In-Patient Coverage (IPD), Simply 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. 

Simply Healthy plan is the basic starting plan that cover In-Patient, helps you pay for the treatment and has low premium which suitable for person who looks for medium range of coverage and premium.

This plan does not have deductible, which means we cover from the first payable amount up to the limit of each coverage. If there are any excess of the coverage, the insured will responsible the excess of treatment.

The difference between Simply Healthy and Wealthy Healthy is the Major Medical Coverage where Wealthy Healthy has the extra Major Medical Coverage. This coverage provide more coverage in case any excess from coverage limit as in Simply Healthy.

In conclude, if you are looking for low premium, average coverage, and without any deductible, Simply Healthy is suitable for you. But if you would like a more coverage please see Wealthy Healthy or Excellency plan.

Inpatient Coverage
INPATIENT HOSPITALIZATION (IPD) COVERAGE SP1500SP2000SP3000SP4000SP6000SP12000
CoverageCoverageCoverageCoverageCoverageCoverageCoverage
THBTHBTHBTHBTHBTHB
1. Inpatient Hospitalization (IPD) coverage195,000
260,000390,000520,000780,0001,560,000
Section 1. Room and Board Cost, Hospital Fee (IPD) per An Inpatient Hospitalization for A Disability (Max. per Day, Limit 60 Days)1,5002,0003,0004,0006,00012,000
In case the Insured hospitalizes in Intensive Care Inpatient Room (ICU), Room and Board, Hospitalize Expenses will be paid by 2 times of Benefit in Section 1. (Limit 15 days)3,0004,0006,0008,00012,00024,000
Section 2. Medical Fee for Diagnosis or Treatment, Blood or Blood's Components Cost, Nursing Care Fee, Medicine Cost, Parenteral Nutrition Cost, and Medical Supplies Cost per An Inpatient Hospitalization for A Disability15,00020,00030,00040,00060,000120,000
Section 3. Physician Fee for Diagnosis per An Inpatient Hospitalization for A Disability (Max. per Day, Limit 60 Days)3755007501,0001,5003,000
Section 4. Surgical Treatment and Medical Procedure Expenses per An Inpatient Hospitalization for A Disability22,50030,00045,00060,00090,000180,000
Subsection 4.5. Surgical Treatment Expenses for Organ Transplant will be paid by 2 times of Benefit in Section 4.45,00060,00090,000120,000180,000360,000
Section 5. Surgical Treatment Expenses for Major Surgery that not require Inpatient Hospitalization (Day Surgery)include in Section 4include in Section 4include in Section 4include in Section 4include in Section 4include in Section 4
2. Coverage in case of Not Require Inpatient Hospitalization
Section 6. Medical Fee for Diagnosis Directly Related to, Before and After Inpatient Hospitalization or Continuous OPD Treatment Directly Related to, After Inpatient Hospitalization per An Inpatient Hospitalization for A Disabilityinclude in Section 2include in Section 2include in Section 2include in Section 2include in Section 2include in Section 2
Section 7. OPD Treatment Expenses for Injuring per Time, within 24 Hours after Accident3,0004,0006,0008,00012,00024,000
Section 8. Rehabilitation Medicine after Each Inpatient Hospitalization per An Inpatient Hospitalization for A Disabilityinclude in Section 2include in Section 2include in Section 2include in Section 2include in Section 2include in Section 2
Section 9. Medical Fee for Treatment of Chronic Kidney Failure by Kidney Dialysis per Policy Yearinclude in Section 2include in Section 2include in Section 2include in Section 2include in Section 2include in Section 2
Section 10. Medical Fee for Treatment of Tumor or Cancer by Radiation Therapy, Interventional Radiology, Nuclear Radiology per Policy Yearinclude in Section 2include in Section 2include in Section 2include in Section 2include in Section 2include in Section 2
Section 11. Medical Fee for Treatment of Cancer by Chemotherapy per Policy Yearinclude in Section 2include in Section 2include in Section 2include in Section 2include in Section 2include in Section 2
Section 12. Ambulance Fee (include in Section 2.)1,5002,0003,0004,0006,00012,000
Section 13. Surgical Treatment Expenses for Minor Surgeryinclude in Section 4include in Section 4include in Section 4include in Section 4include in Section 4include in Section 4
Major Medical CoverageNot coverNot coverNot coverNot coverNot coverNot cover
Maximum payable per disability/time/yearNot coverNot coverNot coverNot coverNot coverNot cover
(Pays 90 percent of the eligible expenses in excess of the deductible)Not coverNot coverNot coverNot coverNot coverNot cover
Deductible (pay by the Insured)
Room and Board, Nursing Care (Max. per day, starts on 61st day)Not coverNot coverNot coverNot coverNot coverNot cover
Personal Accident Coverage (PA 2)
Accidental Death, Dismemberment, and Total Permanent Disability100,000100,000100,000100,000100,000100,000
(Murder or Assault, payable 100 percent of PA coverage)
(Drive Motorcycle or Passenger on Motorcycle, payable 100 percent of PA coverage)
Worldwide Emergency Assistant Coverage (By Mondial Assistant)
Emergency Medical EvacuationUSD 1,000,000USD 1,000,000USD 1,000,000USD 1,000,000USD 1,000,000USD 1,000,000
Medical Repatriation
Repatriation of Mortal Remain

