5 Million Baht Policy Details YOUR WORLDWIDE BENEFITS (ALL IN BAHT) | Maxi Care | Ultra Care | Maximum Coverage for any one disability | 5,000,000.- | 20,000,000.- | (or series of disabilities arising from one event) | | | Life time limit | 20,000,000.- | 80,000,000.- | DEDUCTIBLE | | | (See Premium table for deductible options of 40,000/100,000 or 200,000) | OPTIONAL | OPTIONAL | SUBSTANDARD RISKS | Considered on application | Considered on application | SPORTS COVER (for recreational sports. Incl. Skiing & SCUBA) | Yes | Yes | GUARANTEED RENEWABILITY (premium subject to change) | Life time | Life time | HOSPITAL, OUTPATIENT & EMERGENCY MEDICAL Covers normal, usual an customary charges for: | Maxi Care | Ultra Care | Room and Board | Semi private or | Private or | | 8,000/day | 16,000/day | | | | Operating Theatre | 100% | 100% | Surgeon’s Fee: includes pre-surgical assessment and normal post-surgical care in the treatment country for each disability | 100% | 100% | Organ Transplant: fees for kidney, heart/lung, liver and bone marrow transplants (benefits may include costs for donor) | 1,000,000.- | 2,000,000.- | Anesthetist’s Fee | 100% | 100% | Private Nurse Fee: when certified necessary by the attending physician
(at home for up to 30days immediately after hospitalization) | 100% | 100% | Maternity Benefit : all inclusive limit per pregnancy – Subject to a 12 months waiting period in 1st policy year. | Surgical deliver 100,000.-
Normal delivery 60,000.- | Surgical deliver 150,000.-
Normal delivery 90,000.- | (90 days for miscarriage or “Dilation and Curettage”) | D & C 20,000 | D & C 40,00 | Inpatient psychiatric/mental disorders: - Limit per disability
- Limit per life time | 50,000.-
200,000.- | 100,000.-
400,000.- | Miscellaneous Inpatient Charges: for required Diagnostic Laboratory Fee: X-rays; | 100% | 100% | Professional Fees; Prescribed Medicines, Blood and Plasma; Wheel Chair Rentals; Surgical | | | Appliances, Devices, Standard Prosthetics (as approved by Company) | | | Intensive Care Unit, and Coronary care Unit | 100% | 100% | Outpatient Benefit: Physician and Specialists’ Fees for office visits; Physiotherapist.
Chiropractor, and Acupuncturist when referred by the attending physician; and for required
Diagnostic Laboratory Fees, X-rays, Prescribed Medicines, Outpatient Surgery, Surgical
Appliances, Dressings, Chemotherapy, and Radiation | 100% | 100% | Emergency Room Charges | 100% | 100% | Emergency Local Ambulance Service | 100% | 100% | World-wide Emergency Assistance: 24 hours a Day and 7 Days a Week | 100% | 100% | Emergency Medical Evacuation | 1,000,000.- | 1,000,000.- | Note: 1. Overseas Financial payment direct to providers can be arranged where claims exceed Baht 100,000.
2. All Children born during a policy year are covered free of charge for the duration of the policy year excepting ‘ well care’ and outpatient treatment subject otherwise to Terms & Conditions of Policy. | ADDITIONAL BENEFIT PLANS | Covers normal, usual an customary chares for eligible expenses | Maxi Care | Ultra Care | Dental Benefit: pays 80% to | 80,000/(optional) | 80,000/ (included) | Vision Benefit: pays 80% of eye exams and prescription lens annually for each insured | 20,000/(optional) | 20,000/ (included) | Personal Accident Benefit: Covers loss of life, loss of one both hands or feet, loss of vision in one or both eyes, or permanent and total disability caused directly and solely by accident
(child benefit limits are Baht 100,000.-) Additional rate 1.5/1,000.- | 200,000 to
Additional
20,000,000 (optional) | 400,000 (included)
Additional
20,000,00 (optional) | Annual Travel Benefit; covers the following annual eligible expenses worldwide when traveling out side you country of residence on trips lasting up to 60 days | (Optional) | (Included) | Medical Expenses – covers illness or injury including | 2,000,000.- | 2,000,000.- | Emergency Evacuation (to Baht 1,000,000) with a maximum of Baht 12,000 per day for
Hospital room and board which is doubled when room also includes all professional
services.
“Get You Home” Benefit - covers the additional cost of your own travel accommodation | | | necessarily incurred as a result of a covered disability to get you back home, (additional
cost of travel for family member or business associate limited to Baht 50,000) | | | Baggage Loss - covers up to Baht 10,000 per item, pair or set limit per year. | 20,00.- | 20,000.- | Baggage Delay - covers purchase of essential clothing and toiletries if your checked
baggage is delayed on arrival at your destination for over 12 hours | 50,000.- | 50,000.- | Personal money - covers burglary and armed robbery of cash, bank notes and traveler's
checks to a limit of | 20,000.- | 20,000.- | Hospital Cash Income - pays Baht 1,200 per day for each 24hours you are hospitalized. | 18,000/confinement | 18,000/confinement | Strikes & Hijack - pays Baht 1,000 per day for 12+ hour delays. | 100,000.- | 100,000.- | Personal Liability (excluding vehicle liability) limit per year | 5,000,000.- | 5,000,000.- | DISCOUNT OPTIONS | Outpatient Exclusion | 20% discount | 20% discount | 40,000 Deductible Option (you pay the first Baht 40,000/year) | 25% discount | 25% discount | 100,000 Deductible Option (you pay the first Baht 100,000/year) | 32.5% discount | 32.5% discount | 200,000 Deductible Option (you pay the first Baht 200,000/year) | 40% discount | 40% discount | Treatment Area Limit (excludes treatment in North America, Japan, Hong Kong, EU Countries and Switzerland) | 20% discount | 20% discount | PREMIUMS (BAHT) | Age Band | 0-4 | 5-18 | 19-25 | 26-30 | 31-35 | 36-40 | 41-45 | 46-50 | 51-55 | 56-60 | 61-65 | Maxi Care | 29,000 | 21,500 | 32,000 | 37,000 | 40,000 | 44,000 | 50,400 | 57,500 | 63,000 | 71,500 | 88,500 | Ultra Care | 36,200 | 37,500 | 54,000 | 60,000 | 65,000 | 73,500 | 77,000 | 88,500 | 94,500 | 112,000 | 132,000 |
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