Individual Business Agents and Partners
About Us
Health Insurance Opal Plan Simple health cover with 'as charged' hospitalisation

Opal

Simple health cover with 'as charged' hospitalisation
coverage of up to THB 750k per year

Highlights

Opal Plan Full coverage for medical expenses, up to plan limits
Full coverage for medical expenses, up to plan limits
Opal Plan Inpatient coverage of up to THB 750,000
Inpatient coverage of up to THB 750,000
Opal Plan Optional outpatient treatment (OPD) and personal accident cover
Optional outpatient treatment (OPD) and personal accident cover
Opal Plan Full cover for hospital general expenses
Full cover for hospital general expenses, surgeon’s fees, physician’s hospital visit fees and specialist’s consultation fees, up to plan limits
Opal Plan vHealth telemedicine consultations with free nationwide prescription delivery
vHealth telemedicine consultations with free nationwide prescription delivery*
Opal Plan Can be purchased independently, not bundled with life insurance
Can be purchased independently, not bundled with life insurance
Opal Plan Tax savings on premiums paid, up to THB 25,000
Tax savings on premiums paid, up to
THB 25,000**

Remark:
*vHealth Telemedicine Service is provided by Aetna Services (Thailand) Limited.
**Click here for more information on using health insurance premium as tax deductions.

Please see plan documents for full details of coverage. Before purchasing a plan, you should consider the terms and conditions of the plan carefully.

Table of benefits

Coverage/Benefits

Swipe to view more

Description Benefits (THB)
  Opal 1 Opal 2 Opal 3
Inpatient hospitalization benefits      
Maximum annual benefits 350,000 550,000 750,000
Room and board including fees for nursing services
Non-intensive care room, maximum payable per day 2,000 3,000 4,000
Intensive Care Unit (ICU), maximum payable per day (with a maximum annual limit of 15 days) 4,000 6,000 8,000
Hospital general expenses
Hospital general expenses Full cover*
Emergency accidental outpatient treatment (first visit within 24 hours
after the accident and follow-up treatment within 15 days) 		Full cover*
Ambulance 1,000 1,000 1,000
Surgeon’s fees
Surgeon’s fees including specialist’s consultation fees before operation Full cover*
Physician’s hospital visit fee
Physician’s hospital visit fee, maximum one time per day Full cover*
Specialist’s consultation fees Full cover*
Bone marrow transplant, organ transplant, renal dialysis
Bone marrow transplant, organ transplant, renal dialysis, maximum limit per injury or sickness** 10,000 10,000 10,000
Personal accident
Personal accident (Or.bor.2)*** 100,000 100,000 100,000
Remarks:
*Full cover for hospital general expenses, surgeon’s fees, physician’s hospital visit fees and specialist’s consultation fees but not exceeding the maximum benefit specified in the policy schedule.
**The case when the insured person is treated in a hospital or medical center at any time, which include the treatment for 2 times or more due to the same causes, disease, or complication, with intervals of not more than 90 days from the most recent discharge from a hospital or medical center.
***Personal Accident insurance (Or.Bor.2) provides benefits in case of death, dismemberment, loss of sight, loss of hearing, loss of speech, and total permanent disability (50% of the sum assured for personal accident coverage while riding a motorcycle whether as a rider or passenger).
- Medical expenses for a medical condition occurring within 30 days from the initial effective date of the insurance policy will not be covered.
- Cost associated with tests such as PET scan, MRI, CT scan, Echocardiogram or Exercise stress test will normally be paid under outpatient benefits unless such tests have been approved in advance by Aetna, they will be paid under hospital general expenses benefits.
- Policyholders who purchase a health insurance policy before turning 60 years old and continuously renew the policy will be eligible for life time renewal. However, policyholders who purchase the policy after 60 years old will only be eligible to renew the policy till they turn 70 years old.

