An exclusive health insurance plan for corporate employees and their families with an Allianz Ayudhya group policy.
Health Insurance Employee Care Plus Plan by Allianz Ayudhya
Highlights
Exclusive coverage of inpatient and outpatient treatment (excluding major medical treatment) for pre-existing conditions after the first policy year
Cover up to THB 600,000
Room & Board benefit up to THB 5,000 with cover for 365 days
Top-up your cover with Major Medical benefits with 80% of the eligible expenses of the inpatient hospitalization benefits limit
Worldwide coverage excluding USA
Optional outpatient treatment (OPD), maternity, and personal accident cover
Extensive cashless medical network of over 490 hospitals and clinics nationwide*
No requirement to buy additional life insurance plan
Obtain unlimited health and well-being advice from qualified doctors via telemedicine service**
Lifetime renewal guarantee***
Remarks:
*You may be asked to disburse in case of investigating your pre-existing conditions by Allianz Ayudhya.
**Available only for telemedicine providers within the company's network. To use Allianz Ayudhya’s proprietary telemedicine service please contact 02 677 0999.
***Applicants who purchase their plan before 61 years old and continuously renew the plan will be eligible for lifetime renewal. Applicants who purchase their plan after 61 years old will be eligible to renew the policy until they are 80 years old.
The Applicant is advised to always study details of coverage and conditions carefully before deciding to buy insurance. After receiving the Insurance policy, the insured is advised to study the terms and conditions of the policy contract.
*You may be asked to disburse in case of investigating your pre-existing conditions by Allianz Ayudhya.
**Available only for telemedicine providers within the company's network. To use Allianz Ayudhya’s proprietary telemedicine service please contact 02 677 0999.
***Applicants who purchase their plan before 61 years old and continuously renew the plan will be eligible for lifetime renewal. Applicants who purchase their plan after 61 years old will be eligible to renew the policy until they are 80 years old.
The Applicant is advised to always study details of coverage and conditions carefully before deciding to buy insurance. After receiving the Insurance policy, the insured is advised to study the terms and conditions of the policy contract.
Coverage and Benefits
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Table of Benefits
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| Description | Benefit (Baht) | |||
| Plan 1 | Plan 2 | Plan 3 | ||
| Maximum benefit for an injury or sickness per confinement* | 400,000 | 500,000 | 600,000 | |
| 1. Benefit for Inpatient Care | ||||
| Section 1 | Room and board including service charges (inpatient) per confinement* | |||
| Non-intensive care room, maximum payable per day | 2,000 | 3,000 | 5,000 | |
| Intensive Care Unit (ICU), maximum payable per day (with a maximum limit of 15 days per per confinement*) | 4,000 | 6,000 | 10,000 | |
| Section 2 | Hospital medical expenses for diagnostic and therapeutic procedures, blood and blood components, nursing service, medicines, and parenteral nutrition, and medical supplies per confinement* | |||
| 2.1 | Hospital medical expenses for diagnostic procedures | 20,000 | 30,000 | 50,000 |
| 2.2 | Hospital medical expenses for therapeutic procedures, blood and blood components, and nursing service | |||
| 2.3 | Medicines and parenteral nutrition, and medical supplies | |||
| 2.4 | Home medications and medical supplies 1 | |||
| Section 3 | Medical practitioners’ fees | 800 | 1,000 | 1,500 |
| Section 4 | Fees for surgery and medical procedures | |||
| 4.1 | Operating theater and procedure room | 20,000 | 30,000 | 50,000 |
| 4.2 | Medicines, parenteral nutrition, medical supplies, surgery and procedure equipment | |||
| 4.3 | Surgeons’ fees including fees for surgical assistants | |||
| 4.4 | Anesthesiologists’ fees | |||
| 4.5 | Organ transplantation | 200,000 | 250,000 | 300,000 |
| Section 5 | Day Surgery | Included in Section 4 | ||
| 2. Benefits for Non-Inpatient Care | ||||
| Section 6 | Hospital medical expenses for diagnostic procedures before or after hospitalization relating to the condition diagnosed, or outpatient treatment after hospitalization Per Confinement* | |||
| 6.1 | Hospital medical expenses for diagnostic procedures relating to the condition diagnosed within 30 days before and after hospitalization | Included in Section 2 | ||
| 6.2 | The expenses for OPD visit post hospitalization within 30 days (excluding hospital medical expenses for diagnostic procedures) | |||
| Section 7 | Medical expenses for an injury (OPD) within 24 hours of accident | 2,500 | 3,500 | 5,500 |
| Section 8 | Rehabilitation post hospitalization per confinement* | Included in Section 2 | ||
| Section 9 | Hospital medical expenses for treatment of chronic kidney disease by hemodialysis per policy year | 10,000 | 15,000 | 15,000 |
| Section 10 | Medical expenses for treatment of tumor or cancer by radiation therapy, interventional radiology, nuclear medicine therapy per policy year | 400,000 | 500,000 | 600,000 |
| Section 11 | Medical expenses for treatment of cancer by chemotherapy per policy year | |||
| Section 12 | Emergency ambulance services, maximum payable per trip | 1,000 | ||
| Section 13 | Minor surgical expenses | Included in Section 4 | ||
| Additional Benefits | ||||
| 1 | Major Medical Treatment | Major Medical Treatment paid up to 80% of eligible expenses for inpatient hospitalization**, up to the maximum limit for each plan | ||
| 2 | Specialist’s consultation fees - no operation case | 2,000 | 3,000 | 5,000 |
| 3 | Specialist’s consultation fees - operation case | 2,000 | 3,000 | 5,000 |
| 4 | Fees for special nursing care, maximum payable per day (limited to 15 days) | 500 | ||
| 5 | Personal Accident (Or.Bor.2)*** | 100,000 | ||
*Each hospitalization as Inpatient for medical treatment(s), or each major surgery treatment without the hospitalization as inpatient (day surgery), in a hospital or medical facility. In this regard, hospitalizations as Inpatient for treatments, or major surgery treatments without hospitalization as inpatient (day surgery) in a hospital or medical facility, regardless of how many times, due to the same injury or sickness which has not been cured, including related or continuous complications, within 90 days from the date of last discharge from the hospital or medical facility will be considered as a single confinement.
