Outpatient Insurance Plan or OPD
OPD is a treatment wherein certain treatment or diagnosis of a certain type of illness upon the advice of a medical practitioner. This involves the patient visiting the clinic or any of the doctors’ consultation rooms less than 6 hours. IPD must be purchased first. Applicants can choose to purchase additional coverage for both accidents and sickness.
Outpatient Department (OPD) Treatment for Simply Healthy, Wealthy Healthy and Maxi Healthy
| 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 |
| 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 - 70 | 17,510 | 21,481 | 31,409 | 41,337 | 51,266 | 61,194 |
| *71 - 85 (Renew only) | 17,510 | 21,481 | 31,409 | 41,337 | 51,266 | 61,194 |
Remark
- 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
- 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.
Exclusions
- 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.