Outpatient Coverage (optional)

Out-patient Benefits (OPD) (Optional Purchase)OPD800OPD1000 OPD1500OPD2000OPD2500OPD3000
- Maximum Payable(per Year)32,00040,00060,00080,000100,000120,000
- Maximum Payable per Day (Max. 1 visit per day, limit 30 visits per year)8001,0001,5002,0002,5003,000
- X-ray and Laboratory Test Expenses (Maximum per year)8,00010,00015,00020,00025,00030,000
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)

Age (Years) SP1500 SP2000 SP3000 SP4000 SP6000 SP12000
15 Days - 5 Years 19,03025,22737,620 50,014 74,801 104,545
6 - 108,70211,45616,965 22,47333,489 46,709
11 - 205,6047,325 10,76814,21121,096 29,358
21 - 35 4,571 5,948 8,70211,45616,96523,574
36 - 405,1916,774 9,94213,10919,44327,045
41 - 455,604 7,325 10,76814,21121,096 29,358
46 - 50 6,637 8,70212,833 16,965 25,227 35,142
51 - 557,670 10,07914,89919,71929,358 40,925
56 - 608,702 11,45616,965 22,473 33,48946,709
61 - 65 10,852 14,29521,18028,065 41,836 58,360
66 - 70 15,15119,97129,610 39,24958,52881,663
*71 - 75 (Renew only)21,684 28,56942,340 56,110 83,651116,700
*76 - 85 (Renew only)32,012 42,340 62,995 83,651 124,963174,537

*Renewal only

OPD – Outpatient Annual Premium (included Stamp Duty) 

OPD – Outpatient only available as additional policy to IPD policy.

 
Age (Years)OPD800OPD1000OPD1500OPD2000OPD2500OPD3000
15 Days - 5 Years22,51227,61840,38353,14865,91378,678
6 - 1010,00612,27517,94823,62129,29534,968
11 - 206,2537,67211,21814,76318,30921,855
21 - 355,0036,1378,97411,81114,64717,484
36 - 405,7537,05810,32013,58216,84420,107
41 - 456,2537,67211,21814,76318,30921,855
46 - 507,5049,20613,46117,71621,97126,226
51 - 558,75510,74015,70520,66925,63330,597
56 - 6010,006 12,27517,94823,62129,29534,968
61 - 6512,50715,34422,43529,52736,61843,710
*66 - 85 (Renew only)17,51021,48131,40941,33751,26661,194
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
  • 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.