Unit: Baht
| Benefits | Plan 3000 | Plan 4000 | Plan 5000 | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 1. In-patient benefits | ||||||||||
| Group 1 | Hospital daily room & board, food and hospital service charges (in-patient) per confinement, not exceeding 125 days | 3,000 per day | 4,000 per day | 5,000 per day | ||||||
| In the event of ICU, such benefit will be paid for hospital daily room & board, food and hospital service charges (in-patient), will be twice paid for a maximum of 15 days, provided that total member of days, provided that total number of days under group 1 shall not exceed 125 days | ||||||||||
| Group 2 | Fees for medical service, diagnosis, treatment, blood service, nurse service, medicine, intravenous nutrient and medical supplies, per confinement | Must not exceed 30,000 with all Group 2 benefits combined | Must not exceed 200,000 with all Group 2 and Subgroup 4.1-4.4 benefits combined | Must not exceed 400,000 with all Group 2 and Subgroup 4.1-4.4 benefits combined | ||||||
| Subgroup 2.1 | Medical service fees for diagnosis | 30,000 | As charged | As charged | ||||||
| Subgroup 2.2 | Treatment medical services, blood services and nursing services | |||||||||
| Subgroup 2.3 | Medicine, intravenous nutrition and medical supplies | |||||||||
| Subgroup 2.4 | Take-home medicine and medical supplies (Medical Supply 1), per admission, net exceeding 7 days | 1,000 | ||||||||
| Group 3 | Fees for medical professional services (physician), examination, physical services per confinement, not exceeding 125 days | 800 per day | 1,000 per day | 1,200 per day | ||||||
| Group 4 | Fees for surgery and procedures per confinement | Must not exceed 100,000 with all Subgroup 4.1-4.4 benefits combined | Must not exceed 200,000 with all Subgroup 4.1-4.4 and Group 2 benefits combined | Must not exceed 400,000 with all Subgroup 4.1-4.4 and Group 2 benefits combined | ||||||
| Subgroup 4.1 | Operating or medical procedure room | 100,000 | As charged | As charged | ||||||
| Subgroup 4.2 | Medicine, intravenous nutrition and medical supplies and surgical devices | |||||||||
| Subgroup 4.3 | Medical professional services, physician (and assistant) fees for surgery & procedure, according to the doctor fee guideline | |||||||||
| Subgroup 4.4 | Physician fees-Anesthesiology, according to the doctor fee guideline | |||||||||
| Subgroup 4.5 | Medical expenses for organ transplantation are covered as charged (Limited 1 time per lifetime for this supplementary contract) | 200,000 | 200,000 | 400,000 | ||||||
| Group 5 | Day Surgery | Pay as charged (considered as an in- patient benefit) | ||||||||
| 2. Out-patient benefits | ||||||||||
| Group 6 | Fees for diagnosis before and after in-patient treatment or fees for follow up OPD treatment, which are directly related to in-patient treatment, per confinement | 3,500 | 5,000 | 5,000 | ||||||
| Subgroup 6.1 | Fees for diagnosis directly related to in-patient treatment within 30 days before and after admission | |||||||||
| Subgroup 6.2 | Fees for follow up OPD treatment (per admission) within 30 days after hospital discharge (excluding fees for diagnosis) | |||||||||
| Group 7 | Fees for OPD treatment of injury within 24 hours of each accident | 6,000 | 8,000 | 8,000 | ||||||
| Group 8 | Fee for each of the post-treatment rehabilitation per confinement | Not covered | ||||||||
| Group 9 | Medical services fees for chronic kidney failure treatment by-hemodialysis per policy year. | 35,000 | 50,000 | 50,000 | ||||||
| Group 10 | Medical services fees for tumour or cancer treatment by radiation therapy, interventional radiology, nuclear medicine, per policy year | |||||||||
| Group 11 | Medical services fees for cancer treatment by chemotherapy including targeted therapy per policy year | |||||||||
| Group 12 | Emergency ambulance fees per time | 3,000 | 4,000 | 5,000 | ||||||
| Group 13 | Minor surgery per time | 9,000 | 10,000 | 10,000 | ||||||
| Deductible per confinement (It remains effective before the policy anniversary at which the insured attains 11 years of age) | 10,000 | None | 5,000 | 10,000 | None | 5,000 | 10,000 | |||
| Additional benefits | ||||||||||
| 3. Hospital Income Benefit in case of in-patient but not exercising an in-patient benefit claim (not exceeding 10 days per policy year) | Not covered | 1,000 per day | Not covered | 1,000 per day | Not covered | |||||
| Maximum benefits per policy year | None | |||||||||
| Example Standard annual premium for male and female minors aged 6 year-old. | 9,030 | 24,409 | 18,812 | 14,959 | 29,471 | 22,987 | 18,609 | |||
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