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Health Insurance Employee We Care Plan by Allianz Ayudhya

Your employees are your most important assets. Look after their health with comprehensive health cover, tailored to suit the needs of your business.

Highlights

Worldwide coverage
Various plans to suit different needs and budgets
Budget-friendly for small businesses (5-50 employees)
Accident cover of up to THB 600,000
HB Incentive (Optional daily cash benefit when your hospitalisation is not covered by us)
Cover available to employees and their dependents

Coverage and Benefits

Table of Benefits

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Description   Benefit (THB)
Plan L1 Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6
Room and Board including Fees for Nursing Services              
Non-intensive Care Room (maximum payable per day) 800 1,500 2,000 2,500 3,000 4,000 5,000
Intensive Care Unit (ICU) (maximum payable per day and maximum 15 days per disability)* 1,600 3,000 4,000 5,000 6,000 8,000 10,000
Hospital General Expenses
Hospital General Expenses 10,000 20,000 30,000 40,000 50,000 60,000 80,000
Emergency Accidental Outpatient Treatment (first visit within 24 hours
after an accident and follow-up treatment within 15 days), included in Hospital General Expenses 		4,000 5,000 6,000 7,000 8,000 9,000 12,000
Surgery’s Consultation Fees in case of Non-surgery, included in Hospital General Expenses 3,000 4,000 5,000 6,000 7,000 8,000 9,500
Ambulance in case of an Emergency, included in Hospital General Expenses 1,000 1,000 1,000 1,000 1,000 1,000 1,000
Surgical Treatment
Surgeon’s Fees (per Surgical Schedule) 25,000 35,000 45,000 55,000 65,000 70,000 80,000
Surgery’s Consultation Fees in case of Surgery (per Surgical Schedule), included in Surgeon’s fees 3,000 4,000 5,000 6,000 7,000 8,000 9,500
Physician's Hospital visit fee
Physician’s Hospital Visit Fee (maximum payable per day) 500 700 900 1,200 1,300 1,500 2,000
Personal Accident Insurance
Personal Accident Insurance (Or.Bor 2)** 100,000 100,000 200,000 300,000 400,000 500,000 600,000
HB Incentive***
HB Incentive*** 800 1,500 2,000 2,500 3,000 4,000 5,000
*Maximum Benefit per Disability means Inpatient Hospitalization Benefit (Room and Board including Fees for Nursing Services, Hospital General Expenses, Surgeon’s Fees and Physician’s Hospital Visit Fee) and Optional Benefit “Major Medical Treatment” (if any).
**Personal Accident insurance (Or.Bor.2) provides benefits in case of death, dismemberment, loss of sight, loss of hearing, loss of speech, and permanent disability (50% of the sum assured for personal accident coverage while riding a motorcycle whether as a rider or passenger)
*** HB Incentive shall be payable to member who do not reimburse for any medical expenses from any Allianz Ayudhya insurance policies (Individual and/or group).
- Costs associated with tests such as PET Scan, MRI, CT Scan, Echocardiogram or Exercise Stress Test (EST) will normally be paid under the outpatient benefits; unless such tests have been prior approved by Allianz Ayudhya, they will be paid under the Inpatient Hospitalization Benefits: Hospital General Expenses.

Optional benefits

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Description Benefit (THB)
Plan L1 Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6
Major medical
Major Medical Benefit pays 80% of medical expense in excess of Basic Coverage (excluding Room and Board and Fees for Nursing Services). The total benefit payout per Disability* of Major Medical and Basic Coverage shall not be more than the maximum benefit payable by plan. 50,000 100,000 200,000 300,000 400,000 500,000 600,000
Outpatient Treatment Benefit
Outpatient Treatment Benefit per visit (maximum 1 visit per day and 30 visits per year) 300 500 800 1,000 1,500 2,000 2,500
Dental Treatment Benefit (maximum payable per year)***
Teeth scaling, dental filling, dental extraction Dental examination and dental x-ray Dental 3000 : maximum THB 3,000 per year
Dental 5000 : maximum THB 5,000 per year
Maternity Benefit**** (for the expenses related to pregnancy and childbirth, excluding the expenses related to a child)
Normal delivery, assisted delivery or intentional cesarean delivery 40,000
Etopic Pregnancey or Emergency Cesarean Section 80,000
Miscarriage 20,000
Additional Personal Accident Insurance (Or.Bor.2)**
PA 200 200,000
PA 400 400,000
*Maximum Benefit per Disability means Inpatient Hospitalization Benefit (Room and Board including Fees for Nursing Services, Hospital General Expenses, Surgeon’s Fees and Physician’s Hospital Visit Fee) and Optional Benefit “Major Medical Treatment” (if any).
**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.
***In case the covered person is enrolled or resigned during the policy year, the dental benefit must be on a pro rata basis.
****Cover only when a Covered Person has been insured for at least 280 consecutive days for a childbirth and at least 90 consecutive days for a miscarriage.

