Schedule of Benefits
Ultra Care Plan |
Plans (Baht)
|
| Plus |
Comprehensive |
Select |
Standard |
| If during the plan year, an insured person incurs
a medical condition, we, under the terms and conditions of the plan.will pay necessary,
customary and responable expenses up to an overall maximum, per
insured person. |
80,000,000
|
80,000,000
|
80,000,000
|
34,000,000
|
| Section A : In-patient and Daycare
Treatment |
Plus |
Comprehensive |
Select |
Standard |
| 1. Accidents and Emergencies, Intensive Care and
Theatre costs |
Covered
in Full |
Covered
in
Full |
Covered
in
Full |
Covered
in
Full |
| 2. Hopital accommodation |
| 3. Nursing fees, medical expenses and anciliary
charges |
| 4. Surgeons, consultants, anaesthetists, medical
practitioners' fees |
| 5. Prescribed medicienes and drugs |
| 6. Reconstructive surgery following an accident
or following surgery for an eligible medical condition |
| 7. Prostheses : artificial body parts designed to
form permanent parts of insured person's body |
| 8. MRI and CT scans |
| 9. X-rays, Pathology, diagnostic tests and
procedures |
| 10. Onoclogy tests, drug and consultant's fees
including cover for chemotherapy and radiotherapy |
| 11. Physictherapy by registered physictherapist,
when referred by a medical practitiner, consultant or specialist |
| 12. Alergies: treatment of allergic medical conditions |
| 13. Parent accommodation, insured parent with
insured child under 18 years of age in hospital |
| 14. Accidental damaage to natural teeth |
| 15. Psychiatric treatment up to 30 days available
after 12 months continuous cover under the plan |
Not covered |
Not covered |
Not covered |
| Section B : Out-Patient Treatment
|
Plus |
Comprehensive |
Select |
Standard |
| 1. Primary consultations and treatment to include
medical practitiner's fees, prescribed medicienes, drugs and dressings |
Covered
in Full |
Covered up to 340,000
*Complementary medicicine and treatment, and Physiotherapy up to a maximum sub-limit of 34,000
|
Covered up to 204,000
*Complementary medicicine and treatment, and Physiotherapy up to a maximum sub-limit of 17,000
|
Not covered |
| 2. X-rays, pathology, diagnostic tests and
procedures |
| 3. Specialists' and consultant's fees for
consultation, prescribed medicienes, drugs and dressings |
| 4. Psychiatric treatment available after 12
months continuous cover under the plan |
Covered up to 136,000 |
| 5. Complementary medicienes and treatment by a
therapist, when referred by a medical practitioner, consultant or specialist.
This benefit extends to osteopathic, chiropractic, homeopathic and acupuncture
treatment and Chinese herbal medicine* |
Covered up to 136,000 |
| 6. Physictherapy by registered physictherapist,
when referred by a medical practitiner, consultant or specialist * |
Covered
in
Full |
| 7. Onoclogy tests, drug and consultant's fees
including cover for chemotherapy and radiotherapy |
Covered
in Full |
Covered
in
Full |
| 8. MRI and CT scans |
| 9. Out-Patient surgical operations |
|
10. Alergies: treatment of alergic medical conditions.
|
Covered up to
10,200
|
Covered up to10,200
|
Covered up to
10,200
|
| Post-hospitalization treatment |
Up to 90 days
|
Up to 90 days |
Up to 90 days
|
Up to 90 days
|
| Section C : Dental Out-Patient Treatment
|
Plus |
Comprehensive |
Select |
Standard |
|
Emergency treatment for the immediate relief
of dental pain and accidental damage to natural teeth and the restoration of
natural teeth including x-rays, filling, extractions, roct-canal treatment, gum
treatment
|
Covered up to 75%
of
51,000
|
Covered up to 75%
of
34,000
|
Not Covered |
Not Covered |
| Section D : Wellness Benefit
|
Plus |
Comprehensive |
Select |
Standard |
|
Routine health checks including cancer screening, cardivasular, neurological, well child tests, vital sign tests (e.g. blood pressure, cholesterol) and vacinations.
