| Coverage | Plan 1 | Plan 2 | Plan 3 | ||||
|---|---|---|---|---|---|---|---|
| Maximum benefit for an injury or sickness per confinement* | 2,000,000 | 5,000,000 | 10,000,000 | ||||
| 1. Benefit for Inpatient Care | |||||||
| Section 1 | Room and board including service charges (inpatient) per confinement* | ||||||
| Non-intensive care room, maximum payable per day | 6,000 | 9,000 | 12,000 | ||||
| Intensive Care Unit (ICU), maximum payable per day (with a maximum limit of 15 days) | 12,000 | 18,000 | 24,000 | ||||
| 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* | ||||||
| 2.1 | Hospital medical expenses for diagnostic procedures | Paid in full** except for specialist’s consultation fee in case of non-surgery, not exceeding THB 20,000 | Paid in full** except for specialist’s consultation fee in case of non-surgery, not exceeding THB 50,000 | Paid in full** except for specialist’s consultation fee in case of non-surgery, not exceeding THB 100,000 | |||
| 2.2 | Hospital medical expenses for therapeutic procedures, blood and blood components, and nursing service | Paid in full** | |||||
| 2.3 | Medicines and parenteral nutrition, and medical supplies | ||||||
| 2.4 | Home medications and medical supplies 1 | ||||||
| Section 3 | Medical practitioners’ fees, maximum payable per confinement* | ||||||
| Section 4 | Fees for surgery and medical procedures per confinement* | ||||||
| 4.1 | Operating theater and procedure room | Paid in full** | |||||
| 4.2 | Medicines, parenteral nutrition, medical supplies, surgery and procedure equipment | ||||||
| 4.3 | Surgeons’ fees including fees for surgical assistants | Paid in full** except for specialist’s consultation fee in case of surgery, not exceeding THB 20,000 | Paid in full** except for specialist’s consultation fee in case of surgery, not exceeding THB 50,000 | Paid in full** except for specialist’s consultation fee in case of surgery, not exceeding THB 100,000 | |||
| 4.4 | Anesthesiologists’ fees | Paid in full** | |||||
| 4.5 | Organ transplantation | 2,000,000 | 5,000,000 | 10,000,000 | |||
| Section 5 | Day Surgery | Paid in full** | |||||
| 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* | ||||||
| 6.1 | Hospital medical expenses for diagnostic procedures relating to the condition diagnosed within 30 days before and after hospitalization | Paid in full** | |||||
| 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 | 20,000 | 50,000 | 100,000 | |||
| Section 8 | Rehabilitation post hospitalization per confinement* | Paid in full** | |||||
| Section 9 | Hospital medical expenses for treatment of chronic kidney disease by hemodialysis per policy year | 100,000 | |||||
| Section 10 | Medical expenses for treatment of tumor or cancer by radiation therapy, interventional radiology, nuclear medicine therapy per policy year | 1,000,000 | 2,500,000 | 5,000,000 | |||
| Section 11 | Medical expenses for treatment of cancer by chemotherapy per policy year | ||||||
| Section 12 | Emergency ambulance services, maximum payable per trip | 20,000 | 50,000 | 100,000 | |||
| Section 13 | Minor surgical expenses | Paid in full** | |||||
| 3. Additional Benefits | |||||||
| 1 | Personal Accident (Or.Bor.2)*** | 100,000 | |||||
*Per confinement means 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 center, at any time. The confinements for 2 times or more due to the same causes, disease or complication, with intervals of not more than 90 days from the most recent discharge from a hospital or medical center shall be considered a single confinement.
**Full cover, not over maximum coverage of each plan.
***Personal Accident (Or.Bor.2) means death, dismemberment, loss of sight, loss of hearing, loss of speech or permanent disability from accident. 50% coverage in case of motorcycle accident.
Remark This insurance provides worldwide coverage, except for the medical expenses incurred in the United States, however Allianz Ayudhya will pay the benefits under this insurance only for the injuries arising from accidents occurring to the covered person during their stay in the United States. This is except for medical expenses for organ transplantation and treatments of chronic kidney disease by hemodialysis under Benefits for Inpatient Care and Benefits for Non-Inpatient Care, will be provided in Thailand only.