In-Patient Coverage (IPD), Maxi Healthy
In-Patient Coverage is a patient who needed to be admitted as an inpatient in a hospital or in a medical facility for a minimum of 6 hours, and is registered as an inpatient under the advice of a licensed physician according to the standard medical practice, with reasonable length of stay, to treat for injury or sickness, including the case that a person is admitted and dies within 6 hours after being inpatient hospitalized.
Maxi Healthy plan is different from Simply Healthy plan at the deductible coverage. In Maxi Healthy, you will always have deductible at every claim made and the insurer will pay at 90% of claim amount.
Although Maxi Healthy has the deductible amount, its coverage is high with lower premium which most suitable for those who already has health insurance policy and want to increase their coverage with Major Medical Coverage.
Please be noted, this policy has high complexity than other available plan. For example, Room payment if this is your second policy, it will payable at day 61 onward.
The IPD coverage of Maxi Healthy limits per Disability per Time per Life-Time, which mean if you hold MC1500 which has total coverage at 150,000 Baht. Then, for example, if you claim under “A disease” for 50,000 Baht on year 1, your total available will be 100,000 Baht left for life-time on “A disease”. However on year 2, if you get new “B disease”, you will have 150,000 Baht, as normal. But if in year 2, you get the same “A disease”, your total max limit will still be 100,000 Baht for that particular disease.
*IMPORTANT*
In conclude, this Maxi Healthy plan is for those who already have basic health insurance plan, but still worry in case of excess coverage from first policy, then Maxi Healthy will help you pay under Major Medical Coverage.
Inpatient Coverage
| Health Insurance Coverage Maximum Payable per Disability/Time/Year | MC1500 | MC2000 | MC3000 | MC4000 | MC6000 | MC12000 |
|---|---|---|---|---|---|---|
| Major Medical Coverage | ||||||
| Maximum Payable per Disability/Time/Life Time | 150,000 | 200,000 | 300,000 | 400,000 | 600,000 | 1,200,000 |
| Maximum Payable per Disability/Time/Life Time - Pays 90 Percent of the Eligible Expenses in Excess of the Deductible | 15,000 | 20,000 | 30,000 | 40,000 | 60,000 | 120,000 |
| - Room and Board, Including Nursing Care (Max. per day) - From the 61st day, in case there is coverage from other health insurance | 1,500 | 2,000 | 3,000 | 4,000 | 6,000 | 12,000 |
| Worldwide Emergency Assistant Coverage (By Allianz Globall Assistance) | ||||||
| - 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 | " | " | " | " | " | " |
| Personal Accident Coverage (PA 2) | ||||||
| - Accidental Death, Dismemberment, and Total Permanent Disability | 100,000 | 100,000 | 100,000 | 100,000 | 100,000 | 100,000 |
Outpatient Coverage (optional)
| Out-patient Benefits (OPD) (Optional Purchase) | OPD800 | OPD1000 | OPD1500 | OPD2000 | OPD2500 | OPD3000 |
|---|---|---|---|---|---|---|
| - Maximum Benefit per Policy Year | 32,000 | 40,000 | 60,000 | 80,000 | 100,000 | 120,000 |
| - Physician Fee for Diagnosis and Medicine (Max. 1 visit per day, limit 30 visits per year) | 800 | 1,000 | 1,500 | 2,000 | 2,500 | 3,000 |
| - Laboratory Test Expenses and Diagnosis (Max. per year) | 8,000 | 10,000 | 15,000 | 20,000 | 25,000 | 30,000 |
Premium (annually)
Please see your premium in the table. If you would like to buy OPD, it is required to have IPD first as your main policy and buying OPD as addition.