Underwriting conditions

Eligibility

  • Companies with 5 - 50 employees, with employees' average age not exceeding 48 years
  • Cover available for full-time employees aged 15 to 60 years in Occupation Class 1 and 2
  • All employees must be insured on the plan, and employees of the same seniority must be on the same level of plan. We may underwrite individuals, based on the plan's terms and conditions.
  • All dependents who are eligible must be on the same or lower level plan as employees
  • If more than 1 plan is selected, the plans must not differ by more than 3 levels
  • The optional outpatient benefits and core plan cannot differ by more than 3 levels.
  • For businesses with 5 - 19 employees, all employees are required to be a member of the Social Security Office
  • All female employees, including female spouses where applicable, must be enrolled if maternity benefits are selected
  • We reserve the right to make plan changes during the plan year
  • For mid-term adjustments, dental benefits will be on a pro-rated basis

Health insurance limits

  • Costs associated with diagnostic tests such as PET scans, MRI, CT scans, Echocardiogram or Exercise Stress Test (EST) will typically be paid under outpatient benefits, unless such tests have been pre-approved by us. If pre-approved, they will be paid under inpatient hospitalisation benefits.
  • For members with more than one policy with Allianz Ayudhya, we will pay up to THB 5m per disability depending on eligible plan limits.

Personal Accident limits

For businesses with more than one personal accident policy with Allianz Ayudhya, we will pay up to THB 1m per member, depending on eligible plan limits. The maximum amount of the sum insured for all employees and dependents is THB 20m per company.

Major exclusions

Please see your plan documents for a full list of exclusions. Examples of our typical exclusions are as follow:

Health insurance  

  • Pre-existing conditions 
  • Treatment for congenital anomalies or developmental disorders
  • Medical expenses incurred from the treatment of attempted suicide or self-inflicted injury, alcoholism and drug abuse
  • Acquired Immune Deficiency Syndrome (AIDS), including related complications or sexually transmitted diseases
  • Any medical treatment that is experimental, including alternative treatments
  • Treatment that is not medically necessary
  • Pregnancy, childbirth, miscarriage (unless the maternity option is purchased), contraception, sterilisation
  • Appliances such as spectacles, lenses, hearing aids or wheelchairs
  • Visual acuity, laser eye treatment, LASIK, dental treatment and cosmetic treatments such as for acne or blemishes
  • Weight loss or weight gain treatments


Personal accident  

  • We will cover you for death, dismemberment, loss of sight, loss of hearing, loss of speech, or permanent disability arising from injury due to accident. 
  • We may not cover injuries resulting from:
    - Dangerous sports
    - Flying in a non-commercial aircraft or whilst serving as a crew member in any aircraft
    - Being under the influence of drugs or alcohol
    - Suicide or self inflicted injury
    - Driving or riding as a passenger on a motorcycle - only 50% of the benefit will be paid and not more than THB 200,000
    - Bacterial infections
    - Miscarriage resulting from an accident
    - Taking part in a fight
    - Criminal acts
    - War
    - Radioactivity
  • Personal accident cover is not available for children under 18 years.

Remarks

  • 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.
  • It is the responsibility of the Insured to make premium payments. Insurance agencies and brokers only facilitate the service.
  • Employee, We Care is the marketing name of Insurance Policy of Health and Accident for General Group and Organizational Group
  • 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/sanctions

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