Optional benefits

Swipe to view more

Description Benefits (THB)
  Opal 1 Opal 2 Opal 3
Outpatient benefits
Outpatient benefits, maximum 1 visit per day and 30 visits per year  
- Classic 1,000
- Plus 1,500
- Deluxe 2,000
Personal accident
Personal accident (Or.bor.2)*  
- PA 200 200,000
- PA 400 400,000
- PA 900 (occupation class 1 and 2 only) 900,000
Remarks:
*Personal Accident insurance (Or.Bor.2) provides benefits in case of death, dismemberment, loss of sight, loss of hearing, loss of speech, and total permanent disability (50% of the sum assured for personal accident coverage while riding a motorcycle whether as a rider or passenger).
- Medical expenses for a medical condition occurring within 30 days from the initial effective date of the insurance policy will not be covered.
- Cost associated with tests such as PET scan, MRI, CT scan, Echocardiogram or Exercise stress test will normally be paid under outpatient benefits unless such tests have been approved in advance by Aetna, they will be paid under hospital general expenses benefits.
- Policyholders who purchase a health insurance policy before turning 60 years old and continuously renew the policy will be eligible for life time renewal. However, policyholders who purchase the policy after 60 years old will only be eligible to renew the policy till they turn 70 years old.

Underwriting conditions

Health Insurance

  • Eligible for persons aged 15 days to 65 years
  • Cover is for treatment in Thailand only
  • Members under the age of 20 must have a guardian (parent of the insured) on the same insurance policy
  • 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.
  • Members who purchase their plan before 60 years old and continuously renew the plan will be eligible for lifetime renewal. Members who purchase their plan after 60 years old will be eligible to renew the policy until they are 70 years old.
  • For maternity benefits, members must have had this cover for at least 280 consecutive days before childbirth claims are eligible, and at least 90 consecutive days before claims for miscarriage are eligible.
  • No medical expenses coverage in the following providers:
        1. Bumrungrad hospital
        2. BNH Hospitals and BNH All Season Clinic
        3. Samitivej Hospital (Sukhumvit, Srinakarin and Chinatown) and Samitivej Medical Clinic (Don Mueng, Suvanabhumi and Free Zone)
        4. Bangkok Hospital (Soonvijai, Pattaya, Rayong, Phuket, Had Yai, Samui, Ratchasima, Hua Hin and Chiang Mai), Bangkok Pattaya Medical Clinic (Bang Saray), Bangkok Rayong Medical Clinic (Ban Chang, Bo Win, Pluak Daeng, Nikom Pattana, Eastern Seaboard, Banphe, Saphansi, Mapkha and Nong Chak) and Bangkok Phuket Medical Clinic Mai KHao
        5. Paolo Hospital Prapadaeng
    List of hospitals and clinics without coverage updated as of 11st April 2022.
    Members may obtain an updated list of Aetna’s medical network at www.aetna.co.th or by calling Aetna’s call center 0 2232 8666.
    Aetna Health Insurance reserves the right to change our medical network information without prior announcement.

 

Personal Accident

  • For members with more than one policy with Aetna, we will pay up to THB 1m per member, depending on eligilbe plan limits.
  • For the Personal Accident limit option of THB 900,000, we will only cover members who are in class 1 and 2 occupations. Please contact your Aetna representative for more details.

This list is correct as at 1 April 2021. Members can check on changes to this list by calling 0 2232 8666.

 

Personal Accident

  • For members with more than one policy with Aetna, we will pay up to THB 1m per member, depending on eligilbe plan limits.
  • For the Personal Accident limit option of THB 900,000, we will only cover members who are in class 1 and 2 occupations. Please contact your Aetna representative for more details.

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

Health insurance  

  • Pre-existing conditions or medical expenses for an illness that occurs within 30 days of policy inception
  • Treatment for congenital anomalies or developmental disorders
  • Medical expenses incurred from the treatment of attempted suicide or self-inflicted injury
  • 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
  • Visual acuity, laser eye treatment, LASIK, dental treatment and cosmetic treatments such as for acne or blemishes
  • Specific illnesses that occur within 120 days of policy inception, such as tumors or cancers, polyps or cysts, hemorrhoids, hernias, pterygium, pinguecula or cataracts, tonsillectomy or adenoidectomy, kidney stones, endometriosis, varicose veins, hallux valgus, ganglions


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.