**Except section 1, 4.5, 7, 9, 10, 11, 12
***Applicable to the Insuring Agreement for Personal Accident, Death, Dismemberment, Loss of Sight, Loss of Hearing, Loss of Speech or Permanent Disability Benefits (Or.Bor.2). 50% coverage in case of motorcycle accident.
Remark :
- Worldwide coverage (excluding the United States of America where the benefits will be paid for the injury from an accident only). Medical expenses for treatments of chronic kidney disease by hemodialysis and organ transplantation are covered in Thailand only.
Optional benefits
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| The Insuring Agreement for Outpatient Medical Treatment, per visit (maximum benefit 1 visit per day, 30 visits per year) | ||||
| Classic plan | 1,000 | |||
| Plus plan | 1,500 | |||
| Deluxe plan | 2,500 | |||
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| Maternity Benefits* (Applicant is able to purchase any of the 4 maternity plans) | Plan 1 | Plan 2 | Plan 3 | Plan 4 |
| Normal delivery, assisted delivery or intentional cesarean delivery | 40,000 | 60,000 | 90,000 | 120,000 |
| Emergency cesarean section or ectopic pregnancy | 80,000 | 120,000 | 180,000 | 240,000 |
| Miscarriage | 20,000 | 30,000 | 45,000 | 60,000 |
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| Personal Accident (Or.Bor.2)** | ||||
| PA 200 | 200,000 | |||
| PA 400 | 400,000 | |||
| PA 900 (for occupation class 1 and 2 only) | 900,000 | |||
*For maternity benefits, policyholders must make an advance payment for medical services.
**Applicable to the Insuring Agreement for Personal Accident, Death, Dismemberment, Loss of Sight, Loss of Hearing, Loss of Speech or Permanent Disability Benefits (Or.Bor.2). 50% coverage in case of motorcycle accident.
Remark :
- Maternity coverage will be provided following a waiting period of 280 days, except in the case of miscarriage, which will be covered following a waiting period of 90 days.
**Applicable to the Insuring Agreement for Personal Accident, Death, Dismemberment, Loss of Sight, Loss of Hearing, Loss of Speech or Permanent Disability Benefits (Or.Bor.2). 50% coverage in case of motorcycle accident.
Remark :
- Maternity coverage will be provided following a waiting period of 280 days, except in the case of miscarriage, which will be covered following a waiting period of 90 days.
Underwriting conditions
Examples of Exclusions
- The Company will not pay the Inpatient and Outpatient benefits for pre-existing conditions during the first year from the effective date of your coverage. Pre-existing conditions are not covered under Major Medical benefits, regardless of the aforementioned period.
- Medical expenses incurred for
- Sickness that occurs within first 30 days form the effective date of the insurance policy.
- Sickness or disease that occurs within 120 days of policy in the case of Tumor Cyst or Cancer, Hemorrhoids, Hernias, Pterygium or Cataract, Tonsillectomy or Adenoidectomy, Stones, Varicose veins, and Endometriosis. - Medical expenses incurred for the treatment of attempted suicide or self-inflicted injury.
- Acquired Immune Deficiency Syndrome (AIDS), including related complications or sexually transmitted diseases.
- Any unconventional treatment, alternative medical treatment or experimental treatment.
- Health check-ups, requests for hospitalization, requests for surgery or convalescences that are not medically necessary.
The Applicant is advised to always study details of coverage and conditions carefully before deciding to buy insurance. After receiving the Insurance policy, the insured is advised to study the terms and conditions of the policy contract.
Remark
- The Applicant is advised to always study details of coverage and conditions carefully before deciding to buy insurance.
- It is the responsibility of the Insured to make premium payments. Insurance agencies and brokers only facilitate the service.
- Employee Care Plus is the marketing name of Personal Health and Accident Insurance Policy (Worksite).
- Should coverage provided by any insurance policy be in violation of any United States (US), United Nations (UN) of European Union (EU) economic or trade sanctions, such coverage shall be null and void. For example, we cannot pay for healthcare services provided in a country under sanction by the United States unless permitted under a written Office of Foreign Assets Control (OFAC) license. Learn more on the US Treasury’s website at: www.treasury.gov/resource-center/sanctionsz