| Supplementary contract | BLA Prestige Health (Special) |
BLA Prestige Health | |||
|---|---|---|---|---|---|
| Coverage area | Thailand | Thailand | Thailand / Asia / Worldwide excluding the USA / Worldwide |
||
| Maximum benefits per policy year (baht) | 10 million | 30 million | 50 million | 80 million | 100 million |
| Coverage | Maximum benefits (baht) | ||||
| 1. Inpatient Benefits | |||||
| 1.1 Room and board, daily nursing and other hospital service charge coverage per admittance | 8,000 | 10,000 | 12,000 | 15,000 | 25,000 |
| 1.1.1 Room and board, daily nursing charge coverage (up to 365 days) | |||||
| 1.1.2 ICU room (not exceeding 365 days); after including benefits, room and board, and daily nursing charge coverage under 1.1.1, this shall not exceed 365 days | Pay by actual amount | Pay by actual amount | Pay by actual amount | Pay by actual amount | Pay by actual amount |
| 1.2 Other medical expense coverage in the hospital | Pay by actual amount | Pay by actual amount | Pay by actual amount | Pay by actual amount | Pay by actual amount |
| 1.3 Cost of medical instruments and prosthesis, lifelong benefits of up to | 50,000 | 80,000 | 100,000 | 200,000 | 400,000 |
| 1.4 Daily doctors’ fees in the hospital and medical specialists’ consultation fees | Pay by actual amount | Pay by actual amount | Pay by actual amount | Pay by actual amount | Pay by actual amount |
| 1.5 Cost of surgeon and medical procedures | |||||
| 1.6 Fees for anesthetist and/or nurse anesthetist | |||||
| 1.7 Charges for operating room and equipment | |||||
| 1.8 Inpatient rehabilitation charges (up to 30 days per disease) | |||||
| 1.9 Costs for organ transplantation (maximum 1 time per lifetime) | |||||
| 1.10 Cost of private nursing care according to doctor’s advice after being hospitalized (up to 60 days of policy year) | |||||
| 1.11 Inpatient rehabilitation fee (within 30 days after being discharged from the hospital) | |||||
| 2. Benefits for emergency medical treatment | |||||
| 2.1 Ambulance fee | Pay by actual amount | Pay by actual amount | Pay by actual amount | Pay by actual amount | Pay by actual amount |
| 2.2 Dentistry expense due to accidental injury | |||||
| 2.3 Outpatient medical expense due to accident within 24 hours | |||||
| 3. Outpatients benefits | |||||
| 3.1 General practitioners and specialists’ consultation fees, including cost of diagnostic test and cost of medicines (not exceeding 2 times per day; up to 360 times per year). Maximum benefits throughout policy year not exceeding | - | 15,000 | 15,000 | 30,000 | Pay by actual amount |
| 3.2 Cost of physical therapy | - | 5,000 | 5,000 | 10,000 | 50,000 |
| 3.3 Acupuncture, naturopathy, osteopathy and chiropractic | |||||
| 3.4 Medical expenses for cancer treatments including chemotherapy, targeted therapy, and radiation therapy | Pay by actual amount | Pay by actual amount | Pay by actual amount | Pay by actual amount | Pay by actual amount |
| 3.5 Cost of kidney dialysis | |||||
| 3.6 Cost of Advanced Diagnostic Body Imaging; for instance, MRI | |||||
| The Company will pay benefits for necessary and appropriate expenses incurred due to necessary medical treatments and standards at the coverage areas according to actual amounts paid but not exceeding the maximum benefits per policy year as specified in the Table of Benefits. | |||||
Remarks:
- A choice of 1 coverage area, with the premium being different for each area.
- Asia includes Bangladesh, Bhutan, Brunei, Cambodia, China, Hong Kong, India, Indonesia, Japan, Kazakhstan, Kyrgyzstan, Laos, Macau, Malaysia, Maldives, Mongolia, Myanmar, Nepal, Pakistan, The Philippines, Singapore, South Korean, Sri Lanka, Taiwan, Tajikistan, Turkmenistan, Uzbekistan, Vietnam, and Thailand.
- Worldwide excluding the USA means worldwide excluding the USA and the United States Minor Outlying Islands.