|
Covered up to 23,800 |
Covered up to 17,000 |
Not Covered |
Not Covered |
| Section E : Chronic Medical
Conditions |
Plus |
Comprehensive |
Select |
Standard |
|
1. Maintenance, routine checkups, prescribed medication and palliative treatment.
|
Covered up to a lifetime limit of 2,000,000 with an annual limit of 660,000 |
Covered up to a lifetime limit of 1,700,000 with an annual limit of 560,000 |
Covered up to a lifetime limit of 1,360,000 with an annual limit of 440,000 |
Not Covered |
| 2. Stabiisation of acute exacerbations / episodes
of chronic medical conditions |
Covered within the limit shown in
the In-Patient, Daycare Section and Out-Patient Section |
Covered within the limit shown in
the In-Patient, Daycare Section and Out-Patient Section |
Covered within the limit shown in
the In-Patient, Daycare Section and Out-Patient Section |
Covered within the limit shown in
the In-Patient, Daycare Section and Out-Patient Section |
| Section F : Terminal Illness |
Plus |
Comprehensive |
Select |
Standard |
|
Palliative treatment and hospice care on diagnosis of terminal condition
|
Covered up to a lifetime limit of 2,000,000 with an annual limit of 660,000 |
Covered up to a lifetime limit of 1,700,000 with an annual limit of 560,000 |
Covered up to a lifetime limit of 1,360,000 with an annual limit of 440,000 |
Not Covered |
|
Section G : Harmone Replacement Therapy
|
Plus |
Comprehensive |
Select |
Standard |
|
Harmone replacement therapy in respect of pre- and post- menopausal symptoms
|
Covered up to 10,200 |
Covered up to 10,200 |
Covered up to 10,200 |
Covered up to 10,200 (up to 90 days) immediately following IP or DC treatment release
|
|
Section H : HIV/AIDS (After 4 years of continuos cover)
|
Plus |
Comprehensive |
Select |
Standard |
| Treatment for HIV/AIDS and related medical problems |
Covered up to a lifetime limit of 3,400,000
|
Covered up to a lifetime limit of 3,400,000
|
Covered up to a lifetime limit of 3,400,000
|
Not Covered |
| Section I : Emergency Local Ambulance
|
Plus |
Comprehensive |
Select |
Standard |
| Costs of road Ambulance transport required due
to an emergency or medical necessity to the nearest available and appropriate
local hospital |
Covered
in Full |
Covered
in Full |
Covered
in Full |
Covered
in Full |
| Section J: Organ Transplant
|
Plus |
Comprehensive |
Select |
Standard |
| Treatment for and in relation to an
organ transplant of either ; kidney, liver, heart, lung , or heart and lung, in
respect of the insured person as recipient and not the organ donor |
Covered up to 13,600,000 |
Covered up to 13,600,000 |
Covered up to 13,600,000 |
Covered up to 13,600,000 |
| Section K : Nursing at Home
|
Plus |
Comprehensive |
Select |
Standard |
| Primary care services of registered nurse in
the insured person's home immediately after, or instead of, in-patient or
daycare treatment (Not related to terminal care) |
Covered up to 340,000 |
Covered up to 170,000 |
Covered up to 170,000 |
Covered up to 102,000 |
| Section L : Compassionate Emergency Home
Visit |
Plus |
Comprehensive |
Select |
Standard |
Cost incurred by an insured person for an
economy class return airfare to travel to and from an insured person's home
country in the event of a medical condition of a close family member, up to the
attained age of 75 years, resulting in that close family member being placed on
a critical list, or death of a close family member.
Limited to one return
journey per insured person per plan year. |
Covered
in Full |
Covered
in Full |
Covered
in Full |
Not Covered |
| Section M : Hospital Cost Benefit
|
Plus |
Comprehensive |
Select |
Standard |
| Cash payment payable for each night where
treatment is received by an insured person as a non-paying patient (Public
Hospital) |
17,000 per night (Up to a maximum to 510,000) |
17,000 per night (Up to a maximum to
510,000) |
17,000 per night (Up to a maximum to
510,000) |
17,000 per night (Up to a maximum to
510,000) |
| Section N : Legal Expenses |
Plus |
Comprehensive |
Select |
Standard |
| Legal expenses incurred by an insured person
with our prior written consent in pursuit of a claim against a third party who
has caused bodily injury to, or the death of, an insured person. |
Covered up to 510,000 |
Covered up to 510,000 |
Covered up to 510,000 |
Covered up to 510,000 |
| Section O : Emergency Evacuation and
Repatriation |
Plus |
Comprehensive |
Select |
Standard |
| 1. The Transportation costs of an insured person
to the nearest centre where adequate medical facilities are available. Payment of
this benefit, including treatment incurred,will be subject to the insured person
suffering from a medical condition; (a) that necessitates the insured person
being placed on a critical list, or, (b) for which, in our opinion, adequate
treatment is not available in the country where such treatment is required
and/or recovery would be substantially expedited thereby. |
Covered
in Full |
Covered
in Full |
Covered
in Full |
Covered
in Full when
relating to in-patient and daycare treatment |
|
2. Economy class return airfare following an
emergency medical evacuation, to country of residence.
|
| 3. Travelling, acommodation and economy class
return airfare expenses for pre-authorised costs of a close business collegue, or
the insured person's dependants, or in the case of the insured person being a
dependant, a parent or close family member, having to accompany the insured
person for an emergency medical evacuation. (This benefit will only become available under the conditions detailed in Section 1 .Clause (a) above |
| Section P : Repatriation, Burial or
Cremation of Mortal Remains |
Plus |
Comprehensive |
Select |
Standard |
| In the event of death, the costs of
preparation and air transportation of the body, mortal remains or the ashes of
an insured, from the place of death to the home country, or the preparation and
local burial or chemation of the mortal remains of the insured person, who dies
outside of the home country. |
Covered
in Full |
Covered
in Full |
Covered
in Full |
Covered
in Full |
| Section N : Emergency Medical Treatment
Outside Area of Cover |
Plus |
Comprehensive |
Select |
Standard |
| Emergency medical treatment outside of area of
cover shown in the schedule. |
Covered up to 2,380,000 |
Covered up to 2,060,000 |
Covered up to 1,360,000 |
Not Covered |
| DEDUCTIBLES (Excess) |
Plus
|
Comprehensive |
Select |
Standard
|
| 1. Out-patient medical excess Per medical condition, per year |
1,800
|
1,800
|
1,800
|
Not Applicable
|
| 2. Out-patient dental treatment co-insurance (per claim) |
25%
|
25%
|
Not Applicable
|
Not Applicable
|
|
|
|
|
|
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|
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top |
| Maternity Benefit for Individual
customers |
|
|
|
|
|
| The Cover |
|
|
|
|
|
| Schedule of Benefits
|
| Oveall maximum per pregnancy, per year
; |
THB 68,000,000 |
| Section A - Normal Pregnancy
and Childbirth |
| Delivery costs, ante-natal and
post-natal check-ups and examinations. |
Covered up to THB
340,000 |
| Co-Insurance deduction -
Section A ; |
| A co-insurance will be
deducted from each claim submitted in this section.
You can choose to have a 10% or 20%
co-insurance. |
| Section B - Complications in
Pregnancy During the Ante-Natal Period |
| Treatment as an
in-patient or an out-patient of a medical
complication which arises during ante-natal period due to a medical
condition. |
Covered in Full |
| Section C - Complication in
Pergnancy during Childbirth |
| Treatment as an
in-patient or an out-patient of a medical complication which arises during
childbirth due to a medical condition. |
Covered in Full |
| Section D - Birth Defects and
Congenital Abnormalities |
| Investigation and
treatment of birth defects and
congenital conditions, including birth trauma, provided that
such become apparent in the first six (6) months from birth. Please note : This benefit is available
per pregnancy for a period twelve (12) months from the initial diagnosis date,
up to the specified limit shown. |
Covered up to THB
34,000 |
| Section E - Termination of
Pregnancy |
| Termination of pregnancy when
medically necessary |
Covered in Full |
| Section F - New-Born
Accommodation |
| Fourteen (14) days
hospital accommodation costs for a new-born child to accompany
it's mother while she is receiving treatment as an
in-patient in a hospital for a condition
covered under the Maternity Optional Add-On Plan. |
Covered in Full |
| Section G - Local Ambulance
Services |
| Cost of road Ambulance transport
required due to an emergency or medical
necessary to the nearest available and appropriate local
hospital. |
Covered in Full |
|
This optional add-on benefit available to
persons insured under the plus, Comprehensive and Select plans, This option is
not available to persons insured under the Standard
Plans.
Eligibility
|