IPD – Inpatient Annual Premium (included Stamp Duty)
| ช่วงอายุ (ปี) | MC1500 | MC2000 | MC3000 | MC4000 | MC6000 | MC12000 |
|---|---|---|---|---|---|---|
| 15 วัน - 5 ปี | 9,457 | 12,381 | 18,230 | 24,078 | 35,776 | 49,812 |
| 6 - 10 | 4,583 | 5,883 | 8,482 | 11,082 | 16,280 | 22,519 |
| 11 - 20 | 3,121 | 3,933 | 5,558 | 7,182 | 10,432 | 14,331 |
| 21 - 35 | 2,634 | 3,283 | 4,583 | 5,883 | 8,482 | 11,601 |
| 36 - 40 | 2,926 | 3,673 | 5,168 | 6,663 | 9,652 | 13,239 |
| 41 - 45 | 3,121 | 3,933 | 5,558 | 7,182 | 10,432 | 14,331 |
| 46 - 50 | 3,608 | 4,583 | 6,533 | 8,482 | 12,381 | 17,060 |
| 51 - 55 | 4,096 | 5,233 | 7,507 | 9,782 | 14,331 | 19,789 |
| 56 - 60 | 4,583 | 5,883 | 8,482 | 11,082 | 16,280 | 22,519 |
| 61 - 65 | 5,642 | 7,266 | 10,516 | 13,765 | 20,263 | 28,061 |
| 66 - 70 | 7,759 | 10,034 | 14,583 | 19,132 | 28,229 | 39,147 |
| *71 - 75 (เฉพาะต่ออายุ) | 11,020 | 14,269 | 20,767 | 27,266 | 40,263 | 55,859 |
| *76 - 85 (เฉพาะต่ออายุ) | 15,894 | 20,767 | 30,515 | 40,263 | 59,758 | 83,152 |
*Renewal only
OPD – Outpatient Annual Premium (included Stamp Duty)
OPD – Outpatient only available as additional policy to IPD policy.
| Age (Years) | OPD800 | OPD1000 | OPD1500 | OPD2000 | OPD2500 | OPD3000 |
|---|---|---|---|---|---|---|
| 15 Days - 5 Years | 22,512 | 27,618 | 40,383 | 53,148 | 65,913 | 78,678 |
| 6 - 10 | 10,006 | 12,275 | 17,948 | 23,621 | 29,295 | 34,968 |
| 11 - 20 | 6,253 | 7,672 | 11,218 | 14,763 | 18,309 | 21,855 |
| 21 - 35 | 5,003 | 6,137 | 8,974 | 11,811 | 14,647 | 17,484 |
| 36 - 40 | 5,753 | 7,058 | 10,320 | 13,582 | 16,844 | 20,107 |
| 41 - 45 | 6,253 | 7,672 | 11,218 | 14,763 | 18,309 | 21,855 |
| 46 - 50 | 7,504 | 9,206 | 13,461 | 17,716 | 21,971 | 26,226 |
| 51 - 55 | 8,755 | 10,740 | 15,705 | 20,669 | 25,633 | 30,597 |
| 56 - 60 | 10,006 | 12,275 | 17,948 | 23,621 | 29,295 | 34,968 |
| 61 - 65 | 12,507 | 15,344 | 22,435 | 29,527 | 36,618 | 43,710 |
| *66 - 85 (Renew only) | 17,510 | 21,481 | 31,409 | 41,337 | 51,266 | 61,194 |
Remarks
- Standard premium for each age band for the first policy year only
- Eligible to apply for the first year coverage form 15 days up to 70 years of age, renewable up to 85 years of age for IPD and OPD.
- 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.
- Renewal year premium will be adjusted according to increasing age of each insured person.
- 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.
- 10 percent discount for the renewal year for no claim bonus.
Insuring Agreement
Insuring Agreement
- This health insurance covers for treatment expenses resulting from injury from an accident or suffers from sickness fro 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.
Coverage Commencement
- 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. However, in case there is presence or make known of symptom of any disability for the first time during waiting period, the company reserves the right to void the policy.
- Coverage for injury from accident and shall be start covered immediately from the policy effective date
Exclusion
- Pre-existing conditions, including related symptons 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
Apply for Coverage and Support Document
- 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
** 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.