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 | SP1500 | SP2000 | SP3000 | SP4000 | SP6000 | SP12000 | |
|---|---|---|---|---|---|---|---|
| Coverage | Coverage | Coverage | Coverage | Coverage | Coverage | Coverage | |
| THB | THB | THB | THB | THB | THB | ||
| Inpatient Hospitalization (IPD) coverage | 195,000 | 260,000 | 390,000 | 520,000 | 780,000 | 1,560,000 | |
| Section 1. Room and Board Cost, Hospital Fee (IPD) per An Inpatient Hospitalization for A Disability (Max. per Day, Limit 60 Days) | 1,500 | 2,000 | 3,000 | 4,000 | 6,000 | 12,000 | |
| In case the Insured hospitalizes in Intensive Care Inpatient Room (ICU), will be paid by 2 times of Benefit in Section 1. (Limit 15 days) | 3,000 | 4,000 | 6,000 | 8,000 | 12,000 | 24,000 | |
| 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 Disability | 15,000 | 20,000 | 30,000 | 40,000 | 60,000 | 120,000 | |
| Section 3. Physician Fee for Diagnosis per An Inpatient Hospitalization for A Disability (Max. per Day, Limit 60 Days) | 375 | 500 | 750 | 1,000 | 1,500 | 3,000 | |
| Section 4. Surgical Treatment and Medical Procedure Expenses per An Inpatient Hospitalization for A Disability | 22,500 | 30,000 | 45,000 | 60,000 | 90,000 | 180,000 | |
| Subsection 4.5. Surgical Treatment Expenses for Organ Transplant will be paid by 2 times of Benefit in Section 4. | 45,000 | 60,000 | 90,000 | 120,000 | 180,000 | 360,000 | |
| Section 5. Surgical Treatment Expenses for Major Surgery that not require Inpatient Hospitalization (Day Surgery) | include in Section 4 | include in Section 4 | include in Section 4 | include in Section 4 | include in Section 4 | include in Section 4 | |
| 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, Before and After Inpatient Hospitalization or Continuous OPD Treatment Directly Related to, After Inpatient Hospitalization per An Inpatient Hospitalization for A Disability | include in Section 2 | include in Section 2 | include in Section 2 | include in Section 2 | include in Section 2 | include in Section 2 | |
| Section 7. OPD Treatment Expenses for Injuring per Time, within 24 Hours after Accident | 3,000 | 4,000 | 6,000 | 8,000 | 12,000 | 24,000 | |
| Section 8. Rehabilitation Medicine after Each Inpatient Hospitalization per An Inpatient Hospitalization for A Disability | include in Section 2 | include in Section 2 | include in Section 2 | include in Section 2 | include in Section 2 | include in Section 2 | |
| Section 9. Medical Fee for Treatment of Chronic Kidney Failure by Kidney Dialysis per Policy Year | include in Section 2 | include in Section 2 | include in Section 2 | include in Section 2 | include in Section 2 | include in Section 2 | |
| Section 10. Medical Fee for Treatment of Tumor or Cancer by Radiation Therapy, Interventional Radiology, Nuclear Radiology per Policy Year | include in Section 2 | include in Section 2 | include in Section 2 | include in Section 2 | include in Section 2 | include in Section 2 | |
| Section 11. Medical Fee for Treatment of Cancer by Chemotherapy per Policy Year | include in Section 2 | include in Section 2 | include in Section 2 | include in Section 2 | include in Section 2 | include in Section 2 | |
| Section 12. Ambulance Fee (include in Section 2.) | 1,500 | 2,000 | 3,000 | 4,000 | 6,000 | 12,000 | |
| Section 13. Surgical Treatment Expenses for Minor Surgery | include in Section 4 | include in Section 4 | include in Section 4 | include in Section 4 | include in Section 4 | include in Section 4 | |
| MAJOR MEDICAL COVERAGE | Not cover | Not cover | Not cover | Not cover | Not cover | Not cover | |
| Maximum Benefit per Policy Year for eligible expenses in excess of the deductible (Co-payment 10%) | Not cover | Not cover | Not cover | Not cover | Not cover | Not cover | |
| Deductible (pay by the Insured) | |||||||
| Room and Board Cost, Hospital Fee (IPD) per An Inpatient Hospitalization for A Disability (Starts on 61st day) | Not cover | Not cover | Not cover | Not cover | Not cover | Not cover | |
| Personal Accident Coverage (PA 2) | |||||||
| Accidental Death, Dismemberment, Eyesight, Hearing, Speaking and Total Permanent Disability (PA 2) | 100,000 | 100,000 | 100,000 | 100,000 | 100,000 | 100,000 | |
| (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 AWP Services (Thailand) Co., Ltd.) | |||||||
| Emergency Medical Evacuation | Not cover | Not cover | Not cover | Not cover | Not cover | Not cover | |
| Medical Repatriation | |||||||
| Repatriation of Mortal Remain | |||||||
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)
| Age (Years) | SP1500 | SP2000 | SP3000 | SP4000 | SP6000 | SP12000 |
|---|---|---|---|---|---|---|
| 15 Days - 5 Years | 19,030 | 25,227 | 37,620 | 50,014 | 74,801 | 104,545 |
| 6 - 10 | 8,702 | 11,456 | 16,965 | 22,473 | 33,489 | 46,709 |
| 11 - 20 | 5,604 | 7,325 | 10,768 | 14,211 | 21,096 | 29,358 |
| 21 - 35 | 4,571 | 5,948 | 8,702 | 11,456 | 16,965 | 23,574 |
| 36 - 40 | 5,191 | 6,774 | 9,942 | 13,109 | 19,443 | 27,045 |
| 41 - 45 | 5,604 | 7,325 | 10,768 | 14,211 | 21,096 | 29,358 |
| 46 - 50 | 6,637 | 8,702 | 12,833 | 16,965 | 25,227 | 35,142 |
| 51 - 55 | 7,670 | 10,079 | 14,899 | 19,719 | 29,358 | 40,925 |
| 56 - 60 | 8,702 | 11,456 | 16,965 | 22,473 | 33,489 | 46,709 |
| 61 - 65 | 10,852 | 14,295 | 21,180 | 28,065 | 41,836 | 58,360 |
| 66 - 70 | 15,151 | 19,971 | 29,610 | 39,249 | 58,528 | 81,663 |
| *71 - 75 (Renew only) | 21,684 | 28,569 | 42,340 | 56,110 | 83,651 | 116,700 |
| *76 - 85 (Renew only) | 32,012 | 42,340 | 62,995 | 83,651 | 124,963 | 174,537 |
*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 - 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 |
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.