
120,000 |
| - Emergency OPD Treatment for Accident (Including in General Expenses) |
3,000 |
4.000 |
6,000 |
8,000 |
12,000 |
24,000 |
| - Special Consultation Fee (Including in General Expenses) |
1,500 |
2,000 |
3,000 |
4,000 |
6,000 |
12,000 |
| - Ambulance Fee (Including in General Expenses) |
1,000 |
1,000 |
1,000 |
1,000 |
1,000 |
1,000 |
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- Surgeon's Operation Fee (Max. per disability/time, as per Actual Expenses) |
|
22,500 |
30,000 |
45,000 |
60,000 |
90,000 |
180,000 |
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- Surgical Consultation Fee (Including in Surgeon's Operation Fee) |
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2,250 |
3,000 |
4,500 |
6,000 |
9,000 |
18,000 |
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- Physician Care (Max. per disability/time) |
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22,500 |
30,000 |
45,000 |
60,000 |
90,000 |
180,000 |
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- In-patient Physician Visit Fee (Max. per day, limit 60 days) |
|
375 |
500 |
750 |
1,000 |
1,500 |
3,000 |
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WH 1500 |
WH 2000 |
WH 3000 |
WH 4000 |
WH 6000 |
WH 12000 |
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Health Insurance Coverage Maximum Payable per Disability/Time/Year |
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Maximum Payable per Disability/Time/Year |
150,000 |
200,000 |
300,000 |
400,000 |
600,000 |
1,200,000 |
- Pays 90 Percent of the Eligible Expenses in Excess of the Deductible |
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| - Deductible |
15,000 |
20,000 |
30,000 |
40,000 |
60,000 |
120,000 |
| - Room and Board, Including Nursing Care (Max. per day, starts on 61st day) |
1,500 |
2,000 |
3,000 |
4,000 |
6,000 |
12,000 |
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Worldwide Emergency Assistant Coverage (By Mondial Assistance |
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| - Emergency Medical Evacuation |
USD 1,000,000 |
USD 1,000,000 |
USD 1,000,000 |
USD 1,000,000 |
USD 1,000,000 |
USD 1,000,000 |
| - Medical Repatriation |
| - Repatriation of Mortal Remain |
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Personal Accident Coverage (PA 2) |
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- Accidental Death, Dismemberment, and Total Permanent Disability |
|
100,000 |
100,000 |
100,000 |
100,000 |
100,000 |
100,000 |
Out-patient Benefits (OPD) (Optional Purchase) |
OPD 800 |
OPD 1000 |
OPD 1500 |
OPD 2000 |
OPD 2500 |
OPD 3000 |
- Maximum Payable per Year) |
32,000 |
40,000 |
60,000 |
80,000 |
100,000 |
120,000 |
| - Maximum Payable per Day (Max. 1 visit per day, limit 30 visits per year) |
800 |
1,000 |
1,500 |
2,000 |
2,500 |
3,000 |
| - X-ray and Laboratory Test Expenses (Maximum per year) |
8,000 |
10,000 |
15,000 |
20,000 |
25,000 |
30,000 |
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Annual Premium Includes Duty Stamp and SBT (Baht) |
IPD |
|
WH 1500 |
WH 2000 |
WH 3000 |
WH 4000 |
WH 6000 |
WH 12000 |
15 Days - 5 |
21,969 |
29,062 |
43,251 |
57,439 |
85,815 |
119,867 |
6 - 10 |
11,326 |
14,874 |
21,969 |
29,062 |
43,251 |
60,276 |
11 - 20 |
8,287 |
10,820 |
15,888 |
20,955 |
31,089 |
43,251 |
21 - 35 |
6,767 |
8,794 |
12,847 |
16,901 |
25,008 |
34,738 |
36 - 40 |
7,678 |
10,009 |
14,672 |
19,333 |
28,657 |
39,846 |
41 - 45 |
8,287 |
10,820 |
15,888 |
20,955 |
31,089 |
43,251 |
46 - 50 |
9,808 |
12,847 |
18,928 |
25,008 |
37,170 |
51,764 |
51 - 55 |
11,326 |
14,874 |
21,969 |
29,062 |
43,251 |
60,276 |
56 - 60 |
12,847 |
16,901 |
25,008 |
33,116 |
49,332 |
68,789 |
61 - 65 |
15,974 |
21,041 |
31,176 |
41,311 |
61,579 |
85,903 |
*66 - 70 |
22,229 |
29,322 |
43,510 |
57,699 |
86,075 |
120,127 |
*71 - 75 |
31,695 |
41,831 |
62,099 |
82,368 |
122,906 |
171,552 |
*76 - 80 |
46,898 |
62,099 |
92,503 |
122,906 |
183,713 |
256,682 |
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OPD 800 |
OPD 1000 |
OPD 1500 |
OPD 2000 |
OPD 2500 |
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15 Days - 5 |
17,519 |
21,482 |
31,410 |
41,339 |
51,266 |
61,195 |
6 - 10 |
8,756 |
10,742 |
15,705 |
20,671 |
25,634 |
30,598 |
11 - 20 |
6,255 |
7,673 |
11,219 |
14,765 |
18,311 |
21,856 |
21 - 35 |
5,004 |
6,138 |
8,975 |
11,811 |
14,648 |
17,485 |
36 - 40 |
5,755 |
7,060 |
10,322 |
13,614 |
16,846 |
20,108 |
41 - 45 |
6,255 |
7,673 |
11,219 |
14,765 |
18,310 |
21,856 |
46 - 50 |
7,506 |
9,207 |
13,462 |
17,717 |
21,972 |
26,227 |
51 - 55 |
8,756 |
10,742 |
15,705 |
20,671 |
25,634 |
30,598 |
56 - 60 |
10,006 |
12,276 |
17,949 |
23,622 |
29,295 |
34,969 |
61 - 65 |
12,508 |
15,345 |
22,436 |
29,528 |
36,619 |
43,711 |
*66 - 70 |
17,510 |
21,482 |
31,410 |
41,339 |
51,266 |
61,195 |
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| Remark |
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1. Standard premium for each age band for the first policy year only
2. Eligible to apply for the first year coverage from 15 days up to 65 years of age, renewable up to 80 years of age for IPD and up to 70 years of age for OPD.
3. IPD coverage must be purchased first in order to be able to purchase OPD coverage, in case of purchase OPD as optional, OPD premium will be added to IPD premium.
4. Renewal year premium will be adjusted according to increasing age of each insured person
5. Renewal year premium of each insured person may be charged higher, up to 100 percent of standard premium, according to underwriting experience of the previous policy year
6. 10 percent discount for the renewal year for no claim bonus . |
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| Insuring Agreement |
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• This health insurance covers for treatment expenses resulting from injury from an accident or suffers from sickness for the actual expenses paid, up to the maximum limit of benefit as stated in the schedule of the insurance policy.
• Details of insuring agreement shall be referred to the insurance policy.
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| Coverage Commencement |
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• Coverage for sickness shall be start covered after the first 30 days waiting period, except 8 types of sicknesses that stipulated in the insurance policy shall be start covered after 120 days waiting period.
• Coverage for injury from accident and shall be start covered immediately from the policy effective date.
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| Exclusions |
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• Pre-existing conditions, including related symptoms and chronic conditions that the applicant has had before this insurance policy is in effect, congenital abnormality or genetic disorders
• Cosmetic surgery, beautification treatment, or aging relieve treatment
• Treatment or surgery related to eyesight, dental or gum
• Treatment related to mental disorder
• Treatment which is not considered a modern medicine including alternative medicine.
• Health check up and preventive vaccination
• Suicide or suicide attempt, self inflicted injury
• Other exclusions shall be referred to the insurance policy
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| Apply for Coverage and Support Document |
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• Fill the Application Form and Applicant’s Health Condition Declaration Form truthfully and sign to certify *
• Submit copy of ID Card or copy of Passport for foreigner
• For the youth, submit copy of ID Card or Birth Certification together with copy of ID Card of the parent
• The company reserves the right to reject any application or accept with exclusions, according to underwriting standard of the company.
• The company reserves the right not to renew each insured person within the first 2 years after start coverage.
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* In case the applicant knows any fact but declares false statement or fails to declare it, in which should the company acknowledge it prior, the company may increase the insurance premium or reject the application, this insurance policy shall be voided, according to the Civil and Commercial Code, Section 865. The company has the right to dissolve it,
**The insured person can request for policy cancellation within 90 days after the first policy year effective date, and the company shall refund full premium before tax and duty to the insured person, in case there is no claims.
Remark
Information in this brochure is only preliminary information provided for the applicant to consider for applying for health insurance coverage from the company, all insuring conditions shall be referred to Definition, General Conditions, General Exclusions, and Insuring Agreement of the health insurance policy of the company. |
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