| Description | Benefit (Baht) | ||||||
|---|---|---|---|---|---|---|---|
| Plan 1 | Plan 2 | Plan 3 | Plan 4 | Plan 5 | Plan 6 | ||
| Maximum benefit for an injury or sickness per confinement(1) | 1,000,000 | 2,000,000 | 3,000,000 | 5,000,000(2) | 10,000,000(2) | 30,000,000(2) | |
| 1. Benefit for Inpatient Care | |||||||
| Section 1 | Room and board including service charges (inpatient) per confinement(1) | ||||||
| Non-intensive care room, maximum payable per day | 8,000 | 10,000 | 11,000 | 12,000 | 15,000 | 20,000 | |
| Intensive Care Unit (ICU), maximum payable per day (with a maximum limit of 15 days per per confinement(1) | 16,000 | 20,000 | 22,000 | 24,000 | 30,000 | 40,000 | |
| Section 2 | Hospital medical expenses for diagnostic and therapeutic procedures, blood and blood components, nursing service, medicines, and parenteral nutrition, and medical supplies per confinement(1) | ||||||
| 2.1 | Hospital medical expenses for diagnostic procedures | Paid in full(3) | |||||
| 2.2 | Hospital medical expenses for therapeutic procedures, blood and blood components, and nursing service | ||||||
| 2.3 | Medicines and parenteral nutrition, and medical supplies | ||||||
| 2.4 | Home medications and medical supplies 1 | ||||||
| Section 3 | Medical practitioners’ fees | ||||||
| Section 4 | Fees for surgery and medical procedures | ||||||
| 4.1 | Operating theater and procedure room | Paid in full(3) | |||||
| 4.2 | Medicines, parenteral nutrition, medical supplies, surgery and procedure equipment | ||||||
| 4.3 | Surgeons fee including surgical assistants | ||||||
| 4.4 | Anesthesiologists’ fees | ||||||
| 4.5 | Organ transplantation | 500,000 | 1,000,000 | 2,000,000 | 3,000,000 | ||
| Section 5 | Day Surgery | Paid in full(3) | |||||
| 2. Benefits for Non-Inpatient Care | |||||||
| Section 6 | Hospital medical expenses for diagnostic procedures before or after hospitalization relating to the condition diagnosed, or outpatient treatment after hospitalization per confinement(1) | ||||||
| 6.1 | Hospital medical expenses for diagnostic procedures relating to the condition diagnosed within 30 days before and after hospitalization | Paid in full(3) | |||||
| 6.2 | The expenses for OPD visit post hospitalization within 30 days (excluding hospital medical expenses for diagnostic procedures) | ||||||
| Section 7 | Medical expenses for an injury (OPD) within 24 hours of accident | 10,000 | 15,000 | 18,000 | 20,000 | 30,000 | 50,000 |
| Section 8 | Rehabilitation post hospitalization per confinement(1) | Paid in full(3) | |||||
| Section 9 | Hospital medical expenses for treatment of chronic kidney disease by hemodialysis per policy year | 25,000 | 50,000 | 100,000 | 150,000 | ||
| Section 10 | Medical expenses for treatment of tumor or cancer by radiation therapy, interventional radiology, nuclear medicine therapy per policy year | 1,000,000 | 2,000,000 | 3,000,000 | 5,000,000 | 10,000,000 | 30,000,000 |
| Section 11 | Medical expenses for treatment of cancer by chemotherapy per policy year | ||||||
| Section 12 | Emergency ambulance services, maximum payable per trip | 2,000 | |||||
| Section 13 | Minor surgical expenses | Paid in full(3) | |||||
| Additional Benefits | |||||||
| 1 | Annual health check-up(4) one visit per year on reimbursement basis | 500 | 700 | 800 | 1,500 | 5,000 | 10,000 |
| 2 | Specialist’s consultation fees | 10,000 | 15,000 | 20,000 | |||
| 3 | Fee for special nurse care at home, maximum payable per day (limited to 15 days per confinement ) | 500 | |||||
| 4 | Emergency medical evacution, repatriation and repatriation of mortal remains | 1,000,000 USD | |||||
| 5 | Personal Accident (Or.Bor.2)(5) | 100,000 | |||||
(1)Each hospitalization as Inpatient for medical treatment(s), or each major surgery treatment without the hospitalization as inpatient (day surgery), in a hospital or medical facility. In this regard, hospitalizations as Inpatient for treatments, or major surgery treatments without hospitalization as inpatient (day surgery) in a hospital or medical facility, regardless of how many times, due to the same injury or sickness which has not been cured, including related or continuous complications, within 90 days from the date of last discharge from the hospital or medical facility will be considered as a single confinement.
(2)For insured members who are under 11 years of age will have a copayment 30 % of the covered expenses for coverage in section 1-13 according to the benefit table.
(3)Full cover, not over maximum coverage per confinement.
(4)For annual health check-up, policyholders must make an advance payment for medical services.
(5)Applicable to the Insuring Agreement for Personal Accident, Death, Dismemberment, Loss of Sight, Loss of Hearing, Loss of Speech or Permanent Disability Benefits (Or.Bor.2). 50% coverage in case of motorcycle accident.
Remark :
- Worldwide coverage (excluding the United States of America where the benefits will be paid for the injury from an accident only). Medical expenses for treatments of chronic kidney disease by hemodialysis and organ transplantation are covered in Thailand only.