Health & Personal Accident
Individual Health and Accident Insurance Policy Happy Health Plus 15,000
Care of your health with being beneficial to your annual personal tax income deduction
Benefit Schedule (Currency : Thai Baht) |
Plan 1 | Plan 2 | Plan 3 | Plan 4 |
---|
Entry age condition | 18 – 30 years old | 31 – 45 years old | 46 – 55 years old | 56 - 65 years old |
Overall maximum limit per year | THB 300,000 | THB 300,000 | THB 300,000 | THB 300,000 |
Maximum limit per confinement1 | ||||
Area of overage | Thailand only | Thailand only | Thailand only | Thailand only |
Article 1 Room charge, meal fee and hospital service fee (Inpatient) per confinement | ||||
1.1 Non-Intensive Care Unit (maximum limit per day) | THB 4,000 | THB 4,000 | THB 3,000 | THB 2,500 |
1.2 Intensive Care Inpatient Room, Coronary Care Unit (CCU) | THB 8,000 | THB 8,000 | THB 6,000 | THB 5,000 |
Article 2 Medical fee for examination or treatment, blood and blood component service fee, nurse service fee, medicine fee, parenteral nutrition fee, and medical supplies fee per confinement. |
THB 60,000 | THB 60,000 | THB 50,000 | THB 50,000 |
2.1 Medical fee for examination | ||||
2.2 Medical fee for treatment, blood and blood component service fee, and nurse service fee | ||||
2.3 Medicine fee, parenteral nutrition fee and medical supplies fee | ||||
2.4 Medicine fee and disposable supplies fee (Medical Supplies 1) for home medication | ||||
Article 3 Physician’s examination fee (Physician) (maximum limit per day and up to Maximum limit per confinement1 | THB 6,000 | THB 6,000 | THB 6,000 | THB 6,000 |
Article 4 Operation (surgery) and procedure fee (maximum limit per confinement) | THB 60,000 | THB 60,000 | THB 50,000 | THB 50,000 |
4.1 Operating room fee and procedure room fee | ||||
4.2 Medicine fee, parenteral nutrition fee, medical supplies fee, and surgery and procedure fee | ||||
4.3 Physician’s fee for Physicians performing surgery and procedure (including assistant) (Physician fee) | ||||
4.4 Physician’s fee for anesthetist (Physician fee) | ||||
4.5 Medical fee for organ transplantation e.g. liver, pancreas, kidney, heart, lung, and bone marrow transplantation | ||||
Article 5 Day surgery (maximum limit per confinement) | Customary and Reasonable Medical Charges but up to Maximum limit under Article 2 |
Article 6 Medical fee for related direct examination before and after hospitalization as an Inpatient or Outpatient treatment fee which is in consequence of or in connection with hospitalization as an Inpatient (maximum limit per confinement). | ||||
6.1 Medical fee for related direct examination which occurs within 30 days before hospitalization as an Inpatient and 60 days after hospitalization as an Inpatient. | No coverage | |||
6.2 Outpatient Treatment fee after hospitalization as an Inpatient for each consequential treatment within 30 days after such discharge from the hospital (excluding medical fee for examination) | Customary and Reasonable Medical Charges but up to Maximum limit under Article 2 | |||
Article 7 Medical fee for Treatment of injury in Outpatient case within 24 hours after each accident | THB 10,000 | THB 10,000 | THB 5,000 | THB 5,000 |
Article 8 Rehabilitation, Physical Therapy treatment fee after each hospitalization as an Inpatient within 30 days | Customary and Reasonable Medical Charges but up to Maximum limit under Article 2 | |||
Article 9 Medical fee for Treatment of chronic kidney failure by hemodialysis through vascular access for each policy period (maximum limit per year) | THB 60,000 | THB 60,000 | THB 50,000 | THB 50,000 |
Article 10 Medical fee for Treatment of tumor or cancer by radiotherapy, interventional radiology, and nuclear medicine for each policy period (maximum limit per year) | Customary and Reasonable Medical Charges but up to Maximum limit under Article 2 | |||
Article 11 Medical fee for Treatment of cancer by chemotherapy for each policy period (maximum limit per year) | Customary and Reasonable Medical Charges but up to Maximum limit under Article 2 | |||
Article 12 Ambulance fee (maximum limit per confinement) | THB 1,000 | THB 1,000 | THB 1,000 | THB 1,000 |
Article 13 Medical fee for Mini Surgery (maximum limit per confinement) | Customary and Reasonable Medical Charges but up to Maximum limit under Article 2 |
Loss of Life, Dismemberment, Loss of Sight or Permanent Disability (PA1) by an accident including Assault & Murder, and motorcycle accident as a riding or a passenger | THB 10,000 | THB 100,000 | THB 100,000 | THB 100,000 |
Consultation Fees, Medicines, Drugs Prescribed by a Registered Physician, Laboratory Tests (1 Visit / Day, 30 Visits / Year) | THB 1,500 | THB 1,500 | THB 500 | No coverage |
Remarks:
Medical Necessity means the necessity to use medical services or other services of the Health Facility for examination or treatment of Injury or Illness which shall be subject to the following conditions:
(1) the services must be consistent with the diagnosis and treatment according to the symptoms of the Injury or Illness in a treated person.
(2) there is a clear medical indication in accordance with the standards of modern medical practice.
(3) the services are not solely for the convenience of the Covered Person or the Covered Person's family or the medical service provider.1. The Company will not pay any benefit for any Illness occurring during the 30 days from the first day of the commencement date of the Insurance Policy or
2. The Company will not pay any benefit for the following Illnesses which occurred in the period of 120 days from the first effective date of the Insurance Policy;
2.1 Tumors, cysts or all types of cancer
2.2 Hemorrhoids
2.3 All types of Hernia
2.4 Pterygium or Cataracts
2.5 Tonsillectomy or adenoidectomy
2.6 All types of Calculus
2.7 Varicose Veins
2.8 Endometriosis
3. There is 180 days waiting period for Funeral Benefits if the death caused by sickness.
Reimbursement condition will be applied for the following benefits in which the insured must pay for the medical expenses upfront and get the treatment done, and later submit all the original bills together with medical certificate to reimburse with company after claims.
This insurance does not cover any expenses arising from Medical Treatment, or damage arising from an Injury or Illness (including any complication), symptom, or irregularity, caused by:
Remarks:
The above proofs must be submitted within 30 days from the date of discharge from a Hospital or Health Facility, or the date of treatment at a clinic. The receipt must be an original. The Company will return the original receipt, bearing the certification of the amount paid, to the Covered Person for use in a claim for a shortfall amount from another insurer.
Method 1 Through the hospital network provider (fax claim or outpatient credit)
Method 2 Direct billing to LMG
Submit the following documents:
Remarks:
This insurance policy is underwritten by LMG Insurance Public Company Limited. The Company reserves the right to consider underwriting. | Please ensure you read carefully and understand the insurance coverages and conditions prior to making a decision. | This brochure is not an insurance contract. The coverages and benefits that the insured will receive depend on the definition, conditions and exclusions specified under the purchased insurance policy and coverage plan.