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This a Typical Example of
a
Health Insurance Rider on a Life Insurance
Policy
Health Insurance (HI)
Condition for insured
1. Age of insured: 1 month old - 70 years of age.
2. Coverage period means
the shortest period of;
2.1 Policy period but not over 70 years of age
2.2
70 years minus the age of insured
3. Premium payment period is equal to
policy period.
4. Must buy HI at the same time as life insurance coverage.
Benefit
While the policy and rider is effective, the company will pay the insured as
an in-patient if;
1. The insured is ill after 30 days when the policy is
effective or policy reinstatement.
2. The insured is injured by accident.
Benefit table
The company will pay only one time actual medical cost as the policy is
stated.
| Benefit type |
Plans (Unit :
Baht) |
| HI 700 |
HI 1000 |
HI 1500 |
HI 2000 |
HI 2500 |
HI 3000 |
| 1.1 Room, meal and medical expenses per day (not over 90
days) |
700 |
1,000 |
1,500 |
2,000 |
2,500 |
3,000 |
1.2 ICU expenses per day
(not over 7 days) |
1,400 |
2,000 |
3,000 |
4,000 |
5,000 |
6,000 |
| 2.Other medical expenses |
12,000 |
16,000 |
20,000 |
20,000 |
20,000 |
30,000 |
| 3.Doctor’s surgical fees |
40,000 |
50,000 |
60,000 |
70,000 |
80,000 |
90,000 |
| 4.Surgery room expenses |
4,000 |
5,000 |
6,000 |
7,000 |
8,000 |
9,000 |
| 5.Anesthetic expenses |
4,000 |
5,000 |
6,000 |
7,000 |
8,000 |
9,000 |
| 6.Emergency medical expenses |
2,500 |
3,000 |
4,000 |
5,000 |
6,000 |
7,000 |
7.X-Ray diagnosis and laboratory
examination |
3,500 |
3,500 |
3,500 |
3,500 |
3,500 |
3,500 |
| 8.Doctoral fees per day (not over 90 days) |
400 |
600 |
800 |
900 |
1,000 |
1,000 |
| 9.Medical treatment benefits (per treatment) |
169,900 |
233,500 |
317,000 |
387,500 |
458,000 |
529,500 |
Notice Benefit payment as 1.1 plus 1.2 is not over 90
days |
Details of the benefit as show on the table
1. Room, meal and medical expenses (not over 90 days) :
- In case of being treated in ICU: The company will pay the actual
treatment cost but not over 2 times of Room cost, Meals and medical expenses per
day (not over 7 days)
2. Other medical expenses :
A:
Drug treatment by doctor’s prescription
B: Wound treatment splint and plaster
except supporting tools
C: Physical therapy
D: Blood or plasma
transfusion
E: X-Ray examination or Heart examination with electrical wave
and laboratory tests
F: Ambulance service but not over Room and Meal expenses
per day.
3. Doctor’s surgery fee :
The company will pay the
actual percentage cost but over the benefit as shown in the table. This cost
will be shown on surgery cost/anesthetic cost.
4. Surgery room
cost
5. Anesthetic cost :
The company will
pay the actual percentage cost but not over the benefit as shown in the table.
This cost will be shown on doctor surgery cost / anesthetic cost
6. Emergency medical expenses from accident :
In
case of emergency the insureds need to be treated as an out-patient. The company
will pay the actual cost but not over the policy as is stated in the table.
7. X-Ray diagnosis and laboratory examination :
In
case the insured needs to be examined by an X-Ray, Heart examination with
electrical wave or laboratory tests. These have to be approved by a doctor’s
letter within 30 days. The company will pay the actual cost but not over the
benefit as shown in the table.
8. Doctor’s fee :
The
Company will pay the actual cost for treatment, consultation but not over 90
days as shown in the table.
Policy expiration
1. Non premium payment until grace period will be passed except in case APL
has taken place
2. The insureds are 65 years of age.
3. The policy has
matured or changed the policy to cash surrender value or policy extension.
4.
Either the insureds or the company cancel the policy in writing 30 days in
advance. The company will pay the partial uncoverge payment back to the
insureds.
Policy reinstatement
The insureds can notify in
writing with required documents with their own expenses with the company’s
consent.
Requirement and method for health insurance Rider (HI)
Buying coverage regulation
The insureds have to buy this rider with life insurance at the same time. The
company has a right not to extend the additional coverage in the same policy
after the policy has been issued in case of the insureds do not buy the full
coverage at the first time.
1. The age of insured: 1 month old -5 years of age
In case of being
treated in ICU: The company will pay the actual treatment cost but not over 2
times of Room, Meal and medical cost per day (not over 7 days)
1. The age of insured: 1 month old -5 years of age
| Sum Insured (Life
coverage) |
Maximum buying as the HI is
stated |
|
From 100,000 baht but lower than 200,000 baht
|
HI 1000
|
| From 200,000 + up |
HI 1500 |
2. The age of insured: 6-15years of age
| The amount of insured |
Maximum buying as the HI is
stated |
|
From 100,000 baht but lower than 200,000 baht
|
HI 1000
|
|
From 200,000 baht but lower than 300,000 baht
|
HI 1500
|
| From 300,000 + up |
HI 2000 |
3. The age of insured: 16 years of age + up
| The amount of insured |
Maximum buying as the HI is
stated |
|
From 100,000 baht lower than 200,000 baht
|
HI 1000
|
|
From 200,000 baht but lower than 300,000 baht
|
HI 1500 |
|
From 300,000 baht but lower than 500,000 baht
|
HI 2500 |
| From 500,000 + up |
HI 3000 |
Notice for “Sap Kasian”
Policy (Which has a policy period of more than 20 years) and Koom Thanakij : The
amount of sum insured for calculating to buy the HI is only half of the amount
of sum insured. For example, if the sum insured for Koom Thanakij is 200,000
baht, the insured can buy HI at the same rate as 100,000 baht